Role of HLA alleles polymorphism in systemic lupus erythematosus: A prospective study from North India

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder and has complex etiopathogenesis. The most appropriate hypothesis states that genetic susceptibility in the presence of environmental risk factors predisposes to SLE. HLA class II alleles are critical to immune response and are highly polymorphic. Various alleles in HLA-DR and -DQ regions were analyzed in SLE patients and healthy controls to see their role in susceptibility or protection to SLE. Materials and Methods: This was a prospective observational study, in which a total of 100 SLE patients and 100 controls were analyzed. HLA typing was done by polymerase chain reaction (PCR)-sequence-specific oligonucleotide (SSO) method (SSO probe). Results: DR?1*0301 was significantly increased in SLE patients when compared to controls and had the highest odds ratio. Other risk factor alleles found to be increased were DR?1*0701, DQ?1*0202, and DQ?1*0301, which had a significant positive association with SLE, suggesting their role in susceptibility to SLE. In contrast, DR?1*0401, DR?1*1401, DR?1*1404, DR?1*1501, DQ?1*0501, and DQ?1*0201 showed statistically significant reduction in SLE patients, while these were much more common in controls, suggesting their protective role. Conclusion: This study is only the second study in patients from North India and it determines the role of DR?1*0301, DR?1*0701, DQ?1*0202, and DQ?1*0301 alleles as risk factors in SLE patients.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Study on low birth weight and its associated factors among newborns delivered in a tertiary care hospital of Banda district, Uttar Pradesh

Background: Low birth weight is associated with higher morbidity and mortality including impaired growth and development, malnutrition etc. Worldwide, one- fifth of newborns delivered are low birth weight. Aims & objectives: To estimate frequency of low birth weight & its associated factors among newborns delivered in a tertiary care hospital. Materials & Methods: A cross sectional analysis of 290 newborns delivered in tertiary care hospital, Banda, Uttar Pradesh during period of 15th February 2021 to 31st December 2021 was done for estimating low birth weight frequency & its associated factors including child characteristics, mother characteristics & father characteristics using data from medical record section of hospital. Frequency, percentages, mean, standard deviation, chi square test & independent t- test was used. P value <0.05 was considered significant. Results: 91 out of 290 newborns delivered were low birth weight (27.9%, 95% CI- 23.1%- 33.4%). The following factors were shown to have a significant association with low birth weight: education of mother (p=0.04), education of father (p=0.03), occupation of father (p=0.02), and duration of pregnancy (p<0.001). Conclusion: This study demonstrated that education of mother, education of father, occupation of father, and duration of pregnancy had significant association with low birth weight frequency that suggests that improving literacy status can help in decreasing burden of low birth weight apart from other factors.

Non-surgical Treatment of a Non-vital, Immature Permanent Tooth with a Large Periapical Abscess: A Case Report with 8-month Follow-up

Aim: The purpose of this case report is to present a non-surgical treatment of a non-vital immature upper central incisor with a large periapical abscess within 8 months of follow-up. Methods and Materials: A traumatic case was presented in which a paste of calcium hydroxide and iodoform (Metapex�) was placed in the root canal of an immature permanent tooth with a large periapical abscess. Affected teeth were radiographically evaluated periodically over 8 months after paste insertion. At the end of 8 months, this case showed persistent root growth and apexification with no evidence of periapical radiolucency. After that, a normal root canal treatment was performed. Conclusion: In this clinical case, calcium hydroxide and iodoform paste (Metapex�) was found to induce apical closure radiographically and clinically. At 8 months, the periapical abscess was shown to have healed with continued root growth.

Synchronous uterine serous carcinoma and ovarian sex cord stromal tumor (thecoma)–A rare first case report

Synchronous endometrial and ovarian carcinoma is a rare instance and it accounts for 50 to 70% of all synchronous female genital tract tumors. However, it is very rare to find synchronous endometrial carcinoma and ovarian sex cord–stromal tumor (thecoma). The present case is a 75-year-old woman with a complaint of post-menopausal vaginal bleeding. Radiologically, the magnetic resonance imaging (MRI) pelvis revealed altered signal intensity mass in the uterus. Frozen section and routine histopathological examination were done on radical hysterectomy. Microscopically, serous carcinoma involving uterine corpus and left Fallopian tube was identified along with the unusual finding of contralateral ovarian sex cord–stromal tumor (thecoma), which was confirmed on immunohistochemical examination. It is a very rare association and is first reported in the present study after a thorough search of the published literature. Their relationship based on a high level of estrogen produced by the hyperactive ovary is controversial as serous carcinomas are less hormone-dependent.

