Introduction: First trimester prenatal screening is a risk assessment test which allows to detect pregnancies at increased risk for for most frequent foetal aneuploidies. Methods: A literature review using PubMed was carried out. Results: In this review, we focus on general principles of first trimester screening, assessment of specific sonographic markers and maternal biochemical parameters. In addition, management options are discussed.

Introduction: As a frontline warrior, every anesthesiologist is fighting the coronavirus 2019 (COVID-19) pandemic to save lives, but at the same time, post-COVID sepsis has emerged as a serious challenge opening a new battlefield for corona warriors. In recent times, mucormycosis, a rare opportunistic fungal infection, has emerged as a serious and life-threatening disease that is spreading rapidly, leading to tissue infarction and necrosis in post-COVID patients; hence, quick recognition of this potentially lethal disease and early treatment is of paramount importance in reducing the mortality rate. Methods: The aim of this review article was to summarise the literature on anesthestic management of pulmonary mucormycosis (PM) patients undergoing thoracotomy surgery. Searches had been conducted in Google Scholar, Wiley online library, National Library of Medicine, PubMed, Scopus, Excerpta Medica Database and Cochrane Library using the following keywords: lung, mucormycosis, anaesthesia, presurgical, intraoperative, postsurgical and their permutations. Results: The true frequency of mucormycosis in India is still unknown; however, it is found to be consequentially more than in Western nations. PM has a high mortality rate, which is attributable in part to its locally aggressive nature and in part to the underlying risk factors; however, this rate has improved over time due to advancements in diagnostic techniques. Conclusion: Management of PM must be approached with a multifaceted, assertive plan. Early identification of infection, reversal of the prevailing risk factors, surgical elimination of contaminated tissue and medical management by antimycotic agents are the four critical steps in the management of mucormycosis. The key to a successful operation was a thorough pre-operative assessment, proper pre-operative preparation and much clinical surgical expertise.

Background: For the elderly, affected with Type II diabetes the costs for medications can be immense and forms a substantial part of their savings and pensions. Aims and Objectives: Diabetes mellitus is a major health issue in India and the treatment costs severely affect the elderly who are dependent on their family or on their pensions. In this study, we evaluated the economic cost of branded versus Jan Aushadhi drugs for geriatric pensioners. Materials and Methods: This was an observational, cross-sectional study and was conducted at the outpatient department of General medicine and Endocrinology at Amrita Institute of Medical Sciences, Ernakulam, Kerala, India. The prescriptions of patients attending the clinic for the care of type II diabetes and associated co-morbidities were analysed. The age, sex, and the number of medications were noted. The price of the costliest, cheapest, and most prescribed branded drugs were noted from the CIMS index 2020, while that for Jan Aushadhi drug was observed from the price catalogue. The financial cost burden on retired aged citizens was calculated by considering INR 8000 as the pension amount. Results: The average cost of the drugs when bought from the costliest brands amounted to 2592.52, of which 750.31 amounted for antidiabetics, while when purchased from Jan Aushadhi was 542.3 and 350.46, respectively. The percentages of the cost required for monthly treatment for an individual with 8000 INR pension for the branded drug was 32.4% and 6.77% for all medications and antidiabetic drugs, while when bought from Jan Aushadhi was 9.37 and 4.38, respectively. Conclusions: A significant difference between cost for Jan Aushadhi and branded drugs and this can be of benefit to the geriatric pensioners. As far as the authors are aware of this is the first study that addresses the beneficial effect of Jan Aushadhi antidiabetic drugs in the geriatric pensioners and has high relevance and use in public health.

