Establishment of patient-derived xenografts of retinoblastoma and choroidal melanoma on the avian chorioallantoic membrane

Purpose: To develop a viable in vivo chorioallantoic membrane (CAM) model to study the growth and invasion of patient?derived retinoblastoma (RB) and choroidal melanoma (CM) xenografts (PDXs). The study utilizes primary tumor samples instead of cancer cell lines, which provides a more authentic representation of tumors due to conserved morphology and heterogeneity. Methods: Fertilized chicken eggs were procured, windowed, and their CAM layers were dropped. On embryonic development day (EDD) 10, freshly cut patient?derived CM and RB tumors were implanted on the CAM layer and the setup was incubated for 7 days. The tumor?embedded CAM layer was harvested on EDD 17, and the extracted tumor samples were subjected to hematoxylin and eosin staining and immunohistochemical analysis to evaluate the extent of tumor invasion. Results: Significant changes in the vascularity around the RB and CM PDXs were observed, indicating an angiogenic environment. The cross?sectional histological view of the tumor implant site revealed the invasion of both the tumors into the CAM mesoderm. Invasion of CM into CAM mesoderm was visualized in the form of pigmented nodules, and that of RB was indicated by synaptophysin and Ki?67 positivity in Immunohistochemistry (IHC). Conclusion: The CAM xenograft model was successfully able to support the growth of CM and RB PDXs and their invasion in CAM, thus presenting as a feasible alternative to mammalian models for studying tumorigenicity and invasiveness of ocular tumors. Moreover, this model can further be utilized to develop personalized medicine by inoculating patient?specific tumors for preclinical drug screening.

Prescribing patterns of low vision devices in patients with cone-related dystrophies

Purpose: The aim of this study was to elucidate the type of low vision devices (LVDs) prescribed for patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy and to analyze the visual improvement with the devices. Methods: A retrospective review of 300 electronic medical records of patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy referred to the low vision care (LVC) clinic for the first time between 2014 and 2016 at a tertiary eye care center was done. Collected data included the demographic profile of patients, details of LVDs, and best?corrected vision. Results: Out of 300 patients, 62.6% (n = 188) were male and 37.3% (n = 112) were female. Of the cases, 50% (n = 150) had cone–rod dystrophy, 45% (n = 135) had cone dystrophy, and 5% (n = 15) had rod–cone dystrophy. The most commonly prescribed LVD was SEE?TV binocular telescope (n = 6, 2.0%) for distance and dome magnifier (n = 60, 20%) for near. ET?40 dark grey tint (20.6%) was preferred for managing photophobia. There was a statistically significant difference in both distance and near visual acuities with LVDs (P < 0.05) in all categories, except rod–cone dystrophy. Conclusion: Early diagnosis with appropriate prescription of LVDs including tints helps in achieving good quality of vision in patients with cone?related dystrophies.

Veritable evaluation and inspection of PCOS and its apropos medicaments

Polycystic Ovary Syndrome (PCOS) is a vastly familial, prevalent yet complicated endocrine disorder seen in 5 to 15% of premenopausal women. An estimated one in five ~ 20% Indian women suffer from PCOS. In India, PCOS is a tabooed disorder; If neglected, the condition can prove fatal. However, the past decade has seen the changing discourse in India. PCOS negatively affects reproduction, general health, sexual health, and quality of life. Genetic predisposition of hormonal and non-hormonal factors influence ovary functioning and are responsible for the onset of the syndrome. Hormonal imbalance, metabolic abnormality, and insulin resistance are characteristic features that significantly increase the risk of anovulatory infertility, type 2 diabetes, and cardiovascular diseases. The underlying cause of the path physiology of PCOS is still under the radar, but the derangement of the hypothalamic-pituitary-ovarian axis could be the sweeping reason for the same. PCOS management should address on healthy lifestyle with symptomatic medical therapy and psychological bearing with special emphasis on far reaching side effects and long-term metabolic consequences This review article gives a comprehensive overview of PCOS and the morbidities hooked up with it. It has a notable emphasis on the PCOS guidelines, diagnosis, non-pharmacological, and pharmacological treatments.

Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post?traumatic posterior GRT and full?thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21?year?old?male presented with sudden diminution of vision in the right eye (RE) following blunt?trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior?GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid?assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post?operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior?GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.

Acceptability of artificial intelligence-based retina screening in general population

Purpose: A deep learning system (DLS) using artificial intelligence (AI) is emerging as a very promising technology in the future of healthcare diagnostics. While the concept of telehealth is emerging in every field of medicine, AI assistance in diagnosis can become a great tool for successful screening in telemedicine and teleophthalmology. The aim of our study was to assess the acceptability of AI?based retina screening. Methods: This was a prospective non?randomized study performed in the outpatient department of a tertiary eye care hospital. Patients older than 18 years who came for a regular eye check?up or a routine retina screening were recruited in the study. Fundus images of the posterior pole were captured on fundus on a phone camera (REMIDIOTM, India) with a built?in AI software (Netra.AI) that can identify normal versus abnormal retina. The patients were then given an 8?point questionnaire to assess their acceptance and willingness toward AI?based screening. We recruited 104 participants. Results: We found that 90.4% were willing for an AI?based fundus screening; 96.2% were satisfied with AI?based screening. Patients with diabetes (P = 0.03) and the male population (P = 0.029) were more satisfied with the AI?based screening. The majority (i.e., 97.1%) felt that AI?based screening gave them a better understanding of their eye condition and 37.5% felt that AI?based retina screening prior to a doctor抯 visit can help in routine screening. Conclusion: Considering the current COVID?19 pandemic situation across the globe, this study highlights the importance of AI?based telescreening and positive patient approach toward this technology.

Immunohistochemical and mutational status of telomerase reverse transcriptase in conjunctival squamous cell carcinoma

Purpose: Mutations in human telomerase reverse transcriptase (TERT) are associated with increased telomerase activity in cutaneous melanomas. Conjunctival squamous cell carcinoma, also referred to as ocular surface squamous cell carcinoma, is cancer on the surface of the eye. Recent studies have identified UV signature mutations in TERT promoters in ocular melanoma and ocular surface squamous neoplasia. However, its immunohistochemical status has not been reported in ocular surface squamous cell carcinoma. This study aimed to explore the immunohistochemical and mutational status of TERT in ocular surface SCC. Methods: The immunohistochemical expression of TERT and mutational status of TERT promoter was evaluated in 19 ocular surface squamous cell carcinoma cases. Conjunctival melanoma tissue was used as a positive control. Results: The cytoplasmic overexpression of TERT was detected in 11/19 (57%), and TERT promoter mutations were identified in 6/19 (31%) of ocular surface squamous cell carcinoma. Out of these, 66% had a C228T mutation, and 33% had a C250T mutation. The TERT expression was found to be associated with a high (?T3) AJCC category (P = 0.023), and TERT immunoexpression was significantly correlated with reduced disease?free survival (P = 0.024, log?rank analysis) in ocular surface squamous cell carcinoma patients. Conclusion: The present study demonstrates that TERT promoter mutations with UV signatures are frequent in ocular surface squamous cell carcinoma. The increased expression of TERT could be of biological significance in aggressive ocular surface squamous cell carcinoma.

Generalised Myoclonus and Cerebellar Ataxia Associated with COVID-19 : A Case Report

COVID-19 pandemic is a Global burden to Public Health. An array of Neurological Manifestations have been reported to be associated with COVID-19 like Anosmia, Cerebrovascular accident, Meningitis, Encephalitis, Seizures, Guillain-Barré Syndrome (GBS), Acute Disseminated Encephalomyelitis (ADEM) etc. Generalised Myoclonus and Cerebellar Ataxia, is a less common Neurological Manifestation when compared to others. Here, we report a case of Generalized Myoclonus and Cerebellar Ataxia following COVID-19 infection. The possible mechanisms of Myoclonus and Ataxia following COVID-19 are also discussed

Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis

Background/Aims@#Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: 1. microbiological culture, 2. ethylene oxide sterilization, 3. liquid chemical sterilant processing system, and 4. double high-level disinfection. A systematic review and metaanalysis was performed to assess the impact of ESRT on the contamination rates. @*Methods@#A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model. @*Results@#A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I2=94.96). @*Conclusions@#While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

p53 & Cyclin D1 expression in surgically resected clear margins of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is one of the most well-known malignancies that affect the human population worldwide. The early diagnosis and early intervention of OSCC help improve the survival rate of the patients. The tumour free surgical margins are a positive prognostic factor for recurrence-free survival. The molecular markers can be used to detect the tumour free surgical margins. Aim: The aim of the study is to evaluate the expression of p53 & Cyclin D1 marker in resected surgical apparently clear margins and to correlate the p53 & Cyclin D1 expression with clinicopathological characteristics and patient outcome. Methods: The study population included retrospective cases of OSCC with apparently clear margins (2017-18) n=10 and Clinicopathological variables relevant to survival analysis were recorded. Finally, two margins were selected from each case, a total of 20 margins were included in this study. Paraffin-embedded wax blocks retrieved and tissue sections were made. Expression of cyclin D1 and p 53 was assessed by the immunohistochemical staining procedure Results: Positive expressions Cyclin D1 in 40% of mild dysplasia margins and 60% in clearance adequate margins were present. p53 expression was seen in 16% of mild dysplasia margins and 84% in clearance adequate margins. The expression of p53 and Cyclin D1 molecular markers are noted in the basal & parabasal layer of epithelium. Conclusion: Molecular markers could play a more reliable method for the assessment of dysplasia at the margins

Haematological profile of Chronic Kidney Disease Stage 5 patients undergoing maintenance Hemodialysis at a tertiary care centre.

Background: Kidneys play a central role in the regulation of body fluids, electrolytes and acid- base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. Timely intervention and effective management will minimize complications and can potentially be lifesaving. Aim: To study the haematological profile in patients of chronic kidney disease (CKD) Stage 5 undergoing haemodialysis and to correlate the relation if any, between the study parameters. Material and Methods: Study was conducted on 60 patients undergoing hemodialysis thrice a week. Complete hemogram, RFT, LFT, serum sodium, potassium, calcium and phosphorus values were obtained and their associations were statistically analysed. Results: Out of 60 patients studied, 20% (n=12) had hemoglobin values <8 g/dl, 36% (n=36) had 8-10 g/dl and 12% (n=12) had ?10 g/dl. 18% (n=11) had mild hyponatremia (130-135 mEq/L), 38% (n=23) had moderate (125-129 mEq/L) and 44% (n=26) had severe (<125 mEq/L) hyponatremia.80% of the study group (n=48) had serum calcium <9 mg/dl and 20% (n=12) had >9 mg/dl. 68% (n=41) of the patients had serum phosphorus >5.5 mg/dl and 32% (n=19) of them had <5.5 mg/dl. There was a significant positive correlation of serum sodium with serum calcium (r=0.752, p=0.0001), serum albumin (p=0.0001), hemoglobin (p=0.0001) and significant negative correlation with serum phosphorus (r=-0.730, p=0.0001), serum uric acid (p=0.003). Conclusion: Anemia, hyponatremia, hyperkalemia, hypocalcemia and hyperphosphatemia are most commonly seen in hemodialysis patients. Appropriate timely intervention can significantly prevent the long-term morbidity in such patients.