Coverage evaluation of Mass Drug Administration (MDA) for lymphatic filariasis in a district of Bundelkhand Region of Uttar Pradesh

Introduction: Lymphatic filariasis results in severe disability that leading to severe social and economic burden at each level from individual to family, and community. This study was carried out to assess the coverage and compliance of MDA. Methods: From 300 households (1837 individuals) in both rural & urban area were covered in coverage evaluation survey by systematic selection of subunits using probability proportionate to size (PPS). Each household was visited by WHO designated team and data were collected using predesigned questionnaire. Data was compiled on MS-excel spreadsheet, frequency and percentage were calculated. Results: The overall effective coverage for all drugs was low (19.1%). The coverage was low, compliance was higher in urban as compared to rural area. Females had better coverage and compliance than males. The primary reasons for drug not offered was nobody came to offer drug, drug not swallowed was not sick, drug swallowed was useful information from drug administrator (DA). Only one female reported adverse effect. Conclusion: Increase in coverage along with decrease in coverage-compliance gap is needed to achieve filariasis elimination that warrants intense IEC activities using different platforms, development of better drug delivery strategies and strengthening monitoring system.

HISTOMORPHOLOGICAL SPECTRUM OF UTERINE LEIOMYOMA VARIANTS – A RETROSPECTIVE STUDY IN TERTIARY CARE HOSPITAL

To study the histomorphological spectrum of uterine leiomyoma variants. This study is done over a period of three year (May 2019 to May 2022) in the Department of Pathology, LNMC, Bhopal. Total of 316 hysterectomy and 14 myomectomy specimens were studied. Specimens were fixed in formalin and paraffin embedded. H&E stained tissue sections were studied. In the study we performed retrospective analysis of hysterectomy and myomectomy specimen and 330 cases of leiomyoma were evaluated. Among 330 cases, 316(95.75%) were hysterectomy specimen for varying indication and 14(4.24%) were myomectomy specimen. Histologically the usual leiomyomas was comprising of 164(49.69%) cases followed by hyalinised leiomyoma 70(21.21%), myxoid leiomyoma 15(4.54%), hydropic change 12(3.63%), cellular 11(3.33%), lipoleiomyoma 10(3.03%), calcification 10(3.03%), infarct type necrosis 10(3.03%), mitotically active 8(2.42%), symplastic 7 (2.12%), schwanonian 6(1.81%), epithelioid 3(0.90%), dissecting leiomyoma 2 (0.60%) and stromal metaplasia (osseous and cartilaginous) 2(0.60%). Leiomyoma is the commonest benign smooth muscle tumor of the uterus with a number of histological variants. In this study conventional leiomyoma being the commonest variant followed by hyalinized leiomyoma, myxoid leiomyoma, hydropic leiomyoma and lipoleiomyoma. It is important to categorise various types of leiomyoma on histology to avoid misdiagnosis.

Stroke in sickle cell disease: case report

Sickle cell disease is an inherited blood disorder that affects red blood cells. It is characterized by polymerization of haemoglobin, erythrocyte stiffening, and subsequent vaso-occlusions. These can lead to microcirculation obstructions, tissue ischemia, infarction and acute stroke. Transient ischemic attack, Ischaemic stroke, haemorrhagic stroke, silent cerebral infarction, headache, Moyamoya disease, neuropathic pain, and neurocognitive impairment are neurological complications of sickle cell disease. Here we report a case of ischemic stroke in a patient of sickle cell disease. For early diagnosis and proper management of sickle cell disease neurological complications require specialised haematological and neurological expertise. The newly used medications under ongoing research will be the hope to overcome this devastating disease and its complications.

