ABSTRACT
Purpose: To analyze the efficacy of a deep learning (DL)?based artificial intelligence (AI)?based algorithm in detecting the presence of diabetic retinopathy (DR) and glaucoma suspect as compared to the diagnosis by specialists secondarily to explore whether the use of this algorithm can reduce the cross?referral in three clinical settings: a diabetologist clinic, retina clinic, and glaucoma clinic. Methods: This is a prospective observational study. Patients between 35 and 65 years of age were recruited from glaucoma and retina clinics at a tertiary eye care hospital and a physician’s clinic. Non?mydriatic fundus photography was performed according to the disease?specific protocols. These images were graded by the AI system and specialist graders and comparatively analyzed. Results: Out of 1085 patients, 362 were seen at glaucoma clinics, 341 were seen at retina clinics, and 382 were seen at physician clinics. The kappa agreement between AI and the glaucoma grader was 85% [95% confidence interval (CI): 77.55–92.45%], and retina grading had 91.90% (95% CI: 87.78–96.02%). The retina grader from the glaucoma clinic had 85% agreement, and the glaucoma grader from the retina clinic had 73% agreement. The sensitivity and specificity of AI glaucoma grading were 79.37% (95% CI: 67.30–88.53%) and 99.45 (95% CI: 98.03–99.93), respectively; DR grading had 83.33% (95 CI: 51.59–97.91) and 98.86 (95% CI: 97.35–99.63). The cross?referral accuracy of DR and glaucoma was 89.57% and 95.43%, respectively. Conclusion: DL?based AI systems showed high sensitivity and specificity in both patients with DR and glaucoma; also, there was a good agreement between the specialist graders and the AI system
ABSTRACT
Purpose: The study was conducted to compare the compliance to intravitreal injection treatment and follow?up in patients with center?involving diabetic macular edema (CI?DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center. Methods: A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti?vascular endothelial growth factor (anti?VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12. Results: A review of 136 patients treated for CI?DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12?month follow?up, only 29.16% came for a follow?up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non?compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82–1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02–1.29; P = 0.020). Conclusion: The follow?up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow?up can be improved in people with DME
ABSTRACT
Background: In the Indian subcontinent, the lesbian, gay, bisexual, transgender, and queer community, commonly referred to as the third gender or transgender, is expected to exceed one million by 2030. Data on dermatologic conditions of the transgender population is deficient. Aims: This study aimed to identify the common dermatological concerns and dermatologic procedures of the lesbian, gay, bisexual, transgender, and queer community of India. Methods: This cross-sectional survey analysed the transgender participants of a non-institutionalised population in India via health camps that included 51 adult participants who self-identified as trans men and trans women. Results: This study included 51 participants aged 20–49 years, of which the majority (94%) were trans women. The common dermatological problems were terminal hairs over the face, beard distribution, androgenetic alopecia, scars of gender-affirming surgeries, facial melanosis with topical steroid damaged skin and the need for facial feminisation procedures among trans women, while trans men had testosterone-related acne, androgenetic alopecia. Overall, 40.6% of participants reported dissatisfaction with one or more of their body parts. Laser hair removal was the most common gender-affirming dermatologic procedure. Conclusion: This study provides an essential overview of the common dermatological conditions and procedures in the Indian lesbian, gay, bisexual, transgender, and queer community. Lesbian, gay, bisexual, transgender, and queer persons have insufficient access to dermatological services due to inadequate exposure and fear of discrimination. Even though transgender patients also present with similar dermatologic conditions as the general population, they have distinct cosmetic and treatment concerns during the period of transition owing to hormone-related or surgery-related changes. Addressing these challenges through enhancing dermatology residency training programs should be the focus of tomorrow. Limitations: Considering convenience sampling and representative bias, further studies need to be conducted involving multiple study locations and larger sample sizes.
