Comparative evaluation of effectiveness of twenty versus fifty percent autologous serum eye drops in treatment of dry eye

Purpose: The objective of the study was to compare the efficacy and safety of two concentration of autologous serum (AS) 20% vs 50% in recalcitrant moderate?to?severe dry eye patients. Methods: A double?blind prospective, interventional, and randomized study was done on 44 patients (80 eyes) clinically diagnosed with moderate?to?severe dry eye disease (DED) that was refractory to conventional treatment, and all patients were treated with AS20% or AS50% for 12 weeks. We documented Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), OXFORD corneal staining score (OSS), and Schirmer test (ST) at baseline, 2,4,8, and 12 weeks. These parameters were compared in both groups and between the groups by using Student’s t?test. The study included 11 males and 33 females. Results: Out of 80 eyes, 33 eyes had moderate and 47 had severe DED. The age of patients in AS20% was 44.73 ± 14.37 years, and in AS50% was 46.41 ± 14.47 years. The most common etiology associated with DED was secondary Sjogren syndrome. In moderate DED, both the groups showed significant improvement in both subjective and objective parameters. But in severe DED, the AS20% group failed to show any significant improvement objectively, though subjective improvement was present. Conclusion: In refractory severe DED patients, AS50% is better option for treatment and in moderate DED both concentrations of autologous serum are effective.

Optimization and evaluation of tear protein elution from Schirmer’s strips in dry eye disease

Purpose: Extraction of tear protein from Schirmer’s strip is a prerequisite for the proper identification and screening of biomarkers in dry eye disease. The study compares different methods of extraction of tear proteins from the Schirmer’s strip. Methods: Reflex tear was collected from healthy controls (HC; n = 12), Stevens–Johnson syndrome (SJS; n = 3) and dry eye disease (DED; n = 3) patients using capillary tube. This tear was used to measure the volume absorbed by Schirmer’s strip per microliter. Different buffers (6) were used to compare the protein yield from the Schirmer’s strip in four different conditions. The tear proteins extracted using the highest protein yield buffer were analyzed by mass spectrometry. Results: A linear relationship between the tear volume and wetting length was observed (r = 0.0.997, n = 6). The highest yield was observed after incubation of the Schirmer’s strip in 100 mM ammonium bicarbonate (ABC) with 0.25% Nonidet P?40(NP?40) at 4°C for an hour (P < 0.00005). The in?solution digestion of tear eluted in the above condition 100 Mm ABC + 0.25% NP?40 with one?hour incubation yielded a total of 2119 proteins in HC, SJS, and DED. The unique protein observed in SJS and DED was 0.6% and 17.9%, respectively. The significantly expressed proteins are associated with innate immune response, proteolysis, wound healing, and defense response. Conclusion: A method for extraction of protein from Schirmer’s strip was optimized for increase in protein yield from the tear sample. SJS and DED tear samples have unique protein signature. The study will aid in better design of tear protein?based experimental study.

Fish hook technique for nucleus management in manual small-incision cataract surgery: An Overview

Manual small-incision cataract surgery (MSICS) preserves its utility as a cost-effective and efficient strategy for mitigating cataract-associated blindness. Numerous techniques of nucleus delivery in MSICS have been described in the literature. The fish hook technique of nucleus extraction was advocated in 1997 and has been popular for high-volume surgery in limited pockets of the world. This article describes in detail the steps involved in the construction of a fish hook, tips of nucleus extraction with the help of a fish hook, and the pros and cons of fish hook-based MSICS through text, diagram, and video supplement.

Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19

Purpose: To assess the role of remote teleconsultation (TC) follow?up care following a successful and uneventful laser vision correction. Methods: The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID?19) pandemic and were followed up with physical consultations during their follow?up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post?operative follow?up (Group 2). Results: A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/? 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre?COVID period (3.53 +/? 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight?threatening complication. Conclusion: Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult

Role of Hematological and Inflammatory Markers in Early Diagnosis and Severity of COVID‑19 Disease

