Abstract Background Anthracyclines significantly improve overall survival and play a vital role in the treatment of breast cancer. However, they are associated with cardiac dysfunction, which is often irreversible. Although anthracycline-induced cardiotoxicity (AIC) is dose-dependent, the difference in susceptibility patterns suggests the role of pharmacogenomics. Several studies explored the role of genetic variants in AIC. Integrating pharmacogenomic testing with routine anthracycline surveillance will help to predict the individuals who are at risk of developing AIC. Therefore, this current systematic review aims to evaluate and synthesize the evidence on the pharmacogenomics association of cardiotoxicity in individuals receiving anthracyclines for breast cancer treatment. Methods PubMed, Embase, and Scopus databases are systematically searched for the literature. After the initial search, 842 records have been identified. Following screening, 18 studies investigating genetic associations with AIC in breast cancer patients were found to be eligible for inclusion in the study. The quality of studies is assessed with the Q-Genie tool. The data is extracted and summarized with odds ratios and corresponding confidence intervals were reported. Results A total of 18 candidate gene association studies involving 4,703 breast cancer patients were included in the qualitative synthesis. Out of 57 genetic variants reported, 18 genetic variants (31.5%) are associated with an increased risk, while 3 genetic variants (5.3%) have demonstrated a risk-reducing tendency. Discussion Characterizing genetic variants in biological pathways of anthracyclines could inform precision therapy and the development of targeted interventions. The limitations of the synthesized evidence include the inadequate sample size, methodological bias within the included studies, inconsistent findings from different studies, and imprecise effect estimates. Conclusion The genetic variants influence susceptibility to AIC in breast cancer patients. Further large-scale studies with longer follow-up are warranted to validate these associations and facilitate their translation into clinical practice.

Introduction Upper aerodigestive tract (UADT) malignancies, involving oral cavity, pharynx, larynx and related anatomical regions, are associated with substantial morbidity and mortality worldwide. Early diagnosis remains challenging because conventional diagnostic approaches are often invasive, costly and frequently detect disease at advanced stages. MicroRNAs (miRNAs) involved in post-transcriptional gene regulation have recently emerged as promising minimally invasive biomarkers due to their remarkable stability in biological fluids and their dysregulated expression in cancer. Although literature showcases the diagnostic value of miRNA signatures for UADT malignancies, the reported diagnostic performance remains inconsistent. Therefore, a comprehensive synthesis of current evidence is essential to determine the overall diagnostic precision and clinical applicability of miRNA-based assays.Methods and analysis We will report the results of the systematic review as per Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) reporting guidelines and adhere to the recommendations of the Cochrane Collaboration Handbook for Diagnostic Test Accuracy Reviews for conducting this review. The electronic databases of PubMed, Scopus, Web of Science and Embase will be systematically searched from inception onwards. Studies assessing the diagnostic performance of miRNA biomarkers in histopathologically confirmed UADT malignancies will be included. Two authors will independently perform study selection, data extraction and quality assessment (Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)). Diagnostic accuracy meta-analysis will be conducted using a hierarchical bivariate random-effects model (Reitsma model) to jointly pool sensitivity and specificity estimates while accounting for heterogeneity and threshold effects. Hierarchical summary receiver operating characteristic curves will be constructed, and we will analyse pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic OR at 95% CIs. Meta-regression followed by subgroup analysis will be undertaken to explore potential sources of heterogeneity, including specimen type, miRNA profiling method, study design and patient characteristics.Ethics and dissemination This study will synthesise data from previously published literature without involving individual patient data or direct participant involvement. Findings from this review will be dispersed via publication in a peer-reviewed journal and through presentations at National/International scientific platforms.PROSPERO registration details CRD420261384413.

