Objective: The objective of this study was to establish the diagnostic accuracy, specificity and sensitivity of fine needle aspiration cytology(FNAC) for intra-oral tumors, comparing with histopathology as the gold standard. Materials and methods: Forty cases of FNA cytology from intraoral tumors was performed in AFID along with the demographic data and clinical information and then diagnosed at AFIP, Rawalpindi. Then the cytology results obtained per FNAC were compared with the histopathological biopsy results of the same lesions. The following variables were recorded for each patient: Age, gender, site of biopsy, diagnosis. The data were entered and analyzed using Open-epi version 2.0. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Cohen Kappa was further applied to compare the agreement between the biopsy and FNAC diagnoses. A p-value of < 0.05 was considered as statistically significant. Results: Among the total patients included in the study there were 24 males and 16 females, with a ratio of 1.5:1. Age of the patients ranged from 24 to 80 years with a mean of 52 years. A total of six sites were aspirated from the oral cavity with maximum (11) aspirates taken from alveolar ridge. The results of FNAC revealed that there were 32 malignant and 8 benign aspirates. Confirmation through histopathological analysis came for 31/32 malignant cases while one was falsely given positive for malignancy on FNAC. Among a total of 40 cases, 31(77%) cases diagnosed were found to be malignant and remaining 9(23%) were benign. The FNAC results revealed 32 malignant and 8 benign lesions. Histopathology of the subsequent surgically excised specimen showed malignant lesions in 31(77%) and benign in 9(23%) patients. As a whole, it was found that the absolute sensitivity for introral FNAC was 100% and specificity 89% with positive predictive value of 97% and negative predictive value of 100%. Conclusion: Cytological diagnosis was almost corroborative with final histopathological diagnosis in all cases, with very few exceptions, exhibiting high diagnostic accuracy.
A patient with invasive mucormycosis whose disease progresses despite optimal treatment including surgical debridement, intravenous (IV) amphotericin B, and control of the predisposing factors can be clinically challenging. We report a case of a 67-year-old Caucasian man with invasive mucormycosis that did not respond to first-line treatment. He was subsequently started on isavuconazole in addition to amphotericin B. The patient’s disease progression stopped; he then received IV amphotericin B for 50 days and isavuconazole for four months. Repeated magnetic resonance imaging (MRI) of the orbit and face nine months later, while off the antifungal medications, showed stable disease. This outcome is promising for patients with invasive mucormycosis who are either intolerant to amphotericin B or do not respond favorably to it.
Mucormycosis is an angioinvasive, opportunistic infection. Diabetes Mellitus and immunosuppression are the most common risk factors for fungal infection. Without prompt treatment, the infection can be fatal. A 21-year-old male patient presented with gastritis-like symptoms refractory to proton pump inhibitor (PPI) therapy. He recently received treatment for Hemophagocytic Lymphohistiocytosis (HLH), confirmed by bone marrow biopsy and fungal sinusitis. Esophagogastroduodenoscopy (EGD) revealed extensive gastric involvement by Mucormycosis. The patient was given antifungal drugs and a resection of necrotic stomach tissue. Gastric mucormycosis is a rare presentation of the angioinvasive fungus. The patient's young age and lack of distinguishing risk factors such as diabetes or immunosuppression are also unusual. Furthermore, the patient's unique presentation with gastric mucormycosis compounded by a recent diagnosis of Hemophagocytosis lymphohistiocytosis produces a valuable case study in management.
Media concentration has often been mechanized to weaken the culture of media competition and journalistic independence to safeguard media's commercial and ideological interests. Herman and Chomsky's (1988) propaganda model is utilized to measure the content creation, dissemination and consumption in terms of hegemony of media and public trust. Two questionnaires have been developed to get the responses on media ownership, media and content concentration, journalistic independence, and public trust in media from journalists and media consumers. Results of the study and ownership patterns and practices show that Pakistani media platforms; print, electronic and social are highly concentrated in terms of ownership and audience share. The majority 70% of the audiences have shown low confidence in the media. Regarding the influence of cross-media ownership on content diversity, the majority 64% of audiences viewed that cross-media ownership has a significant negative impact on content diversity and journalistic independence across the mediums. 60% of the journalists do not feel free to express their personal opinion on any issue if it differs from official line of the outlets. Majority 75% journalists feel influence from the political and religious groups on the overall journalistic independence and 61% of audiences have the opinion that media do involve in partisanship on political, religious, ethnic, and ideological grounds. 38% of journalists say that media associations do not support them at the time of pressure on them while 35% observed that the associations do helpful to some extent. A perfect correlation of ˃.92 between journalists and audience opinion on content concentration has been observed. Audiences are considered TV medium as the most trusted media platform with a 48% score while social media is remained at second place having a score of 26%.
BACKGROUND We wanted to evaluate the sensitivity and specificity of ultrasound elastography in the detection and characterization of various breast masses and study its role in differentiating benign vs malignant breast masses with fine needle aspirarion cytology (FNAC) and/or histopathological correlation of its findings. METHODS A total of 120 patients with breast lesions were prospectively evaluated using ultrasonography (USG) in the Department of Radiodiagnosis at Katihar Medical College, Katihar, Bihar. After procuring consent from the patients, B-mode and elastography examination of all the patients was carried out simultaneously, using the Philips EPIQ 5G ultrasound machine. The findings were noted in a proforma for observation and further comparisons. The usefulness of elastography, regarding prediction of the nature of the mass (benign/malignant), delineation of its exact extent, and correlation with clinical/cytological diagnosis was studied. RESULTS A sensitivity of 97.0% and specificity of 86.7% was observed when a cut off value of 3 was used for elasticity score. A specificity of 95.5% and a sensitivity of 93.3% was observed when a cut off of 3.8 was used for strain ratio (SR). In all cases, the extent of the pathology, the local or contiguous spread and vascular involvement, predicted by ultrasound elastography examination corroborated well with the cytological findings. The results of this study are in concordance with results of studies that have been conducted previously. CONCLUSIONS Ultrasound elastography is a simple and rapid method that can improve the sensitivity and specificity of ultrasonography of focal breast lesions and can decrease the rate of unnecessary biopsies. The diagnostic accuracy of combined ultrasound and elastography is quite high and thus improves the diagnostic confidence of the cases under evaluation. KEYWORDS Elastography, Ultrasound, Focal Breast Lesions
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