Requisition Forms Research Articles

A Retrospective Analysis of Concordance Between Clinical and Histopathologic Diagnoses and Completeness of Oral Biopsy Forms at a Tertiary Dental Hospital in Eastern Nepal.

Introduction: Histopathological diagnosis remains the gold standard tool for the diagnosis, yet accurate and detailed clinical descriptions are necessary to facilitate the final diagnosis. Histopathologists believe that clinicians are unaware of how histopathology departments operate, partly because of the less information on requisition forms. The objective of the present study is to assess the concordance of clinical and histological diagnoses of all oral and maxillofacial biopsy samples, along with the completion of the requisition form provided with the biopsy sample. Methods: A retrospective study was conducted at the Department of Oral Pathology. The biopsy request forms of year 2018-2019 were retrieved from the archive of the department and were analyzed for clinicopathological concordance. Descriptive and analytical statistics were performed using SPSS. Results: Of 338 forms, 243 (71.89%) forms had total concordance between clinical and histopathologic diagnosis; 20 forms (5.92%) had concordance with the histopathological diagnosis, but only after the clinical diagnosis had been refined. Of all the forms analyzed, 36 (10.65%) forms lack habit history in cases suspected of oral cancer and oral potentially malignant disorder, and 24 (7.10%) cases lack radiographic details. The categories of clinicohistopathological concordance and the different clinical information groups showed a statistically significant relationship. We also found that the sign-out time for histopathological reports depend on the extent of clinical information provided which was statistically significant too. Conclusions: The current study concluded a sufficient level of concordance between clinical and histopathological diagnosis. A high completion rate of biopsy forms indicated that the clinicians/operating surgeons perceive the significance of clinical information in histopathological diagnosis. We also recommend, irrespective of the type of suspected oral lesions, submitted for biopsy, a detailed clinical information is the backbone for accurate and timely reporting of the histopathological diagnosis.

Evaluation of fresh frozen plasma usage at Tezpur Medical College and Hospital: A two-year study

Background: Rational usage of blood components is important to ensure their availability to needy patients and to avoid unnecessary risk. Despite available guidelines, improvement in quality control, and standardization about the use of fresh frozen plasma (FFP), many studies around the world show a high frequency of its inappropriate use. Aims and Objectives: (i) To evaluate the pattern of FFP usage in our hospital and to categorize usage as appropriate or inappropriate based on FFP transfusion guidelines. (ii) To evaluate the effectiveness of FFP transfusion based on pre- and post-transfusion international normalized ratio (INR) values by calculating P-value using a paired t-test. Materials and Methods: This retrospective observational study was done by retrieving requisition forms of all the patients who received FFP transfusion in Tezpur Medical College, Tezpur, Assam, during the period of 2 years (November 01, 2020–October 31, 2022). Patients who received other blood products along with FFP were excluded from this study. Results: 1420 units of FFP were supplied to 850 patients during the study period of which 64% went to males. The most common age group receiving FFP was 30–39 years (28%). The most common indication for FFP was liver disease (33%). Appropriate usage was found in 74% of episodes and inappropriate usage in 26% of episodes. Statistically significant improvement was seen in post-transfusion INR when usage was appropriate (P < 0.001). Conclusion: The study highlighted the pattern of FFP usage in various clinical settings. Regular screening of requisition forms for proper guidelines-based indications, administrative interventions, and meetings of the hospital blood transfusion committee for education and sensitization of medical staff will go a long way in ensuring appropriate usage and good transfusion practice.

Germline multigene panel testing in acute and chronic pancreatitis.

Germline genetic testing is recommended for younger patients with idiopathic pancreatitis but there has been a lack of consensus in recommendations for those over age 35. We aimed to analyze the results of genetic testing among subjects of varying ages. Individuals who underwent germline multigene testing for pancreatitis susceptibility genes (CASR, CFTR, CPA1, CTRC, PRSS1, SPINK1) through a large commercial laboratory between 2017 and 2022 were included. Test results and information collected from test requisition forms were evaluated. Multivariable logistic regression models were performed to identify factors associated with a positive pancreatitis panel (pathogenic, likely pathogenic, and/or increased risk variants) in pancreatitis-related genes. Overall, 2,468 subjects with primary indication of acute pancreatitis (AP) (n = 401), chronic pancreatitis (CP) (n = 631), pancreatic cancer (n = 128), or other indications (n = 1,308) completed germline testing. Among patients with AP or CP, the prevalence of any positive result for those <35 versus ≥35 years of age was 32.1% and 24.5% (p = 0.007), and the prevalence of a clinically meaningful result was 10.8% and 5.4%, respectively (p = 0.001). Positive family history of pancreatitis was associated with increased odds ratio (OR) of 8.59 (95% confidence interval (CI) 2.92-25.25) for a clinically significant panel result while each 5-year increase in age at test completion had lower odds (OR 0.89, 95% CI 0.83-0.95). The highest prevalence of pathogenic variants is seen in younger individuals with a positive family history of pancreatitis. However, clinically meaningful results are identified in older subjects, suggesting that genetic counseling and testing should be considered for all age groups.

