Enhanced brain tumor classification using graph convolutional neural network architecture.

The Brain Tumor presents a highly critical situation concerning the brain, characterized by the uncontrolled growth of an abnormal cell cluster. Early brain tumor detection is essential for accurate diagnosis and effective treatment planning. In this paper, a novel Convolutional Neural Network (CNN) based Graph Neural Network (GNN) model is proposed using the publicly available Brain Tumor dataset from Kaggle to predict whether a person has brain tumor or not and if yes then which type (Meningioma, Pituitary or Glioma). The objective of this research and the proposed models is to provide a solution to the non-consideration of non-Euclidean distances in image data and the inability of conventional models to learn on pixel similarity based upon the pixel proximity. To solve this problem, we have proposed a Graph based Convolutional Neural Network (GCNN) model and it is found that the proposed model solves the problem of considering non-Euclidean distances in images. We aimed at improving brain tumor detection and classification using a novel technique which combines GNN and a 26 layered CNN that takes in a Graph input pre-convolved using Graph Convolution operation. The objective of Graph Convolution is to modify the node features (data linked to each node) by combining information from nearby nodes. A standard pre-computed Adjacency matrix is used, and the input graphs were updated as the averaged sum of local neighbor nodes, which carry the regional information about the tumor. These modified graphs are given as the input matrices to a standard 26 layered CNN with Batch Normalization and Dropout layers intact. Five different networks namely Net-0, Net-1, Net-2, Net-3 and Net-4 are proposed, and it is found that Net-2 outperformed the other networks namely Net-0, Net-1, Net-3 and Net-4. The highest accuracy achieved was 95.01% by Net-2. With its current effectiveness, the model we propose represents a critical alternative for the statistical detection of brain tumors in patients who are suspected of having one.

Validation and interlaboratory comparison of anticoagulant rodenticide analysis in animal livers using ultra-performance liquid chromatography-mass spectrometry.

Anticoagulant rodenticides (ARs) are used to control rodent populations. Poisoning of non-target species can occur by accidental consumption of commercial formulations used for rodent control. A robust method for determining ARs in animal tissues is important for animal postmortem diagnostic and forensic purposes. We evaluated an ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS) method to quantify 8 ARs (brodifacoum, bromadiolone, chlorophacinone, coumachlor, dicoumarol, difethialone, diphacinone, warfarin) in a wide range of animal (bovine, canine, chicken, equine, porcine) liver samples, including incurred samples. We further evaluated UPLC-MS in 2 interlaboratory comparison (ILC) studies; one an ILC exercise (ICE), the other a proficiency test (PT). The limits of detection of UPLC-MS were 0.3-3.1 ng/g, and the limits of quantification were 0.8-9.4 ng/g. The recoveries obtained using UPLC-MS were 90-115%, and relative SDs were 1.2-13% for each of the 8 ARs for the 50, 500, and 2,000 ng/g spiked liver samples. The overall accuracy from the laboratories participating in the 2 ILC studies (4 and 11 laboratories for ICE and PT studies, respectively) were 86-118%, with relative repeatability SDs of 3.7-11%, relative reproducibility SDs of 7.8-31.2%, and Horwitz ratio values of 0.5-1.5. Via the ILC studies, we verified the accuracy of UPLC-MS for AR analysis in liver matrices and demonstrated that ILC can be utilized to evaluate performance characteristics of analytical methods.

Prevalence of and Factors Associated with Sleep-Wake Abnormalities in Patients with Cirrhosis.