Background: Notably, sickle cell disease (SCD) is a major risk for renal problems. Proteinuria is a feature of sickle cell nephropathy that can develop into end-stage renal disease. Objective: The main goal of this study was to assess the link between microalbuminuria, creatinine, glomerular filtration rate (GFR) and body mass index (BMI) with the predicting early nephropathy in sickle cell disease patients who were admitted to Kosti Teaching Hospital during the period from June to August 2018. Materials and Methods: A total of 156 SCD participants were enrolled in this study. Venous blood and fresh urine samples were collected from each participant using sterile containers. Serum creatinine and urine microalbuminuria were measured. Results: Out of 156 patients, 61.5% were underweight. Interestingly, a decline in creatinine level and GFR was observed in 21.1% and 64.7% of the SCD cases, respectively. Likewise, microalbuminuria was detected in 55.8% of participants. Notably, the duration of SCD (P < 0.05), creatinine level (P < 0.05), age (P < 0.05) and microalbuminuria (P < 0.05) was significantly positively correlated with BMI. SCD duration, GFR, microalbuminuria, weight and highest exhibited a significant positive correlation with creatinine. Furthermore, GFR has presented a positive correlation with weight and highest, P < 0.05. In addition, weight displayed a positive correlation (P < 0.000) with disease duration. Conclusion: Altogether, the study findings highlighted the link of BMI, creatinine, microalbuminuria and GFR with SCD, which is significant in the prediction and assessment of early nephropathy in SCD patients.

Background: There is growing literature on the burden of prostatic lesions: both benign and malignant among men of West African ancestry. There are also some studies on the prostate in Anambra State and South-East Nigeria, but these are mainly on patterns and prevalence, without the use of immunohistochemistry. Aims and Objectives: The aim of this study is to determine the histological pattern of prostatic diseases diagnosed from Tru-Cut biopsies in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria, using the p63 immunohistochemical marker. This will be a pioneer study in both the state and the geopolitical zone. Materials and Methods: This is a 2-year (January 2019 to December 2020) retrospective study of the immunohistochemical expression of p63 on the haematoxylin and eosin-diagnosed Tru-Cut biopsies of the prostate in the archives of the histopathology laboratory in NAUTH, Nnewi. A Purposive sampling method was used with a sample size of 151. Sections were made from the blocks, reviewed and stained using the p63 immunohistochemical marker. Results: There were 191 cases of prostate diseases histologically diagnosed, of which 151 met the inclusion criteria for the study. Of the 151 cases, 97 (64.2%) were diagnosed as benign and 54 (35.8%) were diagnosed as malignant. Following p63 immunohistochemistry, 97 cases were accurately diagnosed as benign and 54 cases accurately diagnosed as malignant with no misdiagnoses. The age of the patients ranged from 50 years to 90 years; however, the predominant population was in the sixth decade (31.8%) and seventh decade (35.1%), with a mean age of 75.3 years. There is no significant difference noted in the mean age of the non-neoplastic and neoplastic groups. Conclusion: This study shows that morphology alone is sufficient for the diagnosis of both Benign and prostatic lesions, as shown by the accuracy level (100%) in the haematoxylin and Eosin results. This is particularly important in resource-poor settings such as ours.

Background: In the field of haematology, there has been a consistent advancement in technology of the complete blood count (CBC) analyzers and hence, there has been an increase in the number of novel parameters that can be measured on these analysers. To put these newer parameters into routine clinical practice, it is essential to evaluate the reference ranges. Aims and Objective: To evaluate the reference intervals (RI) of the parameters which are calculated by Sysmex XN-1000, especially the newer research parameters. Materials and Methods: Blood samples from 150 clinically asymptomatic and apparently healthy individuals were assessed in the study and reference ranges for the same were evaluated on Sysmex XN-1000 CBC analyzer. Appropriate statistical tests were applied for the same. Results: The RIs of CBC parameters were evaluated in 123 adults (65 males and 58 females). Significant gender-dependent differences were found in red blood cells count, packed cell volume, haemoglobin (Hb), platelets and also in reticulocyte Hb and platelet-crit among the newer parameters. The other CBC reference ranges were also assessed from the remaining data. Conclusion: The present study, highlights the significance of different CBC parameters with special emphasis on newer research parameters. Although, the results of the current study are comparable with previous studies; further studies with larger sample sizes are needed for validation purposes in addition to the regional variation pertaining to these parameters.