Evaluation of muscle involvement & degeneration in advanced oral submucous fibrosis using three different stains ­ a retrospective cross-sectional study / Avaliação do envolvimento e degeneração muscular na fibrose submucosa oral avançada usando três colorações diferentes - um estudo transversal retrospectivo

Background: Oral submucous fibrosis (OSMF) is graded according to various histological factors which include the epithelial changes and the connective tissue changes. These features could be identified in routine Hematoxylin and Eosin (H and E) staining in shades of pink. However, the use of special stains provides a contrast to various connective tissue components thereby aiding in better visualization of these connective tissue changes in advanced OSMF cases. Objective:To compare and evaluate muscle involvement and degeneration in advanced oral submucous fibrosis using three different stains namely, H&E, Van Gieson, and Masson's Trichrome. Material and Methods: 10 Formalin-fixed paraffin-embedded tissue sections of advanced OSMFwere stained using 3 different stains namely Hematoxylin and Eosin (H&E), Van-Gieson, and Masson trichrome. The results obtained were tabulated and statistically analyzed using Kruskal Wallis ANOVA. Results: The hyalinization and fibrosis involving the skeletal muscle were better visualized in Masson's Trichrome but were not statistically significant. The muscle degeneration in deeper areas was better visualized in Masson's trichrome when compared to the H&E and Van Gieson. Conclusion: Hematoxylin and eosin stains all the connective tissue components in various shades of pink, use of special stains bestows contrast between different components of connective tissue, thus improvising grading of OSMF. Masson's trichrome stain can be used as a single adjunct to hematoxylin and eosin stain as changes in the superficial and deeper connective tissue could be ascertained (AU)

Contexto: A fibrose submucosa oral (FSO) é classificada de acordo com vários fatores histológicos que incluem alterações epiteliais e do tecido conjuntivo. Essas características podem ser identificadas na coloração de rotina com Hematoxilina e Eosina (H&E) em tons de rosa. No entanto, o uso de colorações especiais fornece um contraste para vários componentes do tecido conjuntivo, auxiliando assim na melhor visualização dessas alterações do tecido conjuntivo em casos avançados de FSO. Objetivo: Comparar e avaliar o envolvimento e degeneração muscular da fibrose submucosa oral avançada usando três colorações diferentes: H&E, Van Gieson e Tricrômio de Masson. Material e Métodos: 10 seções de tecido fixadas em formalina e embebidas em parafina de FSO avançada foram coradas usando essas três colorações. Os resultados obtidos foram tabulados e analisados estatisticamente por meio do teste de Kruskal Wallis. Resultados: A hialinização e fibrose envolvendo o músculo esquelético foram melhor visualizadas no tricromo de Masson, mas não foram estatisticamente significativas. A degeneração muscular em áreas mais profundas foi melhor visualizada no tricrômico de Masson, quando comparado ao H&E e Van Gieson. Conclusão: Hematoxilina e Eosina coloram todos os componentes do tecido conjuntivo em vários tons de rosa. O uso de colorações especiais confere contraste entre os diferentes componentes do tecido conjuntivo, melhorando assim a avaliação da FSO. A coloração com tricrômio de Masson pode ser usada como um único adjunto para a coloração de Hematoxilina e Eosina, pois assim é possível verificar alterações superficiais e profundas no tecido conjuntivo. (AU)

Efficacy of Anhydrous Copper Sulphate as a Solid Dehydrant in Tissue Processing Procedure

Tissue processing in histotechnique is an important procedure after specimen collection involving three main procedures namely, dehydration using alcohol, clearing using xylene, and infiltration by paraffin wax. Isopropyl alcohol, the widely used dehydrating agent is toxic and when exposed to heated isopropyl alcohol fumes, it leads to numerous health hazards. Anhydrous copper sulphate is less toxic than isopropyl alcohol and requires less amount of exposure to the chemicals. The aim of the study was to investigate the dehydrating potential of anhydrous CuSO4 as an isopropyl alcohol substitute. METHODSA descriptive study of forty paired soft tissue specimens were obtained from the Department of Oral Pathology and Microbiology and were subjected to routine histopathological tissue processing with isopropyl alcohol and anhydrous CuSO4 as dehydrating agents. Histomorphological criteria namely nuclear staining, cytoplasmic staining, artefacts, and background staining were evaluated and the scores were tabulated, and statistical analysis was done using SPSS version 20 by IBM. RESULTSOur study results showed that 40 % of alcohol dehydrated tissue samples had better nuclear staining than tissue samples dehydrated by anhydrous copper sulphate and 15 % of alcohol dehydrated tissue samples had better cytoplasmic staining than tissues dehydrated by Anhydrous CuSO4. Background staining of more than 20 % was seen in anhydrous CuSO4 dehydrated tissue specimens than alcohol dehydrated tissue specimens. Artefacts were seen in similar ratios in both alcohol (80 %) and anhydrous copper sulphate (75 %) dehydrated tissue specimens. CONCLUSIONSAnhydrous CuSO4 has superior dehydrating properties than isopropyl alcohol which lead to over-dehydration of the tissue specimens. Further studies are required to validate the findings.

