Ophthalmology

A note from the Editor Hassan A Al-Dhibi Middle East African Journal of Ophthalmology 2019 26(1):1-1

Assessment of macular pigment optical density using fundus reflectometry in diabetic patients Mary Varghese, Joel Antony Middle East African Journal of Ophthalmology 2019 26(1):2-6 PURPOSE: Diabetic retinopathy (DR) is a major cause of visual disability and may be associated with reduction in macular pigment (MP) density and insufficient data are available. We present MP optical density (MPOD) measured by fundus reflectometry in eyes with and without early and moderate DR. SUBJECTS AND METHODS: This was a cross-sectional study conducted in the year 2014–2015. Participants were divided into three groups: the normal individuals without diabetes constituted Group I, while diabetic patients without DR and the patients with mild-to-moderate DR constituted Group II and Group III, respectively. MPOD and maximum optical density (Max OD) were measured using a Visucam 500 fundus camera (Carl Zeiss Meditec AG, Jena, Germany). RESULTS: Fifty diabetic patients without DR, 50 with mild and moderate DR, and 50 healthy individuals underwent MPOD and Max OD measurements. The mean pigment density was the same in all the three groups (0.12). HbA1c levels were inversely correlated with MPOD (P = 0.01) and Max OD (P = 0.002). There was no relationship between MP density and age (P = 0.66), gender (P = 0.24), or duration of diabetes (P = 0.85). The duration of diabetes was compared between the two groups of diabetic patients with and without DR. CONCLUSIONS: The mean pigment density assessed by fundus reflectometry was 0.12 in each of the three groups studied. Higher HbA1c levels in diabetic patients correlated with decreased MPOD and Max OD. Better glycemic control may influence macular health in diabetic patients.

Retinopathy of prematurity among syrian refugees: Incidence and severity Pehmen Yasin Ozcan Middle East African Journal of Ophthalmology 2019 26(1):7-10 PURPOSE: The aim of this study is to compare the incidence and severity of retinopathy of prematurity (ROP) in premature newborns of Syrian refugees and those of Turkish origin. METHODS: This retrospective, the single-center study included 1545 premature infants assigned to two groups based on maternal origin. Group 1 comprised 1366 premature infants of Turkish origin, and Group II comprised 179 premature infants born to Syrian refugees. All the premature infants were screened for ROP by the same ophthalmologist who is experienced in the screening and treatment of ROP. All data including gestational age (GA), birth weight (BW), the presence of ROP, and severe ROP collected from 2014 to 2017 were recorded for each group. The outcomes were compared between the two groups. RESULTS: The mean GA at birth was 30.6 ± 2 weeks and was significantly lower in Group II (P = 0.03). The overall incidence of ROP was similar in both groups. The incidence of severe ROP in Group II was nearly seven times higher than in Group I (1.5% and 10%, respectively). The incidence of severe ROP seen in Group II evaluated according to different ranges of GA and BW was higher than in Group I. CONCLUSION: The higher incidence of severe ROP in the premature newborns of Syrian refugees could play an important role in identifying ongoing health problems of refugees.

The outcome of corneal collagen cross-linking in patients with advanced progressive keratoconus: A 2-year follow-up study Reza Soltani Moghadam, Mitra Akbari, Yousef Alizadeh, Abdolreza Medghalchi, Reza Dalvandi Middle East African Journal of Ophthalmology 2019 26(1):11-16 PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 μm to 431.43 ± 61.92 μm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.

Improved refractive outcomes of small-incision extracapsular cataract surgery after implementation of a biometry training course Jay J Meyer, Hans R Vellara, Riyaz Bhikoo, Lucilla Ah-Ching Sefo, Salome Lolokabaira, Neil L Murray, Charles N J McGhee Middle East African Journal of Ophthalmology 2019 26(1):17-22 PURPOSE: To determine whether a biometry training course could improve refractive outcomes of patients undergoing manual small-incision extracapsular cataract surgery (SICS). MATERIALS AND METHODS: This was a prospective, interventional, cohort study at the Pacific Eye Institute, Fiji. SICS refractive outcomes were evaluated before and after a structured biometry teaching course. Eyes that underwent evaluation and subsequent SICS with placement of a posterior chamber intraocular lens (IOL) were included. Axial length measurements were obtained using A-scan applanation ultrasound and keratometry with a handheld keratometer. Main outcome measures included mean absolute prediction error of IOL calculations, percentage of eyes within ±0.5 D and ±1.0 D of intended spherical equivalent, and proportion of eyes with ≥6/18 uncorrected visual acuity. RESULTS: A total of 240 eyes were analyzed: 120 eyes before and 120 eyes after the structured biometry training. The mean absolute prediction error was 50% lower following the training (1.13 ± 0.84 D pre vs. 0.56 ± 0.44 D post; P < 0.001). A higher percentage of the eyes had a postoperative spherical equivalent within ±0.5 D (26.7% pre vs. 52.5% post; P < 0.001) and ±1.0 D (55.0% pre vs. 90.0% post; P < 0.001) of the intended target. A higher proportion of the eyes achieved ≥6/18 uncorrected visual acuity (77.5% pre vs. 91.7% post, P = 0.004), while the proportion with ≥6/18 corrected visual acuity was similar (94.4% pre vs. 98.3% post; P = 0.28). CONCLUSIONS: A structured biometry training course may improve the accuracy of preoperative IOL calculations to achieve the postoperative refractive target. Ophthalmology training programs should include structured biometry teaching in their curricula.

Ocular surface microbial flora in patients with chronic limbal stem cell deficiency undergoing cultivated oral mucosal epithelial transplantation Srilathaa Gunasekaran, Rebika Dhiman, Murugesan Vanathi, Sujatha Mohanty, Gita Satpathy, Radhika Tandon Middle East African Journal of Ophthalmology 2019 26(1):23-26 PURPOSE: The purpose of this study is to analyze the ocular surface microbial flora in patients with chronic limbal stem cell deficiency (LSCD) due to Stevens–Johnson Syndrome (SJS) and ocular chemical injury undergoing cultivated oral mucosal epithelial transplantation (COMET). METHODS: Patients of SJS and chemical injury who had bilateral total LSCD planned for COMET were studied. Conjunctival swab was taken before surgery. Parameters evaluated were organism cultured, sensitivity pattern, frequency of positive culture, and clinical impact on management strategy. RESULTS: Thirteen patients were included in which nine were males and four females. All patients had positive conjunctival swab culture. Most common organism isolated was Staphylococcus epidermidis, followed by Staphylococcus aureus and Pseudomonas aeruginosa. The staphylococcal species isolated were sensitive to all the conventional antibiotics while Pseudomonas cultured showed resistance to cefuroxime, ceftriaxone, and ceftazidime. Repeat conjunctival swab sent after a week of topical antibiotic therapy yielded positive culture of the same organism twice in 25% (3/12), thrice in 58.3% (7/12), and four times in 16.6% (2/12) of the patients. One patient had a polymicrobial flora with positive yield of S. aureus (thrice), S. epidermidis (twice), and P. aeruginosa (twice) in consecutive conjunctival swab culture in the absence of clinical infection. Two patients with persistent positive cultures had to undergo repeat oral mucosal harvesting as the transplantation of the cultivated explants had to be deferred. CONCLUSION: Ocular surface in LSCD patients yielded pathogenic organisms on culture. Poor ocular surface with absent tear film could be the contributing factors. It is important to perform the conjunctival swab culture before COMET surgery.