BACKGROUND & AIMS: Sleep-wake abnormalities [poor nighttime sleep and excessive daytime sleepiness (EDS)] are common in patients with cirrhosis. The aim of this study was to assess the prevalence of sleep-wake abnormalities and clinical factors associated with these abnormalities in a group of patients with cirrhosis. METHODS: 1098 patients with cirrhosis [Child Turcotte Pugh (CTP) class A, 22.2%; CTP class B, 29.2% and CTP class C, 48.6%], with either no ascites or mild ascites controlled on diuretics, and no history of or current overt hepatic encephalopathy were included in the study. RESULTS: Poor nighttime sleep and EDS were found in 569 (51.8%) and 489 (44.5%) patients respectively. On multivariate analysis, factors associated with poor nighttime sleep were CTP class C (vs. class A), presence of minimal hepatic encephalopathy (MHE), intermediate or evening type of diurnal preference category (vs. morning type), high risk for obstructive sleep apnea (OSA), diuretic use, presence of major depression, and presence of generalized anxiety disorder (GAD). Factors associated with EDS on multivariate analysis were CTP class B and C (vs. class A), intermediate or evening type of diurnal preference category (vs. morning type), high risk for OSA, presence of major depression, and presence of GAD. CONCLUSIONS: Sleep-wake abnormalities are common in patients with cirrhosis. CTP status, diurnal preference chronotype, risk of OSA, major depression and GAD are associated with both poor nighttime sleep and EDS. MHE and diuretic use are associated with poor nighttime sleep, but not with EDS.

Evaluation of Success of Transport Disc Distraction Osteogenesis and Costochondral Graft for Ramus Condyle Unit Reconstruction in Pediatric Temporomandibular Joint Ankylosis.

PURPOSE: The costochondral graft (CCG) is considered the reference standard for pediatric temporomandibular joint reconstruction. It has the disadvantages of unpredictable growth, donor site morbidity, and the need for intermaxillary fixation. It has been reported that transport disk distraction osteogenesis (TDDO) can result in the formation of a neocondyle and disc. We performed a randomized trial to measure and compare clinically relevant outcomes of ramus-condyle unit (RCU) reconstruction using CCG and TDDO for pediatric temporomandibular joint ankylosis (TMJA). MATERIALS AND METHODS: In the present randomized controlled trial (block randomization with a variable block size), pediatric patients with unilateral, nonrecurrent TMJA aged 3 to 16 years who had presented to our unit from December 2015 to June 2017 were enrolled. Instead of temporalis myofascial flap interposition, a buccal fat pad was used to fill the gap created by osteoarthrectomy. The primary outcome parameter was mouth opening. A mouth opening of at least 25 mm at the median follow-up point was considered success. The secondary outcome parameters were occlusion, laterotrusion, protrusion, reankylosis, neocondyle, chin deviation, facial asymmetry, midline shift, and neo-disc formation. Data were analyzed using the independent t test and rank sum test. RESULTS: A total of 24 patients were enrolled in the CCG and TDDO groups (n = 12 in each group). Trauma (40.9%) was the most common etiology with a slight male preponderance (59.09%). The mean age was 10.32 ± 2.85 years. The average distraction achieved in the TDDO group was 10.42 mm. The median follow-up duration was 31.5 months (range, 24 to 39 months). The mean preoperative maximal incisal opening had improved from 8.5 ± 4.1 and 9.5 ± 7.1 mm in the CCG and TDDO groups preoperatively to 35.7 ± 2.7 and 34.4 ± 8.9 mm, respectively, at the median follow-up point (P < .005). RCU reconstruction with both modalities resulted in improvement in all the parameters; however, the intergroup comparison showed statistically non-significant differences. No reankylosis or open bite was found. The 3-hour delayed gadolinium-enhanced magnetic resonance imaging scan showed successful neo-disc formation. CONCLUSIONS: Similar success can be achieved in RCU reconstruction using either CCG or TDDO for pediatric TMJA. Both techniques have some advantages and disadvantages. RCU reconstruction using CCG or TDDO results in formation of a neocondyle, maintenance of occlusion, and correction of facial asymmetry.

Case control study: magnetic resonance spectroscopy of brain in HIV infected patients.

