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Ankita Sharma, Srikant Natarajan, Nidhi Manaktala, Karen Boaz, Nandita KP, Amitha Lewis, Shweta Yellapurkar Department of Oral Pathology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaCorrespondence: Karen Boaz, Department of Oral Pathology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Email karen.boaz@manipal.eduIntroduction: Nomograms are proven in “individualized risk prediction” in sarcomas and breast and prostate cancers. Incorporating immunohistochemical markers and histopathological parameters can enhance accuracy of these graphical representations of statistical predictive models concerning metastasis. D2-40, a monoclonal antibody to podoplanin (regulator of motility expressed in malignant epithelial cells), dually predicts metastatic potential of tumour by estimating the motile tumour phenotype and by detecting lymphatic vessels/density, both essential to metastasis in OSCC. Thus, we propose a model that incorporates D2-40 immunostaining of individual tumour cells (ITC) too with other variables (seen in H+E staining) as a predictive nomogram.Methods: Sixty cases of OSCC were selected with equal number of cases (n=30) of pN0 and pN+ status. Bryne’s grading of invasive front of tumour (ITF) was done on H+E-stained slides followed by D2-40 immunostaining for ITCs at ITF and lymphatic vessels. Multivariate regression analysis was used to generate the nomogram of LNM where the predictive contribution of each covariate, namely depth of invasion, D2-40-stained ITCs, gender, histological grade, and worst pattern of invasion (WPOI), was plotted on a scale of 1– 100 points.Results: The nomogram showed that the strongest variable in OSCC was the WPOI in H+E-stained section followed by D2-40-positive ITCs and gender.Discussion: Our predictive nomogram for LNM in OSCC surprisingly showed that a tumour with lower score of WPOI (islands vs ITC) showed numerous D2-40-positive ITCs, drastically increasing the probability of metastasis. The concept of “individualized risk prediction” can be used to predict lymph node metastasis using a variety of histopathological criteria that can be visualized in routine and immunohistochemical staining in OSCC with the aid of a nomogram.Keywords: nomogram, individualized risk prediction, D2-40, lymph node metastasis in OSCC, podoplanin

Ayyavoo Charmila,1 Suma Natarajan,2 Thevoor Venkatesan Chitra,3 Nivedita Pawar,4 Sucheta Kinjawadekar,5 Yogini Firke,6 Umaiyal Murugesan,7 Poonam Yadav,8 Neelam Ohri,9 Vidhu Modgil,10 Ajinkya Rodge,11 Onkar C Swami11 1Obstetrics and Gynecology, Aditi Hospital, Tiruchirappalli, Tamil Nadu, India; 2Obstetrics and Gynecology, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India; 3Obstetrics and Gynecology, PSG Hospitals, Coimbatore, Tamil Nadu, India; 4Obstetrics and Gynecology, Nivedita Maternity Home, Nashik, Maharashtra, India; 5Obstetrics and Gynecology, Kamalesh Mother and Child Hospital, New Mumbai, Maharashtra, India; 6Obstetrics and Gynecology, Dhanvantari Hospital, Mumbai, Maharashtra, India; 7Obstetrics and Gynecology, Sri Kumaran A Speciality Hospital, Chennai, Tamil Nadu, India; 8Obstetrics and Gynecology, SDMH Hospital, Jaipur, Rajasthan, India; 9Obstetrics and Gynecology, New Life Hospital, Varanasi, Uttar Pradesh, India; 10Obstetrics and Gynecology, Suman Hospital, Ludhiana, Punjab, India; 11Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, IndiaCorrespondence: Onkar C Swami, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, 411 057, India, Tel +91-93724 23101, Email onkar.swami@emcure.co.inBackground: Parenteral iron preparations, like ferric carboxymaltose (FCM), are commonly used to manage moderate-to-severe iron deficiency anemia (IDA). Real-world data on efficacy and safety of FCM is limited in India.Methods: A retrospective, observational and real-world study was conducted to assess the efficacy and safety of FCM in adolescents and adults with IDA across 269 centers in India. Data was retrieved from medical records of patients who received FCM for management of IDA. Physicians’ clinical assessment of efficacy and safety of FCM was also assessed. Data were analyzed for hematological parameters at baseline and at 4 ± 1 week for study population, and for severity of anemia.Results: In 1800 patients with IDA, intravenous FCM resulted in a significant increase in hemoglobin (Hb) of 2.76 g/dL, serum ferritin of 35.85 μg/L, red blood cell (RBC) count, hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (P < 0.001 for all) at 4 ± 1 week as compared to baseline. In subjects with severe IDA, an increase in Hb was of 3.31 g/dL, serum ferritin increased of 35.84 μg/L, RBC count, hematocrit and MCH improved significantly (P < 0.001 for all). In subjects with moderate IDA, Hb (increase of 2.63 g/dL), serum ferritin (increase of 35.92 μg/L), RBC count, hematocrit, MCV, and MCH improved significantly (P < 0.001 for all). In subjects with mild IDA, only the mean Hb values at 4 weeks were significantly higher (P < 0.001; increased by 1.89 g/dL). Physicians rated efficacy of FCM as very good to good in 97.5% of patients. Similarly, safety of FCM was rated very good to good in 97.2% subjects.Conclusion: FCM efficiently, safely and quickly corrects moderate-to-severe anemia in Indian patients in a short span of 4 weeks. Physicians’ positive clinical impression of efficacy and safety supports clinical usage of FCM in real-world scenario.Keywords: ferric carboxymaltose, iron deficiency anemia, pregnancy, efficacy, safety, India

