To study the correlation of neutrophil-to-lymphocyte ratio (NLR) with glycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients and investigate for hyperglycemia-induced “emergency myelopoiesis” derived immature neutrophils in peripheral blood. The study was carried out on 304 participants (both males and females), out of which 118 served as the non-diabetic control group and 186 were T2DM patients (cases). Two milliliters of peripheral blood was withdrawn in an EDTA vial, HaA1c was measured using high-performance liquid chromatography (HPLC), and NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Arneth count was performed on a peripheral smear considering the number of nuclear lobes in 100 neutrophils. Statistical tests were performed using SPSS version 25.0. Total leucocyte count (TLC), absolute neutrophil count (ANC), platelet count (PC) and absolute monocyte count (AMC) were significantly higher in cases as compared to controls (p < 0.05). The Arneth curve showed a shift towards the left with increasing HbA1c levels. NLR is a simple, cheap, and reliable surrogate marker for HbA1c, and any variations over time from static baseline, with well-controlled blood sugar levels, must be documented for personalized patient care. A left shift of Arneth curve may be an indicator of myelopoiesis and should prompt therapeutic interventions.

Ovarian cancers are a very lethal group of cancers, presenting mostly in advanced stages due to their non-specic symptoms in the initial stages. Serum tumor markers, especially CA125 levels play a very important role in the diagnosis and management of ovarian tumors. This study aimed to evaluate the diagnostic and prognostic signicance of CA125 by correlating its values with the clinicopathological prole of patients diagnosed with neoplastic and non-neoplastic ovarian lesions. A total of 138 cases of ovarian masses were studied in a tertiary care hospital in Aligarh, India, and its preoperative CA125 levels were correlated with patient age, presenting complaints, type of tumor (benign or malignant), presence of ascites, stage of disease, and its diagnostic accuracy and it was found to be valuable marker preoperatively

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign, reactive vaso-proliferative condition in the dermal and subcutaneous tissues of the head and neck. A 28-year-old female presented with slow-growing painless swelling behind her left ear. FNAC revealed benign soft tissue neoplasm and histopathological examination after surgical excision revealed angiolymphoid hyperplasia with eosinophilia. ALHE origin has been variously attributed to prior trauma, hyperestrogenemia, infectious agents, atopy, reactive hyperplasia, and benign neoplasia. Retroauricular ALHE has been rarely reported. However, on the basis of our case report, it should be a viable differential diagnosis when large subcutaneous tumors of the head and neck are encountered. When big subcutaneous tumors of the head and neck are present, especially in females, a valid differential diagnosis for angiolymphoid hyperplasia with eosinophilia, a rare condition marked by dermal or subcutaneous endothelial cell proliferation, should also be considered.

Abstract Background Clinical utility of Ki-67 immunohistochemistry (IHC) in breast cancer (BC) is mainly limited to decide for the use of chemotherapy and estimate prognosis in patients with either Ki-67 index < 5% or > 30%; however, lacunae still exists pertaining to its analytical validity. Neutrophilia is common in cancer with accompanying lymphocytopenia. Neutrophil to lymphocyte ratio (NLR) captures the intricate balance between pro-tumor neutrophilia and anti-tumor lymphocyte immunity. This study aimed to correlate cellular proliferation in breast cancer with NLR. Methods An observational study was carried out including 73 cases of BC; pre-treatment NLR and Ki-67 grading were performed. NLR < 3 was considered low, while ≥ 3 was high. The Ki-67 expression was graded as low ≤ 5%, intermediate 6–29%, or high ≥ 30%. Various clinico-pathological variables were studied, and the association of categorical variables was analyzed using Pearson’s chi-square test, and a p-value of < 0.05 was taken as significant. Results Ki-67 correlated significantly with modified Scarff-Bloom-Richardson (SBR) grade (p < 0.01), and tumor-node-metastasis (TNM) stage (p < 0.001). Correlation of NLR was not significant with SBR grade (p > 0.05) and molecular subtype (p > 0.05); however, NLR was found to be significantly correlated with TNM stage (p < 0.001) and Ki-67 (p < 0.001). Conclusion NLR is fast emerging as a personalized theranostic marker in breast cancer. Instead of determining a generalized cut-off value, individual baseline NLR and its dynamics with disease progression will help manage patients better, obviating some of the drawbacks associated with Ki-67.

