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Vipul Vilas Wagh,1 Tanvi Kottat,1 Suchita Agrawal,2 Shruti Purohit,2 Tejaswini Arun Pachpor,3,4 Leelavati Narlikar,5 Vasudeo Paralikar,2 Satyajeet Pramod Khare1 1Symbiosis School of Biological Sciences, Symbiosis International (Deemed University), Pune, MH, India; 2Psychiatry Unit, KEM Hospital Research Centre, Pune, MH, India; 3Department of Biosciences and Technology, School of Science and Environment Studies, Dr. Vishwanath Karad MIT World Peace University, Pune, MH, India; 4Department of Biotechnology, MES Abasaheb Garware College, Pune, MH, India; 5Department of Data Science, Indian Institute of Science Education and Research, Pune, MH, IndiaCorrespondence: Vasudeo Paralikar; Satyajeet Pramod Khare, Email paralikarv2010@gmail.com; satyajeetkhare@gmail.comIntroduction: Stigma contributes to a significant part of the burden of schizophrenia (SCZ), therefore reducing false positives from the diagnosis would be liberating for the individuals with SCZ and desirable for the clinicians. The stigmatization associated with schizophrenia advocates the need for high-precision diagnosis. In this study, we present an ensemble learning-based approach for high-precision diagnosis of SCZ using peripheral blood gene expression profiles.Methodology: The machine learning (ML) models, support vector machines (SVM), and prediction analysis for microarrays (PAM) were developed using differentially expressed genes (DEGs) as features. The SCZ samples were classified based on a voting ensemble classifier of SVM and PAM. Further, microarray-based learning was used to classify RNA sequencing (RNA-Seq) samples from our case-control study (Pune-SCZ) to assess cross-platform compatibility.Results: Ensemble learning using ML models resulted in a significantly higher precision of 80.41% (SD: 0.04) when compared to the individual models (SVM-radial: 71.69%, SD: 0.04 and PAM 77.20%, SD: 0.02). The RNA sequencing samples from our case-control study (Pune-SCZ) resulted in a moderate precision (59.92%, SD: 0.05). The feature genes used for model building were enriched for biological processes such as response to stress, regulation of the immune system, and metabolism of organic nitrogen compounds. The network analysis identified RBX1, CUL4B, DDB1, PRPF19, and COPS4 as hub genes.Conclusion: In summary, this study developed robust models for higher diagnostic precision in psychiatric disorders. Future efforts will be directed towards multi-omic integration and developing “explainable” diagnostic models. Keywords: Schizophrenia, peripheral blood, gene expression, machine learning, ensemble learning

Introduction: SARS-COV-2 infection (COVID-19) may be associated with wide range of bacterial and fungal infections. Mucormycosis is a common and potentially life threatening opportunistic fungal infection responsible for morbidity and mortality. Many factors like diabetes mellitus, hypertension and corticosteroid therapy might have been a role in the immunocompromised state of the patients. The aim of present study was to know the predisposing factors and role of histopathology in diagnosis and assessing the prognosis of post COVID-19 mucormycosis cases. Material and methods: It is a prospective observational study conducted in tertiary care hospital over a period of 6 months from April 2021 to September 2021. Functional endoscopic sinus surgery (FESS) and maxillectomy samples from 157 post COVID-19 mucormycosis suspected cases were studied and details regarding history of diabetes mellitus, hypertension and corticosteroid therapy were retrieved. All tissue samples were examined under H&E stain and special fungal stain (PAS). Results: On histopathological examination, out of total 157 cases, 94 cases were found to be positive for mucormycosis. Of these 94 cases, 63 were males and 31 were females. Age range was from 23 to 75 years. 5 cases showed mixed mucormycosis and aspergillosis infection. Also out of 94 post COVID mucormycosis cases, 72 were diabetic, 21 were hypertensive and 68 had a history of corticosteroid intake for treatment of COVID-19 infection. Conclusion: Histopathology plays a pivotal role in accurate diagnosis and assessing the severity and invasiveness of mucormycosis. Diabetes mellitus and corticosteroid use are the important associated factors.