Prevalence and determinants of dry eye disease among 40 years and older population of Riyadh (Except Capital), Saudi Arabia Ziaul Haq Yasir, Deepti Chauhan, Rajiv Khandekar, Ches Souru, Sejo Varghese Middle East African Journal of Ophthalmology 2019 26(1):27-32 PURPOSE: The prevalence and determinants of dry eye disease (DED) among 40 years and older population of Riyadh (except capital), Saudi Arabia. SUBJECTS AND METHODS: A population-based survey was conducted in Riyadh district between 2013 and 2017. All Saudi aged >40 years attended at the Primary Health Center were the study population. McCarty Symptom Questionnaire was adopted. A representative sample was examined. The best-corrected visual acuity and anterior and posterior segment assessment were performed. DED was graded as absent, mild, moderate, and severe. RESULTS: We examined 890 participants. The age- and sex-adjusted prevalence of DED was 45.1% (95% confidence interval [CI] = 44.8–45.4). One-third of the participants had DED. However, two-third of DED cases were of mild grade. The prevalence of DED among females was significantly higher. The variation of DED by age group was not statistically significant (χ2 = 2.6, Degree of freedom = 3, and P = 0.1). Presence of glaucoma was significantly associated to DED (odds ratio [OR] = 2.6, [95% CI = 1.2–5.6], and P = 0.01). Use of topical glaucoma medication was significantly associated to DED (OR = 4.6 [95% CI = 1.8–11.8], and P = 0.001). However, severity of DED was not found to be associated with glaucoma medication (χ2 = 2.6, P = 0.1). Associations of diabetes and hypertension to DED were not statistically significant (OR = 0.97 [95% CI = 0.73–1.3], and P = 0.84) (OR = 1.1 [95% CI = 0.8–1.4], and P = 0.6). The severe visual impairment was not associated to the grade of DED (P = 0.55). CONCLUSION: The prevalence of DED among Saudi is high, but severe DED is found to be less. Association with female gender, glaucoma, and topical glaucoma medications was reported. Association with diabetes, hypertension, and age group variation was not significant.

Fibrin glue-assisted intraocular lens fixation in weill–Marchesani syndrome Charudutt Kalamkar, Nishant V Radke, Amrita Mukherjee, Snehal N Radke Middle East African Journal of Ophthalmology 2019 26(1):33-36 PURPOSE: To report visual and intraocular pressure (IOP) outcomes of 4 eyes in 2 patients with Weill Marchesani Syndrome having ocular fearures of spherophakia and secondary glaucoma who underwent fibrin glue assisted intrascleral fixation of intraocular lens (IOL). METHODS: Detailed anterior and posterior segment evaluation assessing best corrected visual acuity (BCVA), IOP, central corneal thickness was done in all. Lensectomy, vitrectomy with glued Intrascleral fixation of 3 piece intraocular lens was done. Post operative BCVA and IOP were assessed. RESULTS: Visual acuity and IOP control improved post-operatively. CONCLUSIONS: Glued IOL implantation is an effective method to visually rehabilitate and control glaucoma in patients with Weill Marchesani Syndrome.

Marcus gunn jaw-winking syndrome associated with morning glory disc anomaly Abdulaziz A Alshamrani, Fahad A Alghulaydhawi, Mohammed Al Shamrani Middle East African Journal of Ophthalmology 2019 26(1):37-39 Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.

Corneal toxicity after self-application of Calotropis procera (Ushaar) Latex: Case report and analysis of the active components Huda Al Ghadeer, Ahmad Al Gethami, Hamad Al Sulaiman, Thamer Bukhari Middle East African Journal of Ophthalmology 2019 26(1):40-42 Calotropis procera (ushaar) produces a copious amount of latex, which has both inflammatory and anti-inflammatory pharmacological properties. Local application produces an intense inflammatory response and causes significant ocular morbidity. We report corneal toxicity following self-application of latex from C. procera in a 74-year-old man. He reported painless decreased vision in the affected eye with diffuse corneal edema, and specular microscopy revealed a reduced endothelial cell count. After he was treated with topical corticosteroids, his visual acuity improved from hand motion to 20/80. The composition of the active compounds in the latex was analyzed. When topically administered, the latex may cause severe ocular injuries and a loss of endothelial cells over a period of time. Public education, early recognition of such injuries, and timely intervention may prevent permanent ocular damage.

Otorhinolaryngology Head and Neck Surgery

Deep neck space infection: Are we overlooking the elderly? Shankar P Shah, Shyam Thapa Chetri, Bajrang P Sah, Sudip Mishra, Amit K Singh, Swotantra Gautam Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2018 2(2):17-20 Context: Deep neck space infections (DNSIs) are unique among infectious diseases for potential life-threatening complications. Its early recognition is therefore challenging and a high index of suspicion is necessary to avoid any delay in treatment. Aims: This study aims to analyze the age, sex, source, nature, associated systemic conditions, neck spaces involved, and the bacteria isolated in patients with DNSIs. Settings and Design: A prospective, descriptive study was conducted in the Department of ENT and HNS, B.P. Koirala Institute of Health Sciences, Dharan, Nepal for a period of 2 years from August 2014 to July 2016. Subjects and Methods: All patients with DNSI who required hospitalization were included, whereas those with superficial skin soft-tissue infections, infections due to traumatic or surgical wounds or tumors were excluded. Statistical Analysis Used: The data were recorded on a pro forma and analyzed using Microsoft Excel 2007 (Microsoft, WA, USA). Results: Out of the 76 patients, 25 patients were >50 years of age (32.89%). Male: female ratio was 1:1.17. The most common source was dental infection occurring in 32 cases (42%). Diabetes mellitus was the most common associated systemic condition (4 cases). Submandibular and peritonsillar spaces were most commonly involved. A sterile culture was seen in the majority (18/32). Staphylococcus aureus and Escheria coli were the predominant bacteria isolated. Conclusions: DNSI is a common condition in the elderly populations. Odontogenic infection and diabetes mellitus are the predisposing factors. S. aureus and E. coli are the common causative agents.

Tonsillar cartilaginous choristoma: A rare entity Khushboo Saran, Shashikala Vinayakamurthy, K Vidya, Jay Prakash Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2018 2(2):21-22 Choristoma is a tumour like mass which is an island of normal cells or tissues in abnormal locations due to defects during embryological development. Choristoma is most frequently seen in the tongue and presence of choristoma in the tonsil is extremely rare. On histopathological examination, an island of mature cartilage with normal appearing chondrocytes amidst the lymphoid follicles were seen. We present here a case of cartilaginous choristoma with the complaint of chronic tonsillitis.

