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Gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) are close mimickers and difficult to discriminate. Recent work has focused on the immunological differences between GITB and CD based on cytokines related to T-regulatory cells and Th17 cells. In the present cross-sectional study, suspected cases of GITB or CD underwent extensive clinical, radiological, endoscopic, histological, and microbiological assessment. The diagnosis was based on standard criteria and response to antitubercular therapy endoscopically.Interleukin (IL)-10, transforming growth factor-β (TGF-β), and IL-17 were measured and compared between GITB and CD along with other parameters. Fisher's exact test and Mann-Whitney U test were used as per the data type.Of the 27 patients, 11 had CD, 9 had GITB, and 7 had other conditions. Chronic diarrhea, involvement of left and long segments of the colon, and aphthous ulcers were significantly more frequent in CD; however, transverse ulcers were in GITB. IL-10 was reduced in both GITB (median-interquartile range [IQR] 9.54 [3.65-24.04]) and CD (median-IQR 13.28 [6.91-22.50]) compared to control (median-IQR 26.72 [10.34-35.43]). TGF-β showed little variation, but IL-17 was below the detection limit in most cases. None of these cytokines were significantly different between CD and GITB. The sensitivity and specificity of multiplex Mycobacterium tuberculosis-polymerase chain reaction were 44.44% and 100%, respectively.Serum cytokine profiling (IL-10, IL-17, and TGF-β) could not significantly differentiate GITB and CD. Moreover, extensive molecular, transcriptomic, chemokines, and cytokine analyses may shed light on these aspects.

Background Viral infections cause significant morbidity and mortality in post-transplant period. A highly sensitive and specific detection tool if used may help in early diagnosis and better management in these patients. The study aimed to assess the utility of quantitative real-time polymerase chain reaction (qRT-PCR) as a diagnostic and monitoring tool for viral infections in post renal transplant patients. Methods A quantitative real-time polymerase chain reaction (qRT-PCR) was performed to detect EBV and CMV infection in 50 patients on 1st, 2nd, 3rd, and after 6 months of renal transplantation. Results CMV infection was found in 34%, EBV in 28% of recipients, and 17% showed dual infection. Viruses were detectable after the first month of transplantation followed by symptomatic infections within first three months of follow-up, with diarrhea being the commonest symptom. These patients were also at high risk for developing other infections. Anti-thymocyte globulin (ATG) induction was a definitive risk factor for CMV/EBV infection in post operative period. Conclusion Renal transplant patients frequently develop one or more viral infections at a time. Regular monitoring with qRT-PCR and prompt antiviral therapy with reduction in immunosuppression may be an ideal approach for management of these patients.

Background and aims: Study of origin of obturator artery, its variable origin and course is significant as knowledge attained by such studies help surgeons to avoid injuries, hemorrhage during operative procedures. Present study is aimed at finding out the variable origin of obturator artery, clinical significance and to correlate its embryological basis. Materials and Methods: Present study was conducted on 60 formalin fixed hemi section of cadaveric pelvis, which were allotted to the under graduate students of Mandya Institute of Medical Sciences, Mandya. Observations obtained were compared with the studies of previous workers. Results: Normal pattern of origin, from the anterior division of internal iliac artery was seen in 40% (24 cadavers). In 60% of the cadavers variations were observed. The most common variant mode of origin was from inferior epigastric artery (18.3%). Next common was origin from superior gluteal artery and least common variant of origin was from inferior vesical artery. Conclusion: Variations observed in present study were at par with the variations observed by previous studies. Although anomalous origins of the obturator artery rarely produces clinical symptoms, their knowledge is necessary for operating surgeons to avoid injuries and is of academic interest.

