Evaluation of utility of immunohistochemistry markers as a tool for objective diagnosis of low-grade myelodysplastic syndrome in routine reporting: Prospective observational study

Purpose: Diagnosis of myelodysplastic syndrome (MDS) primarily relies on the detection of morphological dysplasia in bone marrow. It is subjective and many studies have reported lack of interobserver agreement in reporting. Biopsy is preferred specimen for megakaryocyte assessment. We studied 43 bone marrow biopsies from 40 suspected MDS patient having persistent undiagnosed cytopenia. Utility of immunohistochemistry (IHC) with CD61 and p53 in detecting low-grade MDS was analyzed over routine morphology. Method and Results: Total number of megakaryocytes and number of dysplastic megakaryocytes seen on CD61 IHC was significantly higher than that on H and E stain (P value < 0.05) Out of total 43 biopsies, 13 [30.2%] cases showed dysplastic megakaryocytes that were confirmed by interobserver agreement after IHC. From 30 cases with no significant dysplasia on morphology, 21/43 [48.8%] cases showed >10% dysplastic megakaryocytes on CD61 (P value 0.0001). Nine cases showed no significant dysmegakaryopoiesis with either H and E or CD61 IHC. Fourteen cases could meet higher cut off (30%) of dysmegakaryopoiesis with CD 61 IHC. Out of total 34 cases showing significant dysplasia 7 cases (20.6%) showed positivity for p53 on IHC, which is little less than that reported in low-grade MDS. Conclusion: CD61 IHC is helpful in making correct diagnosis of MDS in cases with minimal dysplasia and should be performed before excluding possibility of MDS on morphology in a patient with undiagnosed cytopenia. IHC is cost effective tool for MDS diagnosis in developing world where access to extensive flow cytometery and molecular testing is limited.

Small cell variant anaplastic large cell lymphoma presenting as leukemia: A case report and review of Literature

Anaplastic large cell lymphoma (ALCL) is a subcategory of the mature T-cell neoplasm characterized by sheets of cluster of differentiation (CD)30-positive pleomorphic large cells mostly present as lymphadenopathy. Here, we describe a case of Small cell variant ALCL with leukemic presentation without lymphadenopathy. A 68-year-old male presented with fatigue and weakness; examination revealed a total leukocyte count of 295,000/uL. The peripheral smear showed cells having cerebriform nuclei comprising 90% of the leukocytes. The flow cytometry showed that the cells were immunopositive for CD3 (weak), CD4, CD7, and negative for the rest of the markers. The cell blocks from the peripheral blood showed cells with immunopositivity for CD30, anaplastic lymphoma kinase (ALK), and Epithelial membrane antigen (EMA). A diagnosis of the small cell variant of ALK-positive ALCL was made. Due to the presence of atypical pleomorphic cells without lymphadenopathy, the case has a diagnostic dilemma with differential diagnosis of Sezary syndrome, T-cell prolymphocytic leukemia, and adult T-cell leukemia/lymphoma. Karyotyping and additional immunohistochemistry help for the confirmation of the diagnosis.

Impact of BMW Segregation Training Program on Hospital Infection Control in a South Indian Hospital