Inherited systemic hyalinosis: Role of surgery Saad Al Shammari, Swathi Velagapudi, Thomas Varghese Mannil, Sarvani Davuluri, Suresh Velagapudi Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2018 2(2):23-26 Inherited systemic hyalinosis is a rare autosomal recessive disorder affecting the mutation in gene ANTXR2. Since this entity was first described in 1978, many authors tried to differentiate two distinct entities: severe form as infantile systemic hyalinosis and milder form as juvenile hyaline fibromatosis. As more cases beginning to appear, it was recognized that these two entities are two ends of the spectrum of the same disease process. Now, there is a general consensus of grouping these entities together under the term inherited systemic hyalinosis. In this genetic disorder, the role of the surgery is limited to improve the quality of life only. We report a case of inherited systemic hyalinosis who presented to us at the age of 3 years and had surgery at the age of 7 years and 8 years, with a follow-up of 2 years postsurgery.

Mondini deformity implanted with minimal incision Munish Saroch, Amit Saini, Gaveshna Gargi Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2018 2(2):27-29 Mondini deformity accounts for majority of cochlear malformations. These children can be given a near-normal lifestyle by performing cochlear implant (CI) surgery. The results of standard incision cochlear implantation (SICI) in these children are very encouraging. However, there are very few centers in world which offer the minimal incision cochlear implantation (MICI) in these patients. We report a case of 2-year-old child suffering from Mondini deformity who underwent CI with MICI. MICI reduces the impact of surgery drastically in these children as it can be performed without shaving of hairs with a 2-cm incision. The complication rate of MICI is comparable to SICI. Apart from better cosmesis, another advantage is early switch on of the device. We are of the opinion that MICI is safe and can be successfully performed in cases of Mondini deformity without any fear.

Undetected mass in vallecula: Failure of airway management Jay Prakash, Natesh S Rao, Prashanth Prabhu, Shagun Sareen Annals of Indian Academy of Otorhinolaryngology Head and Neck Surgery 2018 2(2):30-31

Tropical Biomedicine

Epidemiology, clinical features and transmission of re-emerging arboviral infection chikungunya Balamurugan Shanmugaraj, Ashwini Malla, Sathishkumar Ramalingam Asian Pacific Journal of Tropical Biomedicine 2019 9(4):135-139 A number of re-emerging and emerging infectious diseases including chikungunya, West Nile, yellow fever, Zika, dengue, Japanese encephalitis, and others have increased in recent years, which threaten the public health across the globe. Chikungunya is a neglected re-emerging arboviral infection caused by chikungunya virus. Arboviral infections such as chikungunya, Zika and dengue have similar epidemiology, transmission cycles and clinical symptoms, which makes it difficult to diagnose these three infections. Moreover, there is no commercial vaccine or licensed therapy available for chikungunya infection, thus causing severe burden worldwide. Vector control may reduce the disease risk; however, this remains a challenge due to many factors including, but not limited to, evolution of insecticide resistance in mosquitoes, gaps in vector control tools, urbanization, environmental and demographic changes. Effective integrated vector control strategies and surveillance measures along with affordable vaccine development or anti-viral therapy are essential to control the infection. In this review, we discuss the epidemiology of mosquito-borne infection chikungunya which has re-emerged as an international concern in recent decades.

Keladi candik (Alocasia longiloba Miq.) petiole extracts promote wound healing in a full thickness excision wound model in rats Nurul Hazirah Che Hamzah, Arifullah Mohammed, KNS Sirajudeen, Mohd Asnizam Asari, Zulhazman Hamzah, Ibrahim Khalivulla Shaik Asian Pacific Journal of Tropical Biomedicine 2019 9(4):140-149 Objective: To investigate the wound-healing effect of Alocasia longiloba (A. longiloba) petiole extract on wounds in rats. Methods: Twenty-two male Sprague-dawley rats were randomly assigned to receive 10% solcoseryl gel, phosphate buffer saline, 50% ethanol, 95% ethanol and hexane extracts of A. longiloba at 1.5%, 3% and 6% doses, respectively. A full thicknesses wound (6 mm) was created on the dorsal of the rat; and all rats were applied with the extract solutions, 10% solcoseryl gel and phosphate buffer saline once a day topically until day 12. The wound was photographed on day 1, 6 and 12, and the percentage of wound contraction was calculated. On day 12, rats were sacrificed and histological examination of granulation tissue was carried out using haematoxylin & eosin and Masson’s Trichrome stain to determine the wound healing effect. Results: In this study, 6% of 50% and 95% ethanol extracts of A. longiloba showed 82.50% and 82.32% wound contraction, respectively, and were comparable with 10% solcoseryl gel (82.30%). Meanwhile, phosphate buffer saline treated group showed the lowest wound contraction (69.86%). Histological assessment of wound treated with 6% of 95% ethanol extract of A. longiloba showed distinct epidermal and dermal layer, higher proliferation of fibroblast and more angiogenesis with collagen compared to other wound treated groups. Conclusions: A. longiloba petiole extracts have a wound healing potential and 6% of 95% ethanol extract of A. longiloba is more effective. Further studies are required to understand the wound healing mechanism of action of the extract.

Falcaria vulgaris extract attenuates diabetes–induced kidney injury in rats Jalili Cyrus, Roshankhah Shiva, Salahshoor Mohammad Reza Asian Pacific Journal of Tropical Biomedicine 2019 9(4):150-157 Objective: To assess the effects of Falcaria vulgaris (F. vulgaris) as an antioxidant on damage to kidney of diabetic rats. Methods: Diabetic rats were established via streptozotocin (60 mg/kg). Various doses of F. vulgaris extracts (50, 100 and 150 mg/kg) and streptozotocin + F. vulgaris extracts were administered via intraperitoneal (i.p) injection to 48 rats (n=8 per group) for 28 d. Subsequently, ferric ion reducing antioxidant power (FRAP) of renal tissue, thiobarbituric acid reactive species, blood glucose concentrations, insulin, nitrite oxide, the weight of animals, glomeruli characteristics and kidney function were evaluated. Results: Compared with the control rats, diabetic rats showed significant increase in malondialdehyde, blood urea nitrogen, creatinine, blood glucose, nitrite oxide contents in renal tissues, and glomerular diameter. Furthermore, tissue FRAP level, body weight, number of glomeruli and plasma insulin were markedly reduced in diabetic rats when compared with the control group (P < 0.05). However, in all F. vulgaris and F. vulgaris + streptozotocin groups, malondialdehyde level, blood urea nitrogen, creatinine, glomerular diameter, nitrite oxide, and glucose levels were decreased significantly; meanwhile, tissue FRAP level, body weight, glomeruli number and insulin serum level were increased, compared to the control diabetic group (P < 0.05). Conclusions: F. vulgaris extract alleviates renal damage in diabetic rats.

