IntroductionType 2 diabetes mellitus, characterized by insulin resistance, corresponds to approximately 90% of cases of diabetes worldwide. Hyperglycemia in diabetes contributes to hyperfibrinogenemia and activates the coagulation cascade thereby producing atherothrombotic events.ObjectivesThis study was designed to evaluate the coagulation profile (activated partial thromboplastin time, prothrombin time and fibrinogen) in Type 2 diabetes and to analyze correlations between body mass index, fasting blood glucose, glycated hemoglobin and duration of diabetes with coagulation parameters.MethodsThis study included 60 type 2 diabetics and 30 controls. Diabetic patients were grouped in two sets based on the presence or absence of microvascular complications. The demographic profile and clinical details were recorded. Fasting blood glucose, glycated hemoglobin, coagulation parameters such as prothrombin time, activated partial thromboplastin time and fibrinogen along with other biochemical parameters were investigated.ResultsThere were statistically significant differences in the coagulation parameters between the two groups of diabetics (with and without complications). The present study also found significant correlations between age and the duration of diabetes with and without complications and coagulation parameters such as the activated partial thromboplastin time, which was found to be significantly lower, and fibrinogen, which was found to be significantly higher in subjects with complications compared to subjects without complications.ConclusionClinical tests for prothrombin time, activated partial thromboplastin time and fibrinogen are relatively inexpensive and readily available. The present study shows that shortened prothrombin time, activated partial thromboplastin time and increased fibrinogen levels might be useful hemostatic markers in diabetic patients, especially in those at high-risk for thrombotic complications.

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Primary malignant spindle cell tumors are rare constituting 1.0% of breast malignancies. Spindle cell lesions occurring in soft tissues can occur in breast with overlapping morphologies. It can present as benign lesion and have inconclusive cytological findings, so easily missed if not properly dealt with. Stromal sarcoma should be diagnosed only after thorough sectioning and negative staining for p63, broad spectrum, and high molecular weight keratin. We present a case of right breast lump. Cytological features revealed fibro histiocytic lesion. There were no areas of necrosis, hemorrhage, or calcification. Histopathologically, it showed partially encapsulated tumor with cells arranged in sheets, composed of oval to epithelioid cells with spindling at places with moderate pleomorphism (mitotic activity 6-7/10 hpf). Differential diagnosis of primary stromal sarcoma, metaplastic sarcoma, and phyllodes was made. Immunohistochemistry revealed vimentin positivity with focal positivity of S-100. Desmin, cytokeratin and smooth muscle actin, p63, ER, PR, and Her2-neu were negative. A final diagnosis of primary breast sarcoma of neural origin was established with the help of histopathology and immunohistochemistry. To conclude, it is of utmost importance to identify primary stromal sarcomas as they are known to spread very rapidly and have a poor prognosis.

<p class="abstract"><strong>Background:</strong> The two most frequent types of microcytic hypochromic anemia in developing countries are beta thalassemia trait (𝛽-TT) and iron deficiency anemia (IDA). Several indices using blood cell count parameters have been suggested to differentiate between two. In this study we evaluated the reliability of three indices.</p><p class="abstract"><strong>Methods:</strong> The present cross-sectional study was carried out in 300 pregnant females in third trimester. Out of these, 90 microcytic hypochromic females were selected. Mentzers index, red cell distribution width index and Matos and Carvalho index (MCI) were calculated from the regular 3-part analyser haematological parameters.  </p><p class="abstract"><strong>Results:</strong> The Mentzer index was the most reliable index, as it had the highest sensitivity (97.62%), specificity (66.67%), and Youden’s index (64%) for detecting Iron deficiency anaemia; the Matos and Carvalho Index showed higher sensitivity (98.81%)but a much lower specificity (33.3%) and Youden’s index (32%) while the red cell distribution width index showed the sensitivity and specificity of 92.86% and 66.67%, respectively with Youden’s index of 59%.</p><p class="abstract"><strong>Conclusions:</strong> The Mentzer index provided the highest reliabilities for differentiating<strong> </strong>IDA from 𝛽-TT. The new indices have high sensitivities and positive predictive value for identifying IDA, making them useful for screening population at risk. </p>