Histopathological Study of Peripheral Neuropathies on Nerve Biopsy: A Cross-sectional Study

Introduction: Peripheral neuropathy is common in clinical practice, with a reported prevalence of 2.4% in the general population. There are numerous aetiologies for peripheral neuropathy like diabetes, ischaemia, vasculitis, inflammatory demyelinating disorders, nutritional deficiencies, paraproteinemic disorders, paraneoplastic syndromes, toxic exposures, and hereditary neuropathies. An exhaustive haematological, biochemical, and serological work-up, cerebrospinal fluid evaluation, electrodiagnostic tests, and nerve biopsy are required when overlapping clinical features present a diagnostic challenge. Aim: To analyse the histopathological characteristics of nerve biopsies in individuals with peripheral neuropathy. Materials and methods: This cross-sectional study was conducted in the Department of Pathology at Kasturba Medical College from January 2011 to December 2016. Nerve biopsies received in the Department of Pathology, Kasturba Medical College and Hospitals in the Ambedkar Circle and Attavar area, as well as at Government Wenlock Hospital, Mangaluru, Karnataka, India were studied. Clinical and laboratory data were collected from biopsy requisition forms and patient case records from the aforementioned hospitals. Results were presented in numbers and percentages. Results: A total of 134 nerve biopsies were included in the study. The age range of all cases studied was 7-86 years, with a mean age of 51.8 years. The study population consisted of 63.4% males and 36.6% females, resulting in a male-to- female ratio of 1.7:1. Vasculitic Neuropathy (VN) accounted for 38.1% cases, followed by chronic inflammatory neuropathies (21.7%) and Diabetic Neuropathy (DN) (12.6%). Other diagnosis included ischaemic neuropathy (6.7%), Hereditary Motor and Sensory Neuropathy (HMSN) (3.7%), subacute inflammatory demyelinating neuropathy (3.0%), as well as two cases each of Hansen’s neuritis, amyloid neuropathy, and acute inflammatory demyelinating neuropathy (1.5% each). One case of toxic neuropathy (0.7%) was identified, while 9.0% of cases displayed histological features that were either non specific or not characteristic of any specific diagnosis. Conclusion: Vasculitic neuropathy was found to be the most common aetiology of peripheral neuropathy, followed by Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and DN. The histopathological examination of nerve biopsies is a useful tool in distinguishing between diseases with overlapping clinical features, confirming or excluding vasculitis, and diagnosing hereditary conditions in settings where genetic testing is unavailable or unaffordable.

872. Characterizing Plasma Microbial Cell-Free DNA Sequencing Detections of Public Health Important Pathogens

Abstract Background Timely pathogen identification is critical for meaningful disease surveillance to facilitate effective public health responses. However, public health important pathogens are often diagnostically challenging (e.g., indeterminate serological results, multiple samples separated by long intervals, lengthy turnaround times) and at odds with public health needs. We describe detections of public health important pathogens by the Karius Test®, a validated plasma microbial cell-free DNA (mcfDNA) sequencing test, providing real-time pathogen detection. Methods We identified nationally notifiable infectious diseases (NNID)-associated and selected state reportable pathogens detected and quantified as DNA molecules/μl (MPM) in US patients’ plasma samples submitted to the Karius CLIA certified/CAP accredited laboratory for mcfDNA sequencing between 4/1/18–4/30/22. We evaluated and characterized these detections based on result and test requisition form data. We reviewed gender and immunocompromised status of a subset of patients linked deterministically to the Premier Healthcare Database (PHD), a US hospital-based, all-payer database. Results Plasma mcfDNA sequencing yielded 520 detections of 62 microbes associated with 27 NNIDs and 449 detections of an additional 12 microbes, including public health important parasites, amoebae, endemic mycoses, and selected bacteria, across 27 US states. MPM and patient age varied widely across microbes from 9–300+ million and 0–89 years, respectively (Table 1). For the 167 (17%) PHD-linked detections, 71% were associated with male and 72% with immunocompromised patients. Conclusion Plasma mcfDNA sequencing detected many different public health important pathogens across many states, especially among immunocompromised patients. These patients pose a heightened public health concern given their increased risk for more severe disease and potential for longer infectious periods and greater likelihood of atypical or nonspecific presentations, leading to greater risk of unrecognized disease spread. Plasma mcfDNA sequencing, an unbiased test, may contribute to rapidly identifying disease outbreaks and spread, and facilitate timely interventions to improve public health. Disclosures Constance Lau, MPH, Karius, Inc.: Stocks/Bonds David Berman, DO, Precision Health Solutions, St. Petersburg, Florida: Advisor/Consultant Frederick S. Nolte, PhD, Karius: Stocks/Bonds

