D Durga Prasad, M. Cell: , prasadlandscapes gmail. Faruqmulla Assistant Professor of Pathology P. La Rosa, MD flarosa telepathology. Haresh Saxena Prof. Shopping complex Krishnaganj Sagar M.
Kaufman, M. Ilesh Safi Pathology Labo. No Dr. Jagadeesh P. Keskar Diagnostic services 9, Parijat , Opp. Jafar I. Work for development of Pathology science. Jayashree D. Jayant R. Abhyankar 42 yrs 2, Abhyuday Apartments , Bhandarkar Instt. Jayaram N. Nair Hospital Mumbai Dr. Gujarat Mob , Dr. Jeevana G. Oil and Natural Gas Corporation Ltd.
Sivasagar, Assam Qr. Jigish S. Shah , M. Microbiology ; M. Jitendra Mulky M. MH Dr. Kirit G. Clinic: , Kamlesh S. Suthar, M. Krishnan R. Aravindan Dept. Agartala, Tripura - Mobile : Phone : Residence : , Residence : 29, Old Kalibari Road, P. Col M. Medical College U. Mohini J. Interests: Hematopathology Dr.
Madhavi Deshpande, MD. Par naka Vasai goan west pin ; Dr. My morning begins with two hours spent training these clinical tutors on the lab exercises for the day, followed by two hour-long pathology lectures for the second-year medical students which the clinical tutors also attend.
After a lunch break, we have four hours of teaching lab sessions, whose preceptors are the clinical tutors we have trained. My wife and I move between small groups, overseeing discussions and assisting if needed. Finally, we meet informally with the tutors at the end of the day to tackle any unresolved issues they have faced in their groups.
I also have administrative duties during the day: faculty and staff recruitment, budget, faculty development, performance assessments, curriculum development, test item generation, item banking, administration of tests, item analysis, and more. The diagnostic services work comes later in the day! We process 60 to 80 patient samples per day — mainly in clinical chemistry and hematology, but we also perform fine needle aspiration cytology and sign out surgical biopsies.
Where do we fit this work in? Some of it during our lunch break; the rest after our educational duties are finished for the day. The cases I see here in Grenada are different to those common in India. Here, I see a lot of sickle cell disease, diabetes, hypertension, human T-lymphotropic virus-related lymph node pathology, prostate and breast carcinoma, dengue, thyroid problems, and seasonal flu following the carnival in August which brings in a lot of international visitors.
In Muscat, I saw a lot of Helicobacter pylori , systemic lupus erythematosus, lupus nephritis, and gastric carcinoma. I also saw a case of Budd-Chiari syndrome in a bear owned by His Majesty the Sultan of Oman and cardiomyopathy with granulomatous lesions in his ostriches!
My workday starts with postgraduate teaching — slide seminars, subject seminars, journal clubs, and discussions over surgical specimens. The rest of my morning is spent signing out surgical pathology cases and discussing thesis projects with residents. After a lunch break, I host lectures and practical classes for second-year medical students two afternoons per week and guide residents as they assist with practical teaching.
Every day also features a wealth of administrative work! The most common cases I see are thyroidectomy, appendicitis, cholecystitis, mastectomy, gastrointestinal resections, splenectomy, hysterectomy specimens, ovarian tumors, placenta, and limb amputations. I have seen a few unusual cases, though…. Case 1. A year-old female complained of a lump in her right breast at seven months of gestation. Fine needle aspiration cytology showed features of benign phyllodes tumor.
She delivered a baby boy at term; six days after delivery, there was massive enlargement of the right breast and the skin showed cellulitis, resulting in simple mastectomy. The gross examination showed enlarged breast 25x15x15 cm. The nipple was normal and the skin around the nipple was congested. Cut sections showed multiple yellow infarcts surrounded by zones of hyperemia and red, nodular, polypoid tumors. The histology of the polypoid tumor showed infarction of phyllodes tumor. The histology of peripheral normal breast showed features of lactating breast.
This is a case of coexistent multifocal infarction of breast with infarction of phyllodes tumor. Breast infarction is a rare condition seen with physiological breast hyperplasia and is associated with pregnancy and lactation. To date, only 18 cases of breast infarcts and only one case of phyllodes tumor infarction are described in the literature.
This is the first case of coexistent infarction of breast and phyllodes tumor. Case 2. She was diagnosed with acute appendicitis and appendectomy was performed. The distal end of the appendix showed a well-circumscribed, yellow tumor measuring 2x0. Histology showed small, uniform tumor cells arranged in solid nests and trabeculae with peripheral palisading. The nuclei of these cells were round, with finely granular chromatin. The cytoplasm showed numerous small, round, clear vacuoles.