Background: In vitro allo-specific cytokine response to prospective allograft antigens might provide a means to identify patients at risk to adverse clinical endpoints/graft failure and predict allograft survival after transplantation. Methods: Cytokine profiles of recipient's peripheral blood mononuclear cells cocultured with allograft antigen-pulsed recipient macrophages were studied in 49 renal transplant recipients, 19 of which has acute rejection-12 with acute cellular rejection (ACR) and 37 non-ACR allografts. Cytometric bead array was used to analyze 18 cytokines/chemokines in the culture supernatants of graft antigen-pulsed and un-pulsed cultures. The mean increment in cytokine expression in stimulated versus unstimulated cultures was calculated. Results: Interleukin 6 (IL-6) (2336.42 ± 213.4 vs. 1244.06 ± 224 fg/ml; P = 0.0070), IL-1α (28.3 ± 7.451 vs. 16.78 ± 5.513 fg/ml; P = 0.0417), IL-17A (201 ± 96.73 vs. 28.91 ± 18.45 fg/ml; P = 0.0262), and MIP-1α/CCL3 (2682.25 ± 1013 vs. 1748.99 ± 780.4 pg/ml; P = 0.0383) were found to be high in rejection compared to stable allografts. Similarly, IL-6, IP-10/CXCL10, MIP-1α, and MCP-1 were increased in ACR, whereas granzyme B (11.36 ± 7.974 vs. 28.71 ± 9.393 pg/ml; P = 0.0011) and RANTES/CCL5 were higher in the non-ACR group. Conclusion: Distinct allo-specific in vitro cytokine profiles correlated with the occurrence of posttransplantation rejection episodes in the cohort, which indicated the feasibility of this in vitro model to predict transplant outcomes.

Background: The international consensus on antinuclear antibody (ANA) patterns (ICAP) guidelines recommends that non-nuclear patterns should be reported as positive for ANA. Therefore, a prospective study was planned to investigate the frequency of cytoplasmic and mitotic ANA patterns in routine reporting in a high-throughput lab in a tertiary referral center in Northern India. Materials and Methods: Whole blood samples received were centrifuged and serum was separated within 4 hours of collection. Sera were subjected to indirect immunofluorescence (IIF) assay on HEp-2 cells for ANA determination in a dilution of 1:40, per standardized protocol in our laboratory. IIF staining patterns and intensity were evaluated and the results interpreted. Results: Over a 3-month period, of the 3796 serum samples received for ANA testing, 81 (4.9%) samples were positive for cytoplasmic, 7 (0.4%) for mitotic, and 2 (0.1%) for DNA topoisomerase I (Topo I)-like pattern. The most frequent cytoplasmic fluorescence pattern was dense fine speckled (2%) and the most frequent mitotic pattern was NuMA-like (0.2%). The prevalence of total positive ANA in our study population was found out to be 43.6%. Conclusions: Implementation of ICAP guidelines into routine ANA reporting helped us in detecting important cytoplasmic antibodies such as antimitochondrial antibodies, anti-ribosomal P protein antibodies, anti-Jo-1antibodies, anti-Topo I antibodies and allowed us to introduce more specific and confirmatory tests for the same. The new format for ANA reporting also encouraged clinician-laboratory crosstalk.

Background: Worldwide, hazardous use of alcohol is common among many cultures and societies and adversely impacts families and communities, with significant morbidity and mortality. Scheduled Tribes (STs) who are socially deprived and marginalised have higher rates of alcohol use. Aim: We attempted to determine the nature, prevalence, and risk factors associated with hazardous consumption of alcohol in the tribal community. Methodology: A cross-sectional study was conducted among adult male and permanent residents of Jawadhi hills. A total of 1200 men were interviewed. Study participants were chosen by Probability Proportionate to Size (PPS) sampling method. The questionnaire that documented socio-demographic characteristics and patterns of alcohol use was used. AUDIT tool was used to assess the hazardous use of Alcohol. Data were analysed using SPSS. Results: Majority of the men were middle-aged, married, and were from lower socio-economic strata. A large proportion of men (65%) had a history of alcohol consumption in the last one year using one-year, of whom a quarter showed hazardous use (29%) and another quarter exhibited alcohol dependency (24%). Tobacco use, higher income and local alcohol production were found to be significant risk factors for Hazardous alcohol use. Conclusion: Alcohol consumption needs to be treated as a social problem and has to be tackled at the policy level. Population-based interventions, legislation, taxation, policies regarding the manufacture and sale of alcohol, are some of the ways to address this problem.