BACKGROUND: In vivo proton magnetic resonance spectroscopy ((1)H-MRS) studies on brain in HIV infected patients have shown significant alteration in neuro-biochemicals. METHODS: In this study, we measured the neuro-biochemical metabolites from the left frontal white matter (FWM) and left basal ganglia (BG) caudate head nucleus in 71 subjects that include 30 healthy controls, 20 asymptomatic HIV and 21 HIV patients with CNS lesion. Proton MR spectra were acquired at 3 T MRI system and the concentration (institutional units) of tNAA (N-acetylaspartate, NAA + N-acetylaspartylglutamate, NAAG), tCr (Creatine, Cr + phosphocreatine, PCr), choline containing compounds (tCho), glutamate + glutamine (Glx) and lipid and macromolecules at 0.9 ppm were determined using LC Model. RESULTS: In BG, the concentration of tNAA (6.71 ± 0.64) was decreased and in FWM, the concentration of Glx (20.4 ± 7.8), tCr (9.14 ± 3.04) and lipid and macromolecules at 0.9 ppm (8.69 ± 2.96) were increased in HIV patients with CNS lesion. In healthy controls, the concentration of tNAA in BG was 7.31 ± 0.47 and concentration of Glx, tCr and lipid and macromolecules in FWM were 15.0 ± 6.06, 6.95 ± 2.56, 5.59 ± 1.56, respectively. CONCLUSION: Reduced tNAA in BG suggests neuronal loss in HIV patients with CNS lesion while increased Glx in FWM may suggest excito-toxicity. In addition, increased levels of tCr in FWM of HIV patients were observed. The study indicates region specific metabolic changes in tNAA, tCr and Glx in brain of HIV infected patients.

Determination of Multiresidue Pesticides in Botanical Dietary Supplements Using Gas Chromatography-Triple-Quadrupole Mass Spectrometry (GC-MS/MS).

A simplified sample preparation method in combination with gas chromatography-triple-quadrupole mass spectrometry (GC-MS/MS) analysis was developed and validated for the simultaneous determination of 227 pesticides in green tea, ginseng, gingko leaves, saw palmetto, spearmint, and black pepper samples. The botanical samples were hydrated with water and extracted with acetonitrile, magnesium sulfate, and sodium chloride. The acetonitrile extract was cleaned up using solid phase extraction with carbon-coated alumina/primary-secondary amine with or without C18. Recovery studies using matrix blanks fortified with pesticides at concentrations of 10, 25, 100, and 500 µg/kg resulted in average recoveries of 70-99% and relative standard deviation of 5-13% for all tested botanicals except for black pepper, for which lower recoveries of fortified pesticides were observed. Matrix-matched standard calibration curves revealed good linearity (r(2) > 0.99) across a wide concentration range (1-1000 µg/L). Nine commercially available tea and 23 ginseng samples were analyzed using this method. Results revealed 36 pesticides were detected in the 9 tea samples at concentrations of 2-3500 µg/kg and 61 pesticides were detected in the 23 ginseng samples at concentrations of 1-12500 µg/kg.

Comparison of interferon gamma release assay & tuberculin skin tests for diagnosis of latent tuberculosis in patients on maintenance haemodialysis.

BACKGROUND & OBJECTIVES: Tuberculosis (TB) is a common infection in patients on haemodialysis. There is a definite role of treatment of latent TB (LTB) in these patients. However, diagnosis of LTB in these patients by tuberculin skin test (TST) is unreliable. There is suggestion that interferon gamma release assay (IGRA) will be more reliable test for diagnosis of LTB in this setting. Thus, we evaluated value of IGRA and TST for the diagnosis of LTB in patients on dialysis in an Indian setting. METHODS: Patients with end stage kidney disease on dialysis were included. Patients with active TB were excluded. Each patient was subjected to TST (induration of ≥10 mm was taken as positive) and QuantiFERON TB Gold In-Tube test (QFT-GIT) for diagnosis of LTB. RESULTS: A total of 185 patients were included; 129 (69.7%) were males and mean age was 36.7 ± 12.3 yr. Past history of TB was present in 18 (9.7%) patients. One hundred and thirty four (72.4%) patients had scar of BCG vaccination. QFT-GIT test was positive in 66 (36%), TST in 32 (17%) and both in 13 (7%) patients. Of the 66 patients positive with QFT-GIT, only 13 (19.6%) were positive for TST. Of the 32 patients positive with TST, only 13 (40.6%) were positive with QFT-GIT; 100 (54%) patients were negative for both the tests. Overall, 85 (45.9%) patients were positive for either of the two tests. Poor agreement was shown between the two methods. On logistic regression analysis, odds of QFT-GIT to be positive in patients with BCG vaccination was 1.23 and with history of TB 0.99, both being insignificant. odds of tuberculin skin test to be positive in patients with BCG vaccination was 1.04 and with history of TB 0.99, both again being insignificant. INTERPRETATION & CONCLUSIONS: Our findings showed that more number of patients (36%) on haemodialysis were positive for QuantiFERON Gold In-Tube test as compared to TST (17%). There was poor agreement between the two tests. No significant effect of BCG vaccination and history of TB in past was observed on both tests.