Background: COVID‑19 virus, causing severe acute respiratory illness (SARS‑CoV‑2), was declared as a pandemic by the WHO in March 2020, after its first outbreak in China at the end of 2019. The major purpose is to establish the role of a hematological and inflammatory markers in early diagnosis of COVID‑19 illness and its relationship with the disease severity. Materials and Methods: The study was performed in a tertiary care center from April to September 2020. The study included 150 hospitalized COVID‑19 Reverse transcription‑polymerase chain reaction positive patients. According to ICMR standards, research patients were grouped into mild, moderate, and severe categories depending on clinical evaluation. Different laboratory parameters complete blood counts, prothrombin time (PT), activated partial thromboplastin time (APTT), d‑dimer, serum ferritin, C‑reactive protein (CRP), and mean results are compared among the patient in three disease severity groups. Results: In the studied population, there were 106 (70.7%) males and 44 (29.3%) females. The average age of the research participants was 48.40 ± 11.50 (21–75 years), with majority of patients being old (>60 years). Hematological markers such as total leukocyte count, Neutrophil‑to‑lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) and the levels of PT, APTT, and D‑dimer, as well as ferritin and CRP, all were considerably high with different groups of disease severity (P = 0.001). Conclusion: The study concluded that patients of severe disease category have significantly higher levels of leukocytosis, neutrophilia, elevated NLR, PLR, PT, APTT, D‑dimer, serum ferritin, and CRP. Hematological and coagulation symptoms are associated with COVID‑19 illness, and these indicators might be employed as a prognosticator for prediction of early disease severity.

Clinical, histological and immunohistochemistry characteristics of cornea in the sequelae stage of chronic vernal keratoconjunctivitis

Purpose: To report the clinical outcomes and histopathological and immunohistochemistry (IHC) features in eyes with the sequelae stage of vernal keratoconjunctivitis (VKC). Methods: Investigative study of corneal samples obtained following surgical intervention for vision restoration in four eyes of three patients with VKC. Patient 1 (an 11?year?old boy) had deep anterior lamellar keratoplasty in both eyes, Patient 2 (a 24?year?old male) underwent superficial keratectomy followed by penetrating keratoplasty, and Patient 3 (a 22?year?old male) underwent penetrating keratoplasty. The corneal samples retrieved after surgical intervention were assessed for histology features and immunohistochemistry (IHC) studies. Results: The grafts were clear till the follow?up of 2–18 months. Histopathology of all four corneal samples showed epithelial hyperplasia, absent Bowman layer, thick hyalinized stromal lamellae, vascularization, and chronic inflammatory cells such as lymphocytes and plasma cells. IHC showed strong expression of CK 3 in both eyes of Patient 1 and no expression in Patients 2 and 3. The marker for limbal stem cells, ABCG2, was absent in all four samples; however, p63? was expressed strongly in Patients 2 and 3, moderately in the right eye of Patient 1, and marginally expressed in the left eye of Patient 1. Conclusion: The eyes in the sequelae stage of VKC (having corneal scarring and 360° hypertrophied limbus) can be managed favorably with keratoplasty and amniotic membrane transplantation without allogenic/cadaveric stem cell transplantation. The expression of transient progenitor cells in the scarred corneas of VKC patients in the sequelae stage suggests that the limbal stem cell dysfunction is more likely partial and self?renewal of limbal stem cells is a plausibility in these eyes

Clinical features and microbiology of post-cataract surgery endophthalmitis with and without intracameral moxifloxacin prophylaxis: Endophthalmitis prophylaxis study report 3

