Current trends and advances of Quorum sensing inhibitors and their biotechnological applications

Serious setbacks were witnessed in shrimp farming, the food industry, and the ship industry during the past three decades primarily due to bacterial pathogens that coordinate by quorum sensing (QS). The influence of bacterial pathogens utilizing QS. The impact of QS cell communication on public health is extremely disastrous in terms of spread, spectrum, apart from their economic impact. The overuse of antibiotics has increased drastically to battle bacterial infections, including tons of antibiotics are distributed in the biosphere. Due to the indiscriminate use of antibiotics, multiple antibiotic-resistant strains have emerged, as the antibiotic resistance genes are being transferred to bacteria of terrestrial animals, humans, and pathogens. The increased public awareness of the negative drawbacks caused by over-exposure to antibiotics, also the emergence of multiple antibiotic resistant pathogenic stains led to the search for alternatives and unique solutions. One such unconventional, promising method is the interruption of bacterial cell to cell communication, which is currently termed QS inhibition. Now-a-days, QS inhibition is the potential objective for antimicrobial chemotherapy. This review summarizes the regulatory factors that attenuate the QS activities of deadly pathogens and discusses their distinctive characteristics. Improving awareness of the natural roles of regulatory elements might be useful in unveiling inhibitor applications to understand how QS is inhibited in pathogenic bacteria by different QS inhibitors.

Quality of life in patients treated for COVID-19–associated mucormycosis at a tertiary care hospital

Objectives@#Coronavirus disease 2019 (COVID-19)–associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19. The aggressive management ofCAM affects quality of life (QOL); thus, this study was designed to assess the QOL in patients with CAM at a tertiary healthcare institution. @*Methods@#This cross-sectional study of 57 patients with CAM was conducted over 6 monthsusing a semi-structured standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]) and a self-rated improvement (SRI) scale ranging from 0 to 9. Cut-off values of ≤52 and < 7 were considered to indicate poor QOL and poor improvement, respectively. The correlations of QOL and SRI scores were evaluated using Spearman rho values. @*Results@#In total, 27 patients (47.4%; 95% confidence interval [CI], 34.9%–60.1%) and 26 patients (45.6%; 95% CI, 33.4%–58.4%) had poor QOL and poor SRI scores, respectively. The overall median (interquartile range) QOL score was 52 (41–63). Headache (adjusted B, −12.3), localized facial puffiness (adjusted B , −16.4), facial discoloration (adjusted B, −23.4), loosening of teeth (adjusted B, −18.7), and facial palsy (adjusted B, −38.5) wer e significantly associated with the QOL score in patients with CAM. @*Conclusion@#Approximately 1 in 2 patients with CAM had poor QOL and poor improvement.Various CAM symptoms were associated with QOL in these patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM.

Prevalence of Bronchial Asthma in School Going Children: A Cross-Sectional Study from Uttar Pradesh

Background: Asthma is coined as a chronic inflammatory disorder and disarrays of the airways and respiratory tract which manifests as recurrent episodes of wheezing, breathlessness, chest tightness, and cough. The World Health Organization recognizes asthma as a major health problem. Although asthma can occur at any age, children and young adults are the age groups which are affected more commonly. Objectives: The objective of this study is to find the prevalence of bronchial asthma in school?going children (6–16 years) and its associated factors. Materials and Methods: A cross?sectional study among the school?going children in the age group of 6–16 years was done in the field practice areas of urban health and training center and rural health and training center of the Department of Community Medicine, JNMCH, A. M. U., Aligarh, U.P. the study done for a period of one year. The validated questionnaire (International Study on Allergy and Asthma in Childhood) was used. The sample size was taken as 902. The data were entered and analyzed in the SPSS statistical software version 20.0. Chi-square was used. Results: The prevalence of asthma among the study population was found to be 26.9%. Family history of smoking and history of allergy in an individual came out to be a significant factor associated with asthma. The association is also significant between asthma and the diet of an individual. Conclusions: Asthma among school children is a public health problem in urban and rural areas. There was a rising pattern in the prevalence of asthma at national and subnational levels.