ABSTRACT
Background: Diagnosis of hepatocellular carcinoma (HCC) is difficult on morphology alone in poorly differentiated tumors and metastatic carcinomas. Appropriate immunohistochemical markers are required for definite diagnosis. In this article, we have analyzed the histopathological and immunohistochemical features of HCC and elucidate the best possible immunohistochemistry (IHC) marker combination by comparing the sensitivity of various markers in different grades of tumor. Methods: A total of 116 consecutive cases were analyzed retrospectively. The hematoxylin and eosin stained sections were reviewed in all the cases. IHC was done using hepatocellular specific antigen (HSA), arginase?1, glypican?3, and polyclonal carcinoembryonic antigen (pCEA). The sensitivity of various immunohistochemical markers individually as well as in combination for different tumor grades was determined. Results: Histologically, the predominant subtype comprised of classic variant (109,93.9%) followed by combined hepatocellular and cholangiocarcinoma (4,3.4%) and fibrolamellar variant (3,2.6%). Trabecular pattern was the most common histological pattern. On grading, 65,56.03% were moderately differentiated, 34,29.31% well differentiated, and17, 14.65% poorly differentiated. HSA and polyclonal?CEA showed higher sensitivity than arginase?1 and glypican?3 in well and moderately differentiated tumors. In contrast arginase?1 and glypican?3 showed better sensitivity in poorly differentiated HCC. The overall sensitivity increased to greater than 90% if HSA/polyclonal?CEA is combined with either arginase?1/glypican?3 irrespective of tumor grade. Conclusion: Majority of the tumors were classic variants and moderately differentiated. HSA along with either arginase?1 or glypican?3 is the best combination of immunomarker for identification of hepatocellular differentiation irrespective of tumor grade.
ABSTRACT
Purpose: Emergency delirium (ED), a common postoperative neurologic complication, causes behavioral disturbances leading to self?traumas and also has long?term adverse effects in children. Our aim was to investigate the efficacy of a single?bolus dose of dexmedetomidine in reducing the incidence of ED. Additionally, pain relief, number of patients who needed rescue analgesia, hemodynamic parameters, and adverse events were assessed. Methods: One hundred and one patients were randomly allocated into two groups: 50 patients received 15 mL of dexmedetomidine 0.4 ?g/kg (group D) and 51 patients received volume?matched normal saline (group C). Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored regularly throughout the procedure. ED was assessed with Pediatric Anesthesia Emergence Delirium Scale (PAEDS), and pain was measured using the modified Objective Pain Score (MOPS). Results: The incidences of ED and pain were higher in group C than group D (P < 0.0001 and P < 0.0001, respectively). Group D showed significant decrease in MOPS and PAEDS values at 5, 10, 15, and 20 min (P < 0.05), HR at 5 min (P < 0.0243), and SBP at 15 min (P < 0.0127). There was no significant difference in DBP between the two groups at any time point. The mean blood pressure (MBP) at 10 min was significantly less in group D than group C (P < 0.001). Conclusion: Dexmedetomidine 0.4 ?g/kg as a single bolus over 10 min immediately after intubation is effective for the prevention of ED and significantly reduces the need of rescue analgesia without compromising the hemodynamic parameters in children undergoing ophthalmic surgery.
ABSTRACT
Introduction: Millions around the globe were directly or indirectly affected by COVID-19 pandemic. The COVID-19 epidemic has harmed the lives of children with special needs in many ways, whether directly or in-directly. Few studies have evaluated the Impact of covid-19 lockdown among children with disability. Howev-er, the Impact of COVID on parents dealing with special children was scarcely studied in detail. Investigating parental stress, worries, and morbidity during the lockdown is particularly important for assisting these par-ents during further outbreaks. The aim is to assess the Impact of covid-19 lockdown among parents handling disabled children, parenting stress, their concerns, and morbidity during the COVID-19 lockdown.Materials And Method: The study was done among the parents of disabled children attending special schools in Chennai, using a cross-sectional study design. Parents with any recent trauma, mental disorders, or major diseases and undergoing treatment for themselves were excluded. After obtaining ethics approval, a semi-structured questionnaire was used to assess the Impact of the covid-19 lockdown. Collected data were ana-lyzed using SPSS v.21.Results: The study includes 305 parents, predominantly mothers (58%) and the mean age was 38.9+8.2 years. We observed that the COVID-19 lockdown impacted 149 parents (48.9%). The significant predictors for the Impact of COVID-19 lockdown were being a single parent [AOR-2.91(95%CI- 1.05-8.08)] and having a part-time job [AOR-0.36(95%CI- 0.14-0.93)]. Conclusion: The COVID-19 outbreak and lockdown significantly impacted the parents of disabled children. It is high time we give importance to these parents of children with special needs during this pandemic to help them during similar occasions in the future.
ABSTRACT
Naproxen is a widely used nonsteroidal anti-inflammatory drug (NSAID) in pediatric population, used for mild-to-moderate pains, arthritis, and other immune-mediated disorders. It rarely causes clinically apparent liver injury in the adult population taking high doses of the drug over a prolonged period and is reported even rarer in pediatric population. We present a case of drug-induced liver injury (DILI) in a 13-year-old girl taking naproxen in therapeutic doses for juvenile rheumatoid arthritis. There was a complete recovery of liver function following discontinuation of naproxen therapy.