Intermittent Directly Observed Therapy for Abdominal Tuberculosis: A Multicenter Randomized Controlled Trial Comparing 6 Months Versus 9 Months of Therapy.

BACKGROUND: The duration of treatment of gastrointestinal tuberculosis continues to be a matter of debate. The World Health Organization advocates intermittent directly observed short-course therapy (DOTs), but there is a lack of data of its efficacy in abdominal tuberculosis. We therefore conducted a multicenter randomized controlled trial to compare 6 months and 9 months of antituberculosis therapy using DOTs. METHODS: One hundred ninety-seven patients with abdominal tuberculosis (gastrointestinal, 154; peritoneal, 40; mixed, 3) were randomized to receive 6 months (n = 104) or 9 months (n = 93) of antituberculosis therapy using intermittent directly observed therapy. Patients were followed up 1 year after completion of treatment to assess recurrence. Patients were evaluated for primary endpoint (complete clinical response, partial response, and no response) and secondary endpoint (recurrence of the disease at the end of 1 year of follow-up). RESULTS: Baseline characteristics were similar between the 2 randomized groups. There was no difference between the 6-month group and 9-month group in the complete clinical response rate on per-protocol analysis (91.5% vs 90.8%; P = .88) or intent-to-treat analysis (75% vs 75.8%; P = .89). Only 1 patient in the 9-month group and no patients in the 6-month group had recurrence of disease. Side effects occurred in 21 (21.3%) and 16 (18.2%) patients in the 6-month and 9-month groups, respectively. CONCLUSIONS: There was no difference in efficacy of antituberculosis therapy delivered for either 6 months or 9 months in either gastrointestinal or peritoneal tuberculosis, confirming the efficacy of intermittent directly observed therapy. CLINICAL TRIALS REGISTRATION: NCT01124929.

Development and validation of a high performance liquid chromatographic method for simultaneous determination of vitamins A and D3 in fluid milk products.

An HPLC method for simultaneous determination of vitamins A and D3 in fluid milk was developed and validated. Saponification and extraction conditions were studied for optimum recovery and simplicity. An RP HPLC system equipped with a C18 column and diode array detector was used for quantitation. The method was subjected to a single-laboratory validation using skim, 2% fat, and whole milk samples at concentrations of 50, 100, and 200% of the recommended fortification levels for vitamins A and D3 for Grade "A" fluid milk. The method quantitation limits for vitamins A and D3 were 0.0072 and 0.0026 µg/mL, respectively. Average recoveries between 94 and 110% and SD values ranging from 2.7 to 6.9% were obtained for both vitamins A and D3. The accuracy of the method was evaluated using a National Institute of Standards and Technology standard reference material (1849a) and proficiency test samples.

Corneal Polishing After Pterygium Excision With Motorized Diamond Burr: A Randomized Control Trial.