Purpose: This study aimed to analyze the clinical presentations, microbiology, and management outcomes of post–cataract surgery endophthalmitis, with and without intracameral moxifloxacin prophylaxis. Methods: This study was designed as a retrospective, consecutive, comparative case series. Records of consecutive cataract surgery from January 1, 2015, till June 30, 2020, were analyzed. The cases that developed endophthalmitis were analyzed. The endophthalmitis cases were divided by their prophylaxis treatment into two groups: with intracameral moxifloxacin (ICM) and without (N?ICM). Inclusion criteria were (1) age ? 18 years, (2) cataract surgery with intraocular lens implantation, (3) endophthalmitis within 6 weeks of cataract surgery, and (4) cataract surgery in the institute by any of the three methods—phacoemulsification, manual small incision cataract surgery, and extracapsular cataract extraction. Results: In the study period, 66,967 cataract surgeries were performed; 48.7% (n = 32,649) did not receive ICM. There was no difference between the N?ICM and ICM groups in the incidence of clinical (n = 21, 0.064% and n = 15, 0.043%; P = 0.23) and culture proven (n = 19, 0.033% and n = 11, 0.023%; P = 0.99) endophthalmitis, respectively. Greater number of patients in the N?ICM group had lid edema (76.2% vs. 40%; P = 0.03), corneal edema (71.4% vs. 33.3%; P = 0.03) and lower presenting vision with available correction (logMAR [logarithm of the minimum angle of resolution] 1.26 ± 1.2 vs. logMAR 0.54 ± 0.85; P = 0.02). The final best?corrected visual acuity following treatment was worse in the N?ICM group (logMAR 1.26 ± 1.2 vs. 0.54 ± 0.85; P = 0.02). Conclusion: Endophthalmitis after intracameral moxifloxacin may have relatively milder signs and symptoms and may respond better to treatment.

Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible? / Previsão pré-operatória de fraturas supracondilares de úmero Gartland IV: É possível?

Abstract Objectives The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises. Methods A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected. Results Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures (p < 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17º (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45-118.65). Flexion angulation ≥ 10º (OR = 5.32; 95% CI = 0.24-119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%. Conclusion The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III.

Resumo Objetivos O presente estudo tem como objetivo identificar características pré-operatórias do paciente e da lesão, bem como da imagem que apontaria para uma fratura tipo IV. O presente estudo ajudará a equipe operacional a prever com mais precisão o padrão tipo IV pré-operatório, levando a um melhor aconselhamento dos cuidadores e planejamento da cirurgia, bem como a uma melhor preparação em relação à redução aberta, se tal situação surgir. Métodos Um estudo retrospectivo foi realizado, incluindo pacientes que atendiam os seguintes critérios: 1) idade < 16 anos; 2) fraturas supracondilares Gartland tipos III e IV; e 3) com registros completos. Foram coletados dados demográficos como idade, gênero, lateralidade, modo de lesão, duração hospitalar de lesão, histórico de tentativas anteriores de redução fechada, fratura aberta/fechada, estado neurovascular distal e dados radiográficos como angulação, translação, aposição óssea e cominação de fratura. Resultados A duração hospitalar de lesões e as tentativas anteriores de redução fechada foram os fatores com diferença estatisticamente significativa entre as fraturas tipo III e IV (p < 0,05). O diagnóstico de fraturas supracondilares tipo IV foi significativamente mais provável na presença de angulação em valgo de fragmento distal ≥ 17º (odds ratio [OR] = 20,22; intervalo de confiança [IC] 95% = 3,45-118,65). A angulação de flexão ≥ 10º (OR = 5,32; IC95% = 0,24-119,88) do fragmento distal previram Gartland tipo IV com sensibilidade de 41% e especificidade de 100%. Conclusão A avaliação pré-operatória de suspeitas de fraturas de Gartland IV pode ajudar o cirurgião operacional a prever tais lesões. Fatores não radiográficos, como o aumento da duração da lesão hospitalar, tentativas de redução previamente fechada e parâmetros radiográficos como valgo e angulação de flexão foram mais propensos a estarem associados a fraturas tipo IV. Nível de evidência III.

Arachnoiditis ossificans with syringomyelia: a unique case of myelopathy

Arachnoiditis ossificans (AO) is a rare disorder characterized by calcification of arachnoid membranes first described by Kaufman and Dunsmore in 1971. It is a very rare cause of spinal canal stenosis leading to neurological compromise presenting with progressive lower extremity myelopathy. It has been described to be a sequela of various conditions previous intradural surgery, myelograms, vascular malformations and adhesive arachnoiditis. Associated conditions may include syringomyelia. The imaging findings on MRI may be confusion. Preferred diagnostic method is non contrast computed tomography (CT). Surgical intervention is still controversial and can include decompression. The authors report the case of 48 years female presenting with gradually progressing paraparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but with an extramedullary intradural hypo-intensity. A computed tomography scan clearly demonstrated the abnormality and its extent. We present a unique case of syringomyelia resulting from spinal arachnoiditis ossificans and review the relevant literature. This case reports a unique presentation of arachnoiditis ossificans with syringomyelia in which etiology is not clear. We also highlight the difficulty is diagnosis on MRI and need of non-contrast CT.

