Laboratory Investigations Research Articles

Exploring Type II Diabetes Inhibitors from Genus Daphne Plant-species: An Integrated Computational Study.

Plant species of the genus Daphne clasps a historical background with a potential source of bioactive phytochemicals such as flavonoids and daphnodorins. These compounds manifest a significant chemotaxonomic value in drug discovery. Their flair comprehensive pharmacological, phytochemical, biological, catalytic, and clinical utilities make them exclusively unique. This study was conducted to investigate the optimization and structure-based virtual screening of these peculiar analogs. The majority of the active constituents of medicines are obtained from natural products. Previously, before the invention of virtual screening methods or techniques, almost 80% of drugs were obtained from natural resources. Comparing reported data to drug discovery from 1981 to 2007 signifies that half of the FDA-approved drugs are obtained from natural resources. It has been reported that structures of natural products that have particularities of structural diversity, biochemical specification, and molecular properties make them suitable products for drug discovery. These products basically have unique chiral centers which increase their structural complexity than the synthesized drugs. This work aimed to probe the use of daphnodorins analogs for the first time as antidiabetic inhibitors based on significant features and to determine the potential of daphnodorin analogs as antidiabetic inhibitors through computational analysis and structure-based virtual screening. A dataset of 38 compounds was selected from different databases, including PubChem and ZINC, for computational analysis, and optimized compounds were docked against various co-crystallized structures of inhibitors, antagonists, and receptors which were downloaded from PDB by using AutoDock Vina (by employing Broyden-Fletcher-Goldfarb-Shanno method), Discovery studio visualizer 2020, PYMOL (Schrodinger). Docking results were further validated by Molecular dynamic simulation and MM-GBSA calculation. Quantitative structure-activity relationship (QSAR) was reported by using Gaussian 09W by intimating Density Functional Theory (DFT). Using this combination of multi-approach computational strategy, 14 compounds were selected as potential exclusive lead compounds, which were analyzed through ADMET studies to pin down their druglike properties and toxicity. At significant phases of drug design approaches regular use of molecular docking has helped to promote the separation of important representatives from 38 pharmaceutically active compounds by setting a threshold docking score of -9.0 kcal/mol which was used for their exposition. Subsequently, by employing a threshold it was recognized that 14 compounds proclaimed this threshold for antidiabetic activity. Further, molecular dynamic simulation, MM-GBSA, ADMET, and DFT results screened out daphnegiralin B4 (36) as a potential lead compound for developing antidiabetic agents. Our analysis took us to the conclusion that daphnegiralin B4 (36) among all ligands comes out to be a lead compound having drug-like properties among 38 ligands being non-carcinogenic and non-cytotoxic which would benefit the medical community by providing significant drugs against diabetes. Pragmatic laboratory investigations identified a new precursor to open new doors for new drug discovery.

Patterns of head and neck lesions among HIV/AIDS patients on highly active antiretroviral therapy at Dodoma Regional Referral Hospital in Tanzania