Background:Early hospital arrival is essential for timely thrombolysis in acute ischaemic stroke. However, many patients in low-resource settings continue to reach tertiary care centres beyond the recommended treatment window. Purpose:To evaluate pre-hospital and in-hospital delays among patients with acute ischaemic stroke in Jharkhand and identify factors associated with timely hospital arrival. Methods:A prospective observational study included 237 consecutive patients with acute ischaemic stroke admitted to a tertiary care hospital in Ranchi (July 2022-August 2024). Patients were classified as early (≤4.5 h) or delayed (>4.5 h), and multivariable logistic regression identified predictors of early hospital arrival. Results:Only 15 patients (6.3%) reached the hospital within 4.5 h. Most were men, older adults and from rural, socio-economically disadvantaged backgrounds. Most (85.7%) first visited a nearby non-specialist healthcare facility, while awareness of stroke symptoms (14.0%) and thrombolysis (5.5%) was poor. Timely arrival was less likely after visiting a nearby healthcare facility (aOR 0.005, p < .001) but more likely with higher socio-economic status (aOR 17.02, p = .016) and ambulance availability (aOR 6.11, p = .021). Conclusion:Improving ambulance services, referral pathways and public awareness may reduce delays and improve timely stroke treatment.

INTRODUCTION:With growing urbanization, cities are becoming increasingly polluted, and air pollution is becoming a major health concern. The objective of our study was to compare children travelling either by air-conditioned (AC) vehicles or non-AC school buses in terms of respiratory illnesses, spirometry parameters, and school attendance. MATERIALS AND METHODS:Children aged 6-11 years from classes 1 to 5 were included. Data were collected on demography, transportation details, history, and spirometry findings. Multinomial logistic regression and bivariate correlation tests were applied for the analysis of data. RESULTS:In total, 216 children were randomly selected, of which 210 students were included for the data analysis. In our study, we found 76. Seven percent of children had some or other respiratory symptoms in the last 30 days in either mode of transportation. Pulmonary function test results, including forced expiratory volume in 1 s (FEV1) and FEV1: Peak expiratory flow rate ratio, were similar in both groups, with P = 0.99 and 0.400, respectively. Students who travel by bus or non-AC vehicles are 20% more likely to miss their attendance as compared to those who travel by AC vehicles, with an odds ratio of 1.20 (confidence interval 0.55-2.64; P = 0.641). CONCLUSION:Our research study concluded that children who ride on non-AC buses are more vulnerable to the negative impacts of air pollution and greater distances result in longer exposure to pollution, which aggravates respiratory conditions more frequently and raises school absenteeism.

Abstract Background Stroke is a multifactorial disease. Intracerebral hemorrhage (ICH) is associated with high mortality, morbidity, and recurrence rates worldwide. Studies have reported the accuracy of several blood biomarkers in predicting clinical outcomes; however, their independent contributions to prediction remain to be established. Aim To determine the predictive accuracy of clinical outcomes in patients with ICH in North Indians using blood-based biomarkers. Methods A total of 250 ICH cases were enrolled within 72 hours of onset. Baseline clinical and CT scan measurements were recorded. Serum C-reactive protein (CRP), E-selectin (SELE), and P-selectin (SELP), matrix metalloproteinase-9 (MMP9), and plasma Homocysteine (HCY) levels were measured through ELISA. A telephone follow-up was done at six months using the Modified Rankin Scale (mRS). Results The study cohort's mean age was 54.9 (SD±12.8) years, with 64.8% male patients. A total of 117 (46.8%) deaths were observed over a six-month follow-up. Patients were categorized into two groups; alive (mRS: 0-5) and dead (mRS: 6). ICH cases with mortality had significantly higher serum CRP(p=0.03), MMP-9(p=0.005), SELE (p=0.005), and plasma HCY (0.04), but we did not observe a significant difference in serum SELP (p=0.17) at six months with mortality. Area under the receiver operating characteristics curve (AUROC) for 180-day mortality was 0.57 (HCY), 0.58 (CRP), 0.75 (MMP9), 0.79 (SELE), and 0.76 (SELP). Conclusion Our findings suggest that serum CRP, MMP-9, SELE, and plasma HCY were significant predictors of mortality at 6 months in patients with ICH in the north Indian population. Conflict of interest Authors have nothing to disclose