Nasal chondromesenchymal hamartoma (NCH) is a very rare and benign tumor of sinonasal tract and usually presents in infants and young children with varied symptoms depending upon the site of tumor in nasal cavity or paranasal sinuses. Here we present a case of 12 years old female who presented with on and off nasal obstruction for 1 year. On the basis of clinical and radiological findings she was diagnosed as a case of ethmochoanal polyp but radiological findings also showed bony thinning because of which malignancy could not be ruled out. But surprisingly her histopathological findings were in favour of chondromesenchymal hamartoma which was confirmed by vimentin and S100 positivity.

Background:Mucormycosis necessitates rapid diagnosis and treatment. Microscopy and culture have been considered the gold standard for diagnosis but both take time of 3 - 5 days. KOH mount is another method for fungal identification that takes 1 - 2 h, but it has its own limitations. This study evaluated crush smear as a means of rapid cytological diagnosis.Methods:Biopsy tissue (pre-treatment) from clinically suspicious mucormycosis patients (n = 52) was received in normal saline and crush/imprint smears were prepared; the remaining tissue was processed as routine biopsy specimen. After the rapid initial cytological identification, the patients were managed according to the standard clinical protocol. Random post-therapeutic biopsy samples of some of these patients (n = 19) were also obtained and again evaluated cytologically.Results:Crush smears showed sensitivity/specificity of 77.7%/75.0% with histopathology and 72.2%/62.5% with culture, respectively, while KOH mount had values of 71.4%/70.5% with histopathology and 79.3%/69.5% with culture, respectively. Degenerative fungal morphological characteristics and cellular inflammatory infiltrate (predominantly neutrophilic) in the vicinity of fungal hyphae were compared in pre- and post-treatment groups, and we found a statistically significant difference (P < 0.05) between them.Conclusion:Our preliminary results suggest that crush smear cytology is a simple, rapid, cost-effective and easily available method for diagnosing mucormycosis. Moreover, crush smears also demonstrated morphological alteration in hyphal structure and accompanying immune cell infiltration which may provide valuable insights into mechanism of therapy/host immune response against fungal pathogen.

Introduction: Neonatal sepsis is a clinical syndrome described as any systemic bacterial infection in neonates documented by positive blood culture. However, blood culture is positive in only 5.0%–10.0% of suspected cases. Serum concentration of many acute-phase reactants rises in response to infection, which can be used as a non-specific indicator of bacterial sepsis. Aim and Objectives: The aim of this study was to correlate the levels of serum markers C-reactive protein (CRP), serum ferritin, and thrombocytopenia with neonatal sepsis. Materials and Methods: This was a prospective cross-sectional study conducted in the Neonatal Intensive Care Unit, Department of Paediatrics and Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh from 2019 to 2021 on 172 babies (cases =142; controls = 30). Neonates with sepsis who presented with clinical signs or symptoms of sepsis were taken as case group and healthy neonates served as control. Result: Blood culture was positive in 58 (40.8%) neonates in the case group and Klebsiella was present in maximum number of cases. Blood culture was positive in only 8 (13.8%) cases out of 31 cases of mild thrombocytopenia. The total culture-positive organism was 58 (40.8%), with 09 (15.5%) gram-positive, 46 (79.3%) gram-negative organisms, and 03(5.2%) fungus. Positive CRP was seen in 88 (61.9%) neonates in the case group, out of which, positive culture was noted in 38 (65.5%) neonates and negative in 50 (59.5%) neonates. Serum ferritin values >400 µgm/L was seen in 97 (68.3%) neonates in the case group and 6 (20.0%) neonates in control group. The mean serum ferritin in culture positive neonates was 1024 ± 309 µgm/L and in culture-negative neonates was 999 ± 301 µgm/L. Conclusions: The signs and symptoms of neonatal sepsis are non-specific, leading to difficulty in diagnosis and treatment. Biomarkers such as hematological indices, blood culture, and acute-phase reactants could be more reliable in rapid evaluation and early diagnosis of sepsis and may provide a new diagnostic strategy for the neonates with sepsis.