Introduction: Head and neck lesions associated with Human Immunodeficiency Virus are considered to occur in over 50% of HIV- positive patients and occur in nearly 80% of all patients with acquired immunodeficiency syndrome. The introduction of highly active antiretroviral therapy has led to a remarkable reduction in the global burden of such lesions. Suppose such lesions are undiagnosed or untreated on a prompt basis. In that case, they may cause morbidity and mortality since some lesions, for example, head and neck cancers may interfere with vital functions of life such as respiration, deglutition, and speech. This study determined head and neck lesions among HIV/AIDS patients in Tanzania. Methods: This was a hospital-based descriptive cross-sectional study that recruited 222 HIV/AIDS patients at a care and treatment clinic at Dodoma Regional Referral Hospital. Physical examination and laboratory investigations (histopathology, viral load and CD4 counts) were collected and data was analyzed using Statistical Package for Social Sciences (SPSS) version 23. P-value<0.05 was statistically significant. Results: Of all the 222 patients recruited in this study, 26 (11.7%) had head and neck lesions. Most patients with head and neck lesions were females (57.6%). Half of the patients (50.0%) were between 40 and 59 years old. About 21 (80.8%) patients were diagnosed with HIV/AIDS within two years, and 22 (84.6%) were initially diagnosed with CD4 counts less than 200 cells/μL. The most common head and neck lesion was oral candidiasis (46.2%) and others were cervicofacial lymphadenitis (15.4%), head and neck squamous cell carcinoma (laryngeal and hypopharyngeal) (11.5%), sinonasal Kaposi’s sarcoma (7.7%), odontogenic abscess (7.7%) and aphthous ulcers (7.7%) and the least encountered head and neck lesion was a ranula in 3.8% of patients. Similarly, a significant association was found between the occurrence of head and neck lesions with viral load, CD4 counts, duration since a patient was diagnosed with HIV/AIDS, presence of comorbid illness, alcohol consumption and cigarette smoking. Conclusions: The prevalence of head and neck lesions among HIV/AIDS patients on HAART was low. Females outnumbered males in terms of being affected by head and neck lesions. Oral candidiasis was the most common head and neck lesion. Head and neck (laryngeal and hypopharyngeal) squamous cell carcinoma was the predominant subtype of malignant lesions in HIV/AIDS patients on HAART.

Progressive demyelinating polyneuropathy after hematopoietic cell transplantation in metachromatic leukodystrophy: a case series.

Metachromatic leukodystrophy (MLD) is a neuro-metabolic disorder due to arylsulfatase A deficiency, causing demyelination of the central and peripheral nervous system. Hematopoietic cell transplantation (HCT) can provide a symptomatic and survival benefit for pre-symptomatic and early symptomatic patients by stabilizing CNS disease. This case series, however, illustrates the occurrence of severely progressive polyneuropathy shortly after HCT in two patients with late-infantile, one with late-juvenile, and one with adult MLD, leading to the inability to walk or sit without support. The patients had demyelinating polyneuropathy before HCT, performed at the ages of 2years in the first two patients and at 14 and 23years in the other two patients. The myeloablative conditioning regimen consisted of busulfan, fludarabine and, in one case, rituximab, with anti-thymocyte globulin, cyclosporine, steroids, and/or mycophenolate mofetil for GvHD prophylaxis. Polyneuropathy after HCT progressed parallel with tapering immunosuppression and paralleled bouts of infection and graft-versus-host disease (GvHD). Differential diagnoses included MLD progression, neurological GvHD or another (auto)inflammatory cause. Laboratory, electroneurography and pathology investigations were inconclusive. In two patients, treatment with immunomodulatory drugs led to temporary improvement, but not sustained stabilization of polyneuropathy. One patient showed recovery to pre-HCT functioning, except for a Holmes-like tremor, for which a peripheral origin cannot be excluded. One patient showed marginal response to immunosuppressive treatment and died ten months after HCT due to respiratory failure. The extensive diagnostic and therapeutic attempts highlight the challenge of characterizing and treating progressive polyneuropathy in patients with MLD shortly after HCT. We advise to consider repeat electro-neurography and possibly peripheral nerve biopsy in such patients. Nerve conduction blocks, evidence of the presence of T lymphocytes and macrophages in the neuronal and surrounding nerve tissue, and beneficial effects of immunomodulatory drugs may indicate a partially (auto)immune-mediated pathology. Polyneuropathy may cause major residual disease burden after HCT. MLD patients with progressive polyneuropathy could potentially benefit from a more intensified immunomodulatory drug regime following HCT, especially at times of immune activation.