Background and objectives: Sickle cell disease poses a significant healthcare burden across several regions and states in India. We present findings from a sickle cell anaemia registry in the State of Jharkhand, a tribal predominant state situated in Eastern India, to provide an insight into the clinico-epidemiological profile and need-based management of sickle cell anaemia. Methods: Sickle cell disease Registry at Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand was started in the year 2022 and it has 334 sickle cell disease patients recruited over two and a half years. This clinical research provides systematically captured comprehensive data of sickle cell anaemia patients with HbSS genotype, including demographics, clinical presentation, laboratory findings, treatment modalities, complications, and their outcomes. Results: Clinical manifestations varied from mild to severe, with the most common presentation being vaso-occlusive crises (n=257, 94.5%). A significant proportion of patients required blood transfusion n=260, (95.6%). Hydroxyurea the mainstay of treatment, was taken regularly by 136, (50%) of patients, whereas n=68, 25% were irregularly taking hydroxyurea medication and n= 68, 25% never took it. Regular intake of hydroxyurea therapy was significantly associated with reduction in pain crises and a decreased need for blood transfusion. Interpretation and conclusions: Establishment of hydroxyurea monitoring units, monitoring of blood transfusion through appropriate investigations, increased utilisation of iron chelation therapy, and identification of patients with increased stroke risk can lead to improved patient care, escalated awareness and reduced rate of hospitalisation in sickle cell disease.

Src homology region 2-containing phosphatase 1 (SHP-1), encoded by the protein tyrosine phosphatase non-receptor type 6 (PTPN6), regulates immune and metabolic signaling pathways. Although its functions in immune cells and insulin-responsive tissues are separately established, its integrative function in immunometabolic regulation remains unclear. A damaging variant in the PTPN6 gene (Ala455Thr) was discovered in a French-Canadian family and found to be the cause of early-onset emphysema. Using mice carrying this whole-body human-relevant mutation, we studied immunometabolic phenotypes across aging. Old mutant mice showed decreased body, liver and adipose tissue weights, improved glucose tolerance, and enhanced hepatic insulin sensitivity. Despite improved metabolic parameters, aged mutant mice developed liver abnormalities, including increased fibrosis and aberrant immune cell infiltration. Transcriptomic and histological analyses revealed an age-associated accumulation of intrahepatic B lymphocytes and macrophages, accompanied by increased SHP-1 protein levels and activation of Signal transducer and activator of transcription 3 (STAT3) signaling. Experiments in primary hepatocytes and old hepatocyte-specific Ptpn6 knockout mice suggest that these alterations are driven by immune rather than intrinsic hepatocyte mechanisms. These findings identify SHP-1 as a critical modulator of liver immune homeostasis during aging and demonstrate that immune cell infiltration contributes to age-related hepatic remodeling under SHP-1 deficiency.

Oral squamous cell carcinoma (OSCC) is a growing concern due to its poor prognosis, treatment failures, andnoncompliance. Since there is significant variation in neck involvement of OSCC patients, the aim here is to identify current practicesand gaps in OSCC management strategies across various cases with distinct clinical presentations. The literature was accessed from various sources such as PubMed, MEDLARS Online (MEDLINE), CINAHL, Web ofScience, Global Index Medicus, CENTRAL, AMED, and Embase from inception till 31 August 2024. The survival outcomes of variousneck treatments were screened and the data was extracted using the PRISMA strategy. Following this, the data was pooled using arandom effects model to analyse the effect size of interventions pertaining to overall survival, disease-free survival, 5-year/2-yearsurvival, and recurrences achieved through neck management(s). The risk of bias assessment was performed using the QUIPS tool.Heterogeneity was assessed by chi-square and I2 statistics. All the statistical analysis was conducted using STATA 18.0. The initial search of 1746 records were screened and filtered to achieve an outcome of 25 studies for qualitative synthesis,out of which six studies were eligible for meta-analysis. The pooled risk ratio for the analysis was statistically significant (RR=1.73) at95