Antioxidant compounds and capacities of Gac (Momordica cochinchinensis Spreng) fruits Ali Abdulqader, Faisal Ali, Amin Ismail, Norhaizan Mohd Esa Asian Pacific Journal of Tropical Biomedicine 2019 9(4):158-167 Objective: To identify and determine the composition of antioxidant compounds, and to evaluate the antioxidant abilities of Gac fruit parts (peel, pulp, seed and aril) grown in Malaysia. Methods: LC-MS/MS was used for identification of antioxidant compounds and UV-Vis for estimation of the contents of phenolics, flavonoids, and carotenoids. Lycopene and β -carotene were quantified using high-performance liquid chromatography. DPPH (2, 2-diphenyl-1- picrylhydrazyl) and ferric reducing antioxidant power assays were employed to evaluate antioxidant capacities. Results: Phytochemicals were found amongst all the fruit parts. Notably, significant amounts of carotenoids [(107.4 ± 4.5), (85.7 ± 4.4), (110.6 ± 2.1) mg/100 g dry weight (DW)], and relatively high levels of both phenolics [(27.3 ± 1.7), (28.9 ± 2.4), (30.8 ± 2.7) mg/100 g DW] and flavonoids [(38.1 ± 2.2), (8.8 ± 1.3), (24.5 ± 3.3) mg/100 g DW] were found in the fruit’s peel, pulp and aril, respectively. Seed part also showed a relatively high level of flavonoids [(18.1 ± 2.3) mg/100 g DW]. Lycopene and β -carotene were found to be significantly high (P < 0.05) in aril [(579.3 ± 22.7) and (621.0 ± 35.0) μg/g DW], followed by peel [(51.0 ± 7.5) and (210.0 ± 12.5) μg/g DW] and pulp [(37.6 ± 10.9) and (205.6 ± 22.1) μg/g DW)]. Antioxidant assays revealed that aril possessed the highest scavenging activity (IC50 = 865 μg/mL), while the peel possessed the highest ferric reducing power of 140 pmol FeSO4/μg. Conclusions: The current results demonstrate that Gac fruit grown in Malaysia is a rich source of phytochemicals, especially carotenoids, and possesses antioxidant activities. Thus, such findings suggest Gac fruit as a source of an antioxidant plant.

GC–MS analysis and anti–mosquito activities of Juniperus virginiana essential oil against Anopheles stephensi (Diptera: Culicidae) Azar Tahghighi, Naseh Maleki-Ravasan, Navid Dinparast Djadid, Hamzeh Alipour, Raziyeh Ahmadvand, Fateh Karimian, Saeed Yousefinejad Asian Pacific Journal of Tropical Biomedicine 2019 9(4):168-175 Objective: To investigate phytochemicals present in the essential oil from aerial parts of eastern red cedar, Juniperus virginiana (J. virginiana) L. (Cupressaceae) and to determine its killing and repellent activities against larvae, pupae, and adults of the Asian malaria mosquito, Anopheles stephensi (Diptera: Culicidae). Methods: J. virginiana essential oil was extracted by hydrodistillation, and its chemical composition was determined by gas chromatography-mass spectrometry. Seven different logarithmic concentrations of J. virginiana essential oils were used in larvicidal and pupicidal assays. J. virginiana essential oils-impregnated bed nets were applied in a designed animal module to test excito-repellent activity against adult mosquitoes. Results: Fourteen constituents corresponding to 99.98% of J. virginiana essential oils were identified. Five main components were terpinen-4-ol (25.21%), camphor (19.89%), E-3-hexen- 1-ol (13.30%), γ-terpinene (7.86%), and l-menthone (2.27%). The LC50 and LC90 values against larvae of the Anopheles stephensi were 11.693 and 66.140 ppm and for pupae were 9.640 and 40.976 ppm, respectively. In excito-repellency assay, J. virginiana essential oils-impregnated bed nets provided an average of 54.63% protection for guinea pig and 45.37% mortality for the mosquitoes. Conclusions: Four monoterpenes and one leaf alcohol were identified by gas chromatography-mass spectrometry. J. virginiana essential oils showed potent larvicidal, pupicidal, adulticidal, and repellent activities against Anopheles stephensi at acceptable concentrations. Evaluation of bioactivity of identified chemicals (alone or in combination) will provide new eco-friendly substances for mosquito-management programs.

Antimalarial activities of butanol and ethylacetate fractions of Combretum nigricans leaf Enegide Chinedu, Peter A Akah, Dabum L Jacob, Ifeoma A Onah, Chimere Y Ukegbu, Chukwuma K Chukwuemeka Asian Pacific Journal of Tropical Biomedicine 2019 9(4):176-180 Objective: To evaluate the antimalarial activity of the ethylacetate and butanol fractions of Combretum nigricans (C. nigricans) leaf extract in mice. Methods: C. nigricans solvent (butanol and ethylacetate) fractions were screened for their phytochemical constituents using standard procedures illustrated by Harborne and Evans. The Peters’ 4-day suppressive test against early malaria infection, Rane’s curative test against established malaria and prophylactic test for residual activity were employed for evaluating the antimalarial potential in mice. Results: The phytochemical screening revealed the presence of alkaloids, terpenoids, saponins, and flavonoids in both fractions at different intensity. Both fractions exhibited significant antimalarial activity in all test models (P<0.05). The ethylacetate fraction of C. nigricans had better chemosuppressive and curative effects compared to the butanol fraction, which however, elicited a better chemoprophylactic effect. The chemosuppressive effect of C. nigricans ethylacetate fraction (200-800 mg/kg) was 77.6%, 69.1% and 86.1%; curative effect was 62.3%, 71.3% and 72.4%; while the chemoprophylactic activity was 32.1%, 48.6% and 61.2% respectively. C. nigricans butanol fraction (200-800 mg/kg) had 40.3%, 54.1% and 69.1% chemosuppression; 26.2%, 36.9% and 34.5% curative effect; and 48.4%, 70.0% and 87.4% chemoprophylaxis. Conclusions: Both solvent fractions of C. nigricans possess antimalarial activity, and may be useful at different stages of malaria therapy.

Lungs

Endobronchial metastasis: The challenge continues Neeraj Gupta Lung India 2019 36(3):181-182

New combined assessment of chronic obstructive pulmonary disease: Utilization, pitfalls, and association with spirometry Ruchi Dua, Ranjeeta Kumari, Vivek Yadav, Mayur Ranjan, Subodh Kumar, Mayank Mishra, Suryakant Tripathi Lung India 2019 36(3):183-187 Introduction: Classification of chronic obstructive pulmonary (COPD) disease has changed from being solely based on spirometric variables to combined assessment including symptom scores and history of exacerbations/ hospitalizations. There is both lack of awareness regarding change in its assessment as well as underutilization due to time constraints and seeming complexity. Moreover, treatment of COPD needs to be tailored according to the new combined assessment. Aims: Current study was planned to look at current stratification of patients according to new revised combined assessment (Global Initiative for Chronic Obstructive Lung Disease GOLD 2017) in comparison to old(GOLD 2011) as well as its incorporation in clinical practice. Co-relation between revised combined assessment and spirometric staging was also assessed. Methods: 418 consecutive COPD patients were enrolled, their dyspnea scores in terms of modified medical research council scale (mMRC), preceding history of hospitalization/ exacerbation over preceding one year and spirometric variables were recorded. Their stratification according to old and new classification recorded. Their past treatment records were reviewed and combined assessment if done recorded. Results: Substantial shift of categories is seen from C and D respectively to stage A and B on applying the new classification compared to old i.e more severe to less severe. Secondly, revised combined assessment is still highly underutilized. Revised combined assessment has positive co-relation with spirometry and post bronchodilator forced expiratory volume in 1 second(FEV1). Conclusions: Management of substantial number of stable COPD patients may need to be stepped down in accordance with revised combined assessment. There is a need to disseminate information regarding change in COPD classification and stress on its incorporation in our day-to day clinical practice. Revised combined assessment has positive co-relation with spirometry, stressing its utility even in peripheral centers without spirometry facilities.