Differences between Men and Women in Terms of Clinical Features of ST-Segment Elevation Acute Myocardial Infarction

Background: Several research have investigated further into differences in clinical characteristics of acute myocardial infarction between men and women (AMI). Prospective studies, on the other hand, are few, and sex-related variations in AMI symptoms are unknown. We studied at the variations in clinical characteristics of ST-segment elevation AMI between men and women.Material & Methods:We evaluated at 151 patients with ST-segment elevation AMI who were hospitalized within 24 hours of symptom onset (70 women and 81 males). Within 48 hours of hospitalization, all patients were interviewed by many of the same cardiologist.Results:Women exhibited higher rates of hypertension (70 vs 56 percent, p=0.010), diabetes mellitus (36 vs 26 %, p=0.047), and hyperlipidemia (51 vs 38 %, p=0.019) than males (72 vs 62 years, p0.001). Non-specific symptoms (45 vs 34%, p=0.033), non-chest discomfort (pain in the mouth, throat, neck, shoulder, arm, hand, and back), moderate pain (20 vs 7%, p0.001), and nausea (49 vs 36 percent, p=0.013) were all more common in women than in males. The severity of coronary artery lesions was equal in both sexes on coronary angiography. Women had a considerably greater in-hospital death rate than males (6.6 vs. 1.4%, p=0.003).Conclusions:Women and men with AMI have different clinical profiles and presentations. AMI symptoms are less common in women than in males.

Osteocalcin, a promising marker of osteoporosis: evaluation in post-menopausal females with osteoporosis

Background: Osteocalcin, has high affinity for calcium. In osteoporotic women, deficiency of calcium may lead to lowering of the formation of hydroxyapatite crystals. Thus, in the state of hypo mineralization, free osteocalcin available in the circulation. Therefore, present study was designed to evaluate significance of serum osteocalcin in diagnosis of osteoporosis, and relationship between Serum Osteocalcin and BMD (Bone mineral Density) in post-menopausal females with osteoporosis and without osteoporosis.Methods: One hundred and forty seven post-menopausal women between age 45 to 80 years attending the hospital OPD were studied. To be eligible for the study they had to have been postmenopausal for at least one year. The diagnosis of osteoporosis was made based on T-Scores (BMD) at the lumber spine (L1 to L4 and femaral neck) by DEXA (GE lunar Densitometer). Serum osteocalcin level was estimated by LIAISON osteocalcin assay. Patients with chronic conditions affecting skeletal health and patients on drugs affecting the skeleton were excluded from the study.Results: Serum osteocalcin level in post-menopausal female without osteoporosis was 9.87±1.04ng/ml, while post-menopausal female with osteoporosis had 22.62±2.25ng/ml suggesting significant increase in bone marker level in osteoporotic females (p<0.05.) Correlation study between BMD and osteocalcin showed strong Negative Correlation (r=-0.77, p<0.05).Conclusions: Serum osteocalcin can be considered as a specific marker of osteoblast function as its levels have been shown to correlate with bone formation rates. Thus, serum osteocalcin can be used for diagnosis and monitoring of response to therapy and this may be the better predictor than BMD.

A comparative study of preoperative and postoperative changes in corneal astigmatism after pterygium excision by different techniques

Purpose: To study the changes in corneal astigmatism before and after pterygium excision as well as with differences between various surgical techniques (bare sclera, conjunctival autograft, amniotic membrane graft). Methods: The study population included 71 patients with primary pterygium who underwent surgery. The surgical techniques used differed among the study population. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were assessed for visual acuity, autorefraction, and autokeratometry on day 5, 1 month, and 3 months and the results were analyzed. Paired and unpaired t-tests were used to compare the variables. The probability level of 0.05 was considered as statistically significant. Results: The reduction in the mean preoperative astigmatism of 3.47 ± 1.74 Diopters (D) to 1.10 ± 0.78 D 3 months after surgery was statistically significant (P < 0.0001). Bare sclera, conjunctival autograft, and amniotic membrane graft techniques exhibited changes in astigmatism amounting to 1.85 ± 0.88 D, 2.55 ± 1.26 D, and 2.67 ± 1.44 D, respectively. Pterygium excision surgeries using amniotic membrane graft and conjunctival autograft techniques were more effective than pterygium excision surgery using bare sclera technique in reducing astigmatism. Conclusion: Pterygium excision results in significant reduction in astigmatism which leads to improvement in visual acuity. Amniotic membrane graft and conjunctival autograft are better surgical techniques than bare sclera as far as reducing astigmatism is concerned.