PURPOSE: To evaluate outcomes of motorized diamond burr polishing versus manual polishing after pterygium excision. SETTING: Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi. DESIGN: A randomized, interventional observer-masked controlled trial. METHODS: Forty consecutive eyes underwent pterygium excision with fibrin, glue-assisted conjunctival autograft. In group 1 (20 eyes), polishing of the corneal bed was done using a crescent blade, and in group 2 (20 eyes), using a motorized diamond burr. RESULTS: There was no difference in the 2 groups with respect to mean age (P=0.08), gender (P=0.3), preoperative uncorrected visual acuity (UCVA) (P=0.45), best spectacle-corrected visual acuity (BCVA) (P=0.52), spherical equivalent (P=0.5), mean astigmatism (P=0.7), tear function tests like tear break-up time, tear film meniscus height, Schirmer I and II (P=0.6, 0.5, 0.7, 0.9 respectively), pterygium dimension (P=0.4), and conjunctival autograft size (P=0.24). Mean intraoperative surgical time was significantly more in group 1 (16.9 ± 2.85 min) as compared with 12.25 ± 1.88 min in group 2 (P=0.0001). Postoperatively, there was a statistically significant reduction in astigmatism and improvement in UCVA, BCVA, spherical equivalent in all eyes. No difference was found in mean epithelial defect healing time, UCVA, BCVA, astigmatism, tear film break-up time, Schirmer I and II, and tear meniscus height at 6 months between 2 groups; however, significantly better UCVA was found in group 2 at 3 months (P=0.04). Surgically induced astigmatism (SIA) was significantly more in group 2 as compared with group 1 at 6 months (P=0.0006). CONCLUSIONS: Motorized diamond burr polishing of the corneoscleral bed during primary pterygium excision in comparison with manual polishing requires significantly lesser surgical time with better UCVA, decreased astigmatism, and greater SIA at 6 months, which indicates greater astigmatic correction.

Method validation and proficiency testing for determination of total arsenic in apple juice by inductively coupled plasma/ mass spectrometry.

A proficiency test (PT) program for determination of total As in apple juice samples was conducted by the Food Emergency Response Network (FERN) laboratories. An analytical method using inductively coupled plasma (ICP)-MS was validated for this project. The LOD and LOQ were determined to be 0.315 and 2.32 ng/g, respectively. A total of eight apple juice samples were sent to 38 FERN laboratories, and results were statistically evaluated according to ISO 13528:2005. The total As concentrations in the PT samples reported by the participating laboratories were very close to those obtained in the homogeneity and stability tests. The reproducibility, repeatability, interlaboratory, and intralaboratory variability results led to 69% of participating laboratories being rated as satisfactory using the widely accepted Izl score

A preliminary descriptive analysis of Corneal Transplant Registry of National Eye Bank in India.

PURPOSE: To describe and analyze the Corneal Transplant Registry of National Eye Bank and also evaluate graft outcomes in India. METHODS: All patients who underwent corneal transplant at our center within six months of setting up of Corneal Transplant Registry and installation of database at National Eye Bank were included in the study. The established database was analyzed for utilization, donor and recipient details and graft outcomes. Outcome was assessed at the end of one year follow up. The influence of various donor and recipient factors affecting outcome were evaluated. Visual outcome was analyzed in terms of shift in visual handicap category. Statistical tests like analysis of variance, Kruskal-Wallis test and Chi square tests were applied for determination of clinical significance wherever required. RESULTS: 326 corneas were received from 168 donors; of these, 234 (71.7%) were utilized for transplantation. Out of 177 patients with adequate (one year) follow up (75.6% patients), optical corneal replacement was performed in106 patients and therapeutic keratoplasty in71. 78% (82/106) patients in the optical group retained clear grafts at the end of follow up. 59.7% (49 of 82) of patients who attained clear grafts belonged to visual disability category 3 or worse pre-operatively. 59.1% of these achieved BCVA of ≥6/60 at the end of follow up; thus shifting up their visual handicap category. Primary graft failure was found to be associated with full thickness keratoplasty and not with lamellar procedures (p<0.05) and occurred in 4.2% patients (5) with optical corneal replacement whereas 7.5% patients (8) developed secondary graft failure. Age of donor (p=0.54), death enucleation time (p>0.05), cause of donor death (p=0.15), type of surgical procedures (p=0.538) and indication for surgery did not have any significant effect on outcome. 76% patients who underwent therapeutic graft achieved elimination of corneal infection. CONCLUSIONS: The development of corneal graft registry established an effective means to evaluate our corneal transplantation services. Outcomes of sight restoring corneal transplants performed were comparable to results of graft registries from developed nations.