This study aimed to investigate anaerobic co-digestion of palm oil mill effluent (POME) with cassava peels (CP) and cabbage waste (CW) for biomethane production. The anaerobic digestion (AD) in 10L capacity bioreactors loaded separately with three different ratios (3L/ 520g, 3L/ 600g and 3L/ 680g) of POME/CP, POME/CW and POME only (control) was operated under ambient temperature (25 - 36?C) and pH range of 6.5 - 8.5 for 45 days. Standard methods were adopted in the characterization of the bioreactor feeds and microbiological study. The biomethane content of the biogas was determined using Gas Chromatography (GC). The results showed the presence of Escherichia coli, Staphylococcus, Pseudomonas sp, Bacillus sp Salmonella sp among others. Fungal isolates identified include Saccharomyces, Aspergillus, Rhizopus, Penicillum, and Geotrichum species. The mean cumulative biogas yield recorded in bioreactors charged with POME/ CP 520g, POME/ CP 600g, POME/ CP 680g and POME/CW 520g, POME/CW 600g, POME/CW 680g were 7.08, 5.18, 9.06, 9.13, 9.28 and 8.33 dm3, respectively, whereas POME alone (control) was 4.64 dm3. The best performance in biogas yield was exhibited by POME/CW 600g (9.28dm3), and the highest percentage biomethane content (68.80%). Analysis of variance (ANOVA) revealed a significant difference (P ? 0.05) in biogas yield in all the treatments compared to control (POME alone) except in POME/CP 3L: 520g and POME/CP 3L: 600g. The results have shown that biogas production and biomethane content could be efficiently improved via co-digestion process, depending on the substrates used as feedstock.

Correlation of Menopausal Status with Body Composition and Abdominal Fat Distribution

Background: Body composition parameters changes in women before and after menopause which makes ageing more complex and stressful in women. Objective: to compare the body composition parameters among pre and post menopausal women. Methods: A cross-sectional study, conducted in the population around Rural Health Training Centre (RHTC), Barabanki district between May to December 2016 among women in the age group 25-65 years. Body composition parameters of 348 women (total and visceral fat distribution) by bioelectric impedance method (for Model: OMRON Hbf 375) was noted for all the pre-menopausal and post-menopausal women. The variables included -weight, BMI, body fat percentage (BF %) and visceral fat percentage (VF %), Body Surface Area (BSA), Body volume index (BVI), Body volume (BV) and Lean body weight (LBM). Result: The difference in body composition parameters in the pre and post-menopausal groups is found to be statistically significant in waist circumference, waist-hip ratio, BMI and visceral fat p<0.05. Conclusion: There is increase in body composition parameters during post-menopausal period. A deeper aspect on prevention of obesity after menopause is required to be studied.

Smartphone Addiction in Medical Students: Association with Perceived Stress, Personality Factors and Loneliness

Background: Smartphone addiction (SMA) is an emerging concept. It has been associated with high perceived stress. There is a dearth of data on its association with loneliness and personality in the Indian context. Objectives: We planned this study to estimate the prevalence of SMA in medical students, verify its reported association with perceived stress, and determine its association with personality factors and loneliness. Methods: Four hundred and two medical students participated in this cross‑sectional study. We used the SMA scale‑short version to divide students into those having an addiction and not having an addiction. The Perceived Stress Scale, ten‑item personality inventory, and University of California, Los Angeles Loneliness Scale were used to assess perceived stress, personality, and loneliness. Ninety‑five percent confidence intervals were reported for all comparisons. Results: The prevalence of SMA in medical students was 34.8%. SMA was associated with higher perceived stress and loneliness. Students having SMA scored lower on personality domains of extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience. Moreover, SMA interfered with students’ social life and academic performance. Conclusions: SMA is a cause for concern. We need to plan the awareness campaigns focusing on SMA and its association with social life and academic performance. Researchers need to explore this concept in larger samples and diverse population groups to know its actual magnitude and impact. Moreover, dedicated psychiatric committees need to recommend the guidelines for the judicious use of smartphones.

Emergency Medical Service (EMS) Belt

Background:Emergency medical service has been a well-know n subject of discussion in India where the population is vast and the health care system is inadequate. Essential drugs are a category of drugs that are needed during the golden hour of saving a patient’s life. It becomes necessary that time, when a simple drug can save the life of a patient, a competent health care provider, is needed to administer the drug to the patient. In such a situation, any health care provider in the vicinity of the person who needs medical assistance must get an alert so that the health care provider can reach the site of the emergency and provide assistance. EMS belt is a system in which with the help of a mobile application, any person in case of a medical emergency can get service from a nearby health care provider within a few minutes. The concept is to raise an alarm alerting the nearby health care practitioners about the person in need of medical assistance. This concept is promising with the advantage that it doesn’t need any special manufacturing of the device. Conducting trials on this concept shall yield good observations and produce hopes for a cost-effective EMS system in India.