ABSTRACT
India is the largest consumer of antibiotics in the world. High antibiotic consumption is linked to the emergence and community spread of multidrug-resistant bacteria. It is well-established that antibiotic overuse is one of the leading causes of antibiotic resistance, which is a major global public health challenge. Optimizing antibiotic usage is, thus, an essential issue. Before promoting and defining judicious antibiotic prescribing, it is crucial to analyze practitioners' diagnostic and prescribing practices. Hence, a nationwide retrospective questionnaire-based survey was conducted among 950 Indian doctors. This survey aimed to describe the approaches and practices of Indian doctors towards antibiotic use in upper respiratory tract infections (URTIs) and pyrexia of unknown origin (PUO) and compare practices with national guidelines. These are the most common reasons for primary health care consultations and significantly contribute to the overuse of antibiotics. According to the survey, amoxicillin-clavulanic acid remains the first-line antibiotic for URTI treatment. Third-generation cephalosporins were found to be the most prescribed antibiotics for PUO, uncomplicated typhoid and infections during pregnancy. Our survey results show that most of the clinicians in our study were well aware of the guidelines for antimicrobial use issued by Indian Council of Medical Research (ICMR) and the nationwide problem of antimicrobial resistance. This study provides an important insight into the prescribing practices of antibiotics among Indian doctors.
ABSTRACT
Objective: Preterm delivery is a major adverse birth outcome, approximately 15 million babies are born prematurely every year. There are several causes for preterm deliveries. This study focuses on folate metabolic pathways. Dietary folate plays a crucial role in premature labor. We examined the relationship between methylenetetrahydrofolate reductase (MTHFR) (C677T) and thymidylate synthase (TYMS) 6bpdel polymorphism. Materials and Methods: A total number of 300 pregnant women were selected for this study; among which ( n = 150) were preterm and ( n = 150) were term delivery cases. The selected samples were further processed for molecular polymerase chain reaction-restriction fragment length polymorphism analysis. The demographic profile of birth status resulted significantly with ( P = 0.0001) proving chances of high infant mortality due to prematurity. Results: The genotype distribution of MTHFR C677T showed significant data ( P = 0.0021) whereas insignificant genotypic distribution was observed for the TYMS gene ( P = 0.067). Our results imply that genes that are involved in the folate pathway play a crucial role in early pregnancy. Conclusion: Advanced and better strategies can be brought to an improved intervention of folate at the time of pregnancy which will help to reduce the rate of premature deliveries.
ABSTRACT
Background & objectives: Every year more than one billion people are infected and about one million people die from vector-borne diseases; of which mosquito-borne diseases remain as the world’s most severe insect-borne diseases with excessive rates of morbidity and mortality. This study aimed to examine the mosquito vectors and the possible diseases transmitted by them in the Mananthavady Taluk of Wayanad, Kerala. Methods: The area selected for the present study was Mananthavady Taluk of Wayanad district, Kerala, during 2019–2021. The collected specimen were subjected for morphological identification using taxonomic keys and were confirmed by DNA barcoding. Molecular phylogeny assessment was done for the collected species of vector mosquitoes. Results: A total of 17 mosquito species belonging to 5 genera, Anopheles, Aedes, Culex, Mansonia and Armigeres were identified. The mitochondrial COI gene sequences generated for molecular identification of these species were submitted to NCBI GenBank. Interpretation & conclusion: Overall, this study extends our understanding of the molecular evolution of mosquito vectors of medical and veterinary concern, which could aid in developing biotechnological approaches used in Culicidae control programs.
ABSTRACT
ABSTRACT Introduction The increasing popularity of cannabinoids for treating numerous neurological disorders has been reported in various countries. Although it reduces tetrahydrocannabinol psychoactivity, it helps patients tolerate higher doses and complements the anti-spasmodic effects of tetrahydrocannabinol. One of the most important potential of cannabinoids are related to its potential to help children with cerebral palsy, a contributor of lifelong disability. Therefore, this systematic review aimed to assess the efficacy and safety of medical cannabinoids in children with cerebral palsy. Methods This review adhered to The Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 guidelines. Seven databases, namely, Scopus, PubMed, EBSCO Host, ProQuest, Google Scholar, Semantic Scholar, and JSTOR, were used to identify relevant studies. Studies examining pediatric patients with cerebral palsy and reporting the efficacy and safety of medical cannabinoids through clinical trials, observational cross-sectional studies, or cohort designs were included. The outcomes of the studies included the efficacy of medical cannabinoids administered for spasticity, motor components, pain control, sleep difficulties, adverse effects, and seizure control. Results Of 803 identified articles, only three met the inclusion criteria for data synthesis. One study exhibited a moderate risk-of-bias. A total of 133 respondents, mainly from Europe, were investigated. Overall effectiveness and safety were considered good. However, the results are inconsistent, especially regarding spasticity treatment variables. Conclusion The anti-spasticity, anti-inflammatory, and anti-seizure properties of cannabinoids might be beneficial for patients with cerebral palsy, although their effectiveness has not been widely studied. Further studies with larger sample sizes and various ethnicities are warranted. Prospero database registration: (www.crd.york.ac.uk/prospero) under ID CRD42022358383.