THE HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR-LIKE LESIONS OF ORAL CAVITY AND OROPHARYNX

Objective: The objective is the histopathological study of tumor and tumor-like lesions of the oral cavity and oropharynx. Methods: This study was conducted in the Department of Pathology, SBKS Medical Institute and Research Centre, Piparia, for 1 year. One hundred oral biopsies received from the ENT department were studied. Clinical details were obtained from the requisition form. Biopsies received were processed and stained with Hematoxylin and Eosin. Histopathological diagnosis regarding type and differentiation was made. Results: Among 100 cases of the oral cavity and oropharynx biopsies analyzed in the present study, malignant lesions were 90 (90%), premalignant lesions were 4 (4%), and benign lesions were 6 (6%). The study included 86 cases (86%) of squamous cell carcinoma, 2 cases (2%) of verrucous carcinoma, 1 case (1%) of adenosquamous carcinoma, 1 case (1%) of adenocarcinoma, 3 cases (3%) of leukoplakia, 1 case (1%) of severe dysplasia, 3 cases (3%) of pleomorphic adenoma, and 1 case (1%) each of pyogenic granuloma, squamous papilloma, ossifying fibroma. Maximum number of cases was of squamous cell carcinoma (86%). Maximum number of cases was seen inthe age group of 36–45 years, the youngest patient was 25 years old. There was a male preponderance for oral and oropharyngeal lesions (73%) as compared to females (27%). Male: Female ratio was 1:0.37. The most common site of the lesion was the tongue (41%) followed by buccal mucosa (30%). The majority of the tumors were well-differentiated. Conclusion: Males are more likely to develop lesions of the oral cavity and oropharynx than females. Typically, older age groups are affected. Drinking alcohol, smoking, and chewing tobacco can contribute to oral and oropharyngeal lesions. The most frequent place implicated is the tongue. The most prevalent histological variation is squamous cell carcinoma, and the majority of these tumors are well-differentiated.

Enhancing precision medicine testing process in a breast cancer population of a community oncology practice: Use of oncology patient navigators (OPN) and a molecular processing team (MPT) to improve germline testing.

559 Background: In 2021, universal germline testing was recommended to breast cancer patients. Historically, germline testing has been ordered using manual paper requisition forms or via molecular vendor portal input with no capabilities of follow-up to ensure timely results. There are few reports of how to optimize universal germ line testing; we endeavored to determine benefit of OPN and a MPT in a breast cancer population in the private practice setting. Methods: For the baseline population, using the Electronic Health Record (EHR), a report was generated to identify breast cancer patients seen that were eligible for germline testing. The patient records from the report were manually reviewed to identify germline testing completed. In the intervention arm, OPN would review provider schedules in real time to identify any newly diagnosed breast cancer pts. Concurrently the pts were offered the opportunity for germline testing along with education by providers during their visit. Certified Medical Assistants (CMAs) placed all orders via vendor portals using OPN supplied templates completed by providers. The MPT would follow orders placed to confirm specimen procurement, receipt by vendor and collaboratively resolve any delays in specimen processing, insurance challenges and test selection revisions. Tracking activities were implemented within the EHR to document all progress in testing and to quantify the volume of tests. Results: For the baseline population, between 1/1/21-3/31/21, 29 (24%) of 120 breast cancer patients received germ line testing. Post intervention, between 1/1/22-3/31/22, 70 (45%) of 155 patients had germline testing. The mean turnaround time (TAT) for germline results for the baseline population was 12 days, and 44% percent were over 11 days. In the intervention arm, the mean TAT was 10 days and 20% were over 11 days. Conclusions: Our results illustrate the early benefit of OPN and a MPT in expediting result obtainment and increasing utilization of germline testing. Enhancing cohesion with the vendors and our MPT and more automated use of the EHR will further improve utilization. Continued practice wide education of providers in the necessity of germline testing in a breast cancer population is also essential.