Outcome and clinical efficacy of bleomycin and doxycycline percutaneous sclerotherapy for treatment of paediatric lymphatic malformations in a limited resource setting

Background: The aim was to study the role of bleomycin and doxycycline as a cheap and readily available sclero-therapeutic agent in the treatment of lymphatic malformations in paediatric populations of poor resource setting.Methods: It was a longitudinal study. A total of 23 paediatric cases with distinct types of lymphatic malformations were treated with injection sclerotherapy. Bleomycin and doxycycline used for microcystic and macrocystic lesion type respectively. The patient was followed up to complete remission. The level of evidence was Level II and type of evidence was prognosis study.Results: Commonest site of lesion was neck (78.3%), followed by cheeck (8.7%), chest, shoulder and suprapubic region. Only 21.7% of patients had good reduction (50-89%) in their lesion volume on first follow up. Overall 43.4% of patients showed a reasonable reduction in lesion volume during the follow-up period. Almost 3/4th of patients improved symptomatically on the first follow up visit. Macrocystic lesion showed an excellent response to treatment (50-89% volume reduction) in 33.3% of cases while only 16.7% of microcystic ad 12.5% of the mixed lesion showed a similar response to treatment.Conclusions: Doxycycline sclerotherapy can be a primary treatment modality in macrocystic and mixed macrocystic lesions. It is inexpensive and widely available and has minimal side effects. In contrast, bleomycine as a sclero-therapeutic agent showed an inadequate response in size reduction of microcystic lesions.

Mental health, functional ability, and health-related quality of life in elderly patients attending a tertiary hospital of Patna

With changing socioeconomic, demographic, and development scenario, there is a cultural shift in looking after the elderly population which may lead to depression in this age group. Materials and Methods: The study was a hospital-based cross-sectional study conducted in the orthopedic department of a tertiary care setting on 157 elderly individuals. This study was conducted with objectives to estimate the proportion of depression using the Geriatric Depression Scale Short Form (GDS-SF) questionnaire along with its associated factors in geriatric population coming to the orthopedic department of the institute. The study tools were GDS-SF, Katz Index of Independence in activities of daily living (ADL), the Lawton instrumental ADL, and health-related quality of life by the Centers for Disease Control. Results: The proportion of depressed individuals was 70/157 (44.6%) using GDS as a tool. The maximum number was in the age group of 60–74 years. Women outnumbered men (51.3% vs. 38.31%) for depression. The depression using GDS score was more prevalent in rural elderly, illiterate, and elderly who were economically dependent on their children and who belonged to lower middle socioeconomic status. Approximately 98% of the study participants were found to be independent using ADL. Approximately 60% males and 68% females were dependent for the instrumental ADL using Lawton score. Most of the study participants had arthritis as a major impairment sharing almost equal proportion among males and females. Conclusion: The current study concludes that there is a very high proportion of elderly subjects who are experiencing depression using the GDS-SF tool. There should be regular screening for this disease in this age group even in a tertiary care setting.

Translation initiation codon (ATG) or SCoT markers-based polymorphism study within and across various Capsicum accessions: insight from their amplification, cross-transferability and genetic diversity

Being an economical and nutritional crop, Capsicum appeases people’s peppery taste and is found to bewidely distributed all over the world having vast diversity. In the present study, genetic polymorphism, cross transferability (CT) and genetic diversity were examined among the 54 different accessions of Capsicum species including 49 of Capsicum annuum, three of C. baccatum and two of C. frutescens, using a set of 36 start codon targeted (SCoT) primers. Of the total, 35 SCoT markers showed successful amplification profile among chilli germplasms and an average primer polymorphism was reported as 81.52% which ranged from 50% (SCoT-6) to 100% (SCoT-11). A total of 365 amplicons were obtained with an average of 10.43 bands per primer and the length of the bands ranged from 150 bp to 1.2 kb. Further, polymorphic information content value of SCoT markers ranged from 0.42 (for SCoT-25) to 0.86 (SCoT-27) with an average of 0.78. The average value of CT of SCoT markers was 44.08% ranged from 14.25% to 57.26% among different chilli accessions. A dendrogram was constructed and established genetic relationship among 54 capsicum species, with the help of translation initiation codon polymorphisms or SCoT primer amplification. This study suggests the effectiveness of SCoT marker system for characterizing and assessing genetic diversity of Capsicum germplasm, which can be used for evolutionary studies and to identify agronomically important traits.

