No abstract

Inequity is deeply embedded in the supply of drinking water in Delhi, India. Using the concept of infrastructural violence, this paper exposes how past and present governance of water has resulted in unequal distribution of supply across the city to exclude vulnerable communities from accessing drinking water. This perspective broadens the gaze away from a narrow gaze on the technical and structural aspects of infrastructure to encompass the socio-political dimensions. This paper starts by outlining the history of the water supply in Delhi. We then outline five axes of exclusion which can be read as infrastructural violence and explores how aspects of water policy, legislation, and planning uphold these injustices. Our discussion centers on how economics, political ideology, and power infiltrate governing mechanisms to influence water infrastructure to entrench poverty and marginalization. Attempts to improve water security for Delhi's residents face minimal impact without addressing these embedded inequities. Therefore, our analysis offers a framework to systematically create awareness of the factors to be addressed to enable a more equitable governance of water supply.

Objectives: Acute leukemias (AL) are a heterogeneous group of hematological malignancies with the presence of 20% or more blasts in the peripheral blood or bone marrow. Malignant cells display characteristic patterns of surface antigenic expression. Aberrant phenotypes are defined as patterns of antigen expression on neoplastic cells different from the process of normal hematopoietic maturation. We sought to evaluate the occurrence of aberrant phenotypes in newly diagnosed cases of AL. Methods: The study included 100 patients in whom both bone marrow aspiration and flow cytometry were performed. Patients with blasts > 20% of all ages were included in the study. Flow cytometric analysis was done using the monoclonal antibody panel of peripheral blood/bone marrow. Results: Out of 100 cases, 53 were categorized as acute myeloid leukemia (AML), 43 as acute lymphoid leukemia (ALL), and four cases of mixed phenotypic acute leukemia (MPAL). ALL were subcategorized based on immunophenotyping into B-ALL and T-ALL, which comprised 88.4% and 11.6%, respectively, of total ALL (43.0%) cases. Cluster of differentiation 33 (CD33) and CD13 were the most commonly expressed antigens in AML, with CD7 being the most common aberrancy. CD19 was expressed in all B-ALL cases followed by cCD79a, CD10, Tdt (86.8%) with CD13 being the most common aberrancy. cCD3, CD7, and CD5 were expressed in all T-ALL cases with aberrant antigen expression in 80.0% of T-ALL cases. MPAL cases showed expression of B/myeloid antigens. Conclusions: The diagnosis and classification of leukemia rely on the simultaneous application of cytomorphology, cytochemistry, flow cytometry, cytogenetics, and molecular techniques. Flow cytometry is of great help in the diagnosis of AL, particularly in ALL for lineage assignment and in classifying MPAL. It also helps in detecting aberrant antigen expression and assisting in minimal residual disease detection.

Giant-cell tumor (GCT) of the bone affecting the hand is a rare lesion that is usually diagnosed at an advanced stage and has a high rate of recurrence. In the current literature, GCT is described as a predominantly osteoclastogenic stromal cell tumor of mesenchymal origin. It is composed of three cell types: the neoplastic GCT stromal cells; mononuclear monocyte cells; and multinucleated giant cells. Clinical imaging is basic for the diagnosis of a GCT. This tumor within the hand tends to be less eccentric and most often central. GCT of metacarpals is noted to be a rare location, with the incidence being as low as 2%. GCT on hand as compared to other sites is locally more aggressive, grows faster, and has a higher recurrence rate.A 22-year-old male patient presented with swelling over the left hand for 7 months, spontaneous in onset, gradually progressive in size, and painfully restricting the joint movement, with no history of fall or trauma. On examination, diffuse swelling of size 5 × 5 × 3 cm was tender on palpation, restricting the movement at the 4th metacarpophalangeal joint. A plain radiograph followed by an MRI scan revealed a Campanacci's Grade III GCT of the 4th metacarpal. An open biopsy showed an expanded and lytic mass with areas of hemorrhage and necrosis. There were few mitotic figures and the tumor was diagnosed to be a GCT. On surgical resection, friable tumor tissue was noted over the region of the entire 4th metacarpal except for the base. The patient was managed by surgical intralesional excision of the mass, followed by Kirschner-wire fixation and reconstruction with synthetic bone graft. The excised tissue was sent for histopathological examination. The patient was followed up at regular intervals, with initial splinting, followed by wire removal at 6-week post-op, and with adequate physiotherapy, as tolerated by the patient. On a 3-month follow-up, the range of motion had returned to a functional level, with good uptake of graft, and no other complications.GCT of the hand is a rare presentation of the disease and requires meticulous workup, including a thorough clinical exam, hematological, radiological, and pathological workup. The various treatment modalities described in the literature for GCTs are curettage alone, curettage and bone graft, en-bloc resection, amputation, and resection with reconstruction, but curettage alone or curettage with bone graft is not effective even for GCTs of long bones and hand, too. Such a procedure creates a skeletal void and hence furthers the need for a challenging reconstructive procedure requiring reconstruction using autograft, allograft, or silastic (synthetic) implant.

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. The objective of this study was to measure β-hCG during 13-20 weeks of gestation and compare the same between those who develop Hypertensive disorders of pregnancy with those who do not. Methods: A prospective observational study was carried out on 200 primigravida patients in their second trimester (13-20 weeks) attending the OPD in Muzaffarnagar Medical College. Serum β-hCG levels were estimated in all these patients by CLIA (chemiluminescent immune assay) technique. All pregnancies were followed up till delivery for the development of Hypertensive disorders of pregnancy. Results: Out of 200 patients, 27(13.5%) cases developed Pregnancy induced hypertension. Of those who developed PIH, 22(70.9%) were having β-hCG levels >2 MOM (P< 0.05). Absolute β-hCG levels (Mean ± SD) were also significantly higher (95963.0 ± 42337.64 V/S 40319.74 ± 10659.42; P< 0.05) in subjects who later developed PIH. Sensitivity, Specificity, Positive predictive value and Negative predictive value for β-hCG were 85.2%, 92.5%, 81.98% and 94.8% respectively. Conclusion: Serum β-hCG estimation at mid trimester (13-20 weeks) is a good predictor of PIH and higher levels of β-hCG are associated with increased severity of PIH.