Investigating the Effect of Palm Kernel Shell Powder on the Rheological and Filtration Properties of Water Based Mud

During drilling operations, the use of drilling fluid plays a critical role, and over time, there has been considerable interest in enhancing drilling fluid characteristics in order to improve performance, reduce costs, and prevent environmental pollution. Deviating from conventional additives, recent studies have explored the use of alternative materials, as drilling fluid additives. In line with this trend, this study focuses on the laboratory investigation of the rheological and filtration properties of water-based drilling fluid treated with Palm Kernel Shell Powder (PKSP) with high viscosity polyanionic cellulose (PAC HV), used as control. To assess the impact of PKSP in water-based mud, experiments were carried out using concentrations spanning from 0.5g to 2.5g, temperatures of 27°C, 40°C, 60°C, and 80°C, and aging of 24, 48, and 72 hours. From the results the plastic viscosity of mud samples treated with PKSP were temperature dependent and also with increasing aging. The addition of PKSP showed improved performance in terms of reducing the filtrate volume as well as the cake thickness with increasing concentration of the additives, and the concentration that gave the best results across all aging duration was 2.5g. The mud weight and pH of all samples remained relatively constant, with no significant changes observed. However, PAC HV showed better results in all the cases of fluid loss and mud cake thickness. It could be attributed to the soluble contents in the PAC HV which increased the viscosity significantly and thus, kept the solid particles in suspension.

Primary angiitis of the central nervous system.

Primary angiitis of the central nervous system (CNS) is an uncommon inflammatory disorder, with highly variable clinical presentation. It needs to be differentiated from several mimickers, such as CNS involvement in systemic vasculitides, connective tissue disorders, infectious disease, and leukodystrophy as well as neoplastic diseases. The diagnosis requires a combination of clinical and laboratory investigations, multimodal imaging, and histopathological examination, which should be available for confirmation. In the present paper, the histopathological features of primary angiitis of the CNS are described and highlighted to help pathologists avoid misdiagnosis of a treatable acquired disease.

Performance characterization of long-term aged bitumen: Field and laboratory investigation

Aging of binder affects the service life of flexible pavements. Aging involves change in physical, rheological, chemical and morphological characteristics of binder making it hard and brittle resulting in pavement deterioration. Oxidation and volatalization are the two main mechanisms involved in aging. Aging stiffens the binder as it increases the viscosity of binder resulting in pavement distresses like fatigue cracking, ravelling and thermal cracking. Hence, it is obligatory to examine the aging effects on binder to predict the service life of flexible pavements. In this study, core samples are collected from 15 years aged in-service pavement section and fresh binder was aged for varying aging duration in the laboratory to simulate field aging condition. Field aged and laboratory aged binders were subjected to physical, chemical, rheological and morphological investigations for evaluating the variation of these properties with long-term aging. It is evident that the traffic speed influences the dynamic viscosity of binders. With aging, the rutting resistance of binders improved and fatigue resistance of binders diminished considerably. The severity of aging in binder increases with pavement depth in the field and 8 days of normal oven aging in the laboratory simulates 15 years field aging condition.

Promoting Water Sustainability through Degradation of 4-Nitrophenols by Spirodela polyrrhiza and Rhodococcus sp. Strain PKR-1 Association

The removal of chemicals from water sources that are harmful to humans and the environment can contribute to improving water quality. Biological treatment methods, such as bioaugmentation are an environmentally sustainable approach for pollutant removal. The 4-nitrophenol is the most hazardous nitrophenol chemical pollutant. In this study, a laboratory investigation was conducted on a flask scale to evaluate the rhizoaugmentation of 4-nitrophenol-polluted water. This was achieved by employing Rhodococcus sp. strain PKR-1, which was reintroduced into the roots of Spirodela polyrhiza. The selected strains were inoculated into the root at the rate of 104 to 106 colony-forming units (CFU) per plant. At high levels exhibited stability across five consecutive two-day degradation cycles, and full elimination of 4-nitrophenol was accomplished within these five repeated cycles. Therefore, the introduction of degraders into the root systems of aquatic plants has proven to be a successful method for treating effluents or aquatic resources contaminated with 4-nitrophenol.