An experiment was conducted to investigate the role of Antioxidant Enzymes (AOE) in Salicylic Acid (SA) induced salt-stress tolerance during chickpea (Cicer arietinum L.) seed germination at ICAR- Indian Institute of Seed Science, Mau during 2018. Results showed the differential germination performance of salt-sensitive (PG 186) and salt-tolerant (CSG 8962) chickpea cultivars under three levels (0, 75, 150 mM NaCl) of salt stresses. Salt stress adversely affected the seed germination and traits of early seedling establishment in PG 186 cultivar than in CSG 8962. Sand matrix priming (SMP) of seeds using SA @ 150 ppm improved the germination (up to 2 times) and other seed quality parameters in sensitive cultivar under higher (150 mM NaCl) salt-stress level. Further investigating the role of SA on modulating AOE, a negative influence of SA on major AOE (POX, CAT and GR) was observed in cotyledons of PG 186 genotype under high salt stress. However, the level of APX was observed to be constitutively higher in tolerant CSG 8962 chickpea genotype. The summary of results suggested that, SA alleviates oxidative stress through reducing major AOE in cotyledon to improve chickpea seed germination.

Fabian Höhn,1,* Florian TA Kretz,2,* Saumil Sheth,3 S Natarajan,3 Pankaj Singh,4 Frank H Koch,4 Michael J Koss2,51Helios Klinikum Pforzheim, Pforzheim, Germany; 2Department of Ophthalmology, Hospital of the Ruprecht-Karls University, Heidelberg, Germany; 3Aditya Jyot Eye Hospital Pvt. Ltd, Mumbai, India; 4Department of Ophthalmology, Hospital of the Goethe University, Frankfurt am Main, Germany; 5Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA*These authors contributed equally to this workAim: To evaluate the safety and effectiveness of the Intrector® for treating postoperative endophthalmitis.Materials and methods: In a retrospective multicenter study, patients who received a single port 23-gauge core pars plana vitrectomy and isovolumetric injection of vancomycin, ceftazidime, and dexamethasone/amphotericin B using the Intrector® for postoperative endophthalmitis of intermediate severity (grade II or III vitreous inflammation and best-corrected visual acuity between hand movements and 0.3 logMAR [logarithm of the minimum angle of resolution]) were evaluated. Improvement in visual acuity, resolution of intraocular inflammation, the need for additional surgical procedures, and the development of complications were evaluated at a 1-month follow-up examination.Results: Fifteen patients (mean age 55.6±7.2 years) underwent treatment with the Intrector®. The mean vitreous volume aspirated was 0.78±0.22 mL. The vitreous samples indicated positive microorganism culture results in six of the 15 cases, but the samples were positive when analyzed by real-time polymerase chain reaction in all cases (15/15). The mean best-corrected visual acuity improved significantly (P=0.01) from 0.88±0.29 (logMAR) to 0.32±0.28. Each patient demonstrated at least three lines of visual improvement. No additional medical or surgical interventions were required, and the complete resolution of intraocular inflammation was noted in all patients at the 1-month follow-up examination. No procedure-related complications were observed.Conclusion: The Intrector® may be a safe and effective treatment option for infectious postoperative endophthalmitis. Larger studies comparing the outcomes of the Intrector® to the traditional treatments for postoperative endophthalmitis need to be conducted before its role in the treatment of postoperative endophthalmitis can be properly defined.Keywords: Intrector®, postoperative endophthalmitis, 23-gauge vitrectomy

