Decoding the Rejection Code: Understanding Why Articles Get Axed

In the competitive arena of medical publishing, manuscript rejection remains a significant barrier to disseminating research findings. This editorial delves into the multifaceted nature of manuscript rejection, elucidating common reasons and proposing actionable strategies for authors to enhance their chances of acceptance. Key rejection factors include a mismatch with journal scope, lack of novelty, methodological flaws, inconclusive results, ethical issues, poor presentation, data inaccessibility, author misconduct, and plagiarism. Ethical lapses, such as lacking informed consent, or submissions fraught with grammatical errors, further doom manuscripts. In addressing these pitfalls, authors are advised to ensure content originality, methodological rigor, ethical compliance, and clear presentation. Aligning the manuscript with the journal's audience, scope, and editorial standards is crucial, as is professional conduct and responsiveness to feedback. Leveraging technological tools for citation management, grammar checking, and plagiarism detection can also significantly bolster manuscript quality. Ultimately, understanding and addressing common rejection reasons can empower authors to improve their submissions, contributing to the advancement of medical knowledge and their professional growth.

Statistics in the Operating Room: A Cardiovascular Surgeon's Guide to Numbers That Matter

Pediatric cardiac surgery demands meticulous technique, but optimal outcomes hinge on translating data into actionable insights. This editorial bridges the gap between scalpel and statistical jargon, empowering surgeons to decipher common tests. Descriptive statistics paint portraits of patient cohorts, while hypothesis testing discerns real differences from chance. Regression analysis unveils hidden relationships, predicting outcomes based on complex interplays of variables. Survival analysis tracks the delicate dance of time and survival, informing therapeutic strategies. By embracing statistical fluency, surgeons become architects of personalized care, tailoring interventions to mitigate risks and maximize the precious gift of a beating heart.

The Myths, Perils, and Pitfalls of Redo Pediatric Cardiac Surgery: The New Normal in Developing Countries Such as India

Pediatric patients undergoing reoperative cardiac surgery after a previous sternotomy face a higher degree of surgical complexity compared to those undergoing initial procedures. They have higher intraoperative and postoperative risks. The increased risk of surgery is due to preoperative patient factors and intraoperative technical challenges. Redo-pediatric cardiac surgery is a common event in almost every pediatric cardiac surgeon's professional life. Redo-surgery is almost inevitable in patients who have multi-stage repair of congenital heart surgeries and biological valves at a young age, and often in those having valve repair in rheumatic disease. So, being familiar with the pitfalls and precautions to be taken is of crucial importance. In general, the patients presenting for repeat procedures are sicker, older, and have more comorbid conditions. The dissection is always rendered difficult by adhesions, scarring, and previous graft placements. Hence, prolonged dissection time, intraoperative injuries to heart chambers, great vessels, and grafts, increased bleeding, and poorer cardiac function result in higher morbidity and mortality in such subsets of patients. The outcome is worse with emergency redo-cardiac surgeries.

The Utility of Invengenx® Bovine Patch for Right Ventricular Outflow Tract (RVOT) Reconstruction and Augmentation in the Surgical Management of Tetralogy of Fallot (TOF): A Contemporary Study and Review of the Literature

Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right ventricular outflow tract (RVOT). This procedure requires the use of both synthetic and natural materials. However, finding the ideal material for tissue implants can be challenging. Biological materials often face issues such as tissue degeneration, calcium deposition, antigenicity, rejection, shrinkage, and fibrosis. These issues can lead to complications such as stenosis and insufficiency, potentially requiring early reoperations. In light of this, this study aimed to investigate the effectiveness of the Invengenx® bovine patch for RVOT reconstruction and augmentation. Methods This was a retrospective observational study conducted among eight children who underwent TOF correction cardiac surgery. Their demographic and clinical characteristics, intraoperative findings, and postoperative follow-up results at six months were collected from the hospital patient database. Results There were no deaths or complications in this study. We observed a significant reduction in the gradient across the pulmonary valve and the outflow tract at six months post-procedure. The analysis demonstrated that the Invengenx® bovine patch was successful and did not lead to any complications. Conclusions This study demonstrates the safety and efficacy of this engineered bovine pericardial patch (Invengenx®) as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects.