Computed tomography imaging-based normative orbital measurement in Indian population

Purpose: This study aims to evaluate normal orbital structures with nonenhanced computed tomography (NCCT) and determine normative data for the Indian population. Methods: CT images of the orbits of 100 patients were retrospectively reviewed on a work station to record the normative data of the orbits. Clinical details of all patients were reviewed to ensure that they did not have ocular/orbital diseases. Both axial and coronal images were utilized to record the data. Results: The mean age of the population evaluated was 34.07 years, with male to female ratio of 1.77. The average orbital index for the left orbit was 97 and for the right side was 103. The mean thickness of left inferior rectus, lateral rectus, medial rectus, and the superior rectus was 3.36 mm, 3.14 mm, 3.80 mm, and 3.75 mm, respectively. The right inferior rectus, lateral rectus, medial rectus, and the superior rectus measured 3.46 mm, 3.14 mm, 3.83 mm, and 3.78 mm, respectively. The optic nerve sheath complex diameter varied between 3.05 mm and 7.17 mm for the left eye and 3.05 mm and 7.0 mm for the right eye. Conclusion: The study provides normative data on various orbital structures in an Indian population. This data is likely to be useful for diagnosing various orbital pathologies and in planning surgical orbital procedures.

C-cell hyperplasia in sporadic and familial medullary thyroid carcinoma

Context: C-cell hyperplasia (CCH) is characterized by increased mass of C-cells and has been identified as a precursor condition for medullary thyroid carcinoma (MTC). Varying proportion of MTCs is associated with CCH in different studies. This could be due to the lack of uniformity of the definitions and techniques used to identify CCH in these studies. Aims: This study aims to study the occurrence, clinicopathological, and immunohistochemical features of CCH in MTC diagnosed during a 22-year period at a tertiary care center in North India and to review the available literature on CCH. Materials and Methods: Eighty-seven consecutive cases of MTC were included in the study. Histological evaluation for the presence of CCH and neoplastic CCH was performed. Confirmation of CCH was done by immunohistochemistry for calcitonin and chromogranin. The presence of neoplastic CCH was correlated with clinical factors and prognostic factors. Results: Of 87 cases of MTC included in the study, 71 (82%) patients were sporadic and 16 (18%) had familial MTC. Neoplastic CCH was seen in 12 (75%) familial and in 9 (13%) sporadic MTC. Patients with familial MTC were more frequently associated with neoplastic CCH than sporadic MTC (P < 0.001), were younger (P < 0.001), and had more often bilateral and multifocal tumors (P < 0.001). However, there was no significant difference in mean survival time and progression-free survival in patients with and without CCH. Conclusion: CCH, though more common in familial MTC, can also be seen in sporadic tumors. CCH is not associated with patient survival and disease progression.

A prospective observational study and survival pattern of organo phosphorous poisoning patients with intensive care treatment in a tertiary care hospital

Background: Organophosphate poisoning is poisoning due to organophosphates (OP’s), used in insecticides, medications and nerve agents. It occurs mostly during suicide attempts in the farming areas, developing world and less by accident. The study is to evaluate the drugs used, respiratory conditions, complications occurred during course of treatment.Methods: This was a prospective observational study conducted for 9 months in a tertiary care hospital. The study was conducted in a 500 bedded tertiary care hospital in an intensive care unit. The study was conducted for nine months (September 2016 - May 2017).Results: A total of 234 patients who had consumed OPP with known and unknown agents were admitted in the emergency department. Out of which 180 males and 54 females.Conclusions: This study concluded that the patients consumed poison is mainly due to mental disturbances and financial problems. The stress and burden on the life will shows the effect after consumption, the maximum people suffer with respiratory problems due to poison consumption. If the government should take the measures to avoid consumption of poison and availability of poison to the public may overcome the complications and reduce the deaths due to poison.