Randomized, Placebo-controlled Homeopathic Drug-proving of SARS CoV-2 nosode (BiosimCovex) in healthy volunteers

Introduction
 The Homeopathic Pathogenetic Trial (HPT, Drug-proving) is a systematic examination and recording of the symptoms experienced by healthy volunteers after an administration of an investigational medicinal substance. Randomized, placebo-controlled HPT was conducted using BiosimCovex (SARS CoV-2 nosode) in healthy volunteers. 
 Materials and methods
 BiosimCovex 30c was given orally in a randomized, placebo-controlled trial to examine the safety and pathogenetic effects of 30 volunteers (18- 65 years of age and both genders). Volunteers were administered a dose of 6 pills of the nosode once a day for two weeks followed by 30 days observation period. Pre and post-examination (physical), vital signs, and laboratory investigations were done with a run-in period of 7 days. Symptoms experienced by the volunteers were recorded and analyzed, and Qualitative and Quantitative indices per volunteer were reported. Trial registered at http://ctri.nic.in (CTRI/2022/06/043392).
 Results
 BiosimCovex nosode exhibited quantitatively distinct symptoms, which can be applied in clinical practice. The number of symptoms reported in the verum arm was 73 (placebo 11). The incidence of the Pathogenetic effect per volunteer in the verum group was 8.1 vs that of the placebo 5.5. The Qualitative Pathogenetic Index was 0.295 in the verum group as compared to the placebo 0.193. The symptoms observed matched with the symptoms produced in an open-label Phase 1 study conducted during the COVID-19 pandemic and also with that of the viral infection. There were no serious/fatal adverse events during the study. Safe use was documented.
 Conclusion
 BiosimCovex nosode developed during a pandemic condition produced specific symptoms in the homeopathic pathogenetic trial which could be used in clinical practice.

Correlates of iron deficiency among adult patients with sickle cell nephropathy at a tertiary health facility in Lagos, Nigeria: A cross-sectional study

Background: Iron deficiency presents a muddled clinical picture in patients with sickle cell anemia (SCA). The picture is further complicated when these patients develop sickle cell nephropathy (SCN). This study aimed to identify the correlates of iron deficiency among adult patients with SCN in Lagos, Nigeria. Methods: This was a cross-sectional study conducted among adult patients with SCN who presented at the nephrology clinic of the tertiary health facility. Data on demographics, clinical history, laboratory investigations, and iron status were collected and analyzed using the Statistical Package for the Social Sciences (SPSS) version 28. Results: One hundred and nineteen adult patients with SCN were enrolled in the study. The mean age was 28.9 ± 9.5 years, and the majority were females. Iron deficiency was present in 36 (30.2%) subjects, while 7.6% had elevated iron status. Younger age and male sex were associated with iron deficiency state. Participants with an estimated glomerular filtration rate (eGFR) of ≥60 mL/min had a higher prevalence of iron deficiency (r = −0.28 P < 0.01/r = −0.32 P < 0.01). A logistic regression analysis showed no independent association between these factors and iron deficiency. Conclusion: This study showed that iron deficiency is common in adults with SCN, seen in one-third of participants. Therefore, although iron overload is frequently acknowledged as a significant issue in SCA, it should not be automatically assumed in cases where nephropathy is present. The study findings also highlight the need for routine screening for iron deficiency among SCN patients, especially among males, younger patients or those with an eGFR ≥60 mL/min, to optimize their management and improve their outcomes.

IJCM_283A: Clinico-demographic profile of patients attending anti retroviral therapy centre in a tertiary care hospital: a cross -sectional study