Detection and enumeration of four foodborne pathogens in raw commingled silo milk in the United States.

A nationwide survey was conducted to obtain qualitative and quantitative data on bacterial contamination of raw commingled silo milk intended for pasteurization. The levels of total aerobic bacteria, total coliforms, Enterobacteriaceae, Escherichia coli, and Staphylococcus aureus were determined using the TEMPO system. The prevalence rates and levels of presumptive Bacillus cereus, E. coli O157:H7, Listeria monocytogenes, and Salmonella spp. were determined in 214 samples. B. cereus was detected in 8.91% of samples, at 3.0 to 93 CFU/ml. E. coli O157:H7 was detected in 3.79 to 9.05% of samples, at <0.0055 to 1.1 CFU/ml, depending on the assay utilized. Salmonella spp. were recovered from 21.96 to 57.94% of samples, at <0.0055 to 60 CFU/ml. L. monocytogenes was detected in 50.00% of samples, at <0.0055 to 30 CFU/ml. The average log-transformed counts of total viable bacteria were slightly lower in samples containing no pathogens. No correlation was observed between the levels of organisms detected with the TEMPO system and the presence or levels of any pathogen except E. coli O157:H7. A higher average log-transformed count of total viable bacteria was observed in samples positive for this organism. The high prevalence rates of target pathogens may be attributed to a variety of factors, including detection methods, sample size, and commingling of the milk in the silo. The effects of commingling likely contributed to the high prevalence rates and low levels of target pathogens because of the inclusion of milk from multiple bulk tanks. The high prevalence rates also may be the result of analysis of larger sample volumes using more sensitive detection methods. These quantitative data could be utilized to perform more accurate risk assessments and to better estimate the appropriate level of protection for dairy products and processing technologies.

Oxidative stress and antioxidant capacity in patients with chronic pancreatitis with and without diabetes mellitus.

AIM: To determine oxidant stress and antioxidant capacity in chronic pancreatitis (CP) patients with and without diabetes mellitus. METHODS: This study is a secondary data analysis of our earlier study on 127 (male = 86) patients with CP, grouped as those with diabetes (case; n = 23) and those without diabetes (control). Markers of antioxidant status included vitamins A and E, total antioxidant capacity (TAC; measured as ferric-reducing ability of plasma [FRAP]), and total glutathione (T-GSH). Markers for oxidative stress included lipid peroxidation, measured as thiobarbituric acid reactive substances (TBARS) and serum superoxide dismutase (s-SOD). RESULTS: Patients with diabetes were older (mean [SD] age 36.4 [9.7] vs. 29.3 [10.0] years; p = 0.032), had longer duration of CP [4 (0.3-21) vs. 3 (0.3-24) years; p = 0.07), and had a lower TAC (269.8 [92.4] vs. 355.5 [128.6] µmoles Fe(+2) liberated; p = 0.003) compared to those without diabetes. In multiple logistic regression analysis taking all exploratory variables, FRAP (<270 µmoles Fe(+2) liberated) was associated with diabetes independent of duration of CP, age of patients, and TBARS levels. However, oxidative stress levels were not different between diabetic and nondiabetic patients. CONCLUSIONS: Diabetes was found to be associated with longer duration of CP and with low antioxidant capacity. Further studies will be needed to evaluate a causal association.