One Virus! But Different Masks in Different Countries for Protection Against it! How to Choose?

COVID -19 is causing plenty of deaths in India as well as globally andmany of them are health care workers (HCWs).As per data given by IMA 744 MBBS doctors have been died due to Covid–19 till 4 February 20213.As this disease transmitted between person to person by respiratory droplets hence mask hygiene is very important effective preventive measure for HCWs. In market due to high demand, much different type of masks is available with different specifications. Some of them are from Indian origin and many of them are procured from foreign. Many of them are not effective to safeguard health care workers against COVID 19 infection2. Hence this paper will discuss different country specific standards of masks in relation to SARS COV-2 as well as home based disinfection method of masks. In market many masks are available and most of them are sub-standard and making falsely claim of N95. Most of them are not able to protect Health Care Workers from the infection of SARS COV-2. Hence in this paper will examine different countries specific standard of mask with respect to size of SARS COV-2. US standard N95 masks will give desire level of protection against SARS COV-2. Conclusion:NIOSH certified N95 or N99 or N100 mask should be given priority over other counties N95 equivalent masks. Chinese masks GB2626-2006 are least recommended among all other countries N95 equivalent masks6.

A Critique On Learning Theory

Learning in humans is an extremely complex process.Many theories have been espoused to explain the learning process. However, no single theory can fully explain how learning process occurs. There is no clear cut demarcation between the theories. Their boundaries seem to be overlapping with each other. Cognitive psychologists have explained how learning takes place from different perspectives. The major traditional schools of thought concerning learning include behaviourist, cognitivist, and constructivist schools. Socio-cultural, situated and activity theories of learning have emerged more recentlythroughunderstanding the ways in which students learn, teachers can help them learn by planning the most effective way to learn. The appropriateness of any learning theory depends on the context. A blend of learning theories is suitable most of the times.

National consensus statement regarding pediatric eye examination, refraction, and amblyopia management

Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.

Prevalence and causes of childhood blindness in India: A systematic review

Childhood blindness is one of the priority targets of Vision 2020—Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.

Evaluation of Barrett universal II formula for intraocular lens power calculation in Asian Indian population

Purpose: Barrett Universal II (BU-II) is considered as one of the most accurate intraocular lens (IOL) power calculation formulas; however, there is no literature studying the same in Indian population. The aim of this study was to evaluate the accuracy of BU-II formula in prediction of IOL power for cataract surgery in Asian Indian population. This was an institutional, prospective, observational study. Methods: Patients with senile cataract who underwent phacoemulsification with posterior chamber IOL implantation were enrolled in the study. Biometry data from Lenstar-LS900 was used and IOL power was calculated using four IOL formulas: modified SRK-II, SRK/T, Olsen, and BU-II. Primary outcome was measured as the prediction error in postoperative refraction for each formula and secondary outcome was measured as the difference in mean absolute errors between the four formulas. SPSS Version-21 with P < 0.05 considered significant. Results: A total of 244 eyes were included in the study and were divided into three groups in accordance to axial length (AL): Group 1 (AL: 22�.5 mm; N = 135), Group 2 (AL <22 mm; N = 53), and Group 3 (AL >24.5 mm; N = 56). BU-II formula gave the lowest mean absolute error (0.37 � 0.27D) and median absolute error (0.34) in predicted postoperative refraction in the entire study population. When compared with the other formulas, mean absolute error was significantly lower in all three groups (P < 0.0005) as well, except for Olsen formula in the normal AL group, where the results were comparable (P = 0.742). Conclusion: BU-II performed as the most accurate formula in the prediction of postoperative refraction over a wide range of ALs.