Ki-67 a cellular proliferation marker is used in breast cancer (BC) to guide therapy decision and predict prognosis in some clinical cases. It could signify treatment responsiveness/ resistance before, during and after neoadjuvant therapy. However, despite having potential applicability Ki-67 has still not been completely integrated as a standard point of care tool in clinical decision making or routine pathological reporting. Neutrophil to lymphocyte ratio (NLR) has emerged as a potential prognostic factor in various cancers, including breast cancer. Neutrophil: Lymphocyte roughly translates as tumor: immunity and this ratio in fact becomes more significant with polarization state of neutrophils and recognition of pro-tumor N2 neutrophils. 73 histopathologically diagnosed cases of BC were included in this study, their pre-treatment NLR was noted and Ki-67 expression graded. NLR was calculated from 2 ml peripheral blood as a ratio of absolute neutrophil count to absolute lymphocyte count and was categorized as low < 3 or high ≥ 3. Ki-67 immunohistochemistry was visually graded as low ≤ 5%, intermediate 6-29% and high ≥ 30%. Various clinical and histopathological characteristics of these patients were also noted. Statistical tests were performed using SPSS version 25.0, p value of < 0.05 was taken as significant. The Ki-67 immunoexpression showed a statistically significant correlation (p < 0.05) with tumor grade (modified SBR grading), tumor size, lymph node status, and clinical stage. Correlation of NLR with tumor SBR grade turned out to be non-significant (p > 0.05), however, NLR showed a statistically significant correlation with tumor size, lymph node status, and clinical stage (p< 0.05). Amongst themselves, the peripheral NLR and tumor Ki-67 immunoexpression showed a statistically significant correlation (p< 0.05). The tumor proliferative potential and its subsequent therapeutic and prognostic implications as deducted from the Ki-67 index could very well be signified by peripheral NLR. Baseline NLR and its dynamics in relation to breast tumor biology could serve as a minimally invasive personalized marker for early diagnosis, guiding therapy, prognosis and follow-up in clinical settings.

This investigation aimed to assess the pandemic impact on the incidence of newly prescribed dermatological agents compared to the pre-pandemic period TrinetX is a real-time, federated healthcare database that was used in the retrospective review comprised of 61 million patient records at the time of the analysis This database was used to identify the incidence of newly prescribed drugs each month for two periods of the pandemic Medications were categorized by LOINC codes and categorized into groups The first period was from April-July 2020, and the second was from August-November 2020 The mean for each drug group was then compared with the pooled monthly incidence from similar periods between 2018-2019 before the pandemic Descriptive analyses were performed, and comparisons were made using a student's t-test 11 groups of dermatological agents were analyzed in both periods In the early pandemic period, 7 of 11 groups of agents showed a statistically significant reduction of up to 32 1% in prescription These agents included anti-psoriatic, anti-acne, topical anti-neoplastic, topical anti-viral, topical anti-inflammatory, topical anti-fungal, and all dermatological agents as a whole Newly prescribed topical analgesics, keratolytic, anti-perspirant, and anti-bacterial agents did not show a statistically significant decrease in prescription During the later pandemic, five of the dermatological agents showed a statistically significant decrease in prescription Anti-psoriatic, topical analgesics, topical antineoplastics, topical keratolytic, topical anti-perspirant, and topical anti-bacterial agents did not show a significant reduction This study shows that there has been a significant reduction in incidence of prescribed dermatological agents during the COVID19 pandemic Further research is needed to determine the future impact of this disruption in the dermatological care