Background: Yoga is increasingly recognized for its therapeutic benefits in managing chronic medical and psychiatric conditions, including substance use disorders. Despite its growing clinical acceptance, challenges remain regarding its real-world feasibility, particularly in medically oriented settings. Objectives: This analysis aimed to explore reasons for nonparticipation in a randomized controlled trial evaluating the efficacy of add-on yoga (dhyana meditation) in patients with opioid dependence who were stable on pharmacological treatment. Design, Setting, Participants, and Interventions: This sub-analysis was part of a larger randomized controlled trial of add-on yoga conducted at a tertiary care addiction treatment center in north India. Patients on stable doses of medications for opioid use disorder treatment were approached for participation in yoga that included 7 consecutive days of training followed by yoga practice or wait list control. Main Outcome Measures: The main outcome measures for the present analysis were the reasons for nonparticipation. Results: Only 24% (n = 120) of approached participants consented to join the trial. The most common reason for refusal was lack of time (73.2%), followed by logistical challenges and lack of familiarity with yoga. Education level was significantly associated with participation (p = 0.018). While 80.3% of nonparticipants believed yoga could be beneficial, few expressed interest in online formats or reduced-frequency visits, indicating limited practical feasibility. Conclusion: Despite a general belief in yoga's benefits, participation was limited by time and logistical constraints. Future interventions should consider hybrid or digital formats, flexible scheduling, and tailored recruitment strategies. Understanding nonparticipation reasons can enhance engagement and guide future yoga-based trials in clinical populations.

Background Sepsis is a major cause of morbidity and mortality in critically ill patients, especially in low- and middle-income countries like India. Albumin and fibrinogen are key plasma proteins with opposing kinetic responses during inflammation and may serve as useful biomarkers in sepsis. This study aims to evaluate the kinetics of albumin and fibrinogen in septic patients to better understand their correlation with disease severity and outcomes. Methods This prospective, observational, comparative study was conducted at RIMS, Ranchi, over 12 months. Fifty-five patients (37 septic, 18 non-septic) were enrolled. Hepatic protein synthesis was assessed using stable isotope-labeled L-[ring-²H₅] phenylalanine infusion, followed by GC-MS analysis to determine FSR and ASR of albumin and fibrinogen. Results Septic patients had significantly lower plasma albumin and higher fibrinogen levels (p < 0.001). Albumin FSR was elevated (p = 0.03) without a significant change in ASR (p = 0.42), while both FSR and ASR of fibrinogen were significantly increased (p = 0.01, <0.001). The albumin/fibrinogen ASR ratio was markedly reduced (p < 0.001), indicating a shift toward acute-phase protein production in sepsis. Conclusion Sepsis is associated with hypoalbuminemia despite increased synthesis, likely due to elevated clearance. Hepatic protein synthesis shifts toward fibrinogen, reflecting a prioritized acute-phase response. Recommendation Future research with larger, multi-center cohorts is recommended to validate these findings and further investigate the biochemical differences between septic and non-septic patients. Exploring hepatic protein synthesis parameters may also offer valuable insights for clinical applications in sepsis management.

BACKGROUND:Extranodal extension (ENE) is an important adverse prognostic indicator for head and neck cancers. However, ENE needs further risk stratification in terms of optimum cutoff for the extent of ENE and interaction with clinicopathological risk factors. METHODS:Retrospective single-center study on patients with treatment-naïve head and neck cancer with final histology indicating ENE. RESULTS:Pathological ENE was observed in 122 patients (12.4%). With the 2 mm cutoff separating Mi-ENE and Ma-ENE, no difference was observed in overall survival (OS) and disease-free survival (DFS) for unmatched (OS: 40.9% vs. 33.6%, p = 0.7; DFS: 34.05% vs. 26.12%, p = 0.5) as well as propensity score-matched cohort (OS: HR 1.08, p = 0.82; DFS: HR 0.95, p = 0.89). Receiver-operator curve (ROC) analysis showed the highest area under the curve with a 4 mm cutoff for the extent of ENE (AUC: 0.52). On assessing the impact of adjuvant chemoradiation (CRT) on Ma-ENE and Mi-ENE, only Ma-ENE showed OS (HR: 0.42, 95% CI: 0.18-0.9) and DFS (HR: 0.33, 95% CI: 0.15-0.70) benefit with CRT, which was statistically significant. The revised 4 mm cutoff was predictive of therapeutic benefit with adjuvant CRT (HR: 0.27, 95% CI: 0.1-0.73). Clinicopathological factors with statistically significant interaction with ENE in worsening OS and DFS were tumor location in tongue/floor of mouth (OS), T3/T4 category (OS), depth of invasion greater than 10 mm (OS), ≥ 5 nodes with metastasis (OS), and male sex (DFS). CONCLUSION:The standard 2 mm cutoff for the extent of ENE failed to reveal sufficient hazard discrimination for OS/DFS. Instead, the 4 mm cutoff determined on ROC analysis was found to have the best predictive ability for DFS.

