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Background: Several observational studies have reported the prevalence of cerebral microbleeds (CMBs) and their risk factors in an elderly population. Any information in this regard is currently lacking from India. Aim of this study was to estimate the prevalence, risk factors of CMBs, and association with cognition in an Indian urban population aged 50 years and above. Methods: Household surveys were conducted as part of ongoing Longitudinal Cognition and Aging Research on Population of the National Capital Region (LoCARPoN) study in areas of urban Delhi. Magnetic resonance imaging of the brain was performed in 2599 participants. Using standard neuropsychological battery, mean Z-scores for each domain (memory, executive, information) were derived. Binary and stepwise logistic regression models were used to determine associated risk factors for the presence of CMB and its association with cognitive domains. Results: The prevalence of CMBs was 14.42% (95% confidence interval [CI]: 13.06–15.73). Of these, 203 (7.81%) participants had single CMBs and 172 (6.61%) had multiple microbleeds (≥2). Higher prevalence was observed in older age (60–70 years: odds ratio [OR]: 1.25 [95% CI: 0.93–1.67]; 70–80 years: OR: 2.05 [95% CI: 1.48–2.84]; ≥80 years: OR: 3.27 [95% CI: 1.97–5.44]) compared to individuals in the age group 50–60 years. History of stroke (OR: 2.97 [95% CI: 1.56–5.66]), hypertension (OR: 1.36 [95% CI: 1.05–1.75]), and smoking (OR: 1.43 [95% CI: 1.11–1.85]) was associated with at least one CMB. Multiple CMBs were associated with worse scores in memory and executive domains. Conclusion: Older age, hypertension, history of stroke, and history of smoking emerged as important risk factors for the presence of multiple CMBs. Follow-up study is required to determine implications of CMBs.

Dermatomyositis (DM) and polymyositis are idiopathic inflammatory myopathies (IIMs), most associated with solid organ malignancies, and less commonly hematological malignancies. We discuss a case of DM associated with diffuse large B-cell lymphoma, followed by a review of literature on the pathogenesis, clinical course, treatment, and prognosis. Various challenges with the diagnosis and management of underlying lymphoproliferative disorders (LPDs) in patients with IIM are discussed. The case demonstrates the importance of being vigilant of the association between IIM and LPD. Cancer screening in patients with IIM is discussed, including the recently published International Guideline for IIM-Associated Cancer Screening. More research is required to address knowledge gaps in cancer screening in IIM.

Introduction: Acquired angioedema due to C1 esterase inhibitor deficiency (C1INH-AAE) is most associated with lymphoproliferative disorders (LPDs), particularly low-grade B-cell subtypes. The condition remains under-recognized with long diagnostic delays due to various challenges including a lack of awareness of the condition. Case Presentation: We discuss 4 cases of C1INH-AAE associated with low-grade B-cell LPDs, including various diagnostic and management challenges. As our cases illustrate, constitutional symptoms or overt manifestations of LPD at diagnosis are often absent. Hence, a comprehensive multimodal approach to screening for an underlying B-LPD is important when a diagnosis of acquired angioedema is made. Levels of complement C4, C1q, and C1INH are useful for diagnosing C1INH-AAE and for monitoring disease activity. Changes in these parameters may also indicate relapse of the underlying hematological malignancy. Treating the underlying disorder is important as this commonly leads to clinical improvement with decreased episodes of angioedema and normalization of complement studies. Conclusion: Awareness of C1INH-AAE can lead to an early diagnosis of hematological malignancies. The absence of constitutional symptoms emphasizes the need for a comprehensive multimodal approach to screening for LPD in C1INH-AAE. C4, C1INH level, and function are useful for monitoring disease activity.