Background: HIV is a major global public health issue, having claimed 40.4 million lives so far globally. In India the estimated number of people living with HIV (PLHIV) is 2.5 million (WHO, 2022). For planning targeted interventions, it is essential to know the socio-demographic and clinical profile of the HIV/AIDS patients in any particular area. Objectives: To study the socio-demographic and clinical profile of PLHIV attending anti-retroviral therapy (ART) centre of J.N. Medical College, A.M.U., Aligarh (U.P.). Methodology: This is a cross sectional study and data was accessed from routine records at ART centre, JNMCH, AMU, Aligarh. Records of 370 PLHIV aged =18 years attending the antiretroviral clinic were studied and analyzed. Socio-demographic characteristics, risk behaviours and laboratory investigations were studied. Anemia was defined according to WHO criteria. Data was analyzed using SPSS version 20.0. P value <0.05 was considered significant. Results: Mean age of the patients was 33.6 + 10.1 years and 60.8% of them were males. Majority of the patients belonged to rural areas (60.5%). Sexual route was the most common (69.5%) mode of transmission; among which heterosexual route was the commonest (96.1%). CD4 count was found to be less than 200 cells/mm3 in 22.2% of patients. Anemia was present in 67.3% of patients, among which moderate anemia was commonest (50.2%). Prevalence of anemia was significantly higher in females (83.4%) than males (56.9%) (p<0.001) and in rural population (71.9%) than urban population (60.3%) (p=0.02). Conclusion: Majority of patients were males and belonged to rural areas. Commonest mode of transmission was sexual route. Thus, IEC activities should be targeted to these particular groups and knowledge regarding safe sexual practices should be given particularly in rural areas. Prevalence of anemia is very high in PLHIV. Targeted interventions aiming to prevent anemia in PLHIV should be strengthened.

Characterizing glare effects associated with diffractive optics in presbyopia-correcting intraocular lenses.

To objectively quantify glare of intraocular lenses (IOLs) utilizing a diffractive principle to extend visual range. To identify models with increased susceptibility to inducing glare. David J Apple Laboratory, Heidelberg, Germany. Laboratory investigation. Glare was assessed by means of straylight parameter with a standard C-Quant (Oculus GmbH) intended for 7°. In addition, two C-Quant modifications were used to test lower angles (i.e., 2.5° and 3.5°). The following IOL models were assessed: PanOptix (Alcon Inc.) and AT Lisa Tri (Zeiss Meditec), Synergy (J&J Vision), and Triumf (BVI Medical), the latter two with chromatic-aberration correction at distance. Straylight from trifocals was compared against a monofocal W-60R lens (Santen). The C-Quant test was performed through the studied IOLs via additional optical components attached to its ocular. Straylight (deg2sr-1) of the control was <1 at all tested angles, with the trifocal models showing comparable straylight at 7°. At 3.5°, Triumf's straylight increased to 15.5 ±0.6, followed by Synergy (6.2 ±1.1), PanOptix (4.1 ±0.3), and AT Lisa Tri (2.0 ±0.8). The chromatic-aberration correcting models demonstrated correspondingly high straylight (Synergy: 18.8 ±1.3; Triumf: 17.3 ±0.5) at 2.5° compared to PanOptix (4.3 ±0.4), AT Lisa Tri (2.1 ±0.1) and monofocal IOLs yielding minimal or no increase. Trifocal IOLs induced increased straylight, but it was limited to lower angles, which may cause difficulties detecting these effects using a standard clinical approach. The latest IOL designs featuring chromatic aberration correction at far-focus appear more susceptible than the established trifocals to inducing glare phenomena.

IJCM_410A: Prevalence of metabolic syndrome in rural area of District Kangra of Himachal Pradesh

Background: Metabolic risk factors and abnormalities such as obesity and hypertension are rapidly rising in Indian population following widespread change in lifestyle and dietary habits. A study was conducted to estimate the current situation of metabolic syndrome in rural area of Kangra district of Himachal Pradesh. Objective: To find out the prevalence of metabolic syndrome in adult population in identified rural area of Kangra district of Himachal Pradesh. Methodology: A community based cross-sectional study was conducted among 177 individuals. The relevant anthropometric measurements and laboratory investigations were performed. NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines were used to diagnose the metabolic syndrome. Results: The prevalence of metabolic syndrome in our study was found to be 42.4% (34.99%-50.01%) and was higher among female population (71.8%). The proportion of metabolic syndrome was higher among older age group (66.7%) and only 2.7% in those who were less than 30 years of age. Conclusion: The present study documented 42.4% prevalence of metabolic syndrome in rural population, with more prevalence among females. The data was skewed, with more proportion of females in the study. Consequent upon this, development of health policies and protocols for the screening of metabolic syndrome would aid in early diagnosis and timely management of non-communicable disease.