Extranodal histiocytic sarcoma in a child with acute lymphoblastic leukemia: Cytomorphological features of a rare entity with brief review of literature

Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunophenotypic evidence of histiocytic differentiation. We describe a rare case of synchronous HS in a patient of B-cell acute lymphoblastic leukemia (ALL). A 16-year-old boy diagnosed as ALL also presented with a swelling over the right Achilles tendon. The cytological features of the swelling suggested a histiocytic lesion. Histological and immunohistochemical examination clinched the diagnosis of HS. The available 5-year follow-up showed no recurrence. It was a diagnostic dilemma on fine-needle aspiration. We discuss the cytological features of HS which can help in reaching a diagnosis and emphasize that it should be considered in the differential diagnosis for unexplained swellings in patients of hematological malignancies. Wide local excision of localized HS is associated with a long-term favorable outcome.

Estimation of levels of carbohydrates in mealey bug (Maconellicoccus hirsutus) infected stem of hibiscus rosa sinensis.

Mealey bug (Maconellicoccus hirsutus) causes dreadful infection in Hibiscus rosa sinensis.Infections are highly virulent and alters biochemical componenets of the species. Therefore an attempt has been made to evaluate the alteration of biochemical components in Hibiscus stem at various stages of infection. The results reveal that partial infected stem had shown 14.2% increase in its total soluble sugars whereas highly infected had shown 40% decrease.The results also show that total soluble sugars had increased significantly(14%) in highly infected stem and noticeable increase (3%) in partial infected.

Serum albumin in poorly differentiated, oral squamous cell carcinoma: a possible diagnostic marker of significance / Albumina sérica em carcinomas de células orais escamosas e pobremente diferenciadas: um possível marcador de diagnóstico de significância

Objectives: Serum albumin is considered to be the most potent and abundant extra-cellular anti-oxidant thatmight have a protective role in the ongoing process of transition of the various oral pre-cancerous lesions andconditions into frank malignant degenerations. The aim of this study was to check the reliability of serum albuminas one of the diagnostic anti-oxidant parameter. Materials and methods: The study consisted of seraanalysis of albumin in the age and sex matched normal healthy adults and patients with histologically proven,poorly differentiated oral squamous cell carcinoma. The results were analyzed using Student’s t-test andwere averaged as mean ± standard deviation. In above test, p-values less than 0.05 were taken to be statisticallysignificant. The normality of data was checked before the statistical analysis was performed. Results:The study revealed variations in sera levels of albumin to be statistically significant with the mean level ofsera albumin to be 4.956 ± 1.0579 in controls as against 3.6933 ± 1.2177 in patients with histologically proven,poorly differentiated, oral squamous cell carcinoma. Conclusions: The results of the study emphasize theneed for more studies with larger sample sizes to be conducted before a conclusive role could be drawn infavor of sera levels of albumin as diagnostic markers of significance in oral squamous cell carcinoma.

Objetivos: A albumina sérica é considerada o antioxidante extracelular mais poderoso e mais abundante, que pode exercer um papel protetor no processo de transição das várias lesões e circunstâncias pré-cancerígenasorais em degenerações malignas. O objetivo deste estudo foi verificar a confiabilidade da albumina sérica como um dos parâmetros de diagnóstico antioxidante. Materiais e métodos: A análise consistiu no estudo da albumina sérica em pacientes adultos saudáveis normais, separados por idade e sexo, e em pacientes com carcinoma oral de células escamosas pobremente diferenciadas com evidência histológica comprovada. Os resultados foram analisados usando o teste t de Student, e as médias foram calculadas com ± desvio-padrão. No teste citado, os valores de p menores que 0,05 foram considerados estatisticamente significantes. A normalidade dos dados foi verificada antes da realização da análise estatística. Resultados: O estudo revelou diferenças estatisticamente significantes nos níveis de albumina sérica com o nível médio de 4.956 ± 1.0579 nos controle sem contraste com 3.6933 ± 1.2177 nos pacientes com carcinoma oral de células escamosas pobremente diferenciadas.Conclusões: Os resultados do estudo enfatizaram a necessidade de mais estudos com tamanhos de amostra maiores antes que um papel conclusivo possa ser atribuído, em favor dos níveis de albumina sérica,como marcador diagnóstico para o carcinoma oral de células escamosas.

Developing and maintaining website of department of forensic medicine and toxicology: a need of the hour.