Cytological Study of Cervical Lymph Nodes with Clinico-Radiological Correlation in Adults

Objective: The spectrum of lesions diagnosed by fine needleaspiration cytology with routine & special stains and it’scorrelation with radiological findings.Materials & Methods: The study is performed on a total ofhundred (100) patients over duration from February 2017 toSeptember 2018. The data was collected in cytopathologysection of TMMC & RC from the patients referred from OPDsor was admitted through the period of study.Results: Among 100 FNAC cases, 36(36%) had NecrotizingGranulomatous Lymphadenitis, 23(23%) had GranulomatousLymphadenitis, 20(20%) had Reactive Lymphadenopathy, 6%had suppurative lymphadenitis & 2% had Necrotic Lymphnode, 10(10%) had Metastatic Squamous cell carcinoma,2(2%) had Hodgkin Lymphoma, 1(1%) had Non – HodgkinLymphoma.Conclusion: Our study concluded that FNAC is a minimallyinvasive, cost effective and rapid diagnostic tool. When used inconjunction with radiology for the diagnosis oflymphadenopathy FNAC can be a cost effective method

Practice of self-medication among medical students in a region of northern state of India

Background: Self-medication usually leads to irrational drug utilization pattern leading to various issues like economic burden, incomplete treatment and antibiotic resistance. Self-medication is a common practice in developing countries and prevalent among medical students, influencing their future decision making as medical professional. The current study was carried out to determine the prevalence of self-medication among medical students and their attitude towards the same.Methods: A cross-sectional questionnaire based study was conducted in a tertiary care teaching hospital from July 2015 to Oct 2015. Structured and validated questions were used to collect information about knowledge, attitude and practice of self-medication among undergraduate medical students. The study included total of 328 participants. Data were collected from each participant and analyzed statistically by using SPSS version 20 for count and percentages.Results: A total of 328 subjects studying at a medical school were assessed regarding their practice, attitude and perception of self-medication behavior. Out of total recruited subjects, 53% were males and 47% were females. The prevalence of self-medication among recruited subjects was 89.9%. Symptoms like fever, Headache and weakness were the most common reasons of self-medication. The most commonly used drugs were antipyretic, analgesics (81.7%), antibiotics (51.2%). Approximately 15% subjects were not aware about the completion of the course of antibiotic treatment. Subjects obtained information and procured drugs from their family members, friends and pharmacist and the reasons for this were cited as lack of time, minor ailments and quick relief. Only 32.6% students opined that self-medication should be encouraged in future.Conclusions: Current study reveals that practice of self-medication is highly prevalent among medical students without adequate knowledge of drugs used. Students should be educated regarding advantages and disadvantages of self-medication.

Computer assisted learning module in experimental pharmacology for medical students: introduction and evaluation

Background: Animal experiments have been restricted due to strict Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA) rules and regulations for animal procurement and experimentation. At present, teaching is done by showing cards with tracings. This helps in the development of cognitive domain only. There is a need to change the traditional passive learning methodologies to an active technology based experimental learning methodology. Present educational interventional study is aimed at enhancing learning and making teaching interactive and interesting by introducing Computer Assisted Learning (CAL). Objectives of the study are to assess and evaluate the learning outcome of two methods (teaching by showing cards and computer assisted) in experimental Pharmacology and to assess the perception of students and faculty towards implementation of CAL.Methods: The study was conducted at Sarawathi Institute of Medical Sciences, Hapur, UP, India. A departmental meeting was organized to sensitize the faculty members. Test and feedback questionnaire were prepared. Participants were divided into two groups. One group was taught by cards and another by CAL. For second experiment students cross over was done. Students were assessed by post-test analysis. Feedback from the faculty and students were taken and analyzed.Results: There was improvement in knowledge of students as shown from results of post-test analysis. More than 86% of the faculty members and 80% of the students rated CAL methodology more than 3 at Likert scale.Conclusions: As compared to teaching by cards, the learning was enhanced by CAL. Students found CAL more enjoyable, interactive, comprehensible and easy to retain. In future, students would prefer CAL as an alternative method of learning in experimental laboratory.

