BackgroundMalaria may be associated with complications which may be avoided by early diagnosis and treatment. Microscopic diagnosis showing presence of malarial parasites is needed for confirmation which at times may be unreliable and requires technical expertise. The present study was conducted to statistically analyze the haematological parameters including platelet indices which can give initial hint for malarial infection and therefore prompt the laboratory physician for active search of the parasite microscopically.MethodsA retrospective study was conducted which included 334 cases of acute malaria caused by Plasmodium vivax, falciparum and dual infection along with 100 cases of control. Routine haematological parameters along with platelet indices (MPV and PDW) which are easily available on automated cell counter were statistically analyzed to assess their role as indicators for malaria.ResultsLeukocyte count and platelet count were significantly lower in cases of acute malaria in comparison to controls (p value <0.001). Platelet count<150×109/l showed 87.2% sensitivity, 65% specificity, 89.3% positive predictive value and 2.49 likelihood ratio for the infection. PDW of 6–10 and MPV>8 fl had 71.9% and 61.5% sensitivity and 78.2% and 77.7% positive predictive value respectively for infection. Platelet count <150×109/l and MPV>8 fl was comparatively more sensitive indicator for vivax (88% and 70.8% respectively) than falciparum (84.8% and 50.4% respectively) and PDW 6–10 was more sensitive indicator for falciparum (82.6%) than vivax (69.5%) infection.ConclusionThrombocytopenia (<150×109/l) and low leukocyte count (<4×109/l) may be used as probable indicator for malaria in endemic countries. Higher MPV (>8 fl) and PDW of 6–10 also show considerable sensitivity for malarial infection. In addition, thrombocytopenia (<150×109/l) and higher MPV (>8 fl) was more sensitive for vivax infection while PDW 6–10 was more sensitive for falciparum infection.
Studies have compared the role of bone marrow aspirate cytology and trephine biopsy for diagnosing various hematological disorders but fewer studies have compared the relative value of imprint cytology with aspirate and trephine biopsy. The present study was conducted to compare the role of bone marrow aspirate, touch imprint and trephine biopsy to formulate an effective and rapid method for diagnosing wide spectrum of hematological diseases. The study included total 565 cases of bone marrow examination from January 2006 till May 2010. All the smears and sections were reviewed for morphological details and findings on aspirate, imprint and biopsy were compared to each other. The diagnostic accuracy of bone marrow aspirate was 77.5%, imprint cytology 83.7% and that of biopsy was of 99.2%. The study showed 78% positive correlation between aspirate and biopsy and 84.3% between imprint and biopsy; 93.3% cases of metastatic solid tumors were correctly diagnosed on imprint while only 70% cases were diagnosed on aspirate cytology. The study concludes that all the three preparations of aspirate, imprint and biopsy complement each other. The assessment of iron status by Perl's stain is most suitable on aspirate smears but trephine biopsy remains the gold standard for diagnosing granulomatous inflammation and hypoplastic/ aplastic anemia. Meticulously prepared imprint smears not only provide cellular composition of marrow but may also be helpful in defining the architecture of marrow especially in cases of metastatic solid tumors. Imprint cytology smears should be standard practice for evaluating any marrow.
Introduction:Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) of Bethesda system for reporting thyroid cytopathology has emerged as most controversial category due to its heterogeneity and inconsistent usage. Initially associated risk of malignancy was estimated to be about 5–15%, but eventually different results have been obtained across institutions due to variable follow-ups and interpretation. The present study was conducted to evaluate the rate of malignancy along with appropriate management in this category.Materials and Methods:The study included AUS/FLUS cases diagnosed over period of 4 years on thyroid fine needle aspiration cytology (FNAC). Detailed clinical history and radiological examination were recorded along with follow-ups and management of all cases. Histopathology was available for cases which underwent surgery due to high clinical suspicion, worrisome radiological features or two consecutive AUS/FLUS reports.Results:The incidence of AUS/FLUS was 6.4% with repeat FNAC done in 39.6%, immediate surgery in 49.2% and follow-up without intervention in 11.1% cases. The overall malignancy rate was 28.5% with most common malignancy being follicular variant of papillary carcinoma (FVPC). Malignancy rate was more in cases (24.1%) which morphologically showed atypical nuclear features in comparison to architectural atypia.Conclusion:AUS/FLUS is associated with higher risk of malignancy than previously anticipated. Surgical intervention may have greater implication than repeat FNAC in appropriate management of this category. Substratification of this category according to nuclear features and architecture may be more useful in predicting malignancy risk and reducing the variability in the group.