Background: The present study was conducted with the aim to determine the pattern of distribution and to detect any association of transfusion transmitted infections (TTI) with ABO and Rh blood groups. Methods and Findings: A retrospective study was conducted at the blood bank of Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, U.P., India over a period of two years. A total of 36,614 healthy donors were included in the study. All the donor blood bags were screened for HbsAg, HIV, HCV, Syphilis and Malaria. The most common blood group was B positive (34.91%) while the least common was AB negative (0.61%). The total seroreactivity of TTI was 5.59%. Out of the total, 2.38% cases were reactive for HBsAg, 0.35% for HIV, 1.27% for anti HCV, 1.29% for syphilis and 0.29% for Malaria. Maximum seroreactivity was seen in bloodgroup B positive (1.79%) followed by O positive (1.54%) and then A positive (1.28%). A significant association was seen between Rh positive bloodgroup and HBsAg seropositivity (P value of 0.0459). In VDRL positive donors, there was significant association between VDRL infection and AB bloodgroup with a p value of 0.0331. Conclusion: This study provides the prevalence of ABO and Rh blood group and also their association with the transfusion transmitted infections (TTI). This study shows a significant association between Rh positive bloodgroup and HBsAg and also significant association was seen between AB positive bloodgroup and VDRL infection.

Background: Leprosy was supposed to be eliminated by WHO from the world by the end of the year 2000. However, it still affects the major population in India. It is well realized that even after elimination target has been achieved, new leprosy cases will keep coming for at least some years due to continuation of some level of disease transmission or manifestation of disease by subclinical cases. Hence there is the need to review this disease with proper understanding. Objective: To determine the current leprosy profile and its relation between clinical and pathological diagnosis, at our centre catering the population of Western Uttar Pradesh. Methods and Material: It’s a retrospective study and was carried out on skin biopsy samples sent for histopathological diagnosis in clinical suspicion of leprosy at Jawaharlal Nehru Medical College and Hospital, Aligarh, from June 2015 to November 2017. Tissue Sections were stained with Haematoxylin and Eosin stain for morphological studies, and modified fite stain to identify acid fast bacilli. Results: Out of 325 clinically suspected leprosy cases, we diagnosed leprosy in 282 cases with 86.7% parity. Most commonly affected age group was between 16 -30 years (110 cases). Tuberculoid leprosy was the most common histological subtype (69/282, 24.4%) followed by lepromatous leprosy (58/282, 20.56%), borderline tuberculoid (53/282, 18.7%), borderline lepromatous (42/282, 14.8%), indeterminate leprosy (34/282, 12%) and mid borderline leprosy (22/282, 7.8%). Additionally, histioid type of leprosy was diagnosed histologically in 1.4% (4/282) of the cases. Conclusions: Identification of suspicious skin patch as leprosy with prompt histological diagnosis especially in population of below 30 years is required for timely intervention and eradication. Both clinician and pathologist should have a focused approach especially in diagnosing indeterminate leprosy.

The COVID19 pandemic has caused a major disruption in healthcare delivery as restrictions have limited the ability to seek elective procedures. This investigation aimed to assess the pandemic impact on the incidence of dermatology procedures compared to the pre-pandemic period. TrinetX, a national federated healthcare database comprised of 61 million patient records, was used to identify the incidence of new dermatology procedures performed each month for two periods of the pandemic. The first period was from Apr-July 2020, and the second was from Aug-Nov 2020. The mean for each variable was then compared with the pooled monthly incidence from similar periods between 2018-2019 before the pandemic. Descriptive analyses were performed, and comparisons were made using a student's t-test. Procedures were identified by CPT codes and categorized into groups. In the Apr-July 2020 period, 11 groups of procedures showed a significant statistical decrease in incidence by up to 47.3%. They included: Excision of benign lesions, shaving of epidermal/dermal lesions, skin tag removal, skin biopsy, paring/cutting procedures, surgical procedures on nails, surgical procedures on pilonidal cyst, destruction of malignant lesions, destruction of benign/premalignant lesions, Mohs surgery, and incision and drainage procedures. The incidence of debridement procedures during the initial COVID period was similar to overlapping months in 2018 and 2019. In the late pandemic period, 10 procedure groups demonstrated a significant statistical decrease in incidence. The incidence of debridement procedures and surgical procedures on pilonidal cysts during the later COVID period was similar to overlapping months in 2018 and 2019. The statistically significant decrease in dermatology procedures during the COVID-19 pandemic may suggest that the general public is postponing skin care placing a greater burden on healthcare.