Prescribing pattern and drug utilization study in inpatients of department of Orthopaedics in a rural teaching hospital of Ujjain, Madhya Pradesh, India

Background: Drug utilization study can increase our understanding of how drugs are being used. This study was done to evaluate the current drug prescribing trend in management of indoor patient of orthopaedic department and to comment on rationality of the prescribed medicines.Methods: This is a prospective observational study conducted for 12 months, in Chandrikaben Rashmikant Gardi Hospital, a 600 bedded tertiary care rural based, teaching hospital. Total 611 patients were included in this study.Results: Total 5416 drugs were prescribed in 611 prescriptions. Average number of drugs per prescription was 8.86. Average duration of prescription was 10.7 days. Percentage of drugs prescribed by generic name was 28.8%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 611 prescriptions antibiotics were prescribed in 368. Percentage of encounter with an Injection prescribed was 63% which means out of 611 prescriptions, injectables were prescribed in 385. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 40% of prescriptions had 2 drugs. Orally prescribed Analgesics were 62.6%, Injectables 34.38% and Topical 3.02%.Conclusions: This study reveals that the pattern of prescription in terms of rationality is poor. Special attention needs to be given to the irrational prescribing in terms of polypharmacy and long duration. Continuing medical education regarding appropriate use of drugs, knowledge of adverse effects and standard prescription guidelines will play pivotal role in rational prescription of drugs.

Correlation of Multidrug Resistance and Plasmid Profile in Extended Spectrum Beta Lactamase Producing Escherichia coli Isolated from Patients Suspected of Urinary Tract Infection.

Aims: To determine the prevalence of extended spectrum beta lactamase producing Escherichia coli (ESBL E. coli) strains among the total isolates and study the association between the antibiotic resistance and plasmid profiles of the isolates. Methodology: A total of 1258 urine samples were collected. Identification of Bacterial isolates was done using standard biochemical tests, antibiotic susceptibility pattern was determined using the Kirby - Bauer’s disk diffusion method and confirmation of the ESBL E. coli was done following CLSI guidelines. Isolation of Plasmid DNA of ESBL positive strains was done by alkaline lysis method. Results: Out of 303 isolates, 198 were E. coli. The isolates were tested for antibiotic sensitivity, MDR, ESBL and plasmid profiles. 59.09% of the E. coli isolates exhibited multi-drug resistance. 41(58.57%) out of 76 ESBL E. coli isolates possessed plasmids. Few isolates possessed single plasmid while other had multiple plasmids with different size ranged from 1 kb to 10 kb. Conclusions: High prevalence of ESBL E. coli was found with good association between the antibiotic resistance and plasmid profiles of the isolates.

Primary Pyomyositis Mimicking Soft-tissue Sarcoma: A Case Report.

Aims: Our aim was to present a case of pyomyositis and highlight the need to distinguish it from a soft-tissue sarcoma which it can closely mimic. Presentation of Case: We report a 51-year old diabetic patient who presented with a painful swelling in the right upper arm, which was not associated with fever. The mass was well defined, tender and firm but lacked other signs of inflammation such as redness or increased local warmth. Even the magnetic resonance imaging (MRI) findings were more in favor of a soft-tissue sarcoma. A diagnosis of pyomyositis was revealed when the trucut biopsy performed, yielded frank pus discharge. Discussion and Conclusion: This case illustrates a diagnostic quandary of a soft tissue mass. There may be a paucity of inflammatory signs in patients with an underlying immunocompromised state, masking an initial diagnosis of pyomyositis. Although softtissue sarcomas generally present as painless lumps, they can be painful especially with larger tumors that are increasing in size, further adding to a diagnostic dilemma. While MRI is a valuable tool for early diagnosis of pyomyositis, it can still be misleading. Prompt biopsy is recommended to facilitate the correct diagnosis.

Gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India.