BACKGROUND: Various studies have implicated that plasma causing transfusion-related acute lung injury is from alloimmunized females. The frequency of sensitization to human leukocyte antigen (HLA) was found to correlate with their parity score. No literature on the prevalence of anti-HLA antibodies in Indian blood donors is available to date. Hence, this pilot study was done to know the frequency of HLA alloimmunization in Indian blood donors. MATERIALS AND METHODS: A total of 192 consenting voluntary blood donors from blood donation camps were enrolled in the study. Test group: Parous female donors (n = 96) and control group: Nulliparous female donors (n = 48) and male donors (n = 48). HLA alloimmunization was tested on the Luminex platform by screening assay to detect IgG antibodies to HLA Class I and II molecules of human origin. A mean fluoresence index of more than 2000 was considered as a positive reaction, considering the high sensitivity of Luminex assay. RESULTS: Sixty-three out of 192 donors (32.8%) tested positive for anti-HLA antibodies, out of which 23 donors were in the control group (23.9%), and 40 donors were in the test group (41.7%); P = 0.002. On gender-based comparison, 9 out of 48 male donors (18.7%), as compared to 54 out of 144 female donors (37.5%), tested positive for HLA antibodies (P = 0.02). Based on an increase in parity score, the frequency of HLA alloimmunization was found to be significantly correlated (P = 0.002). A decrease in the trend of HLA alloimmunization was observed as the duration from the last pregnancy increased. A higher frequency of HLA alloimmunization was observed in female donors with a history of transfusion and bad obstetric history. CONCLUSION: The present study substantiates that plasma from parous female donors has a higher chance of containing anti-HLA antibodies as compared to nulliparous female and male donors.

Purpose: The purpose was to evaluate the difference in crestal bone loss (CBL) around implants with flap and flapless methods followed by early loading. Materials and Methods: Twenty implants were placed in twenty patients – ten using flap and ten using flapless techniques. The difference in CBL was measured on standardized digital periapical radiograph taken at 0 week, 6 weeks, 12 weeks, and 6 months. Results: The present study showed the mean CBL on proximal surfaces when evaluated at intervals of 0 week, 6 weeks, 12 weeks, and 6 months for flapless method was significantly lower than with flap method the values of which were +0.07 mm against +0.26 mm on mesial side and +0.15 mm against +0.33 mm on distal side at 6 months. Conclusion: The flapless approach is a predictable procedure when patient selection and surgical technique are appropriate, and results in lesser CBL.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small-vessel vasculitis. The exact mechanism of ANCA involvement in the pathogenesis of AAV is not fully understood. It is an autoimmune disease with multifactorial pathophysiology. The most common ANCA target antigens are myeloperoxidase and proteinase 3. In addition to autoantibodies, dysregulated T and B cells have a pivotal pathophysiological role in this disease. Though the mechanism of action of ANCA is still being explored, ANCA serology is being increasingly used for classification of AAV, though the histological examination still remains the gold standard of diagnosis. The international consensus statement on reporting of ANCA recommended use of both IIF and ELISA as 5% of IIF negative results are ELISA positive. Though ANCA positivity increases the risk of recurrence four or more times, only a weak association is observed between ANCA and disease activity. Controversy exists regarding the utility of serial measurements of ANCA in patients with AAV to predict disease relapse. However, based upon current evidence the treatment decisions should not be based solely on the levels of ANCA titers in patients with AAV.

Sensitized patients, who constitute a considerable proportion of kidney-transplant recipients, often have poor allograft outcomes. Only cell-based complement-dependent cytotoxicity (CDC) assays are typically used to quantify donor-specific antibodies (DSAs) in patients in developing nations, owing to financial restraints. We report the clinical outcomes of ten sensitized patients who were stratified and managed based on Luminex single-antigen beads (SAB) method for the DSA detection in a cost-limited set-up. Sensitization events included a history of blood transfusion, multiple pregnancies, and previous allograft loss. Anti-human leukocyte antigen antibodies, measured by SAB and reported as mean fluorescence intensity (MFI), were considered positive if the value was > 1000 MFI for single antigen. Three best approaches, (1) cadaveric transplants using virtual cross-match for kidney allocation in five patients, (2) desensitization before living donor transplants for four donor–recipient pairs with immunological incompatibility (high DSAs but cross-match compatible), and (3) combined kidney paired exchange with desensitization for one donor–recipient pair with cross-match incompatibility (positive CDC cross-match), resulted in successful allograft outcomes in all the 10 patients during follow-up (range: 3–55 months). DSA by SAB to assess pretransplant immunological risk (in a sensitized recipient) is useful even in cost-limited settings, largely due to reduction of posttransplant rejection rates and avoidance of mortality while on the waitlist.