Lung cancer is the most common cause of cancer-related death worldwide and unfortunately up to 80% of patients amongst newly diagnosed are inoperable therefore the cytological sample is often the only material available for diagnosis and assessment of molecular characteristics driving the treatment.

Giant cell angiofibroma (GCA) is a rare, soft-tissue neoplasm that has a tendency to arise from the mesenchymal tissues of the head and neck, especially involving the orbital region. It is a benign neoplasm characterized by the presence of multinucleated stromal giant cells and angiectoid spaces. GCA belongs to the group of solitary fibrous tumor with histomorphological features intermediate between those of solitary fibrous tumor and giant cell fibroblastoma. CD34 immunoreactivity of tumor cells carries potential diagnostic value. Recurrence after the complete surgical excision is rare. We report the case of a 62-year-old male who presented with complaints of pain and heaviness in the lower abdomen. On computed tomography, a well-defined solid cystic mass was observed in the pelvis. Surgical resection was done, and the histopathological and immunohistochemical examination findings rendered the diagnosis of GCA. The patient had an uneventful postoperative period.

Primary signet-ring cell carcinoma (SRCC) of vermiform appendix is extremely rare. A 62year-old man presented to the Surgical Clinics with right lower abdominal pain, where he was diagnosed with acute appendicitis based on the history and examination with hematologic investigations and computed tomography. Appendectomy specimen grossly showed acute inflammation with appendiceal adhesions and body of the appendix showed wall thickening and luminal occlusion. Microscopically nests of carcinoma cells were seen with compressed nuclei and intracytoplasmic mucin invading into the muscular layer. No lymphovascular permeation was seen. The cut margins were negative for carcinoma cells. Immunohistochemically, SRCC cells were positive for cytokeratin (CK) AE1/3, EMA, CEA, MUC2, and high Ki-67 labeling index. They were negative for CK5/6, CK7, Vimentin, MUC1 and chromogranin. Our patient is fine after 6 months of follow up, with no evidence of recurrence or metastasis.

Cancer of uterine cervix is the most common cancer among Indian females. Surgery is the main modality of treatment along with radiation and chemotherapy depending upon clinical stage of the tumor and surgical findings. However, patients with advanced or recurrent disease have a poor survival despite the use of cisplatin-based combination chemotherapy. Hence, there is an increasing need for developing novel therapeutic target that can replace or be added to the current therapy for these patients. The present study was conducted to evaluate the presence of Her-2/neu expression. Two hundred cervical specimens were included in this study. These comprised cases with diagnosis of cervical intraepithelial neoplasia, squamous cell carcinoma, adenocarcinoma. HER-2/neu immunostaining was performed by using BioGenex monoclonal mouse anti-human HER-2/neu Receptor IgG1 antibody. Higher expression of HER-2/neu was noted in malignant lesions as compared to premalignant lesions. Intensity of staining also correlated with grade of malignant tumor, clinical stage and lymph node metastasis. The over-expression of HER-2/neu oncoprotein is found to be associated with poor prognosis, metastatic potential and aggressive biological behaviour.