Exacerbation of chronic obstructive pulmonary diseases as a risk factor of the skeletal muscle dysfunction Vitalii Poberezhets, Yuriy Mostovoy, Hanna Demchuk Lung India 2019 36(3):188-192 Background: Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) contributes to increased systemic inflammation, oxidative stress, hypoxia, hypercapnia and other risk factors of the skeletal muscle dysfunction. Aims and Objectives: This study aimed to determine whether the frequency of the COPD exacerbations promotes deterioration of the skeletal muscle dysfunction in patients with COPD and to figure out which characteristics of the muscles will reflect this changes. Materials and Methods: We examined 98 male COPD patients, mean age 60.4±11.2 years, GOLD groups B, C, D. To assess the degree of skeletal muscle dysfunction we used hand-grip strength, 6-minute walk test, bioelectrical impedance analysis. Quality of life was evaluated using St. George's respiratory questionnaire (SGRQ). Results: Increase in the frequency of COPD exacerbations was associated with the decrease in the 6-minute walk test distance (r= -0.214, P = 0.034) and with the rise of sarcopenia according to the results of bioelectrical impedance analysis – lower fat-free mass index (r = -0.201, P = 0.047). Frequency of COPD exacerbations had a weak correlation with the degree of the activity limitation component of SGRQ (r = 0.436, P < 0.001). Conclusions: COPD exacerbation plays an important role in progression of the skeletal muscle dysfunction. It decreases endurance of the skeletal muscles, diminishing their size, which manifests itself in reduced exercise tolerance. Increase in the frequency of the COPD exacerbations also worsens all components of the life quality.

Nonadherence to treatment and quality of life among patients with chronic obstructive pulmonary disease Shorouk Mohsen, Fadia Zaki Hanafy, Aya Ahmed Fathy, Abdel-Hady El-Gilany Lung India 2019 36(3):193-198 Objectives: Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases. Assessment of medication nonadherence and quality of life (QOL) is important in such chronic diseases. The aim of the study was to describe treatment nonadherence and QOL of COPD patients and their associated factors. Materials and Methods: A cross-sectional study was performed in Mansoura Chest Hospital on 133 already diagnosed inpatient cases of COPD from March to August 2017. Data were collected using two validated questionnaires, Morisky Medication Adherence Scale to assess medication adherence and St George's Respiratory Questionnaire for COPD patients (SGRQ-c) to assess QOL. Results: About 45% of studied group were nonadherent to prescribed medications. Logistic regression analysis showed that duration of disease is the only independent risk factor for nonadherence. The scores on SGRQ-c indicated sever QOL affection in COPD. SGRQ-c scores show significant impairment with the presence of comorbidities, hospital admission, and frequency of exacerbations. Conclusions: Nonadherence to treatment was affected mainly by the duration of disease. QOL impairment in COPD is influenced by broad range of factors suggesting the importance of QOL assessment in those patients. No association was found between nonadherence to treatment and QOL.

Flexible bronchoscopy-guided vocal cord biopsy under conscious sedation: An option to surgical biopsy in special situations Ravindra M Mehta, Abhinav Singla, Pavankumar Biraris, Sheelu Srinivas, Lakshmipriya Srinivasan Lung India 2019 36(3):199-201 Introduction: Vocal cord (VC) biopsies are usually performed with rigid laryngoscopy under general anesthesia (GA). In patients with comorbidities such as cardiovascular or pulmonary disease, the risk of GA is high, with morbidity and potential mortality. We describe VC biopsy (VCB) in such a high-risk cohort, done safely and successfully with flexible bronchoscopy-VCB (FB-VCB) and conscious sedation. Methods: FB-VCB was done in two groups of patients – the first at high risk for GA due to comorbidities and the second group where VC lesions were found incidentally in the course of FB done for other reasons. FB was done with local anesthesia and conscious sedation, and the VC lesion was identified. Flexible forceps were introduced through the working channel of the bronchoscope, and the lesions were carefully sampled. Results: FB-VCB was performed in 15 patients (14 males and 1 female) with a mean age of 60.7 ± 12.1 years. Of these 15 patients, 6 patients were poor candidates for GA due to comorbidities and 9 patients had incidental VC lesions found during bronchoscopy. A diagnosis was made in 14/15 (93.3%) patients. Complications included a mild ooze and hoarseness of voice for a few days, which did not require any intervention. Conclusion: We report one of the few series of patients with VC biopsies done with FB (FB-VCB) under conscious sedation, without significant complications. It is safe and useful in high-risk patients who are poor candidates for GA, with a good diagnostic yield.

A single-center experience of pediatric foreign-body aspiration: A retrospective 4-year case series Mustafa Erman Dorterler, Osman Hakan Kocaman, Tansel Gunendi, Mehmet Emin Boleken Lung India 2019 36(3):202-206 Introduction: Foreign body aspirations (FBA) in children are serious life-threatening clinical conditions that require immediate intervention. In this study, it was aimed to retrospectively investigate the demographic features, clinical diagnosis and treatment methods of children admitted to our clinic due to FBA. Materials and Methods: The study included 86 children aged <16 years, diagnosed with tracheobronchial foreign body aspiration (FBA) between January 2013 and December 2017. All patients with two-way chest radiography were examined for foreign body aspiration diagnosis. In case of suspicion of diagnosis, low-dose multi-slice chest CT was taken. In cases of FBA diagnosis, rigid bronchoscopy was performed under sevoflurane and propofol anaesthesia supported by controlled ventilation. Evaluation was made of the patient demographic characteristics, type and localization of the foreign body removed with bronchoscopy and operation-related complications. Results: The mean age of the patients with FBA diagnosis was 3.17 years and 55.8% (n = 48) of the patients were male. The most commonly aspirated foreign body was nuts (peanut and hazelnut) (70%) and the most common finding on the chest radiographs was obstructive emphysema, determined on 51% of the patients. Bronchoscopy revealed that the foreign body was in the right main bronchus and left main bronchus in 41%. Conclusion: The main treatment for FBA is prevention. However, in patients applied with bronchoscopy for FBA, controlled ventilation and appropriate general anesthesia should be generally used. Early bronchoscopic intervention with safe anesthesia and controlled ventilation support will improve the success rates in FBA cases.