Background:Traumatic nerve injuries are associated with neuropathic pain, which is resistant to conventional analgesics. Often, opioids do not have a beneficial effect. Hence, the aim was to evaluate its effect in an animal model and compare it to a nonsteroidal anti-inflammatory drug. Among the different preclinical models for nerve damage, partial sciatic nerve ligation (PSNL) shows persistent levels of nociception without autotomy. In the present study, the ligated sciatic nerve was assessed for damage. Morphine and ketoprofen from two distinct classes of analgesics were evaluated for antinociception in these rats.Materials and Methods:Sprague-Dawley rats were divided into the sham surgery (n = 6) and PSNL group (n = 30) where about 1/3-1/2 of the sciatic nerve was ligated. Histological analysis was performed at the end of the study by light and electron microscopy. Nociception was assessed once every week for 3 weeks by von Frey filaments. Nociception was noted to be present throughout the study in the neuropathic group with maximum nociception at the end of the 2nd week when morphine or ketoprofen or both morphine and ketoprofen were administered in separate groups of animals.Results:Considerable degeneration was observed in nerve fibers and surrounding myelin within the sciatic nerve in rats with PSNL. Furthermore, these showed decreased withdrawal threshold, which persisted till the end of the study. Morphine and morphine + ketoprofen produced significant antinociceptive effect, but not ketoprofen.Conclusion:Morphine likely produced antinociception by binding to mu-opioid receptors. Inhibition of prostaglandin synthesis is not enough to relieve neuropathic pain. The results may have clinical relevance.

Oral squamous cell carcinoma is the leading type of cancer in Southeast Asian countries and many parts of the world. Many factors increase the risk of oral cancer, like tobacco, betel nuts, alcohol consumption, sharp teeth, infections, and other factors. Oral health-related issues have been reported in many studies of oral cancer, but there is a need to understand the role of the same as a risk factor. The systematic review and meta-analysis were conducted to assess the role of oral health as a risk factor in oral cancer. The population diagnosed with oral cancer (P) of all age groups and both gender, exposure (E) is oral health (includes poor oral hygiene, periodontal disease, and other oral diseases excluding oral potentially malignant disorders (OPMD)), the comparator (C), is patients without oral health issues, outcome (O) is the role of poor oral health as a risk factor for oral cancer. A systematic review and meta-analysis were conducted. The databases used for the search were PubMed, Cochrane Database, Embase, Scopus, and Google Scholar. The unpublished reports, reviews, and grey literature were considered. Case-control studies were included assessing poor oral health as a risk factor with odds ratio as an effective measure. Newcastle Ottawa Scale for risk of bias in the case-control study was considered. The study results showed that tooth loss odds ratio (OR)=1.13, CI (0.99-1.26), I2 value of 71.7%, Oral hygiene OR=1.29, CI (1.04-1.54), I2 value of 19.7% and in periodontal diseases OR=2.14 CI (1.70-2.58), I2 value of 75.3% had a higher risk of developing oral cancer. The risk factors for tooth loss and periodontal disease showed moderate heterogenicity and less heterogenicity for oral hygiene. Poor oral health factors such as periodontal disease, poor oral hygiene, and loss of teeth show higher odds of oral cancer than the control. The periodontal disease shows the highest odds than other factors. These risk factors can be considered for the primordial prevention of oral cancer.