ABSTRACT
Solitary fibrous tumors (SFTs) are an uncommon group of neoplasms. The visceral pleura is the most common site of origin of these tumors. The colonic mesentery is an unusual site of origin of SFTs. A pre-operative diagnosis of SFT is challenging as there are no pathognomonic clinical or radiological signs. Most patients reported thus far were diagnosed post-operatively with the aid of immunohistochemical markers. Complete surgical excision is the treatment of choice for SFTs. Recurrences are uncommon. However, they can occasionally show aggressive behavior. In this report, we describe two cases of rare colonic mesentery SFTs.
ABSTRACT
Understanding of nonalcoholic fatty liver disease (NAFLD) continues to expand, but the relationship between race and ethnicity and NAFLD outside the use of cross-sectional data is lacking. Using longitudinal data, we investigated the role of race and ethnicity in adverse outcomes in NAFLD patients. Methods: Patients with NAFLD confirmed by imaging via manual chart review from any clinics at Stanford University Medical Center (1995–2021) were included. Primary study outcomes were incidence of liver events and mortality (overall and non-liver related). Results: The study included 9,340 NAFLD patients: White (44.1%), Black (2.29%), Hispanic (27.9%), and Asian (25.7%) patients. For liver events, the cumulative 5-year incidence was highest among White (19.1%) patients, lowest among Black (7.9%) patients, and similar among Asian and Hispanic patients (~15%). The 5-year and 10-year cumulative overall mortality was highest for Black patients (9.2% and 15.0%, respectively, vs. 2.5–3.5% and 4.3–7.3% in other groups) as well as for non-liver mortality. On multivariable regression analysis, compared to White patients, only Asian group was associated with lower liver-related outcomes (aHR: 0.83, P=0.027), while Black patients were at more than two times higher risk of both non-liver related (aHR: 2.35, P=0.010) and overall mortality (aHR: 2.13, P=0.022) as well as Hispanic patients (overall mortality: aHR: 1.44, P=0.022).Conclusions: Compared to White patients, Black patients with NAFLD were at the highest risk for overall and non-liver-related mortality, followed by Hispanic patients with Asian patients at the lowest risk for all adverse outcomes. Culturally sensitive and appropriate programs may be needed for more successful interventions.
ABSTRACT
Background : COVID-19 has made a series changes in all system of life especially in education. As a result, education has changed dramatically with the distinctive rise of e-learning. The present study was aim to examine the preference and perception of MBBS student on newly introduced online live video classes. Methods:An online questionnaire survey consisting of closed and open-ended questions on nine different categories such as accessing online video content, previous experience with online learning, interaction with video lectures addressing the content, duration, visualize, timings and screen size, perceived learning experience, the online content learning assessment methods and the experience with the online learning management system.Two hundred and thirteen undergraduate medical students were participating in this study. And it was conducted by the large medical institution in Andhra Pradesh. Results: The e-learning methods were encouraged and its gaining popularity among the medical students and faculty. Our analysis shown 97.7% students were highly satisfied and 2.3% were not satisfied with online classes on comparison to the traditional methods of learning. Conclusions:The teaching method and teachers support are the pivotal elements which enable online learning experience with a mutual relationship. Furthermore, the usefulness and acceptability of e-learning among medical students as a part of their curriculum is still not fathomed in medical education.
ABSTRACT
Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality
ABSTRACT
We report a case of pituitary adenoma with normal hormone levels in a 34-year-old female. She presented to OP with headache, milky discharge from nipples and secondary amenorrhea with transient loss of vision. Patient had hyperprolactinemia with normal levels of all other pituitary hormones. MRI revealed space occupying lesion in sellar and suprasellar region. Neurological consultation suggested Rathke抯 cyst/ craniopharyngioma/ macroadenoma. Excised lesion was diagnosed as pituitary adenoma during histopathological analysis.