Patient characteristics and outcomes of a home mechanical ventilation program in a developing country Narongkorn Saiphoklang, Apichart Kanitsap, Pitchayapa Ruchiwit, Pattarin Pirompanich, Thiti Sricharoenchai, Christopher B Cooper Lung India 2019 36(3):207-211 Background: There are limited data on home mechanical ventilation (HMV) in developing countries. This study aimed to describe the patient characteristics, feasibility, and outcomes of an HMV program at a university hospital in Thailand. Materials and Methods: Data were collected on all patients who were discharged with HMV between October 2014 and August 2015 at Thammasat University Hospital. Results: Twelve patients (eight men and four women) underwent HMV. They were aged 71.5 ± 17.6 years; mean ± standard deviation. Indications for HMV were 6 neurologic diseases (4 amyotrophic lateral sclerosis, 1 multiple system atrophy, and 1 stroke), 2 chronic obstructive pulmonary disease (COPD), 1 tracheomalacia, and 3 combined neurologic diseases and respiratory diseases (2 stroke and COPD, 1 stroke and tracheomalacia). The duration of follow-up was 799.5 ± 780.5 days. The ratio of family income to cost of HMV usage was 77.2:1 ± 5.5:1. All patients had tracheostomies. Modes of HMV were biphasic positive airway pressure (66.7%), pressure-controlled ventilation (16.7%), pressure-support ventilation (8.3%), and volume-controlled ventilation (8.3%). Complications occurred in ten patients (83.3%), including tracheobronchitis (20 events) and ventilator-associated pneumonia (12 events). Overall mortality was 41.7% (5/12 patients), including two patients who died due to ventilator-associated pneumonia. There were no instances of ventilator malfunction. Conclusions: HMV is feasible for patients with neurological diseases and COPD in a developing country. The relatively high rate of complications indicates the need for more comprehensive clinical services for chronic ventilator-dependent patients in this setting.

Endobronchial metastasis from extrathoracic malignancies: A clinicopathological study of 11 cases Monika Breta, Sudheer Arava, Karan Madan, Ashok Singh, Deepali Jain, Randeep Guleria Lung India 2019 36(3):212-215 Introduction: Endobronchial metastases are uncommon. It accounts for 2-28%. Most common tumors that metastasis to the endobronchial site are breast, renal, endometrial and colon carcinomas. They have to be identified properly because they present poor prognosis and different treatment modalities when compared to that of primary lung carcinomas. Materials and Methods: We studied a total of 11 retrospective cases of Endobronchial metastasis. Detailed clinic pathological and radiological findings were analyzed along with a detailed Immunohistochemical workup and Endobronchial findings. Results: Mean age of presentation was 55 years with female predominance (Male to female ratio was 1:1.2). Most common tumors encountered were carcinoma breast (3), colorectal carcinomas (2), renal cell carcinoma (2) followed by one each from carcinoma endometrium, cervix and thyroid. Common symptom was cough followed by dyspnea. Exophytic endobronchial growth was common with right main bronchus being the common site. Conclusion: Endobronchial metastasis occurs in various types of malignancies. It should always be differentiated from primary lung carcinomas as they carries poor prognosis and different treatment protocol when compared to that of primary lung tumors.

Pneumococcal disease burden from an Indian perspective: Need for its prevention in pulmonology practice Parvaiz A Koul, Sudhir Chaudhari, Ramesh Chokhani, D Christopher, Raja Dhar, Kumar Doshi, A Ghoshal, SK Luhadiya, Ashok Mahashur, Ravindra Mehta, Amita Nene, Md Rahman, Rajesh Swarnakar Lung India 2019 36(3):216-225 Globally, pneumococcal diseases are a significant public health concern. They are preventable and frequently occur among older adults. Major risk factors for the disease are extremes of age, alcohol intake, smoking, air pollution, and comorbid conditions (diabetes, chronic obstructive pulmonary disease, chronic kidney disease, liver disease, and heart disease). Risk factors, coupled with limited disease-burden data and the emergence of antibiotics resistance, are hindering the effective management of the disease in older adults. Various global guidelines recommend pneumococcal vaccines for the prevention of pneumococcal diseases, as they reduce disease burden, hospitalization, and mortality rates among patients with comorbid conditions. Besides being an integral part of childhood immunization, these vaccines are advocated by various Indian healthcare bodies/groups for older and younger adults with certain medical conditions. The article presents an overview of the closed-door discussion by the Indian pulmonary experts on the scientific evidence and clinical practice followed for the prevention of pneumococcal disease in India.

Barber's neck manipulation causing bilateral diaphragmatic paralysis and type-2 respiratory failure Ashish Kumar Prakash, Anand Jaiswal, Sandeep Mittal, Poulomi Chatterjee, Sameer Kotalwar, Bornalli Datta Lung India 2019 36(3):226-228 This is a case report of an unusual cause of bilateral diaphragmatic palsy. A 54-year-old gentleman, presented to us with exertional dyspnea and chest heaviness for the past 6 months which had increased in the last 6 days. Dyspnea increased on lying down. He was diagnosed as pneumonia on the basis of X-ray and chest CT scan, received treatment for the same and responded to the therapy. However, breathlessness and hypercapnia persisted. He had unexplained hypercapnia for which extensive investigations were carried out. Neurological and cardiac assessments were essentially normal. On revisit clinical examination, he was found to have paradoxical diaphragmatic movement with respiration. Ultrasound of chest detected no diaphragmatic movement. Detailed history elicited that patient was fond of neck massage and neck cracking wherein his barber would bend his neck with jerk to either side after a haircut.After considering all possible etiologies; we concluded that it was a case of diaphragm palsy induced by barber neck manipulation, leading to Type-2 respiratory failure. The fact that the vital clues to the diagnosis were elicited by detailed history and thorough examination reinforces that history and clinical examination for doctors shall remain a very important tool for clinical diagnosis.

Biomedical Research

Klotho: An emerging factor in neurodegenerative diseases Gauri V Pathare, Kavita K Shalia Biomedical Research Journal 2019 6(1):1-6 Soluble Klotho protein is present in blood, urine, and cerebrospinal fluid and works as a humoral factor exerting different biological effects. Several animal studies have demonstrated the association of age-related neurodegeneration with Klotho deficiency. Lower Klotho levels have been reported in patients suffering from cognitive impairment, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and other neurodegenerative diseases. Due to its antiaging properties, Klotho is the obvious choice to be studied as a protective/therapeutic agent in neurobiology. In this review, we have attempted to shed light on the different neurodegenerative diseases affected by deficiency of Klotho and its neuroprotective role against pathogenicity of the disease.

Nitrate stress-induced bioactive sulfated polysaccharides from Chlamydomonas reinhardtii Jyoti Vishwakarma, Vaishnavi Parmar, Sirisha L Vavilala Biomedical Research Journal 2019 6(1):7-16 Sulfated polysaccharides (SPs) are anionic carbohydrate polymers synthesized as extracellular or cell wall components by most of the algae and have potent bioactive properties. In the current study, Chlamydomonas reinhardtii (Cr) cells were attributed to sodium nitrate stress in concentrations such as 5 mM, 10 mM, 20 mM, 30 mM, and a control to determine the productivity and bioactivity of SPs. SPs are extracted by hot water method using 80% ethanol. The percentage yield of SPs increased with an increase in concentration of sodium nitrate as compared to control. Biochemical analysis of the extract showed an increase in carbohydrate content (22%–95%), uronic acid content (23%–60%), and sulfate content from control to 30 mM NaNO3-treated extracts. The amount of reducing and nonreducing sugars was found to be 6.16% and 89.06%, respectively, while the protein content is ~16%. The antioxidant potential of SPs showed increased antioxidant activity with an increase in concentration of NaNO3 stress. The analysis resulted in maximum chelating activity of 83.73% assayed in concentration range of 1–8 μg/ml, total antioxidant activity of 70.36% in concentration 0.05–2μg/ml, and hydroxyl radical scavenging activity of 79.52% in concentration 250–1000 μg/ml; reducing potential was observed with the highest absorbance of 0.87; the 2,2-diphenyl-1-picrylhydrazyl scavenging activity showed the highest activity of 63.61%, while the superoxide scavenging activity was 92% at 0.1–1 μg/ml. Furthermore, Cr-SPs inhibited the growth of Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli bacterial growth as indicated by clear zones that increased in size with an increasing concentration of NaNO3. These results provide opportunities to develop Cr-SPs as natural antioxidant and antibacterial agents.

