Diabetic retinopathy remains the leading vascular-associated cause of blindness throughout the world. Its treatment requires a multidisciplinary interventional approach at both systemic and local levels. Current management includes laser photocoagulation, intravitreal steroids, and anti-vascular endothelial growth factor (VEGF) treatment along with systemic blood sugar control. Anti-VEGF therapies, which are less destructive and safer than laser treatments, are being explored as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as diabetic macular edema (DME). This review provides comprehensive information related to VEGF and describes its role in the pathogenesis of diabetic retinopathy, and in addition, examines the mechanisms of action for different antiangiogenic agents in relation to the management of this disease. Medline (Pubmed) searches were carried out with keywords “VEGF”, “diabetic retinopathy”, and “diabetes” without any year limitation to review relevant manuscripts used for this article.

Background:Acinetobacter is clinically important pathogen with widespread resistance to various antibiotics. We assessed the incidence of Acinetobacter infection at a tertiary care hospital, analyze their resistance pattern and identify the production of extended spectrum β-lactamases (ESBLs) and metallo β-lactamases (MBLs).Materials and Methods:The study was conducted in tertiary care hospital, India over a period of 2 years. Acinetobacter species were isolated from various clinical samples received in Department of Microbiology. After identification, Acinetobacter isolates were speciated and antibiotic susceptibility was determined by the standard disc diffusion method. ESBL and MBL production was detected by the double disc synergy test and combined disc diffusion test respectively.Results:Of 3298 infected samples, 111 (3.36%) were found to be Acinetobacter. The most predominant species was Acinetobacter calcoaceticus-A. baumannii (Acb) complex (72%). High incidence of resistance was recorded for piperacillin (55%), followed by ceftriaxone (46%) and ceftazidime (46%). Isolation rate and antibiotic resistance was higher in the Intensive Care Units (ICUs) of the hospital. ESBL and MBL production was detected in 31.5% and 14.4% of the isolates respectively.Discussion and Conclusion:A high level of antibiotic resistance was observed in our study and maximum isolation rate of Acinetobacter was in the ICUs. Acb complex was the most predominant and most resistant species. The analysis of susceptibility pattern will be useful in understanding the epidemiology of this organism in our hospital setup, which will help in treating individual cases and controlling the spread of resistant isolates to other individuals.

BackgroundFlow cytometry (FCM) is a simple, sensitive, and specific technique that can potentially determine DNA ploidy in B‐cell precursor ALL (BCP‐ALL) and is complementary to cytogenetics.MethodsA prospective FCM DNA ploidy analysis using FxCycle™ Violet (assay sensitivity 0.01%) was done in 125 consecutive new cases of BCP‐ALL (90 cases <15 years of age) and compared with corresponding cytogenetic ploidy (karyotyping and/or FISH) data wherever available. This assay was also subsequently evaluated for detection of residual aneuploid clone in few BCP‐ALL cases.ResultsOf the total 125 BCP‐ALL cases evaluated, flow ploidy analysis revealed diploidy (DI 0.96–1.05) in 44.8% (n = 56), low‐hyperdiploidy (DI 1.06 to 1.15) in 13.6% (n = 17), high‐hyperdiploidy (DI 1.16–1.39) in 32.8% (n = 41) and near‐tetraploidy (DI ≥ 1.80) in 2.4% (n = 3) cases. The high risk sub‐group of low‐hypodiploidy (DI 0.70 to 0.88)/near‐triploidy (DI 1.40 to 1.79) constituted 5.6% (n = 7) cases while there was only one case with haploidy (DI 0.58). Overall, high concordance of 90.4% (n = 113) was noted between the combined cytogenetics ploidy and FCM ploidy. Of the total discordant cases (n = 12), the maximum discordance was seen in the low‐hyperdiploid DI subgroup (n = 10), which included seven cases with low DNA index high hyperdiploidy (LDI‐HHD). FCM DNA ploidy assay was able to detect the residual clone in all six MRD positive aneuploid cases evaluated.ConclusionsFxCycle™ based DNA ploidy ascertains strong correlation with cytogenetic profiles and yields complementary information that can be used by the cytogenetics laboratories or otherwise. © 2019 International Clinical Cytometry Society

