Background: Diabetic foot ulcer (DFU) is well managed by infection control, euglycemic state, debridement of ulcer followed by appropriate dressing and off-loading of the foot. Studies have reported that when DFU is properly off-loaded, about 90% of these would heal in nearly six weeks. Platelet rich plasma (PRP) serves as a growth factor agonist and has mitogenic and chemotactic properties which help in DFU healing. To evaluate the efficacy of local application of PRP with respect to healing rate and ulcer area reduction in treating diabetic foot ulcer. Materials and Methods: Sixty non-infected DFU patients with plantar ulcer of size less than 20cm2 and Wagner's Grade 1 & 2 were randomized to receive normal saline dressing (Control group - CG) or PRP dressing (Study group - SG) in conjunction with total contact casting for 6 weeks (or till complete ulcer healing), whichever was earlier. Evaluation was done at weekly interval for healing rate and change in ulcer area.Results: Mean ulcer area of study participants at baseline was 4.96 {plus minus} 2.89cm2 (CG) and 5.22 {plus minus} 3.82cm2 (SG) (p=0.77) which decreased to 1.15{plus minus}1.35cm2 (CG) and 0.96{plus minus}1.53cm2 (SG) (p=0.432) at 6wks. Percent reduction in mean healing area at 6wks was 81.72{plus minus}17.2% and 85.98{plus minus}13.42% in control group and study group respectively (p=0.29). Average rate of healing achieved at 6 weeks was 0.64{plus minus}0.36cm2 and 0.71{plus minus}0.46cm2 in control group and study group respectively (p=0.734). Conclusions: PRP dressing is no more efficacious than normal saline dressing in management of DFU in conjunction with total contact casting.

With the commencement of the COVID19 pandemic, following its 1 st case reported in Wuhan in China, the knowledge about the virus as well as the symptoms produced by the disease have drastically increased to this day. The manifestations of COVID19 have now known to affect multiple organ systems of the body, which have shown to have acute as well as chronic complications. Histopathological analysis of the biopsies from the affected organs have implied direct cytopathic effect of the virus but at the same time not ruling out other causes like hypoxia metabolic changes etc., occurring during the course of the disease. In this review article, we have highlighted the histopathological changes in various organs as reported by various studies throughout the world for better understanding of the etiopathogenesis of COVID19.

Monkeypox infection (Mpox) is caused by the Orthopoxvirus (OPXV) genus of the Poxviridae family, closely resembling its more famous sibling smallpox. Recently World Health Organization (WHO), have renamed monkeypox as Mpox citing racial concerns, so we will be referring to monkeypox as Mpox. There has been a recent outbreak in May 2022 when Mpox cases were identified in all six WHO regions. On July 23, 2022, WHO declared it a public health emergency. Before the current outbreak, Mpox had been reported in people from several parts of central and west African countries; and almost all Mpox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. With the waning of smallpox vaccine-induced immunity, Mpox can spread in the global population. Though the virus generally does not cause high mortality in immunocompetent individuals, however, severe disease and mortality may result if the virus spreads to immunocompromised individuals, children, elderly individuals, pregnant women, and individuals living with comorbidities such as diabetes. The current transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. It was found that 98% of the persons with infection were either gay or bisexual men, with 41% suffering from HIV infection. The reasons behind this current epidemiological behavior have to be studied further to formulate a hypothesis that, is it the homosexuals who need to be more concerned or is it a global concern, and is monkeypox changing its behaviour to a sexually transmitted infection? The rash, along with associated lymphadenopathy, is a clue toward Mpox infection, but polymerase chain reaction is needed for the confirmative diagnosis. With the discovery of a vaccine, repurposed antivirals, and precautionary steps to prevent the spread of infection, it might help in the containment of the virus. In addition, what we already know about Mpox has to be re-evaluated, because most of the information gathered is from low-resource settings in Africa. The world at large and health care agencies specifically needs to galvanize a well-funded global plan and research initiatives to contain the spread of Mpox. In this article, we have attempted to make the readers aware of the biology, etiopathogenesis including the changes at the cellular level the virus is causing, the changing trends of the virus transmission, and the clinical manifestations. We have also attempted to elaborate on the potential challenges and the need for early

The past few decades have witnessed a major leap in knowledge relating to the role of tumor microenvironment (TME) in carcinogenesis and evolving behavior of the tumor. Multiple factors within the TME modulate the cancer cells and the associated therapies. Stephen Paget first asserted that the microenvironment plays an important role in the growth of tumor metastasis. The most important player in the TME is cancer‐associated fibroblast (CAF) which significantly participates in the proliferation, invasion, and metastasis of tumor cells. CAFs show phenotypic and functional heterogeneity. Mostly CAFs originate from quiescent resident fibroblast or mesoderm‐derived precursor cells (mesenchymal stem cells), although several alternate sources of origin have been noted. However, due to lack of specific fibroblast‐restricted markers, it is very difficult to trace lineage and identify the biological origin of distinct subtypes of CAFs. CAFs are predominantly shown by several studies to mainly act as tumor‐promoting agents, however, tumor‐inhibiting actions are also being validated by several studies. A more objectified and comprehensive functional and phenotypic classification of CAF is required, which will help in better way for tumor management. Here, in this review, we have tried to review the current status of CAF origin, along with phenotypic and functional heterogeneity, and recent progress in CAF research.

