Artificial intelligence and machine learning in ocular oncology: Retinoblastoma

Purpose: This study was done to explore the utility of artificial intelligence (AI) and machine learning in the diagnosis and grouping of intraocular retinoblastoma (iRB). Methods: It was a retrospective observational study using AI and Machine learning, Computer Vision (OpenCV). Results: Of 771 fundus images of 109 eyes, 181 images had no tumor and 590 images displayed iRB based on review by two independent ocular oncologists (with an interobserver variability of <1%). The sensitivity, specificity, positive predictive value, and negative predictive value of the trained AI model were 85%, 99%, 99.6%, and 67%, respectively. Of 109 eyes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of RB by AI model were 96%, 94%, 97%, and 91%, respectively. Of these, the eyes were normal (n = 31) or belonged to groupA (n=1), B (n=22), C (n=8), D (n=23),and E (n=24) RB based on review by two independent ocular oncologists (with an interobserver variability of 0%). The sensitivity, specificity, positive predictive value, and negative predictive value of the trained AI model were 100%, 100%, 100%, and 100% for group A; 82%, 20 21 98%, 90%, and 96% for group B; 63%, 99%, 83%, and 97% for group C; 78%, 98%, 90%, and 94% for group D, and 92%, 91%, 73%, and 98% for group E, respectively. Conclusion: Based on our study, we conclude that the AI model for iRB is highly sensitive in the detection of RB with high specificity for the classification of iRB

Aggressive Central Giant Cell Granuloma in a Child: A Case Report and Review

Introduction: An aggressive variant of central giant cell granuloma in a paediatric patient is a localized benign osteolytic prolif- eration. The lesion consist of fibrous tissue with haemorrhage, hemosiderin deposits and presence of osteoclast-like giant cells with reactive bone formation. Clinically shown with rapid growth, resorption of roots, displacement of teeth and thinning or perforation of cortical bone, and marked recurrence. Case presentation: A 9-year-old boy reported with a 3 days history of asymptomatic soft tissue swelling in left mandibular pos- terior region which was diagnosed as central giant cell granuloma based on clinical, radiological and histopathological features. Management and Prognosis: Surgical resection was performed without any signs of recurrence on 9 months follow up. Conclusion: Prompt diagnosis and treatment of Central giant cell granuloma can significantly improve morbidity and long- term outcomes.

Sarcina Ventriculi of Gastrointestinal Tract: A Clinicopathologic Study

Background: Sarcina ventriculi, a gram-positive coccus, are occasionally found in gastric biopsies. Although Sarcina had been described more than 150 years ago, little is known about its pathogenicity in humans. Method: This retrospective case series included patients who were identified with Sarcina infection. We report clinicopathologic characteristics of 13 patients with Sarcina in gastric or duodenal biopsies. Result: The presenting symptoms included: epigastric discomfort (n=6), epigastric pain (n=4), anorexia (n=6), nausea and vomiting (n=5), constipation (n=2), diarrhoea (n=2) and weight loss (n=3).All patients had evidence of mucosal injury.Sarcina was found on mucosal surface.12 patients had food residue on oesophagogastroduodenoscopy (OGD). 10 patients had gastric outlet obstruction (GOO), antral narrowing in 7 and duodenal obstruction in 3. 6 patients had malignant GOO. Causes of benign GOO included Helicobacter Pylorigastritis (n=1), eosinophilic gastritis (n=1) and duodenal ulcers (n=2, 1 NSAIDs). Of the 5 patients that had follow-up OGD, 2 had gastric residue. One patient had recurrence of symptoms with the persistence of sarcina on biopsy at 3 months. Symptoms improved at 6 months and no evidence of sarcina on biopsy at 6 months. Conclusion: Our findings suggest GOOcan be considered as a predisposing factor for Sarcina infection. Sarcina infection may not be the aetiology for GOObut may complicate recovery and may lead to life-threatening complications. Clinicians and pathologists must be aware of such microorganisms and must be documented in the histology report for further investigation and therapeutic consideration.