Anemia in Chronic Liver Disease and Liver Failure in Adults - A Clinical Study

Introduction: Chronic liver disease with or without liverfailure is associated with considerable morbidity andmortality and affects the quality of life as usually they areprogressive and often non-reversible. In the present study wehave attempted to look at the clinical presentation, etiologiesand anemia profile for chronic liver disease patients in ourpopulation. Curent study aimed to assess the clinical profileand type of anemia in chronic liver disease and liver failurein adult patients.Material and Methods: This was a prospective observationalhospital-based study carried out in the department of GeneralMedicine at, over a period of eighteen months. A total of 38patients with chronic liver disease with/without liver failurewere studied for patient demographics, clinical presentation,symptomatology, for etiology of the disease, for degree ofanemia and morphologic type of anemia.Results: The patient age ranged from 19 to 76 years and themale to female ratio was 2.8:1. CLD was most common inthe fifth and sixth decades of life. Malaise, nausea, emesis,jaundice, anemia and hepatomegaly were the most commonclinical features. Most (44.7%) cases were of chronic hepatitiswith cirrhosis. Alcoholic liver disease and HBV infectionwere the most common causes for CLD and liver failure. Atotal of 33 (86.8%) patients had anemia and the normocyticnormochromic type of anemia was the most common (39.4%)type seen.Conclusion: Chronic liver disease and liver failure are morecommon in the fifth and sixth decades of life and are mostoften caused by alcoholic liver disease and HBV infection inIndia. CLD has varied clinical presentation with symptomsoften related to the gastrointestinal tract and organomegaly.It is frequently associated with moderate degree of anemiawhich is often of normocytic type.

Validation of Deep Convolutional Neural Network-based algorithm for detection of diabetic retinopathy – Artificial intelligence versus clinician for screening

Purpose: Deep learning is a newer and advanced subfield in artificial intelligence (AI). The aim of our study is to validate a machine-based algorithm developed based on deep convolutional neural networks as a tool for screening to detect referable diabetic retinopathy (DR). Methods: An AI algorithm to detect DR was validated at our hospital using an internal dataset consisting of 1,533 macula-centered fundus images collected retrospectively and an external validation set using Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (MESSIDOR) dataset. Images were graded by two retina specialists as any DR, prompt referral (moderate nonproliferative diabetic retinopathy (NPDR) or above or presence of macular edema) and sight-threatening DR/STDR (severe NPDR or above) and compared with AI results. Sensitivity, specificity, and area under curve (AUC) for both internal and external validation sets for any DR detection, prompt referral, and STDR were calculated. Interobserver agreement using kappa value was calculated for both the sets and two out of three agreements for DR grading was considered as ground truth to compare with AI results. Results: In the internal validation set, the overall sensitivity and specificity was 99.7% and 98.5% for Any DR detection and 98.9% and 94.84%for Prompt referral respectively. The AUC was 0.991 and 0.969 for any DR detection and prompt referral respectively. The agreement between two observers was 99.5% and 99.2% for any DR detection and prompt referral with a kappa value of 0.94 and 0.96, respectively. In the external validation set (MESSIDOR 1), the overall sensitivity and specificity was 90.4% and 91.0% for any DR detection and 94.7% and 97.4% for prompt referral, respectively. The AUC was. 907 and. 960 for any DR detection and prompt referral, respectively. The agreement between two observers was 98.5% and 97.8% for any DR detection and prompt referral with a kappa value of 0.971 and 0.980, respectively. Conclusion: With increasing diabetic population and growing demand supply gap in trained resources, AI is the future for early identification of DR and reducing blindness. This can revolutionize telescreening in ophthalmology, especially where people do not have access to specialized health care.