Investigation of multi-infections and breast disease comorbidities in granulomatous mastitis.

Granulomatous mastitis (GM) is an inflammatory breast disease typically caused by infection, posing diagnostic challenges. It can coexist with other breast disorders or multiple infections, which have been vaguely discussed. This study investigates the incidence of multi-infection and breast disease comorbidities in GM. The study enroled 63 females who had a confirmed diagnosis of GM. Laboratory investigations and bacterial cultures had been conducted for all the cases. The patients had undergone ultrasonography examination utilizing the LOGIQ E9 system. Core needle biopsy had been done to procure tissue samples for histopathological examination. Thorough scrutiny and assessment of patients' records were performed. The variables encompassed age at presentation, breastfeeding data, parity, smoking status, seasonal affliction, hair-washing agents, exposure to radiation, comorbidities, and clinical, ultrasound and histopathological findings. The patients' ages ranged from 24 to 50. Breastfeeding history was positive in nearly all cases (97%). The majority of cases exhibited multiparity (81%). In total, 63.5% were passive smokers. Multi-infections were detected in six cases (9.5%). Among them, B. cepacia complex and Toxoplasma gondii were identified in two cases (3.16%). Other multi-infections involved Staphylococcus epidermidis and Toxoplasma gondii, Burkholderia cepacia and S. kloosii and Toxoplasma gondii, Staphylococcus epidermis and Brucella spp., Candida spp. and Brucella spp. Histopathological analysis revealed GM comorbidities with other breast diseases in 35% of the cases. Multi-infections and breast disease comorbidities may further complicate diagnosis and management of GM. The findings of this study may raise additional questions about the nature of the disease or potential complications associated with it.

Frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital.

Objective: To determine the frequency of thyroid disorders in patients with menstrual irregularities presenting to the OPD in tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Outpatients Obstetrics &amp; Gynaecology, Ward 8, Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: July 30, 2021 to January 29, 2022. Methods: All patients who met the inclusion criteria and visited JPMC, Karachi were enrolled in the study. After providing a thorough explanation of the procedure, risks, and benefits of the study, informed consent was obtained. The study involved conducting detailed history and examination, as well as recommending relevant laboratory investigations such as thyroid and ultrasound pelvic/TVS profiles. Results: 150 women of thyroid disorders in patients with menstrual irregularities were included with mean age was 33.72±7.62 years, mean height was 1.69±0.07 meter, mean weight was 76.60±12.70 kg, mean BMI was 26.78±4.13 kg/m2, mean parity was 2.84±2.05 and mean duration of menstrual irregularity was 0.82±0.07 days. Positive family history of thyroid disorder was found to be in 15 (10.0%). Positive history of thyroid surgery was noted in 26 (17.3%) patients. Thyroid disorder was noted in 57 (38.0%) cases. In distribution for type of thyroid disorder, subclinical hypothyroidism was noted in 37 (64.9%), 9 (15.8%) overt hypothyroidism, 11 (19.3%) subclinical hyperthyroidism while overt hyperthyroidism was noted in 0 (0.0%). In distribution of menstrual complain, amenorrhea was noted in 3 (5.3%), 3 (5.3%) oligomenorrhea, 7 (12.3%) metrorrhagia, 32 (56.1%) menorrhagia while polymenorrhea were noted in 12 (21.1%) cases. Conclusion: It is to be concluded that thyroid disorder is frequently observed in patients experiencing menstrual irregularities, as indicated by the study. However, further research is required to validate these finding.

Actinomyces as a rare cause of appendicitis: a case report

Abstract Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of &amp;gt;90%.

Significance of Pretreatment Hemoglobin-Albumin-Lymphocyte-Platelet Index for the Prediction of Suboptimal Surgery in Epithelial Ovarian Cancer.