Clinical study of anemia in rural school children of Mangalore, Karnataka, India

Background: The study was conducted to know the prevalence of anemia in rural school children located within 15km radius of Yenepoya Medical college hospital, Mangalore and to study the risk factors associated with anemia also to correlate the detection of anemia by clinical examination and by lab estimation of hemoglobin.Methods: A total of 550 children in the age group of 6-15 years were included in this study. Parental informed consent was obtained. A preplanner questionnaire was used to collect the health and socio demographic details. Blood was collected by venepuncture method and haemoglobin was determined by automated sysmex machine. Diagnosis of anemia was made according to WHO cut off value of Hb.Results: Out of 550 children 114(20.6%) were anemic. There was no significant difference between age and sex. Anemia was found to be more prevalent in children with h/o passing worms, undernourished, pica and low socio-economic status. Out of 550 children 174 children had conjunctival pallor on clinical examination. Among that 58 (33.3%) children had anemia on hemoglobin estimation. Majority of the children 116 (66.7%) who had pallor on clinical examination was found as non-anemic on hemoglobin estimation. On kappa co efficient, statistics showed that two examinations to detect anemia was 18.47 %, which indicates poor agreement.Conclusions: The overall prevalence of anemia among rural population is variable depending upon the region. Major factors which influence the prevalence of anemia were nutrition, socioeconomic status, pica and worm infestation. Clinical diagnosis by examination of pallor is poorly correlated by estimation of haemoglobin, hence anemia cannot be diagnosed by detection of pallor alone and it requires lab haemoglobin estimation to prevent wrong diagnosis of anemia.

Self-medication practices among rural households atChiraigaon Block, Varanasi

Background & Objective: Self-medication is defined as medication taken on the patient own initiative or on the advice of pharmacist or any other lay person. Unavailability of qualified medical personnel in rural areas pushes the rural households for self-medication practices. The present study was conducted to elicit the self-medication pattern among rural households and its indicators across various socio-demographic parameters. Method: A cross-sectional study was conducted among 270 household. The study was carried during November 2013 to January 2014. A predesigned and pretested questionnaire was used for the study. The door to door approached was used. Out of 1500 household, 270 were sampled in this study. Statistical Analysis: Data analysis was done by using Microsoft excel 2007.Result: Medicine was available in 46.7%. Among these medicine Antibiotics was most commonly available (84.1%), followed by Antipyretics (74.6%), Analgesic (64.3%), anti-histaminic (58.7%), Multivitamin (24.6%).Fever was the most common indication (83.3%) for self-medication, followed by Body ache/Headache (51.6%). Diarrhea (53.2%), Cough (61.9%) Weakness (23.8%). In 11.1% household medicine was found expired. 77.8% of household check expiry before use medicines. Unavailability of qualified doctor (36.5%) was most common reason for self-medication. Responded were getting these medicine from medical shops either by telling symptoms (38.1%) or by using empty blister/bottle (30.2%).Conclusion: Self-medication is increasing at alarming pace. There is need to ensure community education, safety and efficacy of self-medication.

Use of New ACC/AHA 2017 guidelines for estimation of prevalence of hypertension among adult population visiting a Tertiary Care Hospital of Eastern India

Background: In November, 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) released new guidelines for classification of hypertension among adults. JNC 7 guidelines are most used till now. The present study aimed to measure the burden of hypertension among adult population using new ACC/AHA guidelines and to compare it with JNC 7. Method: A descriptive cross sectional study was carried over a period of one month as a part of MBBS student project. Blood pressure of hospital visitors/attendants was measured using Omron HEM-8711 blood pressure monitor with standard technique. A total of 437 participants were got measured their blood pressure. Result: 31.6% of participants self-reported their hypertensive state. Out of 299 participants who were now aware about their blood pressure status, 55% labelled as hypertensive using new ACC/AHA guidelines as compared to only 22% with earlier JNC 7 guidelines.

Analysis of Retinal Nerve Fibre Layer Changes in Cases of Phacomorphic Angle Closure Post Phacoemulsification

Introduction: To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. Methods: This prospective study involved 25 cases of phacomorphic angle closure that underwent phacoemulsification and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness was measured by optical coherence tomography (OCT) at 3–6 months post attack. Result: All cases had mean phacomorphic duration of <10 days. Postoperatively, best correct Snellen visual acuity was 0.42±0.23 and IOP at 6 months was 13.92 ± 2.41 mmHg. There was no difference RNFL between the attack and contralateral eye at 3 months post attack (both
p = 0.102). At 6 months post attack, there was significant thinning in the average (p <0.001), superior (p =<0.001), and inferior (p = 0.001) RNFL. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. Conclusion: An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 6 months post attack. There is a need of long term follow up of such patients.

