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Philadelphia-negative myeloproliferative neoplasms (MPNs) are a group of clonal disorders that are characterized by excessive proliferation of abnormal myeloid precursors and mature cells. Somatic driver mutations in the JAK2, CALR, and MPL genes serve as major diagnostic criteria in the classification of the MPNs, namely polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Although initially thought to be mutually exclusive, recent studies have reported the co-existence of JAK2, MPL, and CALR mutations. In this case report, we describe a case of a Philadelphia-negative myeloproliferative neoplasm harboring mutations in the CALR [NM_004343.3:c.1092_1143del52 (NP_004334.1:p.Leu367Thrfs)] and MPL [NM_005373.2:c.1543T>A (NP_005364.1:p.Try515Arg)] genes. Given the rarity of documented co-occurrence of driver mutations in these two genes and the concomitant paucity of data regarding management of patients harboring mutations in both these genes simultaneously, there are no clear guidelines for the treatment of patients with these mutation patterns and hence it is difficult to assess the true relevance of this genotype. The fact that both the MPL and CALR genes are a part of the JAK-STAT pathway could, however, assist in the clinical decision-making process.

Background In severe alcoholic hepatitis(SAH), we aimed to characterize significant bacterial communities associated with clinical events(CE) and define bacterial relationships associated with specific CE and outcomes at baseline and on corticosteroids. Methods 16-s rRNA sequencing on stool samples(n=38) collected at admission and at last follow-up within 90-days was (N=26, 12 on corticosteroids). Visual-characterization was performed on QIIME data using CIRCOS™, linear-discriminant-analysis-effect-size (LEfSe) method was used to identify significant bacterial communities and their functional metabolites. Conet/Cytoscape® utilized to identify significant co-occurrence with respect to clinical events. Results All were males with mean age 47.3±9.1 years, median discriminant function(DF) 64, Child-Pugh(CTP)12 and model for end-stage liver disease(MELD)25.5. At admission, 27%, 42%, and 58% had acute kidney injury (AKI), hepatic encephalopathy (HE) and infections respectively; 38.5% died at 90-days follow-up. Specific bacteria were found to be associated with HE [Bifidobacteriaceae,Coriobacteriaceae], sepsis [Veillonellaceae,Prevotellaceae], CTP>10 [Bifidobacteriaceae, Synergistaceae], MELD>25 [Dehalobacteriaceae,Turicibacteraceae] and death [Enterobacteriaceae,Peptococcaceae]. Significantly higher relative abundance(RA) of Lachnobacterium, Catenibacterium associated with HE at-admission while orally-represented bacteria were associated with infections at admission. Propionibacterium, Fusobacteria were associated with DF≥65 while Eubacterium, Capnocytophaga were associated with CTP. Enhydrobacter and Pediococcus were preferentially abundant post-steroid-therapy. Aerococcus was associated with post-treatment death. Prevotella was associated with survival post steroid. Upregulation of phenylpropanoid-biosynthesis(innate-immunity) in those without follow-up infections and glycerophospholipid-metabolism(cellular-integrity) in those who died were significant. Co-occurrence between Christensenella, Prevotella and mutual-exclusion between Megamonas, Citrobacter was associated with HE at admission. Mutual-exclusion between Coprococcus eutactus, Catenibacterium and Megamonas was associated with infections at admission while Enterococcus cecorum, Acinetobacter schindleri, Mitsuokella were associated with AKI at admission (figure 1). Conclusions Specific gut-microbiota, their interactions and metabolites are associated with complications of SAH as well as outcomes with steroid-therapy. Advanced metagenomics-based precision-medicine as add-on treatments may be a novel therapeutic area for improving disease outcomes.

Ocular surface squamous neoplasia (OSSN) is relatively rare with an incidence of 0.13–1.9/100,000 population. OSSN includes dysplastic lesions involving the squamous epithelium of the conjunctiva or cornea. Epibulbar squamous cell carcinoma and epithelioma have been noted commonly, but cases in which the tumor is primary on the cornea are sufficiently rare to warrant reporting in each instance. We describe a rare case of noninvasive OSSN involving the entire cornea in a human immunodeficiency virus‑negative patient. The patient was successfully treated with no recurrence, after intact surgical removal, mitomycin C treatment, and cryotherapy.Keywords: Noninvasive ocular surface squamous neoplasia, ocular surface squamous neoplasia involving entire cornea, squamous cell carcinoma cornea

Rhabdomyosarcoma is a malignant neoplasm of primitive mesenchyme exhibiting skeletal muscle differentiation. Rhabdomyosarcoma, which can histopathologically be of embryonal, alveolar, botryoid and pleomorphic types; is a rare tumor in children, with an annual incidence of 4.3 cases per million. Pleomorphic rhabdomyosarcomas is a rare variant, occurring more commonly in adults. We report a rare case of ocular pleomorphic rhabdomyosarcoma in an 18-month-old child with atypical presentation mimicking orbital cellulitis. A provisional diagnosis of orbital cellulitis was made based on clinical and radiological examination and was planned for surgery. Histopathology confirmed the diagnosis of pleomorphic rhabdomyosarcoma. This case shows that pleomorphic rhabdomyosarcoma may also occur in children, it may mimic symptoms of orbital cellulitis, and any fast growing swelling should be carefully examined with a high degree of suspicion of this entity.

Optical transparency of the intraocular lens (IOLs) is paramount in maintaining visual improvement after cataract extraction. There have been reports of the IOL developing opacity after years of cataract surgery. IOL opacities have been reported in silicone, acrylic lens, and very rarely in polymethylmethacrylate (PMMA) IOLs. Though the exact cause is not known, long-term exposure to ultraviolet light can be one of the most probably causes, leading to disruption of PMMA and release of gaseous (nitrogen) within the PMMA substance. We report one such rare case of PMMA IOL opacity in a 75-year-old female.