Background: The present study was undertaken to study the histopathological features of leprosy in skin punch biopsies and to categories them in to various type based on microscopy and bacterial index. The aim of study was to know the role of histopathology in diagnosis of Hansen’s disease and to study the clinicohistopathological correlations of suspected cases of Hansen’s disease. Materials and methods: A retrospective hospital-based study of clinically diagnosed leprosy cases was conducted over a period of one year (April 2021 to March 2022). Lesional skin biopsies obtained were fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Fite-Faraco staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: 63 Skin biopsies were obtained from patients with age range of 14-72 years. Highest incidence was in age group of 31 – 50 years. There was male predominance with male to female ratio of 2:1. Clinically borderline Hansen’s (BB) (25.40%) was the most frequent subtype observed followed by borderline lepromatous (BLH) (19.04%) and lepromatous Hansen’s (LL) (19.04%). On histopathology we found tuberculoid Hansen’s (TT) (28.57%) was the most frequently observed subtype followed by borderline tuberculoid Hansen’s (BT) (19.04%). Fite stain revealed lepromatous bacilli in all cases of LL, BL, histoid and indeterminate Hansen’s; whereas bacilli could be demonstrated in six cases of BB, eight cases of BT and two cases of TT. Conclusion: Early diagnosis of leprosy is clinically difficult as patient present in different clinicopathological form, depending on host immune status. Therefore combined clinical, histopathological and bacteriological features are required for accurate diagnosis and classification.

Ranju Pokharel,1 Sudha Agrawal,1 Prajwal Pandey,1 Madhab Lamsal2 1Department of Dermatology and Venereology, B.P Koirala Institute of Health Sciences, Dharan, Nepal; 2Department of Biochemistry, B.P Koirala Institute of Health Sciences, Dharan, NepalCorrespondence: Ranju Pokharel, Junior Resident, Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, Tel +9779860660852, Email ranjupokharel.rp@gmail.comBackground: Chronic plaque psoriasis is a chronic inflammatory skin disorder. Vitamin D has been shown to have effects on keratinocyte differentiation as well as immune regulation in the skin.Objective: The main objective of this study was to assess the 25hydroxyvitamin D [25 (OH) D] level in patients with psoriasis in comparison with healthy control subjects.Materials and Methods: This case–control study included 180 persons (120 cases and 60 age- and sex-matched control subjects) from outpatient department of BPKIHS, a tertiary care hospital in eastern Nepal. Severity of psoriatic skin lesions was assessed using psoriasis area severity index (PASI) scoring. Serum vitamin D level was assessed by chemiluminescent immunoassay.Results: The mean serum 25(OH) D levels in psoriatic patients and controls were 19.57 ± 6.85 ng/mL and 23.63 ± 6.40 ng/mL, respectively. The difference was statistically significant even after adjusting for confounding factors in a multivariate analysis (aOR 2.929, 95% CI 1.376– 6.230). Low serum 25(OH) D levels were negatively associated with the severity of disease (r= − 0.628, P= 0.01).Conclusion: Serum 25(OH) D levels are significantly lower in psoriatic patients than in healthy control subjects. Deficiency of serum 25(OH) D was associated with severity of disease with an inverse relationship with PASI score.Keywords: psoriasis, psoriasis area severity index, 25hydroxyvitamin vitamin D

INTRODUCTION: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. MATERIALS AND METHODS: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot. RESULTS: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6- 8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value

Harshit Agrawal, Sudha Agrawal Department of Dermatology, B.P Koirala Institute of Health Sciences, Dharan, State-1, NepalCorrespondence: Harshit AgrawalDepartment of Dermatology, B.P Koirala Institute of Health Sciences, Dharan, State 1, NepalTel +977 9842025953Email harshitagrawaldharan@gmail.comBackground: The use of social media and photo-editing practice has grown enormously over the past decades. Photo editing can alter a person’s desire to look better in photographs posted on social media platforms.Objective: To assess the cosmetic dermatology seeking behavior of social media users and those who edit photographs before posting them on social media platforms.Methods: A validated self-administered structured questionnaire via Google form was sent to 550 social media users in Nepal. It included 5 sub-headings: use of social networking sites, photo-editing practices, awareness and motivation about cosmetic dermatology care, cosmetic dermatology care seeking behavior and self-esteem.Results: Facebook and Instagram were the preferred social networking sites for posting photographs. One-fourth of the participants edited > 40% of the total photos posted in social media. Hiding skin lesions was the most common reason (36.3%) for photograph editing. Fifty percent of the respondents felt the need to look better; repair skin damage; be able to look good without make up; look younger; feel happier and improve total quality of life as a “lot and top” motivation for using the cosmetic dermatological procedures. A majority preferred to seek cosmetic dermatology care from non-dermatologists because they felt dermatologist visit was not needed, the services were costly and they could not visit due to their busy schedule. On multivariate analysis, respondents who were aware of skin care favored seeking cosmetic dermatology care from dermatologists.Conclusion: Higher investment in social media and photo-editing practices might be associated with increased non-dermatologist seeking behavior.Keywords: cosmetic dermatology care, motivation, photo-editing practice, self-esteem, social media users