Delayed resolution of inflammatory response compared with clinical recovery in patients with acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: The temporal profile of inflammatory markers during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and their relationship to clinical response are not well characterized. The aim was to assess the changes in levels of inflammatory markers in AECOPD and correlate these with clinical and laboratory indices of recovery. METHODS: Serum levels of C-reactive protein (CRP), interleukin (IL)-6 and fibrinogen were measured in patients with AECOPD within 24 h of hospitalization and pre-discharge (stable state). RESULTS: Ninety-seven patients were evaluated (79 males; mean (SD) age, 61.4 (10.3) years). Eighty eight (90.7%) were current or former smokers, with a median consumption of 15 (0-75) packs/year. The median duration of COPD was 8 (2-25) years. Forty-six patients (56.9%) required mechanical ventilation for a median of 5 days (1-34) while in hospital. The median duration of hospital stay was 13 days (1-77). At reassessment before planned discharge, the levels of dyspnoea, leucocyte counts, erythrocyte sedimentation rate, creatinine, partial pressure of oxygen, and albumin normalized. The levels of CRP, IL-6 and fibrinogen reduced significantly but did not reach the normal range. Changes in IL-6 and fibrinogen levels correlated significantly with the acute physiologic assessment and chronic health evaluation II score, smoking history, blood pressure and leucocyte counts. Baseline IL-6 and fibrinogen levels significantly predicted a prolonged duration of mechanical ventilation. CONCLUSIONS: During AECOPD, the inflammatory response lags behind clinical and biochemical improvement. Fibrinogen and IL-6 are potentially useful markers for monitoring clinical response following an acute episode.

Normative data for anthropometric parameters used in delineation of dysmorphic features in north Indian children.

OBJECTIVE: To provide normative data for a set of anthropometric parameters which are commonly used in delineation of dysmorphic features. METHODS: This cross-sectional observational study was conducted in a tertiary care hospital of Delhi. Six hundred infants and children up to 2 years with hundred subjects each in the age group of 0-3, 3-6, 6-9, 9-12, 12-18 and 18-24 months were included. Both sexes were represented equally in the sample to avoid bias. Inner and outer intercanthal distance were measured by sliding callipers. Inter pupillary distance was measured directly as the distance between midpoint of two pupils. Ear length was the maximum vertical distance from the superior to the inferior edge of the ear. Internipple distance was the distance between centre of both nipples. Hand length was the distance between distal wrist crease to the tip of middle finger. Middle finger length was the distance between proximal flexion crease and tip of middle finger. The data was analyzed using the LMS method and percentile curves were developed for each age group for all the seven parameters. RESULTS: No statistically significant differences between male and female infants were observed. Significant differences were observed from other south east Asian and Caucasian population stressing the need for generation of regional ethnic data. The percentage of other isolated anomalies noted was 1.16% for polydactyly, 2-4 syndactyly 2-4 toe syndactyly (0.89%), Preauricular tags (0.5%), double whorl pattern of hair (1.55%), 2-4 syndactyly (0.33%) and paraumbilical hernia (2.83%). CONCLUSIONS: Normative data directed towards the ethnic origin are useful in charting dysmorphic traits. Children with parameters less than 3rd percentile or more than 97th percentile should be evaluated for other co-existing anomalies. Percentile charts provided in the present study may also be applicable across India but more studies are required to validate the authors' contention.

Current spectrum of malabsorption syndrome in adults in India.

AIM: Tropical sprue was considered to be the most important cause of malabsorption in adults in India. However, several reports indicate that celiac disease is now recognized more frequently. METHODS: We analyzed the clinical presentation, endoscopic and histological features of 94 consecutive patients (age >12 years) with chronic diarrhea and malabsorption syndrome. The spectrum of disease in these patients and features differentiating celiac disease and tropical sprue are reported here. RESULTS: Celiac disease (n = 61, 65%) was the most common cause of malabsorption followed by tropical sprue (21, 22%). Other conditions including cyclosporiasis (3), Crohn's disease (2), common variable immunodeficiency (2), lymphangiectasia (1), William's syndrome (1), and idiopathic malabsorption (3) accounted for the remainder. A greater number (21, 34%) of patients with celiac disease than those with tropical sprue (4, 19%) presented with atypical manifestations. Patients with celiac disease were younger (p = 0.001), more often had anemia, (p = 0.001), scalloping of folds (p = 0.001), moderate (p = 0.02) or severe (p = 0.001) villous atrophy, higher grade of intraepithelial lymphocytic infiltration (p = 0.001), crypt hyperplasia (p = 0.001), cuboidal (p = 0.001) and pseudostratified (p = 0.009) surface epithelial cells, and diffuse (p = 0.001) epithelial damage. In comparison, patients with tropical sprue were older and more often had normal duodenal folds, normal villi, tall columnar epithelial cells and focal epithelial damage. CONCLUSIONS: Celiac disease was the most frequent cause of malabsorption syndrome in this series of patients. There are significant clinical and histological differences between celiac disease and tropical sprue.