Background: The sarcoidosis cases were emphasized to differ seasonally in previous studies. In particular, the seasonal distribution of Lofgren syndrome and sarcoidosis arthritis cases has been reported to vary. Aims and Objectives: In this study, the seasonal variability of sarcoidosis cases defined in the literature was investigated among the patients who applied to our outpatient clinic. Materials and Methods: The data of 582 patients referred to our outpatient clinic and had a preliminary diagnosis of sarcoidosis between January 2010 and March 2020 were evaluated retrospectively. Demographic information, admission dates to the hospital, diagnostic methods, organ involvement, and seasonal characteristics were determined and analyzed. Results: Of the 582 patients evaluated in the study, 359 had the diagnosis of sarcoidosis. The mean age of our patients was 50 years; 96 (26,7 %) were male, and 263 (73,3 %) were female. The number of patients diagnosed histopathologically was 338 (94,2 %), and the most common extrapulmonary involvement was skin involvement with 37 cases. In the last decade, a significant number of patients (134 (37.3%) cases) were referred to the physician during the spring. Conclusion: Sarcoidosis is a multisystem disease with unknown etiology. In our study, similar to other studies, there was an increase in the symptoms during spring. Therefore, sarcoidosis should be kept in mind in patients with symptoms such as cough and shortness of breath accompanied by skin findings during the spring months. However, the data to explain this condition are not sufficient. Therefore, prospective studies are needed to explain the seasonal relationship with the pathophysiology of sarcoidosis.

Background: Labour is traditionally induced with sub lingual (SL) misoprostol but researchers have proposed greater effectives and benefits if Foley's catheter is also used. Aims and Objectives: The aim was to study the effect of cervical Foley's catheter and misoprostol on labour induction in comparison to SL misoprostol alone. Materials and Methods: This randomised controlled trial was conducted from January 2020 to January 2021 on a study population of 96 female patients. They were distributed by lottery method into Groups 0; having been given SL misoprostol alone and Group 1; given the same in addition to cervical Foley's catheter. After randomisation, each group of 48 patients was noted for the method of delivery and time from induction to delivery in hours. Results: Groups 0 and 1 had 48 patients each with a total of 96 patients. Overall means for age in years and age of gestation in weeks were 25.80 ± 5.73 and 39.51 ± 1.13, respectively. Overall parity was 1.88 ± 0.83. Normal vaginal delivery (NVD) was seen in 25 (26%) patients in Group 0 and 34 (35.4%) in Group 1, P = 0.01. Meantime from induction to delivery for Group 0 was 17.89 ± 1.05 h and for Group 1 13.93 ± 1.47 h respectively, with a difference of 3.96 ± 0.42 h and P = 0.01. Conclusion: The combination of misoprostol and Foley's catheter in the cervix is associated with more vaginal deliveries characterised by shorter times of delivery.

Background: Contraception is an integral component for addressing the population emergency faced by resource deprived third-world countries like Pakistan but studies in this regard are lacking. Aims and Objectives: This study was conducted to assess the knowledge and practice of contraception among women in Peshawar. Materials and Methods: This cross-sectional prospective observational study was carried out from March 2020 to November 2021. All women of reproductive age were included in the study. Biodata, socio-economic status (SES), reproductive data, knowledge and practice of contraception were collected from a total of 1260 women during the study period. Results: One thousand two hundred and sixty females of reproductive age visiting the hospital were studied. Regarding reproductive health and contraception 431 (34.2%) had no knowledge and 415 (32.9%) had wrong information. Only 387 (30.7%) patients had correct information about fertility window, 447 (35.5%) had erroneous knowledge about it and 426 (33.8%) were completely uninformed about it. 609 (48.3%) patients were of low SES. 617 (49%) patients were motivated for contraception while 643 (51%) rejected it. 377 (29.9%) patients used no method for contraception, 398 (31.6%) used injectables while the remaining methods included; 225 (17.9%) implants, 68 (5.4%) natural withdrawal and 67 (5.3%) intrauterine contraceptive device. Conclusions: The study population lacked or had inadequate knowledge about reproductive health and contraception. Further, studies should be carried out for a wider understanding of the lack of contraceptive knowledge and practices to control the ballooning population growth and the lack of reproductive and contraceptive health services and practices.