Utility of Indigenously Developed Square Grid Method for Evaluation of Tumor-Stroma Ratio and Stromal Tumor-Infiltrating Lymphocytes in Invasive Breast Carcinoma: A Pilot Study

Background & Objective

Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate the utility of the indigenously designed square grid method for the evaluation of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes in invasive breast carcinoma by assessing the inter-observer variability.

Methods

This was a retrospective study conducted at a rural tertiary care referral institute from July 2018 to June 2020. In each case, microphotographs were taken from 10 representative fields in H&E-stained sections for evaluating TSR in low-power and sTIL in high-power. Both the parameters were evaluated employing an indigenously designed square grid applied onto microphotographs in the power-point slides by making use of principles of the Pythagorean theorem. Both parameters were separately evaluated by two pathologists. Cohen kappa statistics was the statistical tool used to analyze inter-observer variability.

Results

Thirty cases were analyzed. Invasive breast carcinoma of no special type (IBC-NST) was the most common histopathological type (26 cases (86.67%)). For TRS evaluation, a Kappa value of 0.78 suggested substantial agreement with an agreement of 91.67%. For sTIL evaluation, a Kappa value of 0.51 suggested moderate agreement with an agreement of 88.33%. The P-values were statistically highly significant (P<0.001).

Conclusion

Square grid method is a novel technique for evaluating TSR and sTIL in invasive breast carcinoma. It can be considered an example of the application of Pythagoras' theorem in Pathology.

A comparative study of squash smear cytology diagnosis and radiological diagnosis with histopathology in central nervous system lesions

Background:

Space occupying lesions (SOLs) of central nervous system (CNS) constitutes important cause of neurological morbidity and mortality. Squash cytology is technically a simple and rapid intraoperative diagnostic tool. Radiology is supportive of histopathological diagnosis.

Objectives:

To enumerate the histopathological patterns of various central nervous system (CNS) lesions, to correlate cytopathological diagnosis with histopathological diagnosis, and to correlate radiological diagnosis with histopathological diagnosis.

Materials and Methods:

It was a retrospective study of CNS lesion cases from January 2015 to August 2018. Cytological-histopathological concordance and radiological-histopathological concordance were calculated. Chi-square test was the statistical tool used for statistical analysis.

Results:

Histopathological diagnosis of 50 cases included neoplastic lesions (42 cases [84%]) and non-neoplastic lesions (8 cases [16%]). Correct diagnosis was achieved by squash cytology in 36 cases (72%) and radiological diagnosis in 25 cases (50%) by complete concordance. However, diagnostic accuracy of squash and radiology improved considerably by 90% and 76%, respectively, after applying partial concordance criteria. For the detection of neoplastic lesions, squash cytology had 98% and radiology had 80% diagnostic efficacy.

Conclusion:

Preoperative radiological investigation and intraoperative squash smear cytology are complementary to each other. A multidisciplinary approach is necessary for the management of patients.

Utility of Kumkum as a Counterstain in Histopathological Evaluation of Cervix: An Unexplored Archaic Behooveful Colourant

Introduction: The turmeric extract has been used as a potential alternative for eosin on routine histopathology sections. Kumkum is made from saffron flowers of Crocus sativus L. with mild use of turmeric. Aim: To evaluate the staining characteristics of kumkum solution as a counterstain and to compare the staining characteristics of kumkum solution and turmeric solution in histopathology sections of cervix tissue. Materials and Methods: It was a prospective observational study conducted at a rural tertiary care referral institute, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from May 2019 to July 2019. For each case, cervix tissue sections were stained with Haematoxylin and Eosin (H&E), Haematoxylin and Turmeric (H&T) and Haematoxylin and Kumkum (H&K). The staining characteristics of H&T and H&K was documented and evaluated using a scoring system by comparing with that of conventional H&E sections. The parameters were analysed for statistical significance. Chi-square test and two-sample t-test were the statistical tools used to analyse the data. All statistical calculations were done through statistical software STATA version 14.1. Results: A total of 57 cases were analysed. H&K was better than H&T with respect to contrast at low power, morphological details of cytoplasm, nucleus and acellular structures (p<0.001). The overall performance of H&K was better than H&T and was statistically highly significant (p<0.001). Conclusion: Kumkum appears to be an efficient counterstain for demonstrating various structures in histopathology sections of cervix tissue. It may be considered as an unexplored archaic behooveful colourant. The utility of kumkum may be extended to study the histopathology of other tissues and organ systems in the body.