Higher incidence of syndrome of inappropriate antidiuretic hormone secretion during induction chemotherapy of acute lymphoblastic leukemia in indian children

BACKGROUND: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a well-known adverse effect of vincristine (VCR). Literature suggests that Asians are predisposed to develop SIADH following VCR administration. However, data regarding the occurrence of SIADH in children with malignancy are limited. This study aims to analyze the incidence, clinical picture, risk factors, management, and outcome of SIADH during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: A prospective study was conducted among the 166 newly diagnosed pediatric ALL patients who were treated at a tertiary cancer center in India between January 2015 and December 2015. Patients who developed hyponatremia during induction chemotherapy were further investigated for SIADH. RESULTS: The incidence of SIADH was 10.8% (n = 18) with a mean sodium level of 125 mEq/L (114–129 mEq/L). In the preceding 2 weeks, 72% of episodes were associated with the administration of two (n = 6) or three (n = 7) doses of VCR. One child presented with seizures. All the patients were managed with fluid restriction and only two patients required sodium correction with 3% saline. Girls older than 10 years of age showed a marginally significant correlation to develop SIADH (P-value = 0.059). CONCLUSION: We report a higher incidence of SIADH (10.8%) in Indian children, compared to that described in the literature, during induction chemotherapy for ALL. Regular monitoring of sodium levels during this period of chemotherapy is hence essential for the timely diagnosis and appropriate management of SIADH, which in turn will avert complications, including neurological symptoms secondary to SIADH.

Clinical and aetiological profile of Pneumonia in age group between 1 month to 1 year: a hospital based prospective study

Background: Pneumonia is one of the leading causes of morbidity and mortality in children under five years of age across the world. The present study was designed to clinically evaluate the children of age 1 month to 1 year with pneumonia, correlate it with bacteriological, radiological findings and to study the risk factors.Methods: Clinical, bacteriological, radiological features and risk factors of community acquired pneumonia in children of age group 1 month to 1 year were noted and analysed.Results: As per WHO ARI control programme, 72% had pneumonia, 25.3 % had severe pneumonia and 2.6% had very severe pneumonia. Bacterial pneumonia was detected radiologically in 4.6% and viral pneumonia in 88.6% of cases. Chest X-ray was normal in 6.6% of cases. Tachypnoea, chest retractions, crepitations alone and crepitations with rhonchi correlated well with positive radiological findings. Inappropriate immunization for age, lack of breast feeding, preterm birth, smoking in family were significant risk factors for severe Pneumonia. 39.3% had leucocytosis and 24% had positive CRP. Culture was positive in 23 cases (15.3% culture positivity).Conclusions: Radiologically confirmed Pneumonia should be treated with antibiotics because, in clinical practice, it is virtually impossible to distinguish exclusively between viral pneumonia and bacterial pneumonia. As the viruses are most common causative agents of Pneumonia in 1 month to 1 year, PCR kits should be used to identify viral etiological agents. Early and exclusive breast feeding should be promoted to decrease the risk of pneumonia.

Evaluation of partogram in 100 cases of both primi and multi gravida each, their outcome in labour and perinatal outcome

Background: the objective of this study was to study the utility of partogram in both primi and multi gravida and evaluate its role in preventing prolonged labour; assess the rate of cervical dilatation on admission, and to evaluate the maternal and perinatal outcome by comparing their partogram in labour.Methods: This observational prospective clinical study involved randomly selected 200 patients in labor divided into 2 groups of 100 each admitted in Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga. Modified WHO partogram was used. Statistical analysis done by Chi square test.Results: Mean age group in primi was 22.05 years with standard deviation of 2.38 years and in multi mean age group was 25.19 years with standard deviation of 3.09 years. Mean duration of active phase of labor in primi was 2 hrs 12 mins and in multi was 1 hours and 35 mins from time of admission into hospital. Mean duration of second stage of labor in primi was 57 mins and in multi was 35 mins. Out of 100 primi gravida 68% had NVD, 1% had outlet forceps. 13% had vacuum application and 18% underwent LSCS. Out of 100 multigravida 86% had NVD, 1% had outlet forceps, 7% had vacuum application and 6% underwent LSCS. In group A in primi 75% had NVD, 0% had forceps, 5% had vacuum application and 0% LSCS whereas in multi 93% had NVD and 7% had vaccum, NO forceps /LSCS. In group B, in primi 20% had NVD, 4% had forceps, 33% had vacuum application and 43% had LSCS whereas in multi 34% had NVD, 8% had forceps, 8% had vacuum application and 50% LSCS. In group C, in primi 100% had LSCS whereas in multi there were no NVD/Vaccum/ forceps/ LSCS cases. In primi 100% and in multi 96% had no maternal complications. In primi 96% and in multi 97% had no neonatal complications.Conclusions: The partogram is used to assess the labor progress and identify when intervention is necessary. This study showed that it can be highly effective in reducing complications from prolonged labor for both mother & neonate, in reducing operative intervention and improving their outcome.