Evaluation of PD-L1 and PD-1 expression in aggressive eyelid sebaceous gland carcinoma and its clinical significance

Purpose: Eyelid sebaceous gland carcinoma (SGC) is an aggressive but rare malignancy of ocular region. Over-expression of PD-L1 and PD-1 has been demonstrated in a variety of solid tumors including conjunctival melanoma. PD-L1 is an immunoinhibitory molecule that suppresses the effective T cells response against tumor antigen leading to the progression of tumors. Inhibitors of the interaction of PD-L1 and PD-1 are associated with good clinical response various carcinomas. The prognostic value of the PD-1/PD-L1 axis in SGC remains unexplored. The purpose of this study was to evaluate expressions of PD-1 and its ligand PD-L1 in SGC and correlate its expression with clinicopathological features and patients survival. Methods: The immunohistochemical expression of PD-L1 and PD-1 was evaluated in 30 SGC cases. Results: PD-L1 immunopositivity was detected in 41.9% of the SGC cases. PD-1 expression in tumor infiltrative lymphocytes (TILs) was observed in 53.3% samples. Tumor PD-L1 positivity, PD-1 expression in TILs and tumor size (>10 mm) was associated with reduced disease-free survival. On multivariate analysis only tumor size (>10 mm) and a combined positivity of PD-L1 in tumor cells and PD-1 in TILs with an odds ratio of 5.212 (95% confidence interval 1.449-18.737) continued to be signifi�cantly associated with SGC recurrence. Conclusion: PD-L1 is overexpressed in 50% of SGC cases. The combined tumor PD-L1 positivity and TILs showing PD-1 expression within the same SGC patient's samples predict high-risk SGC, suggesting that the up-regulation of PD-L1 in tumor cells and PD-1 positivity within the same SGC patient may aggravate tumor recurrence.

Exposure to Household Air Pollution During Pregnancy and Birthweight

This case-control, hospital-based study aimed to study the role ofhousehold air pollution in adverse birth outcomes like low birthweight. 200 newborn babies weighing <2500 g were included inthe study along with 200 matched controls. After adjusting forconfounders, it was found that exposure to second hand smoke(adjusted OR 1.72, 95% CI 0.85, 3.50, P=0.13) or indoor airpollution due to cooking fuel (adjusted OR 1.63, 95% CI 0.71,3.72, P=0.25) were not significantly associated with birth weight.

Haplotype analysis of ADAM33 polymorphisms in asthma: A pilot study

Background & objectives: ADAM33 is implicated as a potentially strong candidate gene for asthma and bronchial hyper-responsiveness. Many polymorphisms of ADAM33 have been studied along with ADAM33 expression in various cells of the lungs. Haplotype analysis also showed association with asthma in different populations across the world. Therefore, the aim of this study was to perform a comprehensive screening of ADAM33 polymorphisms in adult patients with asthma. Methods: Thirty five polymorphisms of ADAM33 were genotyped in 55 patients with asthma and 53 controls. The association of single nucleotide polymorphisms (SNPs) and haplotypes with phenotypes of asthma was analysed. Results: The genotype, minor allele frequency, odds ratio and Hardy–Weinberg equilibrium did not show any significant difference among cases and controls. No association was found between SNPs of ADAM33 with the severity of asthma. Correlation analysis of ADAM33 SNPs to the phenotypes, based on clinical variables and allergen sensitization, did not show significant difference. Haplotype analysis showed that rs2280090 and rs2280091 were associated with asthma in the patient group. Interpretation & conclusions: Haplotype analysis showed an association of the two SNP variations with asthma. These SNPs lead to amino acid change and are prone to phosphorylation, which may affect expression levels and protein function of ADAM33 and asthma susceptibility.

