Gallbladder cancer (GBC) is a common malignancy of the biliary tract and involves the changes in multiple oncogenes and multiple genetic genes. Since over the past decade there has been an advance in the knowledge of the genetic basis of cancer, mainly as a result of the rapid progression of molecular technology; however, conventional therapeutic approaches have not had much impact on the course of this aggressive neoplasm. Knowledge of the molecular biology of GBC is rapidly growing. Genetic alterations in GBC include adenosine triphosphate-binding cassette transporter ABCG8, membrane-bound enzyme ADAM-17 of multi-functional gene family, and other genes including p53, COX2, XPC, and RASSF1A. The advances in molecular biology have potential implications for the detection of this disease, using Synuclein-gamma, Syndecan-1, glycoprotein 72 (TAG-72), tumor endothelial marker 8 protein (TEM8) and TNF-alpha. The use of these molecular diagnostic methods is of clinical importance for the gene replacement therapy, genetic prodrug activation therapy, and antisense immunology technology for the treatment of malignancy. The author reviewed recent publications on PubMed, and summarized molecular biology of GBC, with an emphasis on features of potential clinical implications for diagnosis and management.

Yoga is an ancient Indian way of life, which includes changes in mental attitude, diet, and the practice of specific techniques such as yoga asanas (postures), breathing practices (pranayamas), and meditation to attain the highest level of consciousness. Since a decade, there has been a surge in the research on yoga, but we do find very few reviews regarding yogic practices and transcendental meditation (TM) in health and disease. Keeping this in view, a Medline search was done to review relevant articles in English literature on evaluation of physiological effects of yogic practices and TM. Data were constructed; issues were reviewed and found that there were considerable health benefits, including improved cognition, respiration, reduced cardiovascular risk, body mass index, blood pressure, and diabetes. Yoga also influenced immunity and ameliorated joint disorders.

Background: Jaundice in Plasmodium falciparum malaria is multifactorial and its incidence varies in different regions. It is important to assess the incidence and factors associated with malarial hepatopathy as well as its complications to understand the pattern of disease presentation in order to undertake appropriate interventional measures. There is a paucity of data with regard to malarial hepatopathy and its outcome at the global level. Aim: The study was conducted to assess the pattern, spectrum of biochemical parameters and complications of hepatopathy related to P. falciparum malaria. Materials and Methods: A descriptive study was conducted in a tertiary care hospital attached to a government medical institution in Assam, India. Demographic details of the hundred patients with P. falciparum malaria, their clinical and biochemical parameters, complications and outcome were collected using a prestructured proforma. Data was compared using proportion and Chi Square test. Results: The proportion of those with malarial hepatopathy was 38% and the incidence was more in males and younger age group. The degree of hyperbilirubinemia, complications that include renal failure, shock, acute respiratory distress syndrome, hypoglycemia and mortality were significantly more among patients with hepatopathy (P<0.05). Conclusion: Malarial hepatopathy is associated with a higher incidence of complications like renal failure, shock, acute respiratory distress syndrome and hypoglycemia. Further studies are required to elucidate the factors associated with malarial hepatopathy and to prevent the complications and mortality.

Background : The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. Aims : This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. Materials and Methods : Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. Results : There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cmH ₂ O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cmH ₂ O). Conclusion : Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.

Background: Anthropometric data describing the palpebral fissure and its position is available for various populations. Unfortunately there is no data available for Malaysian South Indian. Aim: The present study was undertaken to determine the normative values for Malaysian South Indian according to gender. Materials and Methods: Anthropometric measurement was done on standardized photographs taken from 300 MSI aged 18-26 years. The parameters were measured using computerized software. Results: Significant sexual difference was observed in all parameters except canthal index, which includes palpebral fissure width (male, 30.9 mm; female, 29.62 mm), palpebral fissure height (male, 11.06 mm; female, 11.48 mm), palpebral fissure inclination (male, 4.72°; female, 7.04°), outercanthal distance (male, 97.15 mm; female, 91.78 mm), interpupillary distance (male, 68.09 mm; female, 63.6 mm), intercanthal distance (male, 34.1 mm; female, 32.77 mm), and canthal index (male, 35.22 mm; female, 35.86±4.44 mm). Conclusions: Sexual dimorphism was found in all parameters. Comparison of our results with other studies revealed the variation and similarities in key parameters. Establishing normative values and understanding the facial morphology of different ethnic groups is important in designing the treatment planning for an aesthetic oculoplastic procedure.

Background: From a single CT scan in primary intracerebral hemorrhage (ICH), clinical outcome can be assessed on admission by using the CT scan parameters. Aims: The study aims to find out how hematoma volume, location of stroke, midline shift, intraventricular extension of bleed and ventricle compression influence the clinical outcome in patients with acute ICH. Materials and Methods: Non-contrast CT scan was done on admission in hospital for every patient with acute hemorrhagic stroke and was analyzed accordingly. Clinical assessments were done in National Institute of Health Stroke Scale (NIHSS). Chi-square test and multiple logistic regression analysis were used for statistical analysis. Results: Mean hematoma volume associated with death before 30 days is 33.16 cm³ (P < 0.0001), with survived after 30 days is 15.45 cm³ (P < 0.0001), with NIHSS score 16 is 29.03 cm³ (P < 0.0001) and with NIHSS score <16 is 13.69 cm³ (P < 0.0001). Independent poor prognostic factors were hematoma volume > 30 cm³ (OR = 27.857), brain stem hemorrhage (OR = 6.000), intraventricular extension of bleed from other location (OR = 7.846), presence of ventricular compression alone (OR = 2.700) and in combination with midline shift of 5 mm (OR = 2.124). Conclusions: From a single CT scan during hospital admission, mortality and morbidity in next 30 days can be predicted. A hematoma volume >30 cm³, brain stem hematoma, intraventricular extension of bleed and ventricular compression along and with midline shift are associated with early mortality in ICH.

Background: Pseudoexfoliation is a systemic disorder characterized by the deposition of extracellular matrix material. The microfibrillar material that gives rise to the condition is visible clinically in the anterior segment of the eye, and is also found in other tissues, including blood vessels, skin, gallbladder, kidneys, lungs, and heart. Aims: The present study aims to determine whether ocular pseudoexfoliation is associated with selected cardiovascular diseases. Materials and Methods: A cross-section comparison study was conducted with the help of the Veterans Health Administration databases, using the International Classification of Diseases, Ninth revision, Clinical Modification for pseudoexfoliation of