Performance characteristics of semirigid thoracoscopy in pleural effusions of undetermined etiology.

BACKGROUND: The utility of the recently introduced semirigid thoracoscopy in undiagnosed pleural effusions is still unclear. METHODS: A single-center, 4-year retrospective analysis of all semirigid medical thoracoscopy procedures was done. The diagnostic accuracy of thoracoscopy was calculated as the number of positive diagnoses achieved by thoracoscopy in relation to the end-diagnosis achieved in the patient group by any means. RESULTS: One hundred fifty procedures were analyzed. Ninety-two patients (62.3%) were diagnosed as having a malignant disorder, of which mesothelioma was the most common (26%). Pleural thickening and nodularity were the most common abnormalities noted. The combined presence of nodules and hemorrhagic fluid increased the likelihood of malignancy 9-fold. Thirteen patients with a high clinical suspicion of malignancy but negative by thoracoscopy underwent mediastinoscopy, computed tomography-guided biopsy, or open thoracotomy. A malignant etiology was confirmed in all of them. Overall, thoracoscopy provided a diagnostic accuracy of 91.3%, sensitivity of 87%, and specificity of 100%. The addition of a second procedure in selected patients improved the diagnostic accuracy for malignancy by 8.7%. The procedures were well tolerated and only 6 patients developed minor and transient complications such as pain, hypoxia, and bradycardia. CONCLUSION: Semirigid thoracoscopy is a safe, well-tolerated, and efficacious procedure for establishing the diagnosis in pleural effusions of undetermined etiology.

Synthesis, photochemical E (trans)-->Z (cis) isomerization and antimicrobial activity of 2-chloro-5-methylpyridine-3-olefin derivatives.

2-Chloro-5-methylpyridine-3-olefin derivatives (3a-e) have been synthesized from 2-chloro-5-methylnicotinaldehyde (1) and studied their photochemical E (trans)-->Z (cis) isomerization upon direct irradiation and triplet sensitized excitation for the first time. The triplet sensitized excitations of the compounds yielded high Z (4a-e) isomer composition, whereas the direct excitation results in less Z (4a-e) isomer composition, indicating triplet pathway is very efficient in converting the E (trans)-->Z (cis) isomer. Thus synthesized E (3a-c and 3e) and generated Z (4a-c and 4e) isomers were tested for antimicrobial activity. Antifungal activity of these pyridine derivatives are closely comparable to the standard used.

Obstructive sleep apnoea correlates with C-reactive protein in obese Asian Indians.

BACKGROUND: C-reactive protein (CRP), a marker of systemic inflammation, is an important predictor of future cardiovascular events. Whether the relationship of obstructive sleep apnoea (OSA) and CRP is independent of adiposity, needs to be investigated. OBJECTIVE: To investigate the association of CRP levels with OSA in the obese and their comparison with lean subjects without OSA in Asian Indians residing in India. METHODS AND RESULTS: One hundred and eight obese subjects (62 treatment naïve obese subjects with OSA [cases] and 46 obese subjects without OSA [obese controls]) and 26 lean control subjects without OSA were studied. The subjects were without any apparent inflammatory disease. Obese subjects were matched for body mass index (BMI) and percentage body fat (%BF). Assessment included anthropometry, lipid profile and high sensitivity CRP (hs-CRP) levels. Mean hs-CRP levels were significantly higher in cases [(3.6+/-2.0) mg/l than in obese controls (1.4+/-1.4) mg/l, p<0.001)] and in lean controls [(0.93+/-0.71) mg/l, p>0.05]. CONCLUSIONS: In this sample of Asian Indians, subjects with OSA had significantly higher CRP levels. These levels were directly proportional to the increase in severity of OSA and it was independent of adiposity. These observations have important implications for future cardiovascular risk in Asian Indians with OSA.