ABSTRACT
COVID-19 derives from infection with Coronavirus [severe acute respiratory syndrome (SARS)-CoV-2] is associated with high morbidity and mortality. These hazardous impacts are due to the release of a storm of pro-inflammatory cytokines and thrombogenic agents. Increasing evidences about multi organ involvement in COVID infection have started pouring in, where patients who either recovered from or had mild symptoms after COVID-19, exhibit diffuse multi organ related symptoms. We describe a case of a 23-year-old male who presented to emergency room with intermittent high-grade fever, sudden onset of breathlessness, giddiness and weakness. His COVID RTPCR was negative. He was unvaccinated but his covid antibodies were increased multifold. Further examination revealed active multi organ involvement which suggestive for multisystem inflammatory syndrome (MIS). With appropriate diagnosis and treatment patient improved clinically over a course of 3 weeks and discharged and is under regular follow up.
ABSTRACT
Background:The progressivity of chronic kidney disease (CKD) is associated with several clinical conditions which contribute to high morbidity and mortality, including anemia and hypoalbuminemia. This study aimed to assess the association of anemia and hypoalbuminemia with the mortality of CKD patients undergoing routine hemodialysis (HD) in Siloam Hospital Kupang.Methods:We conducted a retrospective cohort study based on Indonesia renal registry data system and hospital medical records. We studied the following variables: gender, age, etiology of CKD, vascular access of HD, and prevalence of anemia and hypoalbuminemia. All analysis was performed using SPSS software version 22.Results:There were 128 patients enrolled in this study. Of the total patients who died, most of them died within the first 3 months since the initiation of HD (62.1%). The majority of patients had anemia (67.2%) and hypoalbuminemia (69.5%). The bivariate analysis showed that anemia (p value=0.192), and hypoalbuminemia (p value=0.336) were notstatistically significant associated with mortality among patients undergoing routine HD.Conclusions:Anemia and hypoalbuminemia are not statistically associated with mortality outcome of CKD patients in Siloam Hospital Kupang. However, these conditions may still have prognostic importance for CKD patients undergoing routine HD. Further studies with larger size of cohort and longer period of time are warranted.
ABSTRACT
Background:Aim of the study was to analyse the relation between elevated neutrophil lymphocyte ratio (NLR), and erythrocyte sedimentation rate (ESR) in Helicobacter pylori(H. pylori)positive chronic gastritis patients, as compared to the control group containing H. pylorinegative chronic gastritis patients.Methods:Chronic gastritis patients were segregated in equal numbers based on H. pyloristatus. NLR was calculated, and ESR noted from the observations, comparison was done between the control and the study groups.Results:A total of 100 patients were included in the study. The 50 each from the control and study group. An observation of elevation in NLR and ESR in H. pyloripositive chronic gastritis patients, as compared to the control group was seen. With an average NLR of 2.43 and 1.43, in the control and study group, respectively.Conclusions:Raise in NLR in H. pyloripositive chronic gastritis patients with an associated raise in ESR suggests, the severity of the infection and the need for eradication and prevent complications
ABSTRACT
Initial diagnosis and timely treatment of Extra Pulmonary Tuberculosis (EPTB) continues to be a challenge in all over World as well as India. First time, this analysis will discover the role of LTA4H gene and may be establishing another candidate that impacts the sensitivity to EPTB in the population of North India. This study will be the first report on LTA4H gene various diagnostic markers, expression of gene may validate as a prognostic factor in (EPTB). The diagnosis (EPTB) poses a special challenge, as it is often missed or misdiagnosed due to its atypical presentations and difficult to isolate M tuberculosis (MTB) due to the small number of organisms present at these sites. Subsequently the outcome of present study will reinforce possible use of LTA4H as biomarkers and the therapeutic utility for (EPTB). This study will be a step to decrease the analytical and therapeutic window to identify another risk factor LTA4H for EPTB. Leukotriene A4 hydroxylase (LTA4H), an enzyme which changes LTA 4 to LTB4, controls the balance amongst the anti-inflammatory lipoxins and pro-inflammatory LTB4, with directly consequences in TB-driven inflammation. In humans and will spawn new ways to protection and enhance the wellbeing status of individuals and population groups. On RT-PCR, Extra Pulmonary Patients had lower expression of LTA4H compared to the controls. Correlation of biomarkers will reveal LTA4H level correlated with age, Gender Smoking, Clinical Parameter Serum Total Protein, BMI Height and TLC, Laboratory Parameter. On ELISA kit and follow as per manufacturer protocol. CEA562Ge 96 Tests Enzyme-linked Immunosorbent Assay Kit For Leukotriene B4 (LTB4) LTB4 Protein level in Extra Pulmonary Patients, (EPTB) (2304.52pg/ml) had lower expression of gene LTB4 compared to the controls (3096.142pg/mls) (P value = 0.0012).