Abstract Background Merkel cell carcinoma (MCC) is one of the deadliest skin cancers. Despite existing national guidelines, treatment of MCC patients is not as well standardized as for more common skin cancers. Objectives The study objective was to investigate factors predisposing to favourable/unfavourable patient outcomes and to which extent guideline‐based care affects patient survival. Methods This noninterventional study investigated a monocentre real‐world patient cohort with a histologically confirmed diagnosis of MCC who presented at the skin cancer centre, University Hospital Essen. Patient and tumour characteristics (age, sex, primary localization, Merkel cell polyomavirus [MCPyV], tumour stage at initial diagnosis and primary treatment measures [surgery, radiation]) were correlated with the patient outcome in terms of recurrence‐free survival (RFS) and overall survival (OS). Results A total of 108 patients were identified. The median age of the patients was 69.9 years (range 39–88), with patients aged

Background: Altered patterns of amino acid profiles are observed in various pathological conditions including nutrition related disorders, cancer, diabetes, urea cycle defects, mitochondrial respiratory chain disorders, and aminoacidopathies. Aim and Objectives: To develop a cost effective Reverse Phase-High Performance Liquid Chromatography (RP-HPLC) method for the quantification of free amino acids in neonatal Dried Blood Spot (DBS) samples. Material and Methods: Free amino acids were extracted from neonatal DBS through elution with ice-cold methanol/2-mercaptoethanol. The extracted samples were then derivitized by using O-Pthalaldehyde (OPA)/2-mercaptoethanol, which resulted in the formation of OPA derivatives of amino acids. These derivatives were quantified by RP-HPLC. The developed method was validated according to the International Conference on Harmonization ICH Q2 (R1) Guidelines and applied to clinically confirmed aminoacidopathies. Results: A good linearity was observed from 2.5 to 1000 μM. The between run imprecision (on two different days) though varied over a wide range for different amino-acids, the Coefficience of Variation (CV) was found to be less than 5% (range; 0.1 to 5% for different amino acids) and the recovery was found to be around 82-125% (for spiked amino acids). The quantified concentration of amino acids in plasma and DBS sample were found to be almost similar except for few amino acids like glycine, tyrosine, alanine, methionine and lysine which showed higher values in dried blood spot samples. DBS amino acid concentrations determined by RP-HPLC showed concordance to the concentrations obtained through Tandem Mass Spectrometry (TMS) of DBS/plasma. Reference intervals of amino acids were established in term neonates. The proposed method was applied to the analysis of samples obtained from confirmed aminoacidopathies. Conclusion: The present approach with DBS offers a valid alternative to the plasma/serum aminoacid profiling in HPLC or DBS in Tandem mass method, with advantages like lower sample volume, feasibility, affordability, improved specificity and can be attempted in a simple diagnostic setup with acceptable accuracy and precision.

Introduction: The Government of India has formulated the Cigarettes and Other Tobacco Products Act (COTPA) to implement measures to ensure that effective protection is provided to nonsmokers from involuntary exposure to tobacco smoke. Bhubaneswar is the capital city of Odisha, India, was declared as “Tobacco Smoke Free City” in 2010. For strengthening the implementation of the COTPA Act, an effective regular assessment is needed, and hence, an observational study was planned to assess the current violations of Tobacco Smoking in Bhubaneswar. Materials and Methods: In this observational study, 416 different places were chosen from four different zones of Bhubaneswar. Data were collected with the help of Mobile enabled global positioning system (GPS) technology and pretested structured questionnaire. Results: In this study, 52.88% places were found to be having smoking violations. The study shows maximum violations have occurred in public places (90.89%) followed by transit places (75%). Violations were found to be very low in government buildings, educational, medical institutes, and hotel/restaurants. The average number of smokers in the city was found to be 4.90/place and the average number of smokers was found to be 4.37/public place. Conclusion: In this study, GPS-enabled Mobile App can be used to identify the different locations, where a violation of law occurs. This may help administrators to properly plan and implement the law. Even though Bhubaneswar was declared “Tobacco Smoke free city” in 2010, it is still lacking behind in fulfilling the implementation of law, to reduce Second Hand Smoking.