Comparison of Staining Characteristics of Papanicolaou Stain and May-Grünwald-Giemsa Stain in Tzanck Smear Cytology

Introduction: Although the skin is more readily accessible to the cytological examination than any other organ, cytodiagnosis is much less frequently used in dermatology. Tzanck smears are routinely stained with May-Grünwald-Giemsa (MGG) stain. But, Papanicolaou (PAP) stain is known to yield polychromatic transparent staining with crisp nuclear and cytoplasmic features. Aim: To compare the staining characteristics of PAP stained and MGG stained Tzanck smears by using a scoring system. Materials and Methods: The present study was a cross- sectional study on Tzanck smears, conducted at a tertiary care referral Institute, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Andhra Pradesh, India, from March 2016 to April 2017. In each case, two Tzanck smears were prepared. One smear was wet-fixed in isoproplyl alcohol and stained by PAP method. The other smear was air-dried and stained by MGG stain. Both the smears were evaluated for the staining characteristics by using a scoring system. The scoring system was indigenously designed for evaluating the stained sections. All the staining parameters such as contrast, cytoplasmic features, nuclear features and background were evaluated in the scoring system employed in the present study. Chi-square test and two sample t-test were used for statistical analysis. Results: Forty cases of Tzanck smears were analysed. Most common diagnostic entity was cutaneous infections in 18 cases (45%). The average scores of all the parameters of staining characteristics and the overall score were better in PAP stained smears than MGG stained smears. The p-values were statistically significant. Conclusion: PAP stain may be considered as a behooveful stain for the evaluation of Tzanck smear. It may be suggested that, although the PAP stained smears scored better than MGG statistically, both the stains may be used as complementary to each other.

A Comparative Study of Cytomorphological Patterns of Lymph Node Aspirates in Paediatric and Adult Populations

Introduction: Lymphadenopathy is one of the most common clinical presentations of patients. Lymph node is a commonly aspirated organ for diagnostic purposes. Fine Needle Aspiration Cytology (FNAC) of lymph node has become an integral part of initial diagnosis and management. Aim: To compare the cytomorphological patterns of the lymph node lesions in the paediatric population with that of the adult population and to correlate with the available histopathological diagnosis. Materials and Methods: It was a retrospective observational study of lymph node lesions conducted at a rural tertiary care referral institute, PES Institute of Medical Sciences and Research (PESIMSR), Kuppam, Andhra Pradesh, India, from January 2017 to June 2018 for a period of 18 months. Cytology smears were retrieved, reviewed and analysed. Cytological diagnosis was compared with available histopathological diagnosis and concordance was calculated. Chi-square test was the statistical tool used to analyse the data in the study. Results: Two hundred and seventy four cases were analysed. Adult population constituted 225 cases (82.12%). Paediatric population constituted 49 cases (17.88%). Reactive lymphadenitis was the commonest pattern in both the groups. Chronic lymphoproliferative lesions {4 cases (1.7%)} constituted the least common lesion in adults and mycobacterial lymphadenitis {1 case (2.04%)} constituted the least common lesion in paediatric population. Conclusion: Distribution of cytological patterns of lymph node lesions in paediatric and adult populations are different and are found to be statistically significant. Cytological evaluation of lymph node lesions has a high diagnostic efficacy for the diagnosis of neoplastic lesions.