Introduction: For diagnosis, sub-categorization and follow up of Acute Leukemia (AL), phenotypic analysis using flow cytometry is mandatory. Material and methods: We retrospectively analyzed immunophenotypic data along with cytogenetics/molecular genetics data (wherever available) from 631 consecutive cases of AL diagnosed at our flow cytometry laboratory from January 2014 to August 2017. Results: Of the total 631 cases, 52.9% (n=334) were acute lymphoblastic leukemia (ALL), 43.9% (n=277) acute myeloid leukemia (AML), 2.2% (n=14) mixed phenotypic acute leukemia (MPAL) and0.5% (n=3) each of acute undifferentiated leukemia (AUL) and chronic myeloid leukemia in blast crisis (CML-BC). ALL cases comprised of 81.7% (n=273/334) B-cell ALLs (95.2%, n=260/273 common B-ALLs and 4.8%, n=13/273 Pro B-ALLs). CD13 was the commonest cross lineage antigen expressed in B-ALL (25.6%), followed by CD33 (17.9%) and combined CD13/CD33 (11.3%) expression. T-ALLs constituted 18.3% (n=61/334) of total ALLs and included 27.9% (n=17) cortical T- ALLs. CD13 was commonest (32.7%) aberrantly expressed antigen in T-ALLs, followed by CD117 (16.0%). AML cases included 32.1% (n=89/277) AML with recurrent genetic abnormalities, 9.0% (n=25/277) with FLT3/NPM1c mutation and 58.9% (n=163/277) AML NOS including 14.7% (n=24/163) AML M4/M5, 1.8% (n=3/163) AML M6 and 3.7% (n=6/163) AML M7. In AMLs, CD19 aberrancy was the most common (16.3%) followed by CD7 (11.9%). Conclusion: In this study we document the spectrum; correlate the immunophenotype with genetic data of all leukemias, especially with respect to T-ALL where the data from India is scarce.

A 55-year-old postmenopausal lady presented with complaints of bleeding per vaginum and lower abdominal pain for the last 3-4 months. She also had increased body hair for last 3-4 years. She had three children and there was no history of any abnormality during her pregnancy. There was no history of any contraception and exogenous hormone intake.Past medical history was otherwise unremarkable. Family history was noncontributory. Ultrasonography revealed a hypoechoic right adenexal mass measuring 65x40x30mm. This mass was not separated from right ovary. A possibility of ovarian sex cord tumour was given. A total hysterectomy with bilateral salpingooophorectomy was done and the specimen was received in our department for histopathological examination.An already cut open gross specimen of uterus was received measuring 9x6x3.5cm in size with one tube and ovary and other fallopian tube and ovary lying separately in container. Ovarian tumour measured 6x4x3cm. It was replacing whole of the ovary without any peripheral ovarian stroma. Cut surface was solid and yellow in colour [Table/ Fig-1a&b]. Other side ovary was grossly normal. Specimen of omentum measuring 45cm in length was also received.Sections from ovarian tumour showed well circumscribed tumour comprising of large round to polygonal cells with centrally placed nuclei, prominent nucleoli and abundant amount of eosinophilic cytoplasm [Table/ Fig-2a&b]. There was no atypia, mitotic figures or necrosis noted in the tumour. Stroma was scanty. Histological features were consistent with steroid cell tumour NOS type. The cervix showed features of chronic cervicitis while the endometrium showed atrophic changes. The other side ovary and tube was unremarkable. Patient was discharged after 1 week with stable condition and was adviced follow up after 1 month. Patient's excessive hair growth reduced after few months and there were no other complaints. DisCussionThe incidence of steroid cell tumours, NOS is highest in women of child bearing age group, particularly during the third and fourth decades, but in rare cases postmenopausal women or children may also have this tumour. Androgenic manifestations are common in these tumours as they secrete hormones like androstenedione, α-hydroxyprogesterone, and testosterone [1,2].These tumours are known to produce symptoms of virilisation particularly hirsutism. So in cases where there is unexplained hirsutism, ovarian and adrenal tumour association should be ruled out as there may be occult malignancies [3]. However, there may be atypical presentations of these tumours also when they do not show any symptoms of virilisation. In these cases the diagnosis is usually made postoperatively on finding a tumour in ovary [4].These tumours have been divided into three subtypes according to their cells of origin: stromal luteoma, leydig cell tumour and steroid cell tumour, not otherwise specified (NOS). Of these subtypes, the steroid cell tumours, NOS account for about 56% of steroid cell tumours [5].A majority of steroid cell tumour NOS are ...

Although a large number of cirrhotic patients have high levels of anti-tTG, duodenal histology and/or anti-EMA is normal in majority of these patients. This suggests high false positivity of anti-tTG in patients with cirrhosis and highlights the need of duodenal biopsy for histological confirmation of the diagnosis of celiac disease.

Oestrogen replacement therapy either via oral or transdermal route has a beneficial effect on serum lipid profile of menopausal women. Whereas the oral route is more effective in increasing HDL cholesterol levels, the transdermal route is better for reducing the serum triglyceride level; hence, the latter should be the route of choice in women with high serum triglyceride levels.

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