Although gender-based health disparities are prevalent in India, very little data are available on care-seeking patterns for newborns. In total, 255 mothers were prospectively interviewed about their perceptions and action surrounding the health of their newborns in rural Uttar Pradesh, India. Perception of illness was significantly lower in incidence (adjusted odds ratio=0.56, 95% confidence interval 0.33-0.94) among households with female versus male newborns. While the overall use of healthcare providers was similar across gender, the average expenditure for healthcare during the neonatal period was nearly four-fold higher in households with males (Rs 243.3 +/- 537.2) compared to females (Rs 65.7 +/- 100.7) (p=0.07). Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care. These results suggest that, during the neonatal period, care-seeking for girls is neglected compared to boys, laying a foundation for programmes and further research to address gender differences in neonatal health in India.

Toxicity of industrial wastewater to the aquatic plant Lemna minor L.

Toxicity evaluation of industrial wastewater has been done by using bioassay system of an aquatic plant Lemna minor at different time intervals. Growth inhibition was measured as reduction in fresh and dry weight in industrial wastewater and sewage water, exposed L. minor plants. Results of fresh and dry weight indicate significant decrease in industrial wastewater and sewage wastewater during the different seasons of the year. At 72 and 96 hr of industrial wastewater exposure, decrease in chlorophyll content was significant in comparison to control. Decrease in total protein content was 32.5%, 14.7% and 30.6% at 96 hr of exposure in industrial wastewater in premonsoon, monsoon and postmonsoon season. Exposure of industrial wastewater to L. minor shows that it is a highly sensitive plant to the pollutants present in industrial wastewater.

Angiotensin-converting enzyme gene polymorphism in coronary artery disease in north India.

BACKGROUND: The aim of this study was to investigate the role of angiotensin-converting enzyme gene polymorphism in patients with coronary artery disease in north India. METHODS AND RESULTS: One hundred forty-six patients with angiographically proven atherosclerotic coronary artery disease, and 146 age- and sex-matched control subjects (treadmill-negative) were included in the study. Genomic DNA was extracted and analyzed for angiotensin-converting enzyme insertion/deletion polymorphism. Two independent investigators scored the genotypes. CONCLUSIONS: When we compared the genotypes of patients with coronary artery disease with those of normal controls, it was seen that all three genotypes, i.e. DD, ID and II, were not statistically different among patients and controls. Further, we categorized the patient and control groups into 2 subgroups, i.e. below and above 50 years of age. Interestingly, it was observed that the DD genotype was significantly higher in patients in the higher age group (i.e. above 50 years of age). However, this needs further validation by studying patients with coronary artery disease from other parts of India.

Polymorphisms in the apolipoprotein B-100 gene: association with plasma lipid concentration and coronary artery disease.

BACKGROUND: The aim of this study was to investigate the association of apolipoprotein B gene polymorphisms with coronary artery disease and lipid levels in Indians. METHODS AND RESULTS: One hundred patients of angiographically proven atherosclerotic coronary artery disease and one hundred age- and sex-matched control subjects (treadmill negative) were included in the study. Serum lipids including cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, and apolipoprotein B were analyzed. Genomic DNA was extracted and the apolipoprotein B 3' hypervariable region amplified by polymerase chain reaction. Regions carrying Xba1, EcoR1, and Msp1 restriction sites present in the apolipoprotein B gene were amplified and digested separately by the respective enzymes. Restriction fragment length polymorphism analysis showed that EcoR1 with the R+/R+ genotype was significantly more common in patients with coronary artery disease. Overall, the genotypes EcoR1+/+, Msp1+/+, Xba1+/+ and Eco R1+/+ Msp1+/-, Xba1-/- were significantly more common in patients as compared to controls (p<0.05). When gene polymorphisms were compared with lipid abnormalities, the genotypes EcoR1+/+, Xba1-/-, and Msp1+/+ were more frequent in patients with elevated apolipoprotein B and very low-density lipoprotein levels. On the other hand, these genotypes were less common in patients with increased total cholesterol and low-density lipoprotein levels. When we studied the individual alleles of the variable number of tandem repeats region, we observed that allele 34 was significantly increased in patients with coronary artery disease as compared to controls. Allele 36 was present with a frequency of 1% in controls while it was totally absent in patients. CONCLUSIONS: This study identifies the apolipoprotein B gene polymorphism associated with coronary artery disease. An association between apolipoprotein B gene polymorphisms and elevated apolipoprotein B and very low-density lipoprotein levels was observed. However, there was no positive association with other elevated lipid levels in North Indians from Uttar Pradesh.