Evaluating Diagnostic Utility of geneXpert Ultra (Mycobacterium tuberculosis/Rifampicin), Microscopy and Liquid Culture to Isolate Mycobacterium tuberculosis and Nontuberculous Mycobacteria among Pulmonary Tuberculosis Suspects

CONTEXT: Nontuberculous mycobacteria (NTM) are posing major public health problems and have recently gained importance as they are being isolated from patients with pulmonary disorders. Most of the time, NTM are misinterpreted as tuberculosis (TB) and this misdiagnosis leads to treatment failure. Hence, this study aimed to identify NTMs isolated from suspected cases of pulmonary TB cases and was aimed to distinguish Mycobacterium TB (MTB) from NTM infections. AIMS: Our study aimed to compare microscopy grading of respiratory samples with the Ct values of GeneXpert Ultra (MTB/rifampicin [RIF]), to assess the diagnostic accuracy of microscopy, GeneXpert ultra (MTB/RIF), liquid culture, to compare GeneXpert ultra (MTB/RIF) results with microscopy with culture and clinical implications, importance of performing a rapid test for pulmonary TB and pulmonary NTM infections in suspected cases of adults. SETTINGS AND DESIGN: The study was conducted in the Mycobacteriology laboratory, Department of Microbiology, in Kasturba Hospital, Manipal. The study was a prospective, cross-sectional study, single center. SUBJECTS AND METHODS: A total of 452 respiratory samples obtained from April to July 2023 were included in the study. Smearpositive pulmonary TB cases were identified and subjected to amplification by GeneXpert ultra (MTB/RIF) and 84 samples were GeneXpert ultra (MTB/RIF) positive and RIF sensitive. Liquid culture by mycobacteria growth indicator tube (MGIT) 960 was performed and for positive tubes, TB Ag MPT64 was performed. The results were compared and analyzed with patients’ demographic information. Clinical and radiological data from the requisition forms were assessed. STATISTICAL ANALYSIS USED: IBM SPSS statistics software version 22 was used. Correlations between GeneXpert ultra (MTB/RIF) Ct values and smear status were calculated by polychoric correlation. Extended McNemar’s test was used to find the association between the variables. RESULTS: GeneXpert ultra (MTB/RIF) yielded a positivity rate of 22.2% compared to smear microscopy 17.2%. Liquid culture yielded a positivity rate of 20.3%. Ct value and smear grading yielded a positive correlation (ρ = 0.8681; P &lt; 0.05). Undetected cases of TB by GeneXpert ultra (MTB/RIF) were identified as positive under liquid culture by MGIT 960. TB Ag MPT64 was performed and yielded NTM and speciated as Mycobacterium abscessus complex by line probe assay. CONCLUSIONS: Our study states the need for identification and differentiation of MTB from NTM.

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute.

We undertook this study to find out the spectrum of the cervical smear pattern along with the clinical profiles of patients who underwent cervical Papanicolaou (Pap) smear evaluation in our newly started tertiary care center. We also tried to find the possible clinical cause for unsatisfactory smears and factors for epithelial cell abnormality. The present study was a retrospective observational study. Pap smears cases with their clinical findings mentioned on the requisition form and cytopathology observations were retrieved from the archives of the department of pathology. Fisher's exact test was used for statistical analysis. Five hundred and ninety-four cases were included in the study. The most common age group was 36- 40 years. White discharge per vaginum was the most common clinical presentation. The negative for squamous intraepithelial lesions or malignancy was the most common interpretation (86.87%). Cervical erosion had statistically significant associations with unsatisfactory smears, while bacterial vaginosis had with satisfactory smears. Epithelial cell abnormality was seen in 4.62% patients. We observed a statistically significant association of cervical mucoid discharge, and inflammation with "no epithelial cell abnormality" cases, while postmenopausal bleeding was associated with "epithelial cell abnormality" cases. In the presence of clinical factors like cervical erosion, which may affect the quality of Pap smear, proper sampling techniques are to be used by health-care providers. The careful evaluation of Pap smears, especially in cases of cervical mucoid discharge, postmenopausal bleeding, and inflammatory smears is required to ensure that epithelial cell abnormalities are not overlooked.

Redefining and capturing pre-analytic deficiencies in an anatomical pathology laboratory: a quality improvement initiative.