Epithelial ovarian cancer (EOC) is the leading cause of death in gynecological cancers in developed countries. In recent years, there has been a growing need for economical and accurate pretreatment laboratory investigations to assess the prognosis of patients with advanced EOC (AEOC). We aimed to investigate the role of the hemoglobin-albumin-lymphocyte-platelet (HALP) index in suboptimal cytoreduction and oncological outcomes. A prognostic prediction model for diagnosing suboptimal cytoreduction for patients with AEOC receiving neoadjuvant chemotherapy (NACT) was developed. Multivariate logistic regression analysis was performed to identify the independent predictors of suboptimal cytoreduction, with a P-value < 0.05, and then transformed into risk-scoring systems. Internal validation was performed using the bootstrapping procedure, and predictive cytoreduction (PSC) scores were compared using non-parametric receiver operating characteristic (ROC) regression. Survival analysis was performed using Kaplan-Meier estimation and Cox proportional regression. In total, 473 patients were analyzed, and the rate of suboptimal surgery was 43%. A scoring system in predicting suboptimal cytoreduction included age, cancer antigen (CA)-125 level before surgery, performance status, cycles of chemotherapy, peritoneal cancer index, and HALP index ≤ 22.6. The model had good discriminative ability (area under the ROC (AUROC), 0.80; 95% confidence interval (CI), 0.76 - 0.84), outperforming the PSC score (AUROC, 0.75; 95% CI, 0.71 - 0.80). The score was divided into the low-risk (positive predictive value (PPV), 22.4; 95% CI, 17.8 - 27.7), moderate-risk (PPV, 65.9; 95% CI, 56.9 - 74.0), and high-risk (PPV, 90.6; 95% CI, 79.3 - 96.9) groups. The HALP index score of ≤ 22.6 was independently associated with progression-free survival (hazard ratio (HR), 2.92; 95% CI, 1.58 - 5.40) and overall survival (HR, 2.66; 95% CI, 1.57 - 4.49). The HALP index is a newly predicted factor for suboptimal cytoreduction and oncological outcomes in patients with AEOC after NACT.

Divergent Phenotypes with Same CHRNE Mutation in Two Siblings with Congenital Myasthenic Syndrome

Background: Congenital myasthenic syndrome is a rare inherited neuromuscular disorder resulting in abnormal weakness and fatigue on exertion with onset at or shortly after birth or in early childhood. Clinical Description: A 2-year-old boy presented to us with respiratory failure, having a history of recurrent respiratory tract infections and underlying isolated motor delay. His 7-year-old elder sister had undiagnosed generalized weakness. Management and Outcome: While the index case was being stabilized with mechanical ventilation, his elder sibling was evaluated. Ptosis was noted in her, which improved with neostigmine. Examination and laboratory investigations ruled out other differentials. Clinical exome sequencing was sent which showed homozygous CHRNE ENST00000649488.2.c.1367_1369del. (p.Asn456del) resulting in acetylcholine receptor deficiency. Both siblings were started on oral pyridostigmine and salbutamol, resulting in improvement in muscle weakness over 3 months and 4 months in younger and older sibling, respectively. Conclusion: Recurrent respiratory insufficiency when associated with motor delay may be suggestive of a neuromuscular disorder. Even siblings with the same mutation may have different levels of severity of clinical manifestation.

IJCM_254A: A Study on Level of Satisfaction among Beneficiaries Under Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in Rural Field Practice Area Of Guntur Medical College. Guntur, Andhra Pradesh: A Cross-sectional Study