The present study was undertaken to investigate the effect of dietary replacement of commonly used vegetable oil (sunflower oil, SFO) with n-3 polyunsaturated fatty acids (PUFA) rich oil sources on broiler chicken performance, carcass yield, meat fatty acid composition, keeping quality and sensory attributes of meat. In the current experiment, 300 day-old Krishibro broiler chicks were randomly distributed to 5 dietary groups (50 replicates with 6 chicks in each) prepared by replacing SFO (2% and 3% of diet during starter and finisher periods, respectively) with n-3 PUFA rich soybean oil (SO), mustard oil (MO), linseed oil (LO) or fish oil (FO) on weight basis. Variation in oil sources had no influence (P > 0.05) on performance and carcass yield. Supplementation of MO, LO or FO significantly (P

Introduction: Ipsilateral floating hip and floating knee are very rare injuries. These injuries so uncommon that only three cases of similar kind have been reported. These injuries are due to high velocity injuries following motor vehicle accidents. Management of such complex injuries is a challenging task even in experienced hands as there are no standard treatment guidelines for such fractures. Case Report: We hereby report a 20 yr old male who sustained ipsilateral floating hip and ipsilateral floating knee injuries following motor vehicle accident. Patient was stabilized initially and later taken up for surgery. Patient was treated with interlocking nail for femur and tibia in the same sitting whereas acetabulam fracture was managed conservatively. At five months all the fractures united well with restoration of good range of motion in both hip and knee. Conclusion: Ipsilateral floating knee and floating hip are very rare injuries seen following high velocity motor vehicle accidents. There are no standard guidelines for treatment of those fractures as only a few cases of similar kind have been reported in literature. Early fixation and aggressive mobilization ensures fracture union and fewer complications. Keywords: Floating hip, Floating Knee, Ipsilateral.

Background: Calcium sulfate belongs to synthetic ceramic group of bone graft substitutes having an osteoconductive property. Calcium sulfate is an easily available, economic bone graft substitute. It is a bio-inert material which over a period of weeks get resorbed and fibrovascular tissue takes its place which eventually allows neovascularisation and bone formation within the area. Use of calcium sulfate as a bone graft substitutes avoids the complications and morbidity associated with autograft like infection, second surgery, and finite amount of graft. Material and Methods: A total of 15 patients with benign bone lesions and chronic osteomyelitis were operated and the osseous defects were filled with calcium sulfate which was comprehensively sterilized .Patients were followed with serial radiographs at six week intervals. Calcium sulfate resorption and new bone formation was studied. Results: Thirteen cases out of 15 showed calcium sulphate resorption and new bone incorporation. Calcaium sulphate resorption occurred at an average of 14.5 weeks (range,13- 18weeks) whereas new bone incorporation occurred at an average of 6months ( range,5-7months). Thirteen patients out of these 15 cases returned to full activities of daily living. One patient had pathological fracture at the osseous defect postoperatively. One patient with GCT of distal end of tibia had recurrence of tumor and had to undergo second surgery. Conclusion: Although autogenous bone graft is the gold standard for bone grafting, it has limitations like finite amount, additional surgery and donor site morbidity. Calcium sulphate is safe, efficient and easily available bone graft substitute in the treatment of osseous defects. Most common complication encountered was aseptic serous discharge. Functional results were favorable in most of the cases.

Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral anterior dislocation of shoulder without associated fracture in a 45 old women without any predisposing pathoanatomy.Case Report: A 45-year-old women presented to casualty with sudden onset of pain and restriction of movement in both shoulders fallowing trauma. Immediately post trauma she had severe pain and restriction of both shoulders. On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted . There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures. Closed reduction done by Milch technique after intraraticular lignocaine injection. MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks.Conclusion: Most of the bilateral shoulder dislocations are posterior type seen in seizure disorders. Bilateral traumatic anterior shoulder dislocations are rare and are seen as a result of unique mechanism of injury. In our case patient had a fall on her elbows causing forced extension. If diagnosed and treated promptly completely normal function of the shoulders can be restored.

Dermatomyositis (DM) and polymyositis are idiopathic inflammatory myopathies (IIMs), most associated with solid organ malignancies, and less commonly hematological malignancies. We discuss a case of DM associated with diffuse large B-cell lymphoma, followed by a review of literature on the pathogenesis, clinical course, treatment, and prognosis. Various challenges with the diagnosis and management of underlying lymphoproliferative disorders (LPDs) in patients with IIM are discussed. The case demonstrates the importance of being vigilant of the association between IIM and LPD. Cancer screening in patients with IIM is discussed, including the recently published International Guideline for IIM-Associated Cancer Screening. More research is required to address knowledge gaps in cancer screening in IIM. [ABSTRACT FROM AUTHOR]