Aim:This study was conducted to assess the role of cytology in the diagnosis of lung lesions and to compare it with histopathology. It was also intended to evaluate the role of rapid on site evaluation (ROSE) as an adjunct to cytological diagnosis of lung lesions.Materials and Methods:The study included all the cases of lung lesions, which were diagnosed on cytology followed by histopathology over a period of 2½ years along with ROSE, wherever possible.Results:Cytology was done in total 782 cases of various lung lesions and of this cyto-histopathological correlation was available in 215 cases. ROSE was done in 93.4% of total cases and smears were considered on the site adequate in the first pass in 68.1% cases and in second pass adequacy increased to 93.4%. The diagnostic accuracy of cytology was 75.3%, and that of histology was 86.9% in the diagnosis of lung lesions. The diagnostic accuracy of cytology for squamous cell carcinoma (94.4%) and adenocarcinoma (96.5%) was higher than that of histology.Conclusion:Cytology is comparable to histology in the diagnosis of lung lesions and may even outperform biopsy in lung tumor diagnosis. The advantages of cytology may be further added by better sampling and preanalytical assessment for adequate diagnostic material and ROSE has proved to be an important, easy and cost effective adjunct in this regard. A multidisciplinary approach involving pulmonologist, radiologist and cytopathologist with ROSE, followed by vigilant morphological examination may increase diagnostic utility of cytology for lung lesions.
Recently, platelet indices have been evaluated to determine their utility in knowing the mechanism of thrombocytopenia. This study was conducted to analyze the role of mean platelet volume (MPV) as a guide or an indicator for bone marrow disease in thrombocytopenic patients. All the patients with thrombocytopenia for various causes followed by bone marrow examination were divided into two groups, one group with and another without bone marrow disease, depending on pathophysiology. The MPV was statistically analyzed in both the groups to assess its role as guide for bone marrow disease in these patients. Mean MPV (average score of all individual mean values in patients) in the group with bone marrow disease was 7.3 fl, while in the group without bone marrow disease, it was 8.62 fl. Although the difference in MPV in the two groups of with (including megaloblastic anemia) and without bone marrow involvement was statistically significant (P value <0.001), its sensitivity and specificity scores as observed by receptor operating characteristic (ROC) curve at cut-off of <8.15 fl were not highly sufficient (67.7% sensitive and 65% specific). The study concluded that although MPV can be used as an initial hint for bone marrow disease in thrombocytopenic patients, it has limited sensitivity and specificity. The differentiation of megaloblastic anemia from other causes of pancytopenia involving the marrow requires bone marrow examination rather than using MPV as an indicator. Bone marrow examination remains the gold standard for discriminating hypoproductive type of thrombocytopenia from the hyperdestructive one. In addition, the role of other platelet indices should also be assessed further to know a better indicator for bone marrow involvement in thrombocytopenic patients.
Angiogenesis plays an important role in progression of tumor with vascular endothelial growth factor (VEGF) being key proangiogenic factor. It was intended to study angiogenesis in different hematological malignancies by quantifying expression of VEGF and MVD in bone marrow biopsy along with serum VEGF levels and observing its change following therapy. The study included 50 cases of hematological malignancies which were followed for one month after initial therapy along with 30 controls. All of them were subjected to immunostaining by anti-VEGF and factor VIII antibodies on bone marrow biopsy along with the measurement of serum VEGF levels. Significantly higher pretreatment VEGF scores, serum VEGF levels, and MVD were observed in cases as compared to controls (p < 0.05). The highest VEGF score and serum VEGF were observed in chronic myeloid leukemia and maximum MVD in Non-Hodgkin's Lymphoma. Significant decrease in serum VEGF levels after treatment was observed in all hematological malignancies except for AML. To conclude angiogenesis plays an important role in pathogenesis of all the hematological malignancies as reflected by increased VEGF expression and MVD in bone marrow biopsy along with increased serum VEGF level. The decrease in serum VEGF level after therapy further supports this view and also lays the importance of anti angiogenic therapy.
Technology transfer is the complete, enabling disclosure of advancement in Science and technology, sufficient for its unfettered use and improvement. Universities and institutions of high end research and learning are the focus of such knowledge economy. University-industry partnerships in the field of Science and technology are complex and develop through a large number of mechanisms. The protection and the licensing mechanism of Intellectual property rights at such institutions are the focus of attention of the policy makers at all levels, including the Parliament, wherein a bill has been passed recently, PFIP Bill,2010, which emulates the technology commercialization at US University through Bayh Dole Act. A detailed commercialization process has been evaluated and the success of such technology transfer analysis and commercialization has been reviewed with reference to controlling parameters and revenue being generated.
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