Atypical parathyroid adenoma

Parathyroid lesions clinically manifest themselves in the form of primary hyperparathyroidism most of the times. Parathyroid adenoma constitutes one of the important causes of the same. Although rare, they pose considerable diagnostic dilemma to the pathologist. A 50-year-old female presented to the surgical outpatient of our hospital with a history of recurrent pancreatitis. Clinical examination revealed a mass in the neck which was radiologically demonstrated as right inferior parathyroid mass. The same mass was surgically excised and histopathological features are discussed in this report.

Renal Primitive Neuroectodermal Tumour: Case Report of a Rare Entity

The peripheral Primitive Neuroectodermal Tumour (PNET) is a member of the family of small round cell tumours. PNET is more aggressive in kidney when compared to the other sites. It usually presents in childhood or adolescence. It has an aggressive clinical course and may process towards metastatic disease culminating in death. A 24-year-old female presented with left sided abdominal swelling. Abdominal ultrasound confirmed a heterogeneous left renal mass. Consequently the patient underwent nephrectomy of left kidney and left oophorectomy. Grossly, the tumour involved almost entire kidney, showed multi-lobular, grey, glistening appearance with focal haemorrhagic areas. Histologically, the tumour cells were arranged in diffuse infiltrating sheets, cohesive lobules, Homer-Wright rosettes and perivascular pseudo-rosettes. Individual tumour cells were small round cells with scant cytoplasm and round nuclei having dispersed chromatin. Features were suggestive of PNET. Immunohistochemistry showed tumour cells displaying strong membrane positivity for MIC 2. Renal PNET needs to be differentiated from other primary and metastatic renal round-cell tumours. Most of the cases of renal PNET have poor response to standard treatment of combined surgical resection, post-operative irradiation, and chemotherapy. PNET is a rare primary tumour in the kidney. Histopathological diagnosis has to be confirmed by immunophenotyping of the tumour cells.

Morphological spectrum of pilar cysts

Background:

Cysts of the skin are one of the commonly excised specimens in the surgical outpatient department. A majority of them being clinically diagnosed as sebaceous cysts, their true nature is only discernible on histopathological examination. Closer examination of the type of keratinization involved will throw light into the exact nature of the cyst. Trichilemmal or Pilar cyst is one such entity, which presents in both a non-neoplastic and neoplastic form.

Aims:

The present retrospective observational study was undertaken to find out the incidence of these cysts in surgical pathology practice in a rural hospital and to enlist the various morphological forms that these cysts may take.

Materials and Methods:

The histopathology files were reviewed for a period of 6 years for cases coded as pilar cyst.

Results:

A total of eight cases (5.75%) were identified, which showed features of trichilemmal differentiation. A single case each of proliferating trichilemmal cyst and malignant proliferating trichilemmal tumors were noted. Most of the cases were seen among females on the scalp.

Conclusions:

Trichilemmal tumor is an uncommon histopathological entity. Many of these lesions may be mistakenly diagnosed due to lack of recognition of the unique type of keratinization.

Lipoleiomyoma of uterus in a postmenopausal woman

Lipoleiomyomas are uncommon benign neoplasms of uterus and are considered to be a variant of uterine myomas. Their reported incidence varies from 0.03 to 0.2%. Lipoleiomyoma consists of variable proportion of mature lipocytes and smooth muscle cells. These tumors generally occur in asymptomatic obese perimenopausal or menopausal women. We report this case of uterine lipoleiomyoma because of its rarity.

Hyaline cell-rich chondroid syringoma of the finger

A mixed tumor is a neoplasm that has microscopic features of both epithelial and mesenchymal differentiation. Such mixed tumors are known as pleomorphic adenomas in the salivary glands, and their cutaneous counterparts are called chondroid syringomas. These tumors commonly occur in the head and neck region of middle-aged men. Hyaline cell-rich chondroid syringoma is a rare benign variant of chondroid syringoma composed of cells with eosinophilic hyaline cytoplasm and plasmacytoid features, the origin of which remains elusive. Although very few cases have been reported in literature, it is important to be aware of this entity so as to avoid misdiagnosis on histopathological examination. In this report we present a case of hyaline cell-rich chondroid syringoma occurring in the finger.