An Unusual Case of Sebaceous Gland Carcinoma of the Upper Eyelid - A Case Report

Sebaceous gland carcinoma of the eyelid is an aggressive malignant tumor derived from adnexal epithelium of sebaceous glands. Sebaceous gland carcinoma took the second place of all malignant eyelid tumors and occurred in 19.1%. The upper lid involved by sebaceous gland carcinoma is 54.6% and has a predilection 3 times more than the lower lid. It presents as a poorly differentiated lesion[1], which suggests a possibility of misdiagnosis because of it similarities to basal or squamous cell carcinoma. A 55-year-old male presented with a left upper eyelid swelling with an ulcerated wound over the lateral 2/3rd of the upper eyelid. A differential diagnosis of sebaceous gland carcinoma, squamous cell carcinoma and basal cell carcinoma of the eyelid was made. The X-ray orbit showed that there is a homogenous soft tissue density lesion along the lateral aspect of orbit on left side and a bony irregularity seen along the lateral margin of orbit on left side. B-scan showed mixed echogenic lesions in the subcutaneous plane involving the upper eyelid. A wide excision with lower lid switch and cheek rotation flap was performed. The diagnosis of sebaceous gland carcinoma was confirmed on histopathological findings. An early diagnosis and appropriate treatment may decrease the long-term morbidity. It may also extend the survival rates of such patients.

Lobectomy for congenital lobar emphysema, experience of two centers in Pakistan

Objective: To assess outcome of lobectomy in congenital lobar emphysema in pediatrics group of patients

Methods: This retrospective study was conducted in Department of Thoracic Surgery Nishtar Hospital Multan and Services Hospital Lahore from October 2003 to December 2015.All the patients of pediatric group who underwent lobectomy for congenital lobar emphysema were included in study. Demographic data, operative findings outcome of the procedure in terms of post operative complications and 30 days morbidity and mortality were recorded .All the patients presented with respiratory distress. Standard lobectomy was performed and bronchial stump was buttressed with surrounding lymph nodes, pericardial or pleural flap

Results: Of these 41 study cases, 30 [73.2%] were boys while 11 [26.8%] were girls and male to female ratio was 2.72: 1. Mean age of our study cases was 3.32 +/- 1.59 months [with age range; 15 days to 7 months]. Mean age of the boys was noted to be 3.38 +/- 1.52 months while that of girls was 3.18 +/- 1.84 months [p = 0.405]. Of these 41 study cases, left upper lobectomy was performed in 27 [65.9%] patients, right middle lobectomy in 11 [26.8%] patients, left lower lobectomy in 2 [4.9 %] patients and right upper lobectomy in 1 [2.4%] patients. Out of 41 patients 8 [19.5%] were preoperatively on ventilator. Out of 8 ventilated patients one had left sided chest intubation which was malpositioned and was in the lung parenchyma. Morbidity was superficial wound infection in 2 [4.9%] patients and post lobectomy empyema in 2 [4.9%] patients who required prolonged tube thoracostomy, antibiotics and chest physiotherapy. Mortality was recorded in 1 [2.4%] patient who was preoperatively on ventilator and had misplaced chest tube. That patient died on the 3rd post-operative day due to respiratory failure secondary tolung parenchymal injury

Conclusion: Our study results support surgical management of congenital lobar emphysema as Lobectomy was found to be safe, reliable and effective in these children presenting with respiratory distress due to lobar emphysema. There were no significant morbidities in these patients and clinical outcomes were satisfactory and surgical management is reported to be treatment of choice in pediatric patients with CLE

A Rare Case of a Dermoid Cyst of Parotid Gland

Dermoid cysts are benign lesions containing tissues of ectodermal and mesodermal germ layers. The incidence of dermoid cyst in head and neck region is only 7% while in parotid gland only 18 cases have been reported in the literature. An 18-year-old male presented with a slow growing, painless and soft swelling in the right pre-auricular region. According to the patient, he had this swelling since birth. Ultrasonography was suggestive of a 3X3 cm cystic lesion within the right parotid gland. Fine needle aspiration cytology (FNAC) showed predominantly anucleate squames and keratinous debris indicating towards the possibility of a dermoid cyst of parotid. The lesion was surgically excised with superficial parotidectomy, preserving the facial nerve. Histopathology confirmed the diagnosis. Post-operative period was uneventful and patient recovered well. Owing to the rarity of dermoid cysts in the head and neck region and more so within the parotid gland, this case is being reported here.