Pre-analytical deficiencies (PADs) are a major source of errors in anatomical pathology, accounting for about 70% of laboratory deficiencies. These can lead to incorrect diagnoses, delayed treatments, and increased healthcare costs. As part of a quality improvement initiative, we retrospectively identified and characterized 237 PADs documented over a 1-year period in a tertiary care academic center. The most common PADs were errors in specimen procurement (56%), handling of samples within the lab (16%), accessioning (10%), incomplete requisitions (9%), and transportation-related issues (7%). Strategies were then devised to mitigate these errors. Categorization of pre- and intra-laboratory PADs was refined into eight categories (collection, requisition, specimen container, transportation, receiving, accessioning, preparation, and communications) in the laboratory information system. Mandatory PAD documentation was implemented for accessioning staff. Post-implementation, prospective analysis identified that the most common PADs were related to surgical requisitions (75%). Among these, missing ordering physician's signature was the most common, accounting for 67.7% of requisition-related PADs and 50.8% of all PADs. Other common PADs included incomplete information of specimens, clinical information, patient information, physician information, source location, collection time, incorrect requisition forms, and illegible handwritten information. This study highlights the importance of identifying and addressing PADs in the anatomical pathology laboratory setting as well as the potential benefits of implementing standardized documentation and quality improvement processes to address these deficiencies.

Analysis of the Six Sigma Principle in Pre-analytical Quality for Hematological Specimens.

Introduction Blood tests are essential for detecting and treating hospitalized individuals with diseases. Laboratory blood tests provide doctors with critical information required to treat their patient's illnesses. The most common sources of error in clinical laboratories are pre-analytical errors. Although quality control measures can remediate analytical errors, there is a requirement for stringentquality checks in the pre-analytical sector as these activities are performed outside of the laboratory. Pre-analytical errors when combined with the sigma value can reflect a better pictureas the sigma value represents the laboratory's performance. Aim In this study, six sigma and the Pareto principle were utilizedto assess pre-analytical quality indicators for evaluating the performance of a clinical hematologylaboratory. Methodology This is a retrospective observational study conducted from 2015 to 2023 (for a period of eight years). Information about the frequency of pre-analyticalerrorswas retrieved from the hematology section of the central diagnostic researchlaboratory information system and the data was entered into an MS Excel sheet and datawas evaluated utilizingSPSS version 23(IBM Corp., Armonk, NY). Results In the current research, total of 15 pre-analytical errors were noted. Out of the total 15 pre-analytical errors studied, 55.4% of pre-analytical errors were notedamong which80% errors were due to lack of mention of sample type or received timeand20% of errorswere attributedto no mention of diagnosis in requisition forms. The next most common errors noted were insufficient samples (8.26%) followed by absence of physician's signature (7%), incomplete request form (5.4%), age (4.2%), unique hospital identification (UHID) number (3.7%), clotted samples and transportation of the samples (3.6%), date and incorrect vials (2.6%). Gender (0.95%), hemolysed(0.85%), and lipemic samples (0.45%).Hemolysed andlipemic samples hada sigma value of 4.4 and 4.6, respectively, whereas gender and age had a sigma value of 4.3 and 3.8, inadequate sample for testing and an incorrect anticoagulant to blood ratio had a sigma value of 3.6, indicating that sample collection has to beimproved as the inverse relationship is noted between sigma value and laboratory performance. Conclusion Pareto chart and sigma value can help recognize most common pre-analytical errors, which consequently will help to prevent further recurrence of pre-analytical errors. Adequate training with regard to best practices in phlebotomy for interns, clinicians and technicians must be provided to decrease quantitative errors, which will further enhancetotal quality management in the laboratory.

Cervical sample-taking in the primary health service

In Norway, approximately 360000 cervical screening samples were taken in 2020, of which 11000 were registered as inadequate. We therefore wished to investigate doctors' knowledge of cervical sample-taking in the primary health service. An anonymous survey on cervical sample-taking was sent by email to around 4700 members of the Norwegian College of General Practice in September 2021. Of the 1039 doctors who responded to the survey, 820 (79%) reported that they always indicate the reason for taking the sample in the requisition form, and 898 (86%) reported that they avoid taking a sample during menstruation. Only one in three doctors (343) correctly indicated the location of the squamocolumnar junction in postmenopausal women. In response to a question aimed at users of the ThinPrep method, which is particularly sensitive to sampling errors, 426 out of 697 (61%) answered that they either avoid using a lubricant or use a water-based lubricant, while only 35% of the doctors responded that they stop taking the sample if bleeding occurs. The results show that although many doctors have satisfactory knowledge, a continuous focus on cervical sample-taking is essential. Correct sampling and knowledge of anatomical factors in postmenopausal women may be significant for reducing the number of inadequate samples.