Tripe palm: a paraneoplastic manifestation of carcinoma stomach

Usually gastrointestinal malignancies present with low SAAG ascites. But when there is diffuse liver infiltration following malignancy, high SAAG ascites can occur. So liver infiltration can masquerade as cirrhosis. Malignant acanthosis and tripe palm are the paraneoplastic manifestations seen in GI malignancies. We are reporting a case which was initially managed as a  straightforward case of cirrhosis ,but later turned out to be a case with tripe palms, malignant acanthosis and carcinoma stomach as primary with diffuse liver infiltration having high SAAG ascites.

Incidence, prevalence, and mortality associated with head and neck cancer in India: Protocol for a systematic review

BACKGROUND: Head and neck cancer (HNC) is a heterogeneous tumor at various anatomic sites and one of the most common cancers in India. Published and existing reports and studies highlight an alarming increase in the incidence, prevalence, and mortality of HNC. Despite its high incidence, there is a dearth of more precise estimates of reliable epidemiological data pertaining to HNC in India. AIM: This protocol aims to conduct a full-scale systematic review and meta-analysis on the HNC epidemiology (incidence, prevalence, and mortality) in 29 states and 7 union territories of India. METHODS AND ANALYSIS: We will search for eligible published studies through PubMed, Scopus, Science Direct, MEDLINE, Web of Science, and Cochrane Review. Cancer registries such as (but not limited to) World Health Organization, International Agency for Research on Cancer, and the National Centre for Disease Informatics and Research-National Cancer Registry Program, which is maintained by the Indian Council of Medical Research, will be used for extracting relevant data using a standardized data collection form. The random-effects model of meta-analysis will be employed to aggregate the pooled estimates of relative ratios with 95% confidence intervals. Publication bias will be assessed using a funnel plot, and Egger's regression will be applied to test the symmetry of the funnel plot. DISCUSSION: This review will provide updated evidence of the current burden of HNC in India. This will guide future studies and cancer registry reports to provide holistically representative epidemiological data. SYSTEMATIC REVIEW REGISTRATION: In accordance with the guidelines, our systematic review protocol was registered with the International Prospective Register of Systematic Reviews and was assigned the registration number, CRD42017077482.

Integration of traditional herbal medicines among the indigenous communities in Thiruvarur District of Tamil Nadu, India

Background: Ethnobotanical studies are recognized as effective methods of finding locally importantplants for discovery of crude drugs. Siddha medicinal system is prevailed in south Indian states principally in Tamil Nadu and gaining recognition as alternative medicine among the indigenous communitiesfor their primary healthcare needs.Objectives: The study was aimed to explore and document folk medicinal plant knowledge among thelocal people in Puliyankudi village of Thiruvarur District, Tamil Nadu, India.Materials and methods: An ethnobotanical study was carried out during February 2016 to January 2017among the local people in study area. Traditional healers, traders, local vendors and local people who arepracticing herbal medicines were approached for documentation of folk medicinal uses. Acquired resultswere further analyzed with descriptive statistical methods such as use value (UV) and informantconsensus factor (ICF).Results: During the survey, a total 116 plant species from 49 families and 103 genera were recorded totreat 73 types of ailments. Among the plant parts used for preparation of medicine, leaves (73 reports)are often used and predominant method of preparation of medicine is paste (56 reports). Limoniaacidissima was reported by all the interviewed informants with an UV of 0.98 and kidney problems havehighest ICF value of 0.91.Conclusion: Plants with highest use values in the study indicates possible occurrence of valuable metabolites and should be investigated for associated pharmacological activities which leads to development of potential new drugs to treat various ailments.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)