Malignant Melanoma of Anal Canal – A Diagnostic Dilemma

A 50-year-old male presented with major complaints of bleeding per -rectum and generalized weakness for past one and a half month. Digital rectal examination (DRE) and colonoscopy revealed a thrombosed internal haemorrhoid, which was surgically excised. Histopathological examination (HPE) was pointing towards anal malignant melanoma, which was further confirmed by positive immunohistochemistry (IHC) for HMB-45. As the patient had no secondaries or lymph node enlargement, he was referred for loco-regional radiotherapy. Primary ano-rectal melanoma is a rare but locally aggressive neoplasm capable of early metastasis. Owing to its non-specific clinical presentation it may be mistaken for benign conditions like haemorrhoids and may prove fatal.  Surgical treatment may range from wide local excision (WLE) to abdomino-perineal resection (APR) with controversial role of chemo-radiation in advanced cases. Prognosis is usually bleak with a 5-year survival rate of less than 20%. Owing to the rarity of ano-rectal melanoma and importance of its early detection and management, this case is being reported here.

Trends in Molecular Classification of Breast Carcinoma in a Tertiary Health Care Centre: A 5 year Retrospective Study

Introduction: ER, PR and HER2 are the most important factors for predicting prognosis and response to treatment. In the present study we retrospectively  measured the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her 2 Neu positivity in breast cancer patients during a span of 5 years and classified them into luminal A (estrogen receptor/progesterone receptor [ER/PR]-positive and human epidermal growth factor receptor-2 [HER2]-negative), luminal B (ER/PR- positive and HER2-positive), HER2 (ER/PR-negative and HER2-positive), and triple negative (ER/PR- and HER2-negative) molecular subtypes. In this study we have also tried to correlate various molecular subtypes of breast cancer with age distribution, histological grade, lymph node status and distant metastasis. Methodology: We conducted a 5-year retrospective study on 547 patients. Clinical data including the age, sex, lymphnode status along with histological type and, grade of the tumour were recorded and the cases were subjected for immunohistochemical evaluation of HER-2/neu, ER, PR receptor status. Results: The results showed that HER2 neu was the most predominant immunomarker, while ER and PR was almost half of it. Among the molecular sub typing HER 2 type was the most prevalent constituting 53% of the cases, followed by almost triple negative and luminal A subtype with 20% cases each. Luminal B was least frequent with 9% of the cases. An inverse relationship exists between expression of her 2 neu and ER/PR. Conclusion: Our study concluded that molecular subtyping of breast carcinoma is an important part of complete histopathology report, in terms of prognosis, recurrence and treatment. A shift in occurrence of breast malignancies towards younger age leads to increased Her-2 neu expression.

Q192R paraoxonase1 polymorphism is a risk factor for cataract in Pakistani population

Cataract, the lens opacity, is among major causes of blindness in Pakistani population. In recent past, oxidative stress is suggested to play crucial role in loss of transparency. Along with other antioxidants, Paraoxonase 1 [PON1] has also shown decreased activity in patients suffering from cataract. The aim of current study was to examine the possible association of PON polymorphism with predisposition of cataract formation in local population. The study was conducted on 51 cataract patients and 50 control subjects considering all ethical issues. DNA was extracted from whole blood and PON1 polymorphism was identified using tetra primer ARMS-PCR method for both positions L55M and Q192R. Tetra primer ARMS-PCR results revealed that association between L55M polymorphism and cataract was insignificant while 192R genotype PON1 frequency was higher among the people suffering from cataract [78.4%] as compared to control subjects [56%], [odds ratio=2.857, confidence interval=1.197-6.820]. Hence, R allele is likely to be a risk factor for cataract with allele frequency [82.3%] and [odds ratio=4.552, confidence interval=1.716-12.073, p-value=0.002]. PON1 Q192R polymorphism is likely to be a risk factor for cataract development in Pakistani population while PON1 L55M was not found to be associated with cataract

Mixed Medullary and Papillary Carcinoma Thyroid in a Young Female- A Rare Case Report

The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.