Plasma Microbial Cell-Free DNA Sequencing from over 15,000 Patients Identified a Broad Spectrum of Pathogens.

Microbial cell-free DNA (mcfDNA) sequencing is an emerging infectious disease diagnostic tool which enables unbiased pathogen detection and quantification from plasma. The Karius Test, a commercial mcfDNA sequencing assay developed by and available since 2017 from Karius, Inc. (Redwood City, CA), detects and quantifies mcfDNA as molecules/μL in plasma. The commercial sample data and results for all tests conducted from April 2018 through mid-September 2021 were evaluated for laboratory quality metrics, reported pathogens, and data from test requisition forms. A total of 18,690 reports were generated from 15,165 patients in a hospital setting among 39 states and the District of Columbia. The median time from sample receipt to reported result was 26 h (interquartile range [IQR] 25 to 28), and 96% of samples had valid test results. Almost two-thirds (65%) of patients were adults, and 29% at the time of diagnostic testing had ICD-10 codes representing a diverse array of clinical scenarios. There were 10,752 (58%) reports that yielded at least one taxon for a total of 22,792 detections spanning 701 unique microbial taxa. The 50 most common taxa detected included 36 bacteria, 9 viruses, and 5 fungi. Opportunistic fungi (374 Aspergillus spp., 258 Pneumocystis jirovecii, 196 Mucorales, and 33 dematiaceous fungi) comprised 861 (4%) of all detections. Additional diagnostically challenging pathogens (247 zoonotic and vector-borne pathogens, 144 Mycobacterium spp., 80 Legionella spp., 78 systemic dimorphic fungi, 69 Nocardia spp., and 57 protozoan parasites) comprised 675 (3%) of all detections. This is the largest reported cohort of patients tested using plasma mcfDNA sequencing and represents the first report of a clinical grade metagenomic test performed at scale. Data reveal new insights into the breadth and complexity of potential pathogens identified.

Study of microvessel density in breast carcinoma with CD34 immunostaining – An institutional experience in Puducherry

Abstract Background: Breast carcinoma is one of the most common neoplasms in women. It is most commonly seen in the age group of 30–90 years of age. The evaluation of microvessel density is one of the frequently used methods to quantify intratumoral angiogenesis in breast cancer. Methodology: Analytical cross-sectional study was done in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital for 1½ years after getting ethics committee approval. All cases diagnosed with breast carcinoma in the Department of Pathology were included, and the sample size was 62. The study tools used were requisition form, Hematoxylin and Eosin, and immunohistochemistry CD34 staining in the excised specimen. Results: It was found the present study included 62 cases of modified radical mastectomy done for various grades and stages of breast carcinoma. The common age group in this study was found to be 40–60 years (40 cases). The most common quadrant involved by the tumor is the upper outer quadrant (31 cases). In this study, 48 cases (77.42%) had tumor size of 2–5 cm, 10 cases had tumor size of &gt;5 cm and 4 cases had tumor size of &lt;2 cm. The most common type of tumor seen in this study is invasive ductal carcinoma (IDC) Not otherwise specified (NOS). The most common tumor grade present in this study is grade II tumors (38 cases). In this study, the correlation of histopathological grade with tumor size and microvessel density was found to be statistically significant (P &lt; 0.05). Conclusion: In this study, a higher mean microvascular density value is seen in Grade III tumor and the value decreased as the tumor grade decreases. In the future, antibodies specific to proliferating endothelium, together with the development of automated image analysis, may improve the accuracy and value of measuring angiogenesis-induced microvessel density. Then, these specific antibodies can be used in used in targeted therapies.