Molecular docking study for evaluation of neuroprotective potential of sericin against cerebral stroke and exploring its biomaterial properties Khushboo Maurya, Anand Kumar Pandey Biomedical Research Journal 2019 6(1):17-24 Background: Cerebral stroke, the third leading cause of death worldwide results from the improper blood supply to the brain due to occlusions in the brain arteries. This leads to production of free radicals contributed by cyclo-oxygenases (COX), acid sensing ion channels (ASIC) and matrix metalloproteinases (MMPs) causing adverse conditions of inflammation, oxidative stress, and acidosis leading to neuronal death thereby proving these enzymes as potent targets. Sericin, a 38 amino acid long protein found in silk fiber is known for its anti-inflammatory and anti-oxidant property. Aim and Objectives: Inhibition of the above-mentioned targets by silk protein sericin to reduce the pathological features by structural interactions as well as reducing inflammation and oxidative stress due to the natural properties of compound. Methodology: In the present study we studied structural inhibition of effective targets by sericin through molecular docking analysis. Also, the semi crystalline nature of sericin was deduced through in silico XRD spectral analysis. Result: Structural inhibition through molecular docking analysis proved highly efficient inhibition. Also, the in silico XRD spectral analysis proved sericin to be a potential biomaterial for scaffold development. Conclusion: Sericin can not only act as an effective drug against cerebral ischemia but can also be used to develop scaffold to repair damaged brain.

Transforming growth factor beta receptor 2 single-nucleotide polymorphism association with oral cancer and In silico identification of small drug-like molecules as inhibitors to transforming growth factor Beta-2 receptor Shaleen Multani, Hetal Damani Shah, Dhananjaya Saranath Biomedical Research Journal 2019 6(1):25-33 Objective: Oral cancer, in India, constitutes 26% of global oral cancer burden. The major risk factors include tobacco, areca nut, alcohol, and human papillomavirus 16/18; however, only 5%–10% of the high-risk individuals develop oral cancer, indicating the role of genomic variants in susceptibility to oral cancer. Conventional treatment options in oral cancer have resulted in relatively poor prognosis and an unmet need of treatment. In silico analysis, therefore, was performed to identify small drug-like molecules as potential inhibitors of transforming growth factor beta-2 receptor (TGFβRII). Materials and Methods: Seven single-nucleotide polymorphisms (SNPs) were analyzed in 500 histopathologically confirmed oral cancer samples and 500 long-term tobacco users (LTTUs) as controls using allelic discrimination real-time polymerase chain reaction or high-resolution melting analysis. The differential frequencies in oral cancer and LTTUs were calculated using SPSS software (version 19), and odds ratio (OR) to indicate risk to oral cancer using Hutchon.net. structure-based virtual screening of drug-like molecules was performed to identify lead inhibitor molecules to TGFβRII using Schrödinger Suite 2015-4. Results: Heterozygous GC genotype of TGFBR2 rs9843143 demonstrated increased risk ([P = 0.011; OR 1.61 [1.25–2.1]) while CC genotype showed decreased risk (P = 0.005; OR 0.61 [0.44–0.83]) to oral cancer. Increased/decreased risk to oral cancer was not observed for the other SNPs. In silico analysis identified six molecules as inhibitors of TGFβRII kinase domain from 17,723 conformers from Maybridge HitFinder library and 2685 conformers from MEGx AnalytiCon natural product library. Conclusion: SNP rs9843143 (TGFBR2) demonstrated a significant association (P < 0.05) with oral cancer and six potential inhibitors of TGFβRII kinase were identified using in silico analysis.

Metastatic hepatocellular carcinoma manifesting as primary esophageal carcinoma: A rare case report K Jayaprakash Shetty, HL Kishan Prasad, Shubha Bhat, Michelle Mathias, Vijith Shetty Biomedical Research Journal 2019 6(1):34-36 Hepatocellular carcinoma (HCC) metastasizing to the esophagus and mimicking as a primary tumor of the esophagus is extremely rare, being present in <0.4% in some autopsy series. This report describes a case of 70-year-old male with metastatic HCC to esophagogastric junction causing diagnostic dilemma. An endoscopic examination revealed an ulcerative lesion in the lower end of the esophagus. The biopsy specimen obtained from a tumor revealed the pseudoglandular arrangement of tumor cells. Ultrasound abdomen showed liver nodule with biopsy confirming as HCC. Immunohistochemistry (IHC) of the esophageal mass showed positivity for Hep par 1, Glypican-3, Arginase, CA 19-9, CK 19, CDX2, pCEA, SATB2, and Ki-67 having 70% positivity confirming the HCC. Among these IHC panels, all are specific markers of HCC, but CDX2 and SATB2 were aberrantly expressed in our case. He was started on six cycles of chemotherapy (apristar 125 mg, epirubicin 40 mg, oxaliplatin 100 mg, and capecitabine 500 mg). After 8 months of follow-up, he was symptomatically improved. However, later, the patient was lost to follow-up. The accurate pretreatment staging and then providing stage-appropriate treatment is crucial in optimizing esophageal and hepatocellular cancer outcomes. Cases of premortem-diagnosed esophageal metastasis from HCC are extremely rare. Our case was ideal for IHC, which plays an important role in arriving at proper cases. Furthermore, it confirmed and highlighted the rare manifestations of hepatocellular carcinoma.

Thyroid

Histopathological findings of solitary thyroid nodule: An institutional retrospective analysis Harendra Kumar Gautam, Suredrendra Kumar Kanaujia, Vinod Kumar, Devendra Maurya, Shiromani Singh International Journal of Head and Neck Pathology 2018 1(2):37-40 Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for the proper management of the patients. Aims and Objectives: The aim of this study was to study the histopathological finding in patients of solitary thyroid nodule at tertiary center of Kanpur region. Materials and Methods: A total of 100 patients with solitary thyroid nodules were thoroughly examined clinically after taking detail history and fine-needle aspiration cytology. All the patients were subjected to surgery after preoperative preparation and anesthesia checkup. Thyroidectomy specimen was evaluated by histopathological examination. Results: Majority of the patients were between the age group of 21 and 40 years. Female:male ratio was about 5.6:1. Swelling in front of the neck was the most common presentation. Most common solitary thyroid swelling was the colloid goiter. The most common surgery performed was hemithyroidectomy. On histopathological examination, a total of 98 out of total 100 patients presented with benign lesions which included 66 patients of colloid goiter, 16 with follicular adenoma, 4 with lymphocytic thyroiditis, and 12 with adenomatous goiter. Two out of total 100 patients had malignant lesions. Among malignant lesions, papillary carcinoma was found in one patient and anaplastic carcinoma in one patient. Conclusion: The most common histopathological findings of solitary thyroid nodule were colloid goiter followed by follicular adenoma, adenomatous goiter and thyroiditis. Thyroid malignancy was very rare histopathological finding.