With recent advancement of civilization, man has been inventing various tools to assist him in living in the changed environment. Online Medical Education System has now become reality. Developing and maintaining website of Department of Forensic Medicine and Toxicology by every medical college is the need of the hour. Developing and maintaining a website is not a difficult task for any department irrespective of the status of the institution. The financial burden is not very much. What makes this task so difficult is the lack of knowledge in this area rather than hurdles on the way. Authors have tried to clarify the various doubts regarding this area i.e. how the website can be developed, the financial burden to register a website, website maintainence, role of on-line medical education, undergraduate and postgraduate students benefits by the website, website use to associate different departments and institutions, obtaining updated information via Internet and other websites, the security issues while sharing the information as well as updating. It is envisaged that whence the departments develop their website, they may be affiliated to IAFM website for their greater visibility.

Proteoliposomes as matrix vesicles' biomimetics to study the initiation of skeletal mineralization

During the process of endochondral bone formation, chondrocytes and osteoblasts mineralize their extracellular matrix by promoting the formation of hydroxyapatite (HA) seed crystals in the sheltered interior of membrane-limited matrix vesicles (MVs). Ion transporters control the availability of phosphate and calcium needed for HA deposition. The lipidic microenvironment in which MV-associated enzymes and transporters function plays a crucial physiological role and must be taken into account when attempting to elucidate their interplay during the initiation of biomineralization. In this short mini-review, we discuss the potential use of proteoliposome systems as chondrocyte- and osteoblast-derived MVs biomimetics, as a means of reconstituting a phospholipid microenvironment in a manner that recapitulates the native functional MV microenvironment. Such a system can be used to elucidate the interplay of MV enzymes during catalysis of biomineralization substrates and in modulating in vitro calcification. As such, the enzymatic defects associated with disease-causing mutations in MV enzymes could be studied in an artificial vesicular environment that better mimics their in vivo biological milieu. These artificial systems could also be used for the screening of small molecule compounds able to modulate the activity of MV enzymes for potential therapeutic uses. Such a nanovesicular system could also prove useful for the repair/treatment of craniofacial and other skeletal defects and to facilitate the mineralization of titanium-based tooth implants.

Upcoming and future strategies of tick control: a review.

Ticks are distributed worldwide and significantly impact human and animal health. Due to severe problems associated with the continuous use of acaricides on animals, integrated tick management is recommended. Increasing public health concern over the tick-borne diseases demands the strategic control of ticks on animals that transmit diseases to human beings. Immunological control of tick vector of Kyasanur Forest Disease (KFD) on cattle and other wild reservoir hosts is one of the possible alternative strategy for reducing the transmission of KFD to man. Chemical-vaccine synergies have been demonstrated and a combination of chemical and vaccine for tick and tick-borne disease control has been identified as a sustainable option. Studies have suggested the possibility of vaccine strategies directed towards both tick control and transmission of pathogens. Besides tick vaccine, use of endosymbionts, which are essential for the survival of arthropod hosts, for the control of tick vectors will be one of the targeted areas of research in near future. India with huge natural resources of herbs and other medicinal plants, the possibilities of developing herbal acaricides is discussed. The future of research directed towards target identification is exciting because of new and emerging technologies for gene discovery and vaccine formulation.

Pulseless cardiomyopathy.

Takayasu arteritis can have myriads of presentation, depending on site and extent of disease. As no age is immune for this disease, it is important to keep a high index of suspicion, otherwise the diagnosis can be missed. We hereby describe a case of Takayasu arteritis, which presented as dilated cardiomyopathy.

Cloning and sequencing of 28 kDa outer membrane protein gene of Brucella melitensis Rev. 1.

Brucella melitensis is an organism of paramount zoonotic importance. The 28 kDa outer membrane protein (OMP) is one of the immunodominant antigens of B. melitensis. The gene encoding 28 kDa OMP (omp28) has been amplified from B. melitensis Rev. 1 strain. A PCR product of 753 bp, encoding complete omp28 gene of B. melitensis, was obtained. The gene was further cloned and sequenced. The nucleotide sequence of B. melitensis Rev. 1 strain showed substitution of 2 nucleotides from that of 16M strain.