Assessment of inconclusive biopsies at a tertiary care dental hospital

Background: Biopsy has crucial role in definitive diagnosis of lesions followed by appropriate treatment of the same. There are situations to clinicians when the report from the oral pathologists comes as “inconclusive biopsy”, instead of a definitive diagnosis. Objectives: To determine the frequency and reasons for inconclusive biopsy as the final diagnosis, in biopsy samples obtained for histopathological evaluation. Methods: This retrospective chart review was conducted in a total of 982 biopsy reports from the archive of the Department of Oral Pathology of Kantipur Dental College. Reports from 2016 to 2021 A.D were assessed after institutional ethical approval utilising convenience sampling. Clinical details were assessed from the patient's biopsy requisition form. Inconclusive diagnosis as the final sign-outs were evaluated, to analyse the reasons for such reports according to the standard criteria. For analysis, SPSS v.20 software was used. Results: Out of 982 biopsy reports, 140 (14.2%) inconclusive biopsy reports were recovered. The reasons for inconclusive biopsy in descending order was 129 (92.1%) poor quality of sample, five (3.6%) insufficient biopsy, three (2.1%) inappropriate fixative, two (1.4%) both insufficient and poor-quality sample and one (0.7%) lack of clinical or radiographic details. Comparison between central and peripheral inconclusive reports was not statistically significant (p &gt;0.05). Conclusion: This study indicates that careful surgical approach is a must along with proper transportation of the biopsy sample and a detailed clinical and radiographic information to avoid inconclusive biopsy reports.

Spectrum, Clinicopathologic Profile, and p16 Expression Pattern of Nonmalignant Cervical Tissues in Enugu, South-East Nigeria

Abstract Background p16 is a marker for p16-induced transformation of high-risk human papilloma virus (hrHPV)-infected cervical epithelium. HPV is a known etiologic agent of cervical cancer. Persistent hrHPV infection of cervical epithelium causes transformation of the infected epithelial cells resulting in increased proliferative potential of the cells and subsequent progression to frank malignancy. Early detection of transformation in cervical cells is crucial in reducing morbidity and mortality associated with cervical cancer. Materials and Methods We aimed to study the clinicopathologic profile of nonmalignant cervical lesions and their p16 staining pattern. Histopathology requisition forms, blocks, and slides of cases containing cervical tissue with nonmalignant diagnosis received into the morbid anatomy department of University of Nigeria Teaching Hospital, Enugu, from 2009 to 2018 were studied. Fresh sections from the blocks were immunohistochemically stained with p16 and examined. Results One-hundred and ninety-one cases were studied. Majority of the cases are normal cervical epithelium. Chronic nonspecific cervicitis was the major non-neoplastic lesion present and accounted for 33.3% of the biopsy and the mean age was 50.5 years. Other lesions were nabothian cyst (8.4%), cervical polyp (10.5%), low-grade and high-grade squamous intraepithelial lesion (LSIL and HSIL; 6.3 and 2.6%, respectively). The mean age for LSIL was 40.3 years, while that of HSIL was 45.2years. Four LSIL, two HSIL, one polyp, one chronic nonspecific cervicitis, and one lobular endocervical hyperplasia stained positively with p16. Conclusion The most common benign lesion of the cervix is cervicitis. Chronic cervicitis is negative to p16 immunoreactivity. There are more low-grade cervical intraepithelial neoplasia (CIN) than high-grade CIN. The low-grade CIN overexpress p16 in one-third of cases. There are more cases of p16-negative high-grade CIN in this study.

Prospective audit of transfusion utilization trends and transfusion practices at a rural tertiary care hospital in Central India

Background: In modern health-care system, practicing safe and appropriate transfusion services is essential. Care should be taken at all three phases of transfusion practices, i.e. pretransfusion, transfusion, and posttransfusion. The blood unit should be appropriately used by the clinicians. Aims: The aim of this study was to evaluate blood transfusion practices at pretransfusion level at blood center as well as bedside and posttransfusion practices. Settings and Design: This was a prospective observational study. Materials and Methods: A total of 15022 requisition forms were received in our blood center for a total of 19904 units of blood and blood products during the study period of 21 months. Statistical Analysis Used: The data were recorded using Microsoft Excel and analyzed using the IBM Corp. Released 2011. The categorical variables were expressed in terms of number and percentage. Results: During the study period, blood bank received transfusion request for a total of 12840 units of blood bag for cross matching. Out of which only 9907 blood units were transfused to the recipients while rest of 2573 blood units were not transfused to the recipient and thus it was ordered excessively for cross match. When looked for overall utilization trends, we found that crossmatch-to-transfusion ratio was 1.26, transfusion probability was 79.38, and transfusion index was 0.79. There were 65 transfusion reactions, out of which only 27.69% (n = 18) reactions were reported and 72.31% (n = 47) were not reported to our blood center. Conclusions: It is important to sensitize the clinicians about the importance of ordering blood unit only when it is absolutely indicated along with correctly and completely filled blood transfusion request forms to lessen the transfusion reactions. It will ultimately improve the clinical practices in the hospital.