25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch

Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.

Demographic And Hormonal Profile Of Acne In Adolescence And Post Adolescence.

Background: Acne vulgaris is one of the most common skin diseases affecting majority of the teens and reaching its pinnacle during adulthood. In some severe cases, it leads to pronounced skin deformity which adversely dampen the self-esteem of the affected which can eventually lead to depression and even suicides. Usually this disease invariably diminishes in twenties but in some cases, it might even persist in thirties, forties and beyond. Majority of females suffer from mild to moderate acne at some stage of life. Androgens cause enlargement and overstimulation of the sebaceous glands in people with acne and this leads to overproduction of sebum coupled with sluggish exfoliation process leads to blocked pores and development of acne, so the present study conducted with objectives to compare hormonal levels of serum testosterone, LH, FSH among patients with and without Acne and to compare the hormonal levels in different categories of acne among study participants.

Development and Validation of a Stability Indicating HPLC Method for the Simultaneous Analysis of Esomeprazole and Itopride in Bulk and In Capsules.

A rapid, simple, selective, precise, and accurate stability indicating HPLC method has been developed and validated for the simultaneous analysis of esomeprazole and itopride in bulk and in capsule form. An isocratic separation was achieved using a Hypersil C4 (250 x 4.6 mm), 5 μm particle size column with a flow rate of 1 mL/min and photodiode array detector at 272 nm. The mobile phase consisted of 0.1M dipotassium hydrogen phosphate: acetonitrile (40:60 v/v). The method was validated for selectivity, specificity, linearity, precision, accuracy and robustness. The selectivity of the method was determined by assessing interference from the placebo, components of mobile phase and common excipients in pharmaceutical formulations. Whereas, specificity was established by stress degradation studies. The method was linear over the concentration range 40–120 μg/mL (R2 = 0.9999) and 150-450 μg/mL (R2 = 0.9999) for esomeprazole and itopride, respectively. Limit of detection is 0.207 and 0.724 μg/mL & Limit of quantitation is 0.691 and 2.415 μg/mL for esomeprazole and itopride, respectively. The precision and accuracy of the method was found to be acceptable. The method was found to be robust and suitable for the simultaneous analysis of esomeprazole and itopride in a capsule formulation. Degradation products resulting from the stress studies did not interfere with the detection and quantification of esomeprazole and itopride. The proposed HPLC method is thus stability-indicating.

A Comparative Study of Lipid Profile in Apparently Healthy Smokers and Non-Smokers.

Background: Smoking is considered as the single most important risk factor for coronary heart disease and cerebrovascular disease, mainly through its effect on accelerating atherosclerosis. It has also been observed that smoking causes increased serum cholesterol, triglyceride and beta lipoprotein levels and alpha lipoproteins. Objective: To compare the lipid profile among smokers and nonsmokers. Method: In this study the lipid profiles of apparently healthy non-smokers in the age group 20-55 was compared with that of smokers with relation to dose response and duration response relationship. Result: It was observed that the mean value of all lipids were significantly higher in smokers as compared to nonsmokers. Analysis of the data with regards to the duration of smoking also showed statistically significant increase in the mean levels of serum lipids with increase in the duration of smoking. There was also significant fall in the mean values of serum HDL in all groups of smokers in a dose response sequence when compared to that in non- smokers. However the fall was not clinically significant. Mean HDL in heavy smokers 31.40± 6.67 as compared to 48.47 ±6. 88 in nonsmokers. P value was <0.001. When the same characteristics were analyzed with regards to the duration of smoking again a statistically significant rise in LDL, VLDL cholesterol & a statistically significant fall in HDL cholesterol were observed when compared to that of non-smokers. Conclusion: The smokers are definitely exposed to the risk of high lipid levels and hence to the risk of cardiovascular diseases,

Diet & nutrition profile of Chenchu population - a vulnerable tribe in Telangana & Andhra Pradesh, India.