BACKGROUND:Ultrasound-guided quadratus lumborum block (QLB) is used for intraoperative and postoperative pain relief in laparoscopic total and partial nephrectomy. The analgesic efficacy of QLB in nephrectomy remains under-explored and needs evaluation. METHODS:A comprehensive literature search was done to assess the effectiveness of preoperative QLB for nephrectomy. The primary objective was to evaluate postoperative opioid consumption following laparoscopic total and partial nephrectomy. In total nephrectomy, the opioid requirement was recorded at 24 h interval. In partial nephrectomy patients, postoperative opioid requirement was recorded at 6-12 h, 12-24 h and 24-48 h. The secondary objective was to assess the incidence of nausea and vomiting in both the groups. RESULTS:Single-shot QLB was compared with no block or sham block in laparoscopic total and partial nephrectomy. In total laparoscopic nephrectomy, significant reduction of postoperative opioid consumption in patients with QLB (weighted mean difference [WMD]: -549.11, 456.07; P = 0.004) than the control group seen. Nausea was 35% lower in the QLB group than the control group (risk ratio [RR]: 0.65, 95% confidence interval [CI]: 0.39-1.10). In partial nephrectomy, QLB group had less opioid use at 6-12 h (WMD: -6.23, 95% CI: -9.76--2.70), 12-24 h (WMD: -5.40, 95% CI: -10.10--0.70) and 24-48 h (WMD: -1.12, 95% CI: -6.52-4.29). Partial nephrectomy group QLB showed 28% decrease in the vomiting than the control group (RR: 0.72, 95% CI: 0.3-1.50). CONCLUSION:Significant reduction in the requirement of postoperative opioid, nausea and vomiting in group receiving single-shot QLB in laparoscopic nephrectomy patients was seen. The results suggest that QLB can serve as an important part of multimodal analgesia strategies.

Objective The study evaluated the predictive utility of Erythrocyte Acetylcholinesterase (E-AChE) and Butyrylcholinesterase (BChE) levels in individuals presenting with OP and carbamate poisoning. Methods Of the 60 patients, 42 had Organophosphorus (OP) poisoning, and 18 had Carbamate poisoning in the ER. Vital signs, symptoms, and POP Severity Scale scores were recorded. E-AChE levels were measured using the Rapid ChE Check Mobile, and BChE levels were assessed through standard lab techniques. SPSS was used for statistical analysis, examining correlations between E-AChE levels and outcomes like ICU stay, mechanical ventilation, and mortality. Results The study involved 60 patients (mean age 32.5 years, ± 10.7), 66.7% male and 33.3% female. Of these, 60% consumed OP chemicals and 40% carbamate. Severe poisoning was associated with significantly lower E-AChE levels (mean = 2.1 U/g Hb) compared to moderate (3.5 U/g Hb) and mild cases (5.1 U/g Hb) (p < 0.001), showing a strong negative correlation with POP Severity scores (rho = -0.76, p < 0.001). Butyrylcholinesterase (BChE) levels also showed a significant decrease in severe poisoning cases, aligning with clinical outcomes, although the correlation was less robust than with E-AChE. Delays in care led to severe consequences in 80% of low-income patients. Lower E-AChE levels correlated with prolonged ICU stays (r = -0.68, p < 0.001), increased ventilation needs (r = -0.62, p < 0.01), and higher mortality (r = -0.74, p < 0.001). Rural patients faced worse outcomes due to inadequate healthcare access. Conclusion Although BChE levels were also measured, their correlation with outcomes was less pronounced but still valuable. Incorporating early measurements of both E-AChE and BChE could enhance clinical decision-making in OP and carbamate poisoning cases. Recommendations Incorporating rapid diagnostic tools for cholinesterase measurement in emergency settings could improve clinical decision-making and patient outcomes.

Background Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease due to the lack of early detection. Because chronic pancreatitis (CP) patients are a high-risk group for pancreatic cancer, this study aimed to assess the differential miRNA profile in pancreatic tissue of patients with CP and pancreatic cancer. Methods MiRNAs were isolated from formalin-fixed paraffin-embedded pancreatic tissue of 22 PDAC patients, 18 CP patients, and 10 normal pancreatic tissues from autopsy (C) cases and processed for next-generation sequencing. Known and novel miRNAs were identified and analyzed for differential miRNA expression, target prediction, and pathway enrichment between groups. Results Among the miRNAs identified, 166 known and 17 novel miRNAs were found exclusively in PDAC tissues, while 106 known and 10 novel miRNAs were found specifically in CP tissues. The pathways targeted by PDAC-specific miRNAs and differentially expressed miRNAs between PDAC versus CP tissues and PDAC versus control tissues were the proteoglycans pathway, Hippo signaling pathway, adherens junction, and transforming growth factor-β signaling pathway. Conclusions This study resulted in a set of exclusive and differentially expressed miRNAs in PDAC and CP can be assessed for their diagnostic value. In addition, studying the role of miRNA-target gene interactions in carcinogenesis may open new therapeutic avenues.