Clinical audit of computed tomography requisition form in a himalayan country, Nepal

Introduction: Medical imaging requisition form is a vital document in the radiology department. Adequate filling ensures justification and effective communication which impacts patient care. This study aims to audit computed tomography (CT) requisition forms to determine their adequate filling and legibility in the Himalayan country, Nepal. Methods: A total of 239 CT requisition forms were collected from the Department of Radiology and Imaging, Bir Hospital, Kathmandu, Nepal through random sampling from June to August 2020. The availability of information such as demographic characteristics, clinical history, clinical diagnosis, differential diagnosis, and proper name of CT procedures was audited. The legibility of the provided information was categorized with the help of a senior radiographer having 10 years of experience. Results: Clinical history was present in 28 percent and clinical diagnosis in 64 percent of forms. Furthermore, 44 percent of contrast-enhanced procedures requiring IV contrast agents did not have a report of renal function test. Surprisingly, details on the last menstrual period for women of the reproductive age group were missing in all requisition forms. Conclusion: Available information is not sufficient for justification of patient dose. Clinicians need to fill up the requisition form properly for quality patient care in the radiology department.

Epidermoid Cyst: An Esthetic Challenge, If Neglected-A Comprehensive Analysis of 217 Cases.

An epidermoid cyst is a benign keratin-filled cyst, commonly located in the face, scalp, neck, and trunk. Although it is a common benign cystic neoplasm, large series of analyses in English literature are still scarce. To comprehend the clinical and pathological variation of epidermoid cysts in the sub-Himalayan region of India, as well as their clinical implications for late diagnosis, a retrospective study on epidermoid cysts was conducted. This was a retrospective observational study conducted on 217 cases of epidermoid cyst subjected for fine-needle aspiration cytology over a period of 3.6 years (from 2018 to 2021). The clinical details and other epidemiological data were archived from the pathology requisition forms. It showed slight male preponderance with head and neck site as the most common area. Most patients were adults. Few uncommon sites were also seen namely breast, parotid, epididymis, and tonsils. Few large lesions were identified measuring up to 10 cm. The skin changes were seen in 5.5% cases, 0.9% cases show extreme ulceration, and 4.1% cases show foreign body giant cell reactions. Due to the province's steep terrain and limited access to medical services, the majority of patients arrived at out patient department (OPD) late. The findings suggest that fine-needle aspiration can be used as a quick diagnostic test even in remote areas by the general practitioner who can send the slides for evaluation to a pathologist. Many times, clinically looking epidermoid cyst can reveal certain challenging entities such as a biphasic fibroepithelial tumor with cystic squamous metaplasia and proliferating pilar tumor in our series. The study of this lesion is also needed for early diagnosis as long-standing lesion may rupture and cause requirement of extensive treatment followed cosmetic impairment.

Endometrial Patterns Among Rural Women Undergoing Gynecological Procedures in a Tertiary Care Hospital.

Introduction Women with endometrial diseases often present in outpatient departments, and outpatient procedures easily enable diagnosis. Histopathological patterns vary with age, menstrual cycle, drug use, and pathological state. Teaching hospitals are often located away from rural areas. Materials and methods An ambispective study was performed over 33 months in a rural medical college hospital by perusing the histopathological registers of the department. Details of history and endometrial samples (biopsy and hysterectomy) were obtained using biopsy numbers and requisition forms. Functional and organic histopathology findings were manually entered into a spreadsheet, and statistics were performed using Statistical Package for the Social Sciences (SPSS)for Windows version22 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 226 women, with total abdominal hysterectomies (TAH) performed in a significantly higher proportion of middle-aged women(range: 41-59 years). Of the middle-aged women, 70% presented with excessive menstrual bleeding, and a similar percentage of older women presented with uterovaginal (UV) prolapse. Hysterectomy specimens constituted most samples in this study. Proliferative endometrium was observed in 40% of patients andmetaplasia (papillary syncytial, tubal, and squamous)in only 1.7%.Normal proliferative and secretory endometrium wereobserved in91 (40.3%) and 41 (18.1%) patients, respectively. The presence of hyperplasia, decidualization, stromal breakdown, adenocarcinoma, adenomyosis, and endometrial polyps did not vary significantly among thethree agegroups (elderly, middle-aged, and young). Conclusion Most women in rural areas presented to the gynecologist with uterine bleeding; middle-aged women constituted most of those with gynecological complaints. Normal endometrium was observed in nearly half of the patients. Adenomyosis was the most common cause of uterine bleeding. Uterine endometrial malignancies were rare.