BRAF status in the variants of papillary thyroid carcinoma Daphne Fonseca, Sudha S Murthy, Ravindranath Tagore, Vishal Rao, Chandrashekar S Rao, K V. V N. Raju, Hemant Kumar Nemade, Sundaram Challa International Journal of Head and Neck Pathology 2018 1(2):41-47 Aim: The aim was to study the BRAF status by immunohistochemistry (IHC) in the variants of papillary carcinoma thyroid and compare it with the clinicopathological parameters. Materials and Methods: All the thyroid carcinomas diagnosed during the period of January 2015–June 2018 were reviewed and classified according to the WHO 2017 criteria. The demographic and clinicopathological features were noted. Microarrays were prepared on 27 cases, including classic and variants of papillary thyroid carcinoma (PTC), poorly differentiated thyroid carcinoma (PDTC), and medullary thyroid carcinoma (MTC). IHC was performed with BRAF V600E by automated staining. The BRAF status was correlated with known prognostic markers. Results: There were 23 PTC, 3 PDTC, and one MTC. The PTC included seven classic, three solid, two each of microcarcinoma, infiltrative and encapsulated follicular variant, tall-cell variant (TCV), oncocytic and one each of diffuse sclerosing, nodular fasciitis-like stroma, and Warthin-like variants. BRAF positivity was seen in 44.44%, including 11 PTC and one PDTC. The positivity was 85.71% in classic and 31.25% in variants. The age (>45 vs. <45 years), gender (male vs. female), number of lesions (unifocal vs. multifocal), type of tumor (PTC vs. other tumors), subtype of PTC (classic PTC vs. variants), invasion (capsular vs. lymphovascular), and aggressive features (extrathyroidal extension vs. lymph nodal involvement) between BRAF positive and negative tumors were not statistically significant (Fisher's exact test at P < 0.05). Conclusion: BRAF status did not show correlation with known prognostic variables in classic as well as variants of PTC.

Head and Neck Pathology

Histopathological findings of solitary thyroid nodule: An institutional retrospective analysis Harendra Kumar Gautam, Suredrendra Kumar Kanaujia, Vinod Kumar, Devendra Maurya, Shiromani Singh International Journal of Head and Neck Pathology 2018 1(2):37-40 Background: Thyroid swellings are commonly encountered in the surgical practice and accurate preoperative evaluation of thyroid disorder becomes mandatory for the proper management of the patients. Aims and Objectives: The aim of this study was to study the histopathological finding in patients of solitary thyroid nodule at tertiary center of Kanpur region. Materials and Methods: A total of 100 patients with solitary thyroid nodules were thoroughly examined clinically after taking detail history and fine-needle aspiration cytology. All the patients were subjected to surgery after preoperative preparation and anesthesia checkup. Thyroidectomy specimen was evaluated by histopathological examination. Results: Majority of the patients were between the age group of 21 and 40 years. Female:male ratio was about 5.6:1. Swelling in front of the neck was the most common presentation. Most common solitary thyroid swelling was the colloid goiter. The most common surgery performed was hemithyroidectomy. On histopathological examination, a total of 98 out of total 100 patients presented with benign lesions which included 66 patients of colloid goiter, 16 with follicular adenoma, 4 with lymphocytic thyroiditis, and 12 with adenomatous goiter. Two out of total 100 patients had malignant lesions. Among malignant lesions, papillary carcinoma was found in one patient and anaplastic carcinoma in one patient. Conclusion: The most common histopathological findings of solitary thyroid nodule were colloid goiter followed by follicular adenoma, adenomatous goiter and thyroiditis. Thyroid malignancy was very rare histopathological finding.

BRAF status in the variants of papillary thyroid carcinoma Daphne Fonseca, Sudha S Murthy, Ravindranath Tagore, Vishal Rao, Chandrashekar S Rao, K V. V N. Raju, Hemant Kumar Nemade, Sundaram Challa International Journal of Head and Neck Pathology 2018 1(2):41-47 Aim: The aim was to study the BRAF status by immunohistochemistry (IHC) in the variants of papillary carcinoma thyroid and compare it with the clinicopathological parameters. Materials and Methods: All the thyroid carcinomas diagnosed during the period of January 2015–June 2018 were reviewed and classified according to the WHO 2017 criteria. The demographic and clinicopathological features were noted. Microarrays were prepared on 27 cases, including classic and variants of papillary thyroid carcinoma (PTC), poorly differentiated thyroid carcinoma (PDTC), and medullary thyroid carcinoma (MTC). IHC was performed with BRAF V600E by automated staining. The BRAF status was correlated with known prognostic markers. Results: There were 23 PTC, 3 PDTC, and one MTC. The PTC included seven classic, three solid, two each of microcarcinoma, infiltrative and encapsulated follicular variant, tall-cell variant (TCV), oncocytic and one each of diffuse sclerosing, nodular fasciitis-like stroma, and Warthin-like variants. BRAF positivity was seen in 44.44%, including 11 PTC and one PDTC. The positivity was 85.71% in classic and 31.25% in variants. The age (>45 vs. <45 years), gender (male vs. female), number of lesions (unifocal vs. multifocal), type of tumor (PTC vs. other tumors), subtype of PTC (classic PTC vs. variants), invasion (capsular vs. lymphovascular), and aggressive features (extrathyroidal extension vs. lymph nodal involvement) between BRAF positive and negative tumors were not statistically significant (Fisher's exact test at P < 0.05). Conclusion: BRAF status did not show correlation with known prognostic variables in classic as well as variants of PTC.

Oral mucosal melanoma: An enigma to the clinician Krishna Sireesha Sundaragiri, Shikha Saxena, Chandni Shekhawat, Bharat Sankhla International Journal of Head and Neck Pathology 2018 1(2):48-51 Oral mucosal melanoma is a rare oral malignancy with well defined clinical presentation of a pigmented brown macular to nodular lesion. The careful histopathological examination along with immunohistochemistry of the biopsy specimen was helpful in identification of this noxious lesion. A clear distinction between management and prognosis of benign gingival lesions and rarer lesions exists. Thus every general dental practitioner should advocate a mandatory histopathological examination of the each and every gingival growth. We present a unique case of oral mucosal melanoma masquerading as a benign gingival growth without any clinical presence of pigmentation in a 58-year-old male patient.

Oral squamous cell carcinoma with myiasis Sakshi Gupta, Arjun Agarwal, Cheena Garg, KY Giri, Archana Chaurasia International Journal of Head and Neck Pathology 2018 1(2):52-54 Myiasis is a rare condition that occurred with advanced ulcerated lesions of the oral cavity caused by the larvae in human tissue that evolve to a parasite and is commonly found in tropical countries. Poor oral hygiene is a primary cause for the growth of maggots leading to the development of myiasis. These cases are reported with chief complaint of pain and irritation in a localized area and diagnosed clinically based on the presence of the maggots. Treatment option is manual removal of maggots to cure the inflammatory process and prevent secondary infections. Here, we present a case of oral squamous cell carcinoma with myiasis diagnosed in a 50-year-old female patient.

A rare case of isolated retro-orbital fungal granuloma Mahmood Dhahir Al-Mendalawi International Journal of Head and Neck Pathology 2018 1(2):55-55