The present work demonstrates the extraction of nickel from low-grade chromite overburden by using solid state reduction and direct smelting route. Goethite & Quartz are present as major phases whereas chromite, hematite were identified as minor phases in the mineral. Solid state reduction of pellets were carried out inside a horizontal tube furnace at 1000°C, 1200°C, 1400°C for 30, 60, 90 and 120 minutes respectively with creating reducing atmosphere. Pellets of varying basicity (i.e. 0.5, 0.6, 0.7, 0.8 and 0.9) were used directly in the EAF for smelting studies. Highest percent of nickel (2%) having ~ 91% recovery were obtained in solid state reduction route for pellets which was reduced at 1400°C for 120 minute. Similar recovery (~90%) of nickel was obtained inside the ingot (0.67% Ni ) by using pellets of 0.9 basicity through smelting route. From the present investigation, it could be concluded that the solid state reduction as well as smelting routes are feasible for the recovery of nickel from low grade chromite overburden. The production of nickel pig (low grade ferronickel) could also be feasible by smelting route.

Introduction: Carpal collapse of wrist occurs in disorders like rheumatoid arthritis and Kienbock's disease. Three techniques have been described to measure carpal collapse. First, the carpal height ratio (CHR), measured by dividing carpal height by 3rd metacarpal length. Second, the revised carpal height ratio (RCH ratio), measured by dividing carpal height by length of capitate. Third, capitate radius distance (CR index), measured by shortest distance between distal edge of radius and the proximal edge of capitate. The index publications describe good reliability of all these but which method out of the three is best in terms of intra- and inter-observer variability is not known. The purpose of this study was to find out which method had the least inter- and intra-observer variability for determining carpal collapse. Materials and Methods: Fifty normal wrist postero-anterior radiographs were studied by three assessors who measured CHR, RCH ratio and CR index separately. The measurements were repeated after one month by all the three observers. The results were then statistically analysed. Results: The p-value was

Surbhi Agrawal Sankara Eye Hospital, Bangalore, IndiaCorrespondence: Surbhi AgrawalSankara Eye Hospital, Varthur Road, Kundalhalli Junction, Bangalore, 560037, IndiaTel +919702023675Email dr.agrawalsurbhi@gmail.com View the original paper by Dr Dib and colleagues

Seraj Ahmed Khan,1 Sudha Agrawal,2 Nirmal Baral,1 Madhab Lamsal1 1Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal; 2Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Background: Psoriasis is a dermatological disorder with a multifactorial origin and is associated with many biochemical and immunological changes. Purpose: This study aimed to examine the association of serum ADA activity, uric acid (UA), and high-sensitivity CRP (hs-CRP) with psoriasis and the role of ADA in disease severity. Materials and methods: In this comparative cross-sectional study, 50 clinically and histopathologically diagnosed psoriasis patients and 50 age- and sex-matched healthy controls were enrolled. Blood samples were taken and analysis of the biochemical parameters was performed according to Giuisti and Galanti method, uricase and ELISA technique for ADA activity, UA, and hs-CRP, respectively. The severity of the disease was scored according to Psoriasis Area and Severity Index (PASI). Statistical analysis of differences within and between the study groups was carried out using the Student’s t-test, one-way post hoc ANOVA, and Pearson’s correlation. Linear regression was used to establish the independent association of ADA with disease severity. Results: The serum ADA activity, UA, and hs-CRP levels of the psoriatic patients were found to be significantly higher (P

Marc Najjar,1 Surbhi Agrawal,1 Jean C Emond,1 Karim J Halazun1,2 1Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA; 2Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medical College, New York, NY, USA Abstract: Hepatocellular carcinoma (HCC) is the most common liver malignancy and the third most common cause of cancer-related deaths. Liver resection (LR) and liver transplantation (LT) are the only curative modalities for HCC. Despite recent advances and the adoption of the Milan and University of California, San Francisco, criteria, HCC recurrence after LR and LT remains a challenge. Several markers and prognostic scores have been proposed to predict tumor aggressiveness and supplement radiological data; among them, neutrophil–lymphocyte ratio (NLR) has recently gained significant interest. An elevated NLR is thought to predispose to HCC recurrence by creating a protumorigenic microenvironment through both relative neutrophilia and lymphocytopenia. In the present review, we attempted to summarize the published work on the role of pretreatment NLR as a prognostic marker for HCC following LR and LT. A total of 13 LT and 18 LR studies were included from 2008 to 2015. Pretransplant NLR was most often predictive of HCC recurrence, recurrence-free survival, and overall survival. NLR was, however, more variably and less clearly associated with worse outcomes following LR. Keywords: neutrophil–lymphocyte ratio, hepatocellular carcinoma, liver resection, liver transplantation

Sanjoy Chatterjee,1 Animesh Saha,1 Indu Arun,2 Sonali Susmita Nayak,2 Subir Sinha,3 Sanjit Agrawal,4 Mayur Parihar,5 Rosina Ahmed4 1Department of Radiation Oncology, 2Department of Pathology, 3Department of Medical Statistics, 4Department of Breast Surgery, 5Department of Molecular Pathology, Tata Medical Center, Kolkata, West Bengal, India Background: Following neoadjuvant chemotherapy (NACT) for breast cancer, changes in estrogen receptor (ER), progesterone receptor (PR), HER2 status, and Ki-67 index (IHC4 status) and its correlation with pathological complete response (pCR) or relapse-free survival (RFS) rates could lead to better understanding of tumor management. Patients and methods: Pre- and post-NACT IHC4 status and its changes were analyzed in 156 patients with breast cancer. Associations between pCR, RFS rates to IHC4 status pre- and post-NACT were investigated. Results: pCR was found in 25.3% patients. Both ER and PR positive tumors had the lowest (14.3%) pCR compared to ER and PR negative (29%) or either ER-/PR-positive (38.6%) tumors. PR positivity was significantly associated with less likelihood of pCR (15% versus 34%). The pCR rate was low for luminal A subtype (13.68%) compared to 24.36%, 26.31%, and 33.33% for luminal B, HER2-enriched, and triple-negative subtypes, respectively. There was significant reduction in ER expression and Ki-67 index post-NACT. RFS of patients in whom the hormonal status changed from positive to negative was better compared to those of patients in whom the hormonal status changed from negative to positive. Conclusion: Although changes in IHC4 occurred post-NACT, pre-NACT hazard ratio status prognosticated RFS better. pCR and RFS rates were lower in PR-positive tumors. Keywords: neoadjuvant chemotherapy, IHC4 status changes, survival

Background: In the current scenario, worldwide there is increase in geriatric population in the society, among whom mental health is an imperative and neglected public health problem. World health Organization (WHO) state that some of the factors responsible for depression in age > 60 years include chronic degenerative diseases & disability, pain, fear, frustration, restriction of day to day activity, personality traits and genetic susceptibility. Objective: The objective of current study is to assess the prevalence of depression and identify associated risk factors for depression in the geriatric rural population. Material and Methods: It was a cross sectional study conducted in a rural community adjoining the Rural Health and Training Centre, comprising of 400 participants. The instrument employed to appraise the participants was World Health Organization Disability Assessment Scale II; following which statistical analysis was done by using chi square test of significance. Results: Of 400 participants interviewed, average age of the participants was 72.7 years. Prevalence of any episode of depression was 14%. Past history of depression was found in only 6% cases; while mild cognitive impairment was observed in 12% cases. Mean WHODAS score was 27.92 ± 13.7. Significant differences were observed in relation to their marital status, religion, type of family and socioeconomic status. Conclusion: We conclude that old age is associated with depression which necessitates it to be accurately and timely diagnosed ensuring proper care and support to elderly population with emphasis on geriatrics mental health care.

Background: Spinal anesthesia is an established mode of anesthesia for lower limb orthopedic surgeries. The limitations of the technique are short duration of action and limited post-operative analgesia. Concomitant use of intravenous infusion of magnesium sulfate may have an effect on the block characteristics and duration of action of intrathecal bupivacaine. Methods: A total of 80 American Society of Anesthesiologists I and II patients, either sex, 20-60 years of age scheduled for elective orthopedic fixation of fracture of long bones of lower limbs under spinal anesthesia were included. Spinal anesthesia administered with 2.5 ml heavy bupivacaine mixed with 10 mcg fentanyl. The groups were then divided to receive an infusion of injection magnesium sulfate 50 mg/kg/h over 15 min followed by 15 mg/kg/h until the end of the surgery (Group M) and 15 ml of Normal Saline over 15 min followed by 100 ml/h until the end of surgery (Group S). Onset, duration of sensory and motor block and amount of post-operative analgesic were noted. Results: A total of 6 patients (Group M) and seven patients (Group S) had inadequate block and excluded from the study. Mean block height was T6. Time required to achieve block height was 8.82 min versus 7.42 min in Groups M and S respectively (P = 0.04). Mean duration of motor block was longer in group M (160.63 ± 17.76 min) compared with Group S (130.12 ± 20.70 min) (P = 0.000). Time for regression of sensory block to T12/L1was 206.88 ± 20.96 min (Group M) and 163.88 ± 15.46 min (Group S) (P = 0.000). Hemodynamic parameters were similar and statistically not significant. Need for first analgesic requirement was after 262.88 ± 21.11 min in group M and 193.25 ± 17.74 min in the group S (P = 0.000). Mean dosage of tramadol needed in first 24 h was less in group M (190 ± 30.38 mg vs. 265 ± 48.30 mg, P = 0.000). Conclusion: Use of intravenous magnesium with spinal anesthesia reduces post-operative pain and analgesic consumption.

Cataractous-opacification of the lens is one of the leading causes of blindness in India. The situation can be managed by surgical removal of the cataractous lens. Various pharmacological strategies have been proposed for the prevention and treatment of cataract. Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo , to epidemiological studies in patients. This review deals with the various mechanisms, and possible pharmacological interventions for the prevention of cataract. The article also reviews research on potential anticataractous agents, including aldose reductase inhibitors, glutathione boosters, antiglycating agents, vitamins and various drugs from indigenous sources.

Idiopathic retinal frosted branch angiitis is a rare bilateral condition and presents with an acute reduction of vision. Unilateral affection is rare. We report an unusual case of unilateral frosted branch angiitis where the patient developed total vitreous haemorrhage.

Dendritic cells (DCs) are critical antigen-presenting cells which are the initiators and regulators of the immune response. Numerous studies support the idea that dietary sugars influence DC functions. Increased consumption of fructose has been thought to be the leading cause of metabolic disorders. Although evidence supports their association with immune dysfunction, the specific mechanisms are not well understood. Fructose is one of the main dietary sugars in our diet. Therefore, here we compared the effect of fructose and glucose on the functions of human DCs. High levels of D-fructose compared to D-glucose led to activation of DCs in vitro by promoting interleukin (IL)-6 and IL-1β production. Moreover, fructose exposed DCs also induced interferon (IFN)-γ secretion from T cells. Proinflammatory response of DCs in high fructose environment was found to be independent of the major known metabolic regulators or glycolytic control. Instead, DC activation on acute exposure to fructose was via activation of receptor for advanced glycation end product (RAGE) in response to increased accumulation of advanced glycation end products (AGE). However, chronic exposure of DCs to high fructose environment induced a shift towards glycolysis compared to glucose cultured DCs. Further investigations revealed that the AGEs formed by fructose induced increased levels of inflammatory cytokines in DCs compared to AGEs from glucose. In summary, understanding the link between metabolic changes and fructose-induced DC activation compared to glucose has broad implications for immune dysfunction associated with metabolic disorders.