Background: With the advent of immediate single-stage implant placement, the edentulous patient can receive replacement in the same surgical visit, thereby reducing the time that has elapsed between tooth extraction and implant placement. There is a scarcity of literature that assesses patient's knowledge, attitude, and practice (KAP) of dental students toward immediate implant placement, therefore the need of the study. Materials and Methods: A multiple-choice questionnaire consisting of 12 questions was framed and distributed to dentists between January 2019 and June 2019 from all the dental clinics in Dhanbad, Jharkhand, India, who have entered their clinical practice with the primary objective to determine their KAP toward loading protocols of immediate and delayed implants. Results: Thirty-one percent of the respondents are aware of loading protocols of immediate implants and delayed loading and 69% were not aware of immediate implant procedures. Conclusion: Although dental implants have changed the outlook of dentistry in the past few decades, the knowledge and practice of implants by dental practitioners in Dhanbad is still limited, and there is a need to improve the same.

Background: Awareness about dental implants is increasing among patients, and patient satisfaction after treatment with implants is prone to be affected by the disparity between extremely high expectations and the final outcomes. Therefore, the aim of the study was to investigate the factors, which could affect patient satisfaction and the single implant treatment plans supported by dentists. Materials and Methods: All patients who received single implant treatments between June 2019 and December 2019, from all the dental clinics in Dhanbad, Jharkhand, India, were included. According to the Oral Health Impact Profile-14 questionnaire (Hongxing L, List T, Nilsson IM, Johansson A, Astrom AN. Validity and reliability of OIDP and OHIP-14: A survey of Chinese high school students. BMC Oral Health 2014;14:158; Heng D, Zou N, Liu H, Huang H, Yang G, Chen L, et al. Satisfaction analysis of patients with single implant treatments based on a questionnaire survey. Patient Prefer Adherence 2019;13:695-704), the Oral Implant Impact Profile Questionnaire was reorganized to contain 15 questions (Q1–Q15) related to satisfaction with the dental implant. Results: The level of patient satisfaction with implant treatment scored positive (mean scores >4). The mean satisfaction score ranged from 4.43 to 4.91 in the 15 items, suggesting that single implant treatments for missing teeth met the expectations of patients. Conclusion: It is essential to raise the general awareness of oral implants and to optimize the dental implant therapeutic processes as much as possible, both of which are conducive to enhance patient satisfaction in dental clinics.

Mycotic pseudoaneurysm of transplant renal artery is a rare complication and warrants allograft nephrectomy. We report a 54-year-old renal allograft recipient who presented with 9.2 cm × 5.9 cm × 5.7 cm sized pseudoaneurysm of transplant renal artery. Blood culture grew Pseudomonas aeruginosa. The allograft was explanted, aneurysm was excised, and the allograft was reimplanted to right internal iliac artery with interposition of autogenous arterial graft. Microbiological examination of the aneurysm wall did not reveal active infection. The patient did well and at four years maintains normal renal function. Salvage of renal allograft is possible in selected patients with mycotic pseudoaneurysm of transplant renal artery.

Background: Neurological manifestations are an important cause of morbidity in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It is not clear whether or not they are indicative of a severe disease course with multiple organ involvement and shortened survival. Aims and Objectives: To characterize the neurological manifestations of AAV and analyze their relationship with other organ system and cumulative survival. Methods: This was a retrospective single-center cohort study of AAV patients at a tertiary care hospital in North India. Data was collected from medical records regarding clinical history, neurological examination, Birmingham Vasculitis Activity Score (BVAS), serology, electrophysiology, imaging, and histopathological examination findings of patients. Results: Ninety-two patients of systemic vasculitis were identified, 67 with granulomatosis with polyangiitis (GPA), 14 with microscopic polyangiitis, 8 with Churg–Strauss syndrome (CSS), and 3 with undifferentiated AAV. The median BVAS at presentation was 18.0 (interquartile range (IQR): 12.0). The median duration of follow-up was 31.3 months (IQR: 40.5). A total of 45.7% patients had neurological manifestations among which 23.8% presented with neurological complaints. Peripheral neuropathy was the most common manifestation noted in 23.9% of the patients. Among patients with GPA, 40.3% had neurological involvement (seen in 33.3% patients at presentation). Patients with nervous system disease were more likely to have associated musculoskeletal manifestations (P = 0.046) and less likely to have renal involvement (P = 0.017). The estimated cumulative survival of the subgroup with neurological involvement was 95.1 months from the time of diagnosis, which was not significantly different from the cohort without neurological involvement (113.8 months, P = 0.631). Conclusion: Neurological morbidity commonly accompanies systemic vasculitis. Nervous system disease does not affect the survival significantly in these patients.