Vertical rectus transposition procedures for lateral rectus palsy: A systematic review

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy,” “vertical rectus transposition for abducens palsy,” “superior rectus transposition,” “inferior rectus transposition,” and “Hummelsheim procedure.” References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.

Extraocular muscle surgery on goats' eye: An inexpensive technique to enhance residents' surgical skills

Hands-on resident surgical training for various ocular procedures is essential to impart good surgical skills to the budding ophthalmologists. Here in this report, we demonstrate a simple and inexpensive technique of performing extraocular muscle surgery on goats' eye. These animal eyes possess soft tissue resemblance to that of human eyes to a greater extent in terms of scleral rigidity, muscle elasticity, its width, thickness, and its insertion onto the sclera. Therefore, rectus muscle recession, resection, and plication surgeries can be performed repeatedly to improve an individual's orientation and practical experience before performing the procedure on human eyes.

A Peripheral Smear Finding Beyond Cells: Cryoglobulins in a Case of Lymphoplasmacytic Lymphoma

A well prepared peripheral smear is an indispensable requisite for the diagnosis of hematological disorders and in some situations, non-hematological diseases. Here, we present the typical hemogram and peripheral smear findings of circulating cryoglobulins that led to the unraveling of the underlying lymphoproliferative disorder. A 51-year lady presented with symptoms of anemia since four months. Her hemogram showed anemia and leucopenia with flagging of platelet count. Peripheral smear at room temperature revealed marked artefactual changes in red blood cells including fragmentation. The morphology was better appreciated after incubating the sample at 37°C and showed normocytic normochromic RBCs, thrombocytopenia with a few lymphoplasmacytic cells and amorphous pinkish material in the background. Bone marrow examination showed near total replacement of marrow spaces by lymphoid cells positive for CD20 and CD138 and was diagnosed as lymphoplasmacytic lymphoma. Cryoglobulins can thus cause a range of laboratory artefacts which need to be recognized, warranting further search for possible underlying etiologies.

Distribution of common BCR-ABL fusion transcripts and their impact on treatment response in Imatinib treated CML patients: A study from India

Background: Philadelphia chromosome (Ph): Hallmark of CML is caused by reciprocal translocation between chromosomes 9 and 22 resulting in BCR-ABL fusion protein. Most commonly associated breakpoint with CML is M-bcr in exon 13 or exon 14, producing splice variant b2a2 or b3a2 respectively. The distribution of these transcripts and their influence on clinico-hematological parameters is variable. Impact of the fusion transcripts on treatment outcome in Imatinib treated CML patients is still a matter of debate. Aims/settings and design: We conducted this study on 400 CML-CP patients to look for the distribution of fusion transcripts i.e. b3a2 and b2a2, their clinico-hematological profile and impact on treatment response in patients treated with Imatinib. Material and Methods: CML-CP was diagnosed by reverse transcriptase PCR (RT-PCR) for the BCR-ABL fusion transcript. Real-time quantitative PCR (RQ-PCR) was performed on peripheral blood every 3-6 monthly to look for treatment response. Results: The overall frequency of b3a2 transcript was observed in 288 (72%) followed by b2a2 in 104 (26%) and hybrid fusion transcript (b3a2 + b2a2) was seen in 8 (2%) cases. MMR was attained in 198/288 (68.7%) patients with b3a2 transcript and 90/288 (31.3%) patients failed to achieve MMR after 12 months of Imatinib therapy. Among the patients with b2a2 transcript, 44/104 (42.3%) patients achieved MMR and 60/104 (57.7%) patients failed to achieve MMR after 12 months of Imatinib therapy. Conclusions: In conclusion, the frequency of b3a2 transcript was more as compared to b2a2 transcript. MMR was significantly higher in patients with b3a2 transcript as compared to patients with b2a2.