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Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the differences if any between the first year and second year MBBS students and their correlation with various socio-demographic parameters.Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered questionnaire. Data was analyzed using SPSS software version 17. Values of p<0.05 were considered significant.Results: Mean knowledge scores of second year MBBS students compared to first year MBBS were 11.73±1.78 versus 10.8±1.92, the difference being statistically significant, however, the difference between mean attitude scores was not found to be significant. There was no effect of age, gender, region or Kuppuswamy’s socio-economic class on the knowledge or attitude of MBBS students towards thalassemia.Conclusions: Majority of the MBBS students had good knowledge and positive attitude towards thalassemia. To confirm the observations, large scale studies need to be conducted comprising of different study populations. Screening for thalassemia should be made mandatory, as part of medical examination, at entry to a medical college so that the medical college students are sensitized and can spread awareness among general population.

Cardiac lesions are responsible for approximately 60-70% of sudden deaths. Histopathological examination of heart on autopsy plays an essential role in determining the cause of death.The present study was conducted to analyse histopathological spectrum of various cardiac lesions in autopsy specimens.This retrospective randomized study was conducted in the Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana. A total of 1152 autopsies were analysed, irrespective of cause of death. Among them heart was included in 1062 autopsies, out of which 62 were autolysed. Hence, 1000 specimen of whole heart were included in our study. A detailed gross and microscopic examination was done and histopathological findings were correlated clinically.Atherosclerosis was the most common cardiac lesion seen in 610 out of 1000 autopsied heart (61%), followed by ischaemic heart disease in 346 cases (34.6%). 27 cases had pericarditis, 23 cases revealed myocardial hypertrophy, 16 cases showed myocarditis, 11 cases had ventricular haemorrhage, 8 cases revealed changes of electrocution, 7 cases had tuberculosis, 6 cases had calcification of valve and 4 cases had metastasis from carcinoma. One case each of infective endocarditis, rheumatic heart disease and aortitis were also noted. The cause of death was not identified in 304 cases. Left anterior descending artery was most frequently involved vessels (35.02%) followed by left circumflex artery (33.41%) then right coronary artery (31.57%). Out of three major vessels 16.24% had single vessel involvement whereas 32.14% & 51.62% cases had two vessels and three vessels involvement respectively. Ischemic heart disease with coronary artery atherosclerosis was found to be the leading cause of death with triple vessel disease as the most common pattern of involvement.

Background: Thalassemia is most common genetic disorder worldwide and about 7% of world population is carrier. The prevalence of Beta thalassemia trait (BTT) is 3.5–10% in India. The National Family Health Survey (NFHS-3) of 2011 reveals the prevalence of iron deficiency anemia (IDA) as 70–80% in children, 70% in pregnant women, and 24% in adult men. As both of them are close differential diagnosis and both can coexist together, this study aims to detect hemoglobinopathies in pregnant women and quantify the effect of iron deficiency on HbA2 levels in order to improve the detection of β thalassemia trait with and without iron deficiency.Methods: Hb, RBC indices, and peripheral smears of 90 pregnant females with microcytic hypochromic blood picture were studied. Serum ferritin and HPLC (High Performance Liquid Chromatography) was performed. The results were analysed statistically by using SPSS version 16.0.Results: 93.3% patients had HbA2 <2%, 4.44% had >4.0% which characterise BTT and remaining 2.22% had between 3.0%-4.0%. HbA2 <2.0% may be seen in IDA, ATT, HbH disease and Delta thalassemia. 91.11% had reduced serum ferritin and 2.22% had normal ferritin levels.Conclusions: This study reveals that there is frequent occurrence of iron deficiency anaemia in patients with thalassemia traits. This can substantially invalidate the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of thalassemia trait.