Background & objectives: Earlier studies have documented high prevalence of undernutrition, morbidity and mortality among Chenchus, a tribal population in Telangana and Andhra Pradesh, India. The present study was carried out to assess diet and nutritional status of Chenchus and cause of death. Methods: A total of 42 Chenchu villages (gudems) were covered using systematic random sampling procedure. In each gudem, all the households with at least one child under the age of five years were covered for various investigations. Weighment diet survey was carried out on a sub-sample of households. In addition, information on cause of death in the selected 42 gudems was collected for past one year using verbal autopsy method. Results: A total of 1396 subjects of all age groups were covered for various investigations. The intakes of food and nutrients were lower than the recommended levels. The prevalences of underweight, stunting and wasting among under five children were 42 per cent (CI: 37.9-46.1), 53 and 13 per cent, respectively, while 41 per cent (CI: 37.8-47.2) men and 42 per cent (34.4-47.8) women had chronic energy deficiency (BMI<18.5 kg/m2). Sixty eight deaths were reported during the past one year in 42 Chenchu gudems. The major causes of death were premature delivery, low birth weight, alcoholic cirrhosis of liver, accidents, snakebite and pulmonary tuberculosis. Interpretation & conclusions: The prevalence of undernutrition in Chenchu population was comparable with other tribal and rural counterparts in Andhra Pradesh, however, the crude death rate (11.7/1000) was higher among the Chenchus. Steps may be taken to promote consumption of balanced diet and utilization of optimal healthcare facilities to control morbidity and mortality.

Development and Validation of RP-HPLC Method for the Determination of Amlodipine.

The present paper describes a simple isocratic RP-HPLC method for the determination of Amlodipine in tablet dosage form. Best symmetric peak shape was obtained with column Zodiac C18 column (250 mm x 4.6 mm, 5μ) at 245nm with retention time of 5.53min. The mobile phase used was Methanol: Water: Acetonitrile 60:20:20 (v/v/v) with flow rate of 1.0 ml/min. The method for estimation of Amlodipine in tablet dosage form was found to be linear, accurate, precise, sensitive and selective. The linearity range was from 60μg/ml to 210μg/ml. Method was found to be highly sensitive as LOD and LOQ were found to 0.4μg/ml and 1.3μg/ml. The repeatability and reproducibility were within the range i.e. less than 2%. The %recovery values were found to be in the range of 98.82-100.93%. The percentage of assay was calculated for market formulation was 99.19%.

Extra corporeal shockwave lithotripsy resulting in skin burns – a report of two cases

Severe skin injury after extracorporeal shock wave lithotripsy (ESWL) is rare. We describe two patients who suffered full thickness skin burns following ESWL for renal calculi. One patient was treated conservatively and the other underwent debridement with skin grafting. We speculate that failure of the thermostatic mechanism of the lithotripter, leading to overheating of the water-filled cushion, resulted in this very rare adverse event. Proper preoperative patient counseling regarding the risk of serious burn injuries will help to avoid potential litigation.

To study the oxidative stress induced by lindane in epileptic rats brains and their modulation by neurosteroids.

Background: Lindane is pesticide has been shown to affect the nervous system adversely. Previous work has shown that lindane is proconvulsant and neurosteroids (NS) has been shown to be neuroprotective against lindane-induced convulsions. As the mechanisms of lindane in epileptogenesis is not completely understood. The present study was designed to investigate the oxidative stress parameters of lindane toxicity in epileptogenesis and their modulation by NS like allopregnanolone (AP), and 4ʹ-chlorodiazepam (4ʹ-CD) in pentylenetetrazole (PTZ) kindling methods. Methods: Kindling was induced by injecting PTZ (30 mg/kg; s.c.) on alternate days i.e., 3 times in a week. Lindane was also administered (15 mg/kg p.o) on alternate days for 6 weeks. AP (2.5 mg/kg, intaperitoneal [i.p.]) and 4ʹ-CD (0.5 mg/kg, i.p.) single dose was given in kindled rats before lindane. Results: Following per oral administration of lindane for 6 weeks produced signifi cant oxidative stress in epileptic brain. There was an increase in brain malondialdehyde (MDA) level and decrease in reduced glutathione (GSH) levels. AP (2.5 mg/kg, i.p.) and 4ʹ-CD (0.5 mg/kg, i.p.) single dose administration were not able to reverse the effect of chronic exposure of lindane. Conclusion: The result of the present study provides evidence that oxidative stress produced in the brain after chronic exposure of lindane may be the mechanism of epileptogenesis. Though NS have been shown to be neuroprotective, but they failed to reverse chronic oxidative stress produced by lindane. Further studies are required to demonstrate interaction of NS with lindane in oxidative stress.