Background: With 30,000 estimated maternal deaths in a year across the country, high MMR remains a matter of grave concern, and thus it is paramount to ensure quality ANC to each pregnant woman, identify the high risk pregnancies (HRPs) and track these for counselling, management birth preparedness and referral till the outcome to close the loop. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016, as a fixed-day, assured, comprehensive quality ANC service on the 9th of every month to every pregnant woman across the country. Screening, identification, line listing and appropriate management of high-risk pregnancies by OBGY/CEmOC/ BEmOCspecialist and referral to appropriate higher facilities are some of the fundamental elements of PMSMA Objective: To determine the level of satisfaction among beneficiaries under PMSMA scheme Methodology: A cross-sectional study was done among 300 pregnant women who were delivered within 6 months from the date of the study and who had registered &amp; availed the Ante-Natal Care (ANC) services under Rural field Practice area of Guntur Medical college. Guntur. Andhra Pradesh. The data thus collected were entered into Microsoft-Excel spreadsheet and was analyzed using IBM SPSS software Version 24.0 Results: Out of 300 beneficiaries, 237(79%) were satisfied with the cleanliness of wards &amp; toilets followed by 278(92.69%) with Adequate privacy During Examination, 287(97.67%) with basic laboratory investigation, 166(55.34%) with transport facilities during discharge. The majority of study participants were in the age group of 20-30 years i.e. 269 (89.70%) and most of their educational status above intermediate i.e. 207(69%) Conclusion: If every pregnant woman in India is examined by a Medical Officer/Specialist and Investigated appropriately at least once during the PMSMA, the Abhiyan can play a crucial role in reducing the number of maternal deaths &amp; High-Risk Pregnancy (HRP) in our country

Serum interleukin 18 level in kidney diseases and age.

Interleukin-18 (IL-18), also known as interferon-gamma inducing factor is a protein which in humans is encoded by the IL18 gene, it is a member of the IL 1 family and has a molecular weight of 18 kDa. Innate and adaptive immunity can be regulated by IL-18, and disorders involving its dysregulation might result in inflammatory or autoimmune conditions. To distinguish between acute kidney injury (AKI) and chronic renal failure (CRF), this research investigates the utility of IL-18 as a novel biomarker and examines how age affects its level. Three hundred participants were included and divided into three groups using the following methodology. Group I consisted of 100 control subjects who were split up by age and gender. Group II consisted of 100 AKI patients who were divided into two groups and subgroups based on age and gender. Group III, which consisted of 100 CRF (hemodialyzed patients), was divided into two groups and subgroups, as patients with acute renal injury and previously healthy people. Patients' blood was drawn to conduct a laboratory investigation blood urea, serum creatinine, sodium, potassium, pH, GFR and PCO2. Patients with CRF had higher serum levels of IL-18 than patients with AKI, regardless of gender, and both groups of patients had levels of IL-18 that rise with age. IL-18 is a reliable indicator for the differentiation between AKI and CRF patients receiving hemodialysis and its level correlates with age independent with gender.

IJCM_216A: Task force study for evaluation of community level acceptability, scalability and linkage within health system of ICMR pre-validated Labike/ Technologies for screening &amp; diagnosis in rural &amp; urban population–An implementation research

Background: The concept of ABDM- Ayushman Bharat Digital Health Mission and Ayushman Bharat- Pradhan Mantri Jan Arogya Yojna are in root for overall aims of the research and importance of this research proposal. There is a need to study the acceptability &amp; scalability of ICMR pre-validated technologies -Mobile Lab technology &amp; digital technologies, skilled manpower needed for health data updating from individuals given individual health ids. Objectives: To do situational analysis of availability of medical diagnostic, testing facilities in under privileged/ remote areas. Methodology: Study Design – Implementation research, Sample - 1000 households (5000 population) have been equally enrolled from rural and urban areas which are further equally divided into two groups of control and intervention. Base Line Data has been collected on following information- socio-demographic characteristics, blood pressure measurement, health needs, health seeking behavior of community, availability and utilization of existing health care facilities and blood investigations. Study tools: Questionnaire for baseline survey – After informed consent, interview of the family head was done using set of quantitative and open-end qualitative questionnaires. Results: 77.9% and 69.3% belong to Upper Lower class in urban and rural areas. 21% and 15.6 % blood pressure measurements were deranged in urban and rural areas, 11.8 % and 10% population in urban and rural areas showed their willingness for lab investigations at door step through LABIKE. Blood glucose measurements of 5.4 % and 10.6% population in urban and rural areas were deranged. Haemoglobin values of 11.8 % and 17% population in urban and rural areas were low than 10 g/dl. 7 % and 12.7 % population in urban and rural areas utilized existing health care facilities. Conclusion: There is need to generate robust grass root level network by integrating community and health service providers.