Immunohistochemistry showed intracytoplasmic positivity for chromogranin A and synaptophysin. A diagnosis of lipid-rich carcinoid of the appendix was made. The literature describes only 24 cases of lipid-rich carcinoid; this was the first in India. The electron microscopy of lipid-rich carcinoid shows lipid droplets in the cytoplasm. The clinical behavior is similar to that of classic carcinoid tumor of the appendix.
Case 3. A year-old female presented with three months of fullness and pain in the left upper quadrant of her abdomen. Clinical examination revealed massive splenomegaly. The CT scan showed splenomegaly and well-defined cysts of varying sizes with rims of calcification.
A clinical diagnosis of hydatid cyst of the spleen was made and splenectomy performed. The spleen measured 28x16x9 cm in size and weighed 1, g. The capsular surface of the spleen was irregular due to numerous cysts. The cut surface revealed replacement of splenic parenchyma with well-defined cysts ranging from 0. The cystic spaces contained blood, serous, or hemorrhagic fluid, and the cyst wall showed calcification.
Microscopic examination showed small and large cystic spaces containing red blood cells and lined by a single layer of flattened cells.
The lining was strongly CDpositive and was Dnegative. A diagnosis of splenic hemangiomatosis was made. Splenic hemangiomatosis with diffuse involvement of splenic parenchyma is a rare condition. Only 37 cases are described in the English literature; this was the first in Indian literature. How does the day-to-day work of a pathologist in India differ from that of a pathologist in North America?
SB : It seems to me that there is much less emphasis on quality control in India, especially in private laboratories. In academic institutions, there is less emphasis on research; although publications matter, their reliability is questionable because of the pressure for promotions and the lack of reliable data. Based on their reports, a clinician can decide the course of treatment. In India, pathologists are permitted to work in multiple laboratories, but norms demand that they should be physically present while samples are being tested in the laboratory, before they make an analysis and sign the report.
In this case, the pathologists were found signing reports, without supervising the testing. The complaint against the pathologists was filed by the Maharashtra Association of Practising Pathologists and Microbiologists MAPPM , a body that monitors practices of pathologists and microbiologists in the state.
In the complaint, they had alleged that several illegal laboratories were collaborating with registered pathologists, willing to sign the lab reports without supervising the tests.
On inspection, the MMC found that it was impossible for one pathologist to visit so many centres, located far apart from one another, on a single day.
The MMC has now formed a five-member committee to submit recommendations on comprehensive guidelines for registered pathologists in the state. The committee will also lay down guidelines for minimum number of laboratories a pathologist could attach himself or herself with. It has the makings of a health crisis of frightening proportions.
A whopping ,odd pathology labs are said to be operating in India, and only about 1, — including top-tier multi-location diagnostic chains and in-house labs at hospitals — have been accredited by the National Accreditation Board for Testing and Calibration Laboratories NABL , which is part of Quality Council of India. This means over 99, labs are thriving in India with zero regulatory oversight.
They are not required to follow any rules, demand basic qualifications from their staff, or invest in critical quality audits. While political parties tout and bicker over big-ticket healthcare schemes, the most basic service of all — pathology and diagnostic tests to determine a disease or help its prevention — is left completely uncontrolled.
You will never know. How the needle got poisonedThe healthcare customer is an inherently vulnerable species. Chances are you have no idea who just came home to collect your sample. Did you inquire what quality and safety parameters the lab follows? What storage or transportation protocols are followed in case your sample has to be moved to a bigger lab for more complex tests and analyses? In the absence of any due diligence, it is a real possibility that your test results may be inaccurate.
Even a small variance may change the way a doctor prescribes medicines. You seesaw between a false positive and a false negative. We will have more on this later.
One of the labs had a real-estate consultancy signage in the same premises, another displayed a board of a pathology lab but had no visible lab activity. Another said it only did X-rays and ECGs and not collection of urine or blood samples. That ratio will only grow as new rapid-testing techniques are introduced. The risk of wrong treatment based on bungled diagnostic data is ever-present. In a decision aimed for better validation of test reports, in , the Supreme Court had ruled that a lab report can be countersigned only by a registered medical practitioner with a post-graduate qualification in pathology.
However, no enforcement mechanism means the diktat remains toothless. A large cancer hospital in Mumbai was found to have issued test reports without the signature of a medical professional. A big reason for the lax enforcement is that quality certification or an NABL accreditation is an entirely voluntary exercise.
The documents the NABL asks for vary according to the size of the lab, and the whole process can be expensive. Tedious paper work, and the need to file evidence for data handling and audit of testing procedures drive away small or mid-sized labs that prefer to operate below the radar. This is the pre-analytic stage, before the sample reaches the pathology lab. But with no mandatory reporting or health data or records available from pathology labs, there is no study to capture this information.
What comes to notice are only freak incidents. Take this example.
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