Rationale: Malaria is a protozoan disease which has a worldwide distribution in tropical and subtropical regions. The peripheral blood smear examination is a gold standard and an immunochromatographic rapid diagnostic test is an adjuvant diagnostic tool for the detection of malaria. For the past two decades, the utility of automated blood cell counters for the detection of malarial infection is growing in the presumptive diagnosis of malaria in developing countries. Patient Concerns: Here, we report a case in which a young male came for surgical evaluation for inguinal hernia surgery. On routine haemogram evaluation, malaria was suspected with the help of flow cytometry based haematology analyser (Sysmex XN 1000) generated histogram showing erroneously high eosinophil count (pseudoeosinophilia) and atypical white blood cell scattergram. Diagnosis: Peripheral smear and malarial antigen examinations confirmed Plasmodium vivax species. Outcomes: Patient was treated with antimalarial medications and elective surgery to repair inguinal hernia was planned after 10 days. Lessons: Here, we hope to increase the awareness of laboratory physicians to explore the possibilities of diagnosing malaria through hints provided by automated haematology analyser generated histograms.

Rationale: Soft tissue sarcoma (STS) arises from mesenchymal tissue and can occur at any anatomic site and age. These tumors can originate from skeletal muscle, adipose tissue, vascular tissues, or connective tissues. Liposarcoma (LPS) is the most frequent type of sarcoma and is commonly found in the retroperitoneal region. Patient Concerns: A case of colonic liposarcoma in a young female patient presented with sub-acute intestinal obstruction due to intussusception. The patient was only 17-years-old, much younger than the average age of occurrence, and thus represents the first case report of primary colonic liposarcoma in this age group. Diagnosis: The patient was resuscitated and subjected to standard investigations. An ultrasonography abdomen/ pelvis revealed colo-colic intussusception and CECT abdomen showed evidence of an enhancing mass within the lumen of the transverse colon. Interventions: The patient was subjected to exploratory laparotomy with segmental colonic resection and primary colo-colic anastomosis. Outcomes: The histopathology and immunohistochemistry revealed the morphology of high grade colonic liposarcoma. The patient is doing well eight months after surgery and is being monitored on a regular basis. Lessons: The primary gastrointestinal liposarcoma tumors are uncommon and colonic variants are extremely rare, especially in the second decade of life, and limited to case reports which can be counted on fingertips. Surgical resection with negative margins is the only curative treatment.

Rationale: Nasal intubation is an inevitable procedure in head and neck and oral cavity surgeries. Most of these patients usually present with distorted oral and nasal anatomy. Patient Concerns: The distorted anatomy in these patients makes their airway difficult and there are high chances of nasal bleed while securing the airway nasally. Diagnosis: Ryle's tube guided nasal intubation in a patient with temporomandibular joint derangement posted for bilateral temporomandibular joint arthrocentesis. Interventions: After induction of anaesthesia, we faced difficulty in passing North Pole tube via nasal passage, hence we rail roaded the North Pole tube over a Ryle's tube and successfully secured the airway. Outcomes: This innovative method helped us to secure the airway in this patient. Lessons: This simple technique of using a Ryle's tube as an aid for nasal intubation provides an alternate technique for difficult nasal intubation. Although it may not be the first choice for nasal intubation, this technique can be used as an alternative method in case, the tube could not be negotiated through the nasal passage.