Ocular surface squamous neoplasia (OSSN) consists of an array of dysplastic, pre-invasive and malignant squamous lesions that impair the ocular surface. We report a case of a 61-year-old female with recurrent OSSN and had chronic hepatitis B. She was managed surgically, excision of the lesion and cryotherapy with amniotic membrane grafting with topical Mitomycin C 0.02% was performed. She came back with recurrence after 8 months and was managed with 6 cycles of Mitomycin C. After 9 months she reported back with recurrence with light perception vision and underwent orbital exenteration.

Objective of the study was to find the association of vitamin D receptor (VDR) polymorphisms (Fokl, Taql and Apal) with vitamin D levels in diabetic foot ulcer (DFU) patients in South India. In this case-control study, plasma vitamin D levels and VDR genotype frequencies of 70 cases (DFU patients) were compared with 70 diabetic (diabetes mellitus [DM] [non-DFU]) patients and 70 apparently healthy controls (HC) from South India. Plasma vitamin D levels were measured using the ELISA technique, and genotyping of VDR polymorphisms was carried out using real-time polymerase chain reaction. Logistic regression was used to find the association between DFU versus HC and DFU versus DM traits. Association analysis was performed based on additive, dominant and recessive models with age and gender as covariates. A 45.7% of DFU patients have sufficient vitamin D levels than 48.6% and 40% of DM patients and HC, respectively. Linkage disequilibrium analysis for DFU versus HC and DFU versus DM traits shows that single nucleotide polymorphisms (SNPs) Taq1 (rs731236) and Apal (rs7975232) are in strong linkage disequilibrium in DFU patients. The alleles and genotype frequencies were similar in all three groups. Although the additive model does not show statistical significance, age and sex correlate with the three SNPs (Fokl, Taql and Apal). No association was found between VDR gene polymorphisms and vitamin D levels in DFU patients in Southern India. On the other hand, age and sex correlate with the three SNPs.

Background The development of nosocomial infection associated with pathogens that are multi-drug resistant and extensively drug-resistant leads to serious complications in hospitalized patients. Since this type of infection has limited treatment options it is necessary to identify and determine their prevalence. This study is conducted to determine the Microbial Profile, Antimicrobial Susceptibility, and Prevalence of MDR/XDR Pathogens Causing Medical Device Associated Infections at our institute. Materials and Methods The patients admitted at the RIMS Ranchi were included in the study. The demography and other clinical characteristics of the patients were recorded. The CLABSI, CAUTI, and VAP were confirmed in the patients. The causative pathogen was isolated. The microbiology profile, resistance, and susceptibility pattern of these organisms were studied. Results Among the 110 patients, 65 were confirmed to have MDAIs based on positive culture results. The average age of the patients was 43.5 ± 5 years, with a majority being male. Comorbidities included liver disorders (30.7%), cardiovascular disorders (29.2%), and renal disorders (21.3%). Immunosuppression was seen in 80% of patients. The infections identified were central line-associated bloodstream infections (53.8%), catheter-associated urinary tract infections (23.07%), and ventilator-associated pneumonia (23.07%). Of the 80 pathogens isolated, 54 were MDR, and 20 were XDR. Carbapenem resistance was noted in 35% of the isolates. Fungal resistance to amphotericin B and fluconazole was observed in 8.75% of cases. Two patients with ventilator-associated pneumonia did not survive. Conclusion MDAIs are inevitable, among them central-line bloodstream infection is found in most patients. The occurrence of resistance among the patients severely reduces the treatment options available and increases the complexities of the treatment. Recommendation Preventative measures and analysis of microbiology profiles are necessary to reduce the occurrence of infection associated with medical devices.