Assessment of macular vascular plexus density using optical coherence tomography angiography in cases of strabismic amblyopia

Purpose: To evaluate the superficial retinal vascular plexus density using optical coherence tomography angiography (OCTA) in cases of strabismic amblyopia. Methods: Ten eyes of 10 patients with purely strabismic amblyopia underwent detailed ocular evaluation followed by the assessment of the superficial retinal plexus vascular density using OCTA (Topcon DRI OCT Triton, Swept Source OCT, Topcon, Japan). Ten contralateral normal eyes of the same patients were considered as control. All these 20 eyes underwent a 4.5 × 4.5 mm cube scan OCTA centered at the fovea. Using the Topcon propriety software all 20 eyes were assessed for the capillary plexus density of the superficial retinal vascular plexus along the superior, inferior, nasal, and temporal quadrants centered at the fovea. The numerical values were statistically assessed using a paired t-test with respect to each quadrant between the normal and the pathological eyes. Results: The average age of patients was 16 years and eight patients were males. The mean superficial retinal vascular plexus density along the superior, inferior, nasal, and temporal quadrants in normal and pathological eyes were 49.25 ± 30.34 and 48.93 ± 2.85, 47.22 ± 4.11 and 47.37 ± 4.8, 45.54 ± 1.55 and 43.81 ± 4.21, and 46.26 ± 4.63 and 46.38 ± 5.40, respectively. Similarly, the capillary densities along the central were 17.84 ± 3.49 and 17.24 ± 2.44 in normal and pathological eyes. The differences among all these four quadrants and central area were not statistically significant (P-values > 0.05 for all four quadrants and central area) as compared with the normal eyes. Conclusion: The superficial retinal vascular plexus density of a 4.5 × 4.5 mm cube centered at the fovea of eyes of cases of strabismic amblyopia is similar to that of normal eyes.

Perceived difficulties and complications in learners of phacoemulsification: A principal component analysis model

Purpose: To evaluate the difficulty perceived of each step of phacoemulsification and analyze the factors affecting them. Methods: Overall, 12 trainee residents were allotted 10 cases of phacoemulsification of eyes with senile cataract, under a single observer, and the steps of each surgery were rated from very easy to very difficult with a questionnaire. The completion rates of steps and complications of each surgery were noted. Principal component analysis of the responses to the difficulty level questionnaire was conducted to obtain factors resulting in the perceived difficulty. Results: The lowest difficulty scores were for initial step of incision creation (1.63 � 0.84), followed by intraocular lens insertion (2.51 � 0.8). The most difficult step was divide/chop of the nucleus (3.74 � 0.97) followed by phacoemulsification (3.32 � 0.82). Highest completion rates were seen for the initial steps of the surgery and the lowest for divide/chop. We identified two major patterns of difficulty among the trainees � one for steps involving high amount of binocularity and the other, for steps involving high precision of hand control. The rate of complication of our study was within acceptable range. Conclusion: Although trainees have practiced phacoemulsification steps on simulation, real-life situation may bring in unprecedented level of difficulty and challenges, which may be documented and used for targeted improvement of surgical skills. Stereopsis and hand control training should form a major part of training modules of cataract surgery both on simulation and real-life scenarios.

Infertility & assisted reproduction: A historical & modern scientific perspective

Infertility has always been considered as a social stigma and has often been treated as socially, mentally and physically damaging experience for the childless women rather than man. Fatherhood was more a social rather than biological concept, thereby making childlessness a legitimate ground for divorce and a matter of disgrace for women. Every country has its own set of customs and traditional beliefs for the relief of childlessness. While introducing a second wife was one way to overcome the predicament of childlessness, divorce was also an available choice. There were several myths that contemplated the human concerns and their needs during ancient times. It is evident that types of the infertility and their treatment in the modern era have some historical background and different representations in the ancient civilizations. The present review discusses the historical and modern perspectives of infertility and assisted reproduction and their importance in different cultures.