Background: Polycystic ovary syndrome(PCOS) is an endocrine metabolic disorder which is rapidly gaining epidemic proportions. Hyperinsulinemia and insulin resistance (IR) are thought to be key pathological factors. This study was undertaken to characterize the phenotypes of PCOS and to determine the prevalence of metabolic syndrome (MetS) and insulin resistance in them.Methods: This observational cross-sectional study was undertaken to assess the distribution of the Rotterdam PCOS phenotypes and to report the prevalence and risk factors for MetS syndrome and insulin resistance using homeostasis model assesment for insulin resistance (HOMA-IR). 90 women aged 18-35 years newly diagnosed with PCOS were classified into one of the four potential PCOS phenotypes based on history, examination and investigations.Results: Phenotype A was the most prevalent phenotype (45.5%). Prevalence of insulin resistance in our study was 31% using HOMA- IR cutoff of 2.5, with highest prevalence in phenotype A and least in phenotype D. The overall prevalence of MetS was 36% with a two- to six-fold higher prevalence in hyperandrogenic phenotypes compared to the non-hyperandrogenic phenotype. Highest mean hs- CRP was found in phenotype A which could possibly indicate greater cardiovascular risk in future. Univariate logistic regression for predictive association of MetS parameters was significantly high for deranged parameters i.e. WC≥80cm, fasting plasma glucose ≥100mg/dl, HDL ≤50mg/dl and WHR ≥0.85. Strong positive association was found with all these parameters (p<0.001) Hirsutism (modified Ferriman Gallwey score ≥8) was strongly associated with MetS (p=0.005).Conclusions: An appropriate diagnosis of PCOS and accurate dentification of phenotype is important as it has long-term health implications for women. We recommend screening all hyperandrogenic PCOS women for IR and metabolic abnormalities. This study has shown that HOMA-IR is a valuable tool in identifying PCOS women with metabolic syndrome and also serve to identify PCOS subtype at high risk of future metabolic syndrome.

Objectives: Cytological examination of effusion sample is a preliminary and minimally invasive method for the diagnosis of body fluids. Recently, the International System For Reporting Serous Fluid Cytopathology (ISRSFC) and the Indian Academy of Cytologist (IAC) have published guidelines for reporting effusion cytology and calculating the risks of malignancy (ROMs) for each defined category. We report our 2 years of experience in reclassifying and assessing the feasibility of applying ISRFSC and IAC categories to effusion fluid and to provide an estimate of the risk of malignancy for each diagnostic category. Material and Methods: Cytological reports of patients from January 2019 to December 2020 were retrieved and reclassified into a five-tiered classification scheme as per ISRSFC guidelines. Cellblock and immunohistochemistry were performed in selected cases. Clinico radiological and histopathological information were obtained and correlated with the cytological findings wherever available. Results: In the study, 652 cases were included during the 2 years. Out of these, 328 (50.3%) were women and 314 (47.3%) were men. Patient’s ages ranged between 2 92 years with a mean age of 47.4 years. There were 366 (56.1%) cases of ascitic fluid followed by 262 (40.1%) cases of pleural fluid and 24 (3.8%) cases of pericardial fluid in the analysis. Of all the cases, 13 (2%) were non-diagnostic (ND), 464 (71.6%) were negative for malignant (NFM) cells, 16 (2.4%) were atypia of uncertain significance, 31 (4.7%) were suspicious of malignancy, and 125 (19.3%) were malignant. Cellblock was prepared in 65 cases. Lung cancer followed by breast cancer was the most common malignancies involving the pleural effusion and ovarian cancer was the most common cause of peritoneal effusion. ROM for each diagnostic category was 23% for ND, 25% for NFM, 56% for the atypical category, 80.6% in suspicious, and 90% were for positive for malignancy category. Conclusion: The use of a five-tiered system as per the ISRFC and IAC guidelines are feasible for the standardized reporting of effusion samples, thus avoiding subjective variation of reporting.

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Extragonadal teratomas in adults are an extremely rare entity. Teratomas may be mature or immature and are characterized by their midline presentation. We are presenting here a case report of immature teratoma of the palm in a 35-year-old female. The patient developed a recurrent swelling of the palm from which a wedge biopsy was taken and sent for histopathological examination. A diagnosis of “immature teratoma, grade 2” was made, whose margins were compromised. Later on ultrasonography (USG) abdomen and pelvis and whole-body magnetic resonance imaging (MRI) showed no significant findings ruling out the possibility of an occult primary. MRI palm showed a well-defined cystic lesion with loculations suggestive of teratoma. Re-exploration was advised to achieve free margins.