CD34 is a transmembrane glycoprotein that is thought to be involved in the modulation of cell adhesion and signal transduction. The connective tissue stroma of virtually all human organs contain large amounts of resident CD34+ fibrocytes, which are involved in multiple functions such as wound healing, secretion of cytokines and also participate in stromal remodeling. It has been seen in various studies that absence of CD34+ fibrocytes within the stroma is associated with invasive carcinomas. In our study, we also investigated the presence and distribution of CD34+ fibrocytes in cervical intraepithelial neoplasia, invasive cervical carcinoma and adjacent normal cervical stroma. It was seen that normal cervical stroma and the stroma adjacent to cervical intra epithelial lesions harbours a dense meshwork of CD34+ fibrocytes, whereas the stroma of invasive carcinoma was nearly devoid of this cell population. Early stromal invasion by squamous carcinoma was characterized by a focal loss of CD34+ fibrocytes. This can be used as a sensitive tool in detecting tiny foci of stromal invasion in early cancer.

Struma ovarii is a monodermal variant of ovarian teratoma. It is a very rare, germ cell tumor of the ovary, constituting less than 1% of all ovarian tumors. Thyroid tissue is the predominant element, constituting more than 50% of the total. Thyroid-type carcinoma arising in struma ovarii is a rare finding, of which papillary carcinoma being more common, followed by follicular carcinoma and a newer entity termed as highly differentiated follicular carcinoma of ovarian origin. A case of 48-year-old female presented with complaints of acute lower abdominal pain and vaginal bleeding. Imaging showed a solid cystic mass in left adnexa whereas right adnexa was unremarkable. Left salpingo-oophorectomy was performed. Histopathological examination and subsequent immunohistochemistry revealed struma ovarii with neoplastic transformation into papillary thyroid carcinoma. Malignant struma ovarii is difficult to diagnose clinicoradiologically and is mostly discovered incidentally, with only handful of cases published in the literature.

Introduction: Acute abdominal pain in the right iliac fossa is the most common symptom of acute appendicitis for which appendicectomy is usually done. Histopathological examination of appendicectomy specimen reveals different causes of appendicitis which will decide further course of action.Aims and Objectives: The aim of this study is to record the percentage of various pathologies of appendix, by carrying out a retrospective study of appendices excised in the past 2 years.Materials and Methods: Three hundred and sixteen cases of appendicitis were taken and H and E sections of the specimens were reviewed.Observation and Results: Out of 316 cases, there were 192 (60.8%) cases of acute appendicitis, 56 (17.7%) of periappendicitis, 1 (0.3%) of acute appendicitis with diffuse lymphoid hyperplasia, 7 (2.2%) of subacute appendicitis, 9 (2.8%) of recurrent appendicitis, 10 (3.2%) of obliterative appendicitis including one case of roundworm infestation, 25 (7.9%) of chronic appendicitis, 3 (0.9%) of mucocoele, 2 (0.6%) of mucinous neoplasm, 2 (0.6%) of carcinoid, 1 (0.3%) of adenocarcinoma, and 8 (2.5%) of normal appendix.Conclusion: This study highlights the importance of histopathology as some of the rare malignancies of appendix as mucinous neoplasm, carcinoid, and adenocarcinoma can present with acute abdominal pain. Hence, careful histopathological examination of appendix and regional lymph nodes is mandatory with follow-up and endoscopy of the patient.

The work focused on the elemental and physicochemical analysis in the textile waste (Effluent and Sludge) where two effluent samples and one sludge sample were collected from Grameen Knit Dyeing Industry (GKDI).Every effluent sample is divided into liquid sample (L1 and L2) and residual sample (R1 and R2).Neutron Activation Analysis (NAA) method used for the elemental analysis.The study revealed that, in the sludge (S) the Sb concentration was found 50.2 mg/L which exceeded the standard.Here Co concentration exceeded the standard.Here the highest Cr and Cd value was found in the (S) which exceeded the standard level.The total alkalinity, hardness and free CO 2 level of discharged water was harmful for the environment.From this study it is revealed that the sludge contain high content of heavy metal and other harmful elements.Soda ash method can be applied to reduce the 'Cr' concentration.