Lurking in the dark: Latent Tuberculosis infection.

A subset of the tuberculous population has latent tuberculosis infection (LTBI). It is a condition wherein the affected individual is infected with Mycobacterium tuberculosis, but does not have any signs or symptoms of tuberculosis nor is he infectious to others. Risk of progression to active tuberculous infection is influenced by co-morbidities like HIV, diabetes, malignancy requiring chemotherapy, infants and children in close contact with susceptible individuals, and healthcare workers. Early diagnosis of LTBI is paramount. In addition to tuberculin test, Interferon gamma release assay (IGRA) is the new diagnostic modality that can be used for this purpose. Quantiferon-TB Gold In-Tube (QFTGIT) and T-SPOT TB are the two currently available IGRAs, of which the latter is slightly more preferred. More recently, TB PCR (Polymerase Chain Reaction) has aided accurate and early diagnosis of all forms of TB. While treating LTBI, it is observed that Isoniazid (INH) has stood the test of time and still prevails as the treatment of choice for active infection and for LTBI. Of course, adverse effects of INH and need for regular laboratory monitoring persist. Recently, moxifloxacin has been used as a substitute for INH. Newer drugs like rifapentine, nitromidazopyran, metronidazole and nitrofurans have all been tried with variable success and several clinical limitations, depending on comorbid conditions. India’s burden of extensive prevalence of TB is compounded by paucity of data on the same. The World Health Organization has estimated a mortality of 36 million by 2020 due to TB. This projection should encourage aggressive research into this entity.

Lower incidence of nonsyndromic cleft lip with or without cleft palate in females: Is homocysteine a factor.

In India, as in other parts of the world, nonsyndromic cleft lip with or without cleft palate (NSCL±P) is a highly prevalent birth defect, its incidence in males being twice that in females. A case–control association study has been carried out with respect to homocysteine level and MTHFR C677T, A1298C and SLC19A1 (RFC1) G80A genotypes from an eastern Indian cohort to investigate whether Hcy and other Hcy-pathway genes also contribute to the risk level. While MTHFR 677T and SLC19A1 80G are individually and cumulatively risk factors, SLC19A1 80A appears to be protective against MTHFR 677T risk allele. Elevated Hcy associates with NSCL±P both in case mothers and cases. Significantly, this difference shows a gender bias: the level of elevation of Hcy in female cases is distinctly higher than in males, and more case females are hyperhomocyteinemic than the case males. It implies that compared with the males, higher level of Hcy is needed for NSCL±P to manifest in the females. We consider this as one of the possible factors why the incidence of this disorder in females is much lower than in males.

Process optimization of efavirenz film coated tablet.

Optimization is often used in pharmacy relative to formulation & processing and one may find it in literature referring to any study of formula. Optimize means to make a perfect, effective (or) functional as possible. Process optimization is the discipline of adjusting a process so as to optimize some specified set of parameters without violating some constraint. The most common goals are minimizing cost, maximizing output, and/or efficiency. This is one of major quantitative tools in industrial decision making. In the present work process parameters at developmental stages of formulation were studied extensively and after completion of the data generated during the Process Optimization of Efavirenz tablets , some critical parameters were identified and some changes are recommended in various stages of manufacturing process and finally proved that process is capable of producing a drug of required quality with proposed process.

Peripheral interaction of opioid and nmda receptors in inflammatory pain in rats.

Both opioid and NMDA receptors have been known to be involved in pain processing in the central nervous system as well as in the periphery. The effect of drugs acting on opioid and NMDA receptors, and their role in modulation of pain response was observed in the formalin model of inflammatory pain in rats. We have demonstrated that morphine has significant antinociceptive effect in the formalin model and this effect was enhanced when given in combination with ketamine. We have also reported modulation of pain response when naloxone or NMDA were co-administered with morphine or ketamine in various combinations. A noteworthy observation in our study is that low dose naloxone when co-administered with ketamine and morphine, or with ketamine and NMDA, caused decrease in the pain response. These observations may suggest that low dose naloxone can cause modulation of opioid and NMDA receptors resulting in antinociceptive effect. Our study thus introduces a new concept of more than two drugs acting on opioid and NMDA receptors to modulate pain response.