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Background Complete diagnostic autopsy (CDA) is considered to be the gold-standard procedure that aids in determination of cause of death in stillbirths and neonatal deaths. However, CDA is not routinely practiced in South Asian countries due to religious beliefs, lack of expertise, and lack of resources. Minimally invasive tissue sampling (MITS) has been recommended as a less mutilating and less expensive alternative to CDA for obtaining tissues for analysis. The present study aims to evaluate the yield of lung tissue and histological findings using MITS as part of a cause of death analysis for stillborns and preterm neonatal deaths. Methods Data were collected during an observational multicenter prospective study called the Project to Understand and Research Preterm birth and Stillbirth (PURPOSe) conducted in India and Pakistan. After obtaining written informed consent from parents, the eligible stillbirths and neonatal deaths were subjected to MITS using a standard protocol. The tissues were obtained from both lungs for histological and microbiological analysis. Results At both sites, a total of 453 stillbirths and 352 neonatal deaths underwent MITS. For stillbirths and neonatal deaths, the yield of lung tissue using MITS was high (92%). Intrauterine fetal distress and respiratory distress syndrome were the leading lung pathologies reported in stillbirths and neonatal deaths, respectively. Conclusions MITS appears to be a reasonable alternative to CDA in obtaining and evaluating lung tissue to inform accurate cause of death analysis in stillbirth and preterm deaths.

Objective: To examine internal organ tissues and placentas of stillbirths for various pathogens. Design: Prospective, observational study. Settings: Three study hospitals in India and a large maternity hospital in Pakistan. Population: Stillborn infants delivered in a study hospital. Methods: A prospective observational study. Main outcome measures: Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths.Results: Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%). Conclusions: In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.

Introduction: Ocular Surface Squamous Neoplasia (OSSN) are a diverse group of lesions varying from Conjunctival Intraepithelial Neoplasia (CIN) to invasive Squamous Cell Carcinomas (SCC). Histopathological examination is the gold standard technique in diagnosing them. However, it is invasive and may not be suitable in recurrent cases. Numerous minimally invasive techniques are available to diagnose OSSN cytologically. This study employs Impression Cytology (IC) to diagnose ocular squamous neoplastic lesions and compare it with the histological diagnosis. Aim: To utilise IC in the diagnosis of OSSN and to compare its findings with histopathological diagnosis. Materials and Methods: This was a retrospective cohort study, conducted in a Tertiary Eye care Hospital, Hubli, Karnataka, India during January 2023. The data included was over a period of three years (from July 2016 to June 2019). A total of 44 eyes (34 patients), in which both biopsy and IC done, were included. The patients’ age, sex and ocular examination findings were recorded. The cytological and histopathological slides were retrieved from the archives and examined morphologically. The cytological findings were compared with histopathological diagnosis and the sensitivity and specificity of the IC technique were calculated. The data was analysed using Microsoft excel sheets. Results: A total of 34 patients were studied ranging from 19 to 85 years. The mean age was 49 years, 21 (61.76%) of them were males and 13 (38.24%) were females. In 24 patients, single eye was affected and in 10 patients bilateral eye involvement was seen. Histology revealed that there were 18 (40.90%) CIN I cases, 4 (9.09%) CIN II, 5 (11.36%) CIN III and 17 (38.65%) SCC. On cytology, 3 (6.82 %) were normal conjunctival epithelium, 30 (68.18 %) were dysplasia and 11 (25.00 %) were SCC. On cyto- histomorphological analysis, 35 (79.55 %) were concordant, out of 44 diagnosis. IC has a sensitivity of 88.89% and specificity of 64.71% to detect dysplasia. To diagnose SCC, it has sensitivity of 64.71% and 100% specificity. Conclusion: According to the present study observations, IC is an excellent preliminary tool to investigate suspected neoplastic lesions of ocular surface. It has a very good concordance with histopathological diagnosis. IC is highly sensitive to detect dysplasia (CIN) and is very specific to diagnose SCC.