An attempt is made to study the hot corrosion behaviour of Inconel 617 under mixed salt environment (Na2SO4, NaCl and/or V2O5) at 900 and 1000 °C. The results were analysed and discussed with respect to mass change, XRD, optical image and SEM/EDAX. The oxide scales are enriched with Ni, Cr, Mo and Co at elevated temperatures. The presence of V2O5 in the salt mixture is found to be the most influencing corrosion species for hot corrosion.

Aim: To describe the results of a combined procedure including phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL) and pars plana vitrectomy (PPV) in eyes with vitreoretinal pathology and coexisting significant cataract. Design: Retrospective, consecutive, noncomparative, interventional case series. Materials and Methods: Medical records of patients who had undergone phacoemulsification, PPV and PCIOL implantation as a combined procedure between January 2000 and December 2004 were retrospectively reviewed. The main outcome measures were the anatomical success of retina, defined as reattached retina, intraoperative and postoperative complications and functional success in terms of final best corrected visual acuity. Results: In all, 65 eyes of 64 patients were included. The mean age of the patients was 50.9 years ± 17.1 (range, five to 82 years). Vitreous hemorrhage with or without retinal detachment (19 eyes, 29.2%) was the most common indication for the vitreoretinal procedure. Primary anatomical success of retina was achieved in 59 eyes (90.7%). Visual acuity improved in 48 eyes (73.8%), was unchanged in 12 eyes (18.5%) and deteriorated in five eyes (7.7%). Postoperative inflammation was significantly more in the subgroup of previously vitrectomized eyes (42%) ( P =0.014, Fisher exact test) compared to those which underwent primary vitrectomy. Conclusions: Combined surgery is a feasible option for patients with vitreoretinal diseases and cataract.

In this paper, we study the static bending and free vibration of cross-ply laminated composite plates using sinusoidal deformation theory. The plate kinematics is based on the recently proposed Carrera Unified Formulation (CUF), and the field variables are discretized with the non-uniform rational B-splines within the framework of isogeometric analysis (IGA). The proposed approach allows the construction of higher-order smooth functions with less computational effort.Moreover, within the framework of IGA, the geometry is represented exactly by the Non-Uniform Rational B-Splines (NURBS) and the isoparametric concept is used to define the field variables. On the other hand, the CUF allows for a systematic study of two dimensional plate formulations. The combination of the IGA with the CUF allows for a very accurate prediction of the field variables. The static bending and free vibration of thin and moderately thick laminated plates are studied. The present approach also suffers fromshear locking when lower order functions are employed and shear locking is suppressed by introducing a modification factor. The effectiveness of the formulation is demonstrated through numerical examples.

We describe the role of intravitreal anti-vascular endothelial growth factor (VEGF) agents in Coats′ disease in children. In a prospective, interventional, non-randomized case series, three patients (three eyes) aged 16, seven and two years were diagnosed to have Coats′ disease. In Case 1 (16 yr/ male) with macular edema, previous laser photocoagulation being unsuccessful, intravitreal pegaptanib sodium (Macugen™) was tried. Case 2 (seven yr/ male) and Case 3 (two yr/ female) were diagnosed to have Stage 4 Coats′ and underwent external needle drainage, laser photocoagulation, SF6 gas injection and intravitreal injection of bevacizumab (Avastin™). Reduction of exudation and attached posterior pole (Cases 2 and 3) was seen at a follow-up of six months and two months respectively. Intravitreal anti-VEGF agents may be successfully used as adjunct treatment in select cases of Coats′ disease in childhood.

A 45-year-old man presented with post-traumatic aniridia. We describe the combined surgery done to treat both aniridia and epiretinal membrane simultaneously. A combined aniridia intraocular lens and vitreoretinal surgery was done. The case report highlights the advantage of combined surgery in terms of cost factor and surgical time.

Infectious endophthalmitis following intraocular surgery is a complication that could cause severe visual loss or loss of the eye. The categorisation of the event that led to intraocular infection will help the clinician to predict the infectious agent and begin appropriate therapy. Most of the cases of postsurgical endophthalmitis are seen following cataract surgery. It is important for all ophthalmologists, irrespective of specialisation and areas of interest,to be familiar with the management of endophthalmitis. This review briefly describes the facets of clinical and laboratory diagnosis, pathology, and management. While the different viewpoints in the management of endophthalmitis are mentioned in appropriate places, more attention is paid to present a rational approach to the management of endophthalmitis.

In the presence of proliferations anteriorly, adequate excision of the vitreous base is essential. To enable a good vitreous base excision, removal of lens often becomes necessary as it may be damaged while attempting to remove peripheral vitreous. To avoid damage or the need to remove the crystalline lens we have used a new modified curved vitreous cutter along with a wide angle observation system binocular indirect ophthalmomicroscope (BIOM). Use of BIOM during vitreous surgery enables easy viewing of the retinal periphery without the need for scleral depression. Sclerotomies are made as for any regular three-port vitrectomy procedure and the vitrectomy is carried out using the curved vitreous cutter, including the vitreous base, avoiding damage to the crystalline lens. The modified curved vitreous cutter is helpful in removing the peripheral vitreous without damaging the crystalline lens, giving the patient the advantage of intraocular lens implantation at a later date.

Background: The adult Bone Marrow Stem Cells (BMSCs) have distinct advantages over the other types of stem cells. They are multipotent, can be stored for upto 10 years and considered to be one of the best sources of hematopoietic and mesenchymal stem cells in an adult body. Genetically inherited diseases such as Retinitis Pigmentosa and Degenerative diseases such as Age Related Macular Degeneration remain unsolved as no definitive treatment is available to repair the damages caused to the RPE and Photoreceptors as of now. In this scenario, the technique of Bone Marrow aspiration & isolation of Mono Nucleated Cells (MNCs) & intra-vitreal injection of a very small volume of MNCs in human retinal disorders has been standardized and is safe and feasible for human studies (Mohanty et al) and autotransplantation of RPEs from periphery to affected area are underpractice(Coffey et al). In this study we report our research work on different approaches to the above diseases using cell therapeuticsStudy 1 Materials & methods: Ciliary Pigment Epithelium was harvested from donor eyes from Aditya Jyot Eye Hospital, Mumbai and was taken to and grown at NCRM lab. The cells were grown in the earlier reported methodology of Brenda et al (Science 2004). Results: The CPE derived Retinal stem cells grew well in the lab. However, the practical difficulties of harvesting the same in patients limited our further steps in this study. Study II:? Materials & methods: Cadaver eye RPE cells were harvested and grown using polymer scaffolds after transporting them over 6 to 12 Hrs. The RPEs were grown on conventional methods and in polymer scaffolds and were subjected to RT-PCR. Results: Human RPEs were able to grow without amniotic membrane and the same was proven by RT-PCR. This would make it possible for the peripheral RPEs taken from patients to be stored and later expanded and used for replacing the diseased cells of the central portion of the retina in future, without having to harvest the RPEs again. Study III: Materials & methods: Bone marrow mono nuclear cells were isolated and transported in cold containers (4-8oC) over a period of 6-12 Hrs and viability was evaluated.Results: The bone marrow mononuclear cells were viable up to 12 Hrs in our methodology with a viability of more than 95% making it possible for cells isolated from Chennai centre to be taken to Mumbai or any other destination within a reach of 12 Hrs for application as reported in earlier studies.Conclusion: The in-vitro expansion of RPEs without Human Amniotic Membrane is expected to open up a new possibility for treating the Retinal Degenerative Diseases. However an animal study is needed before clinical application. Intra vitreal application of Bone Marrow Mono Nuclear cells to treat RP and AMD as reported earlier are considered safe. We plan to undertake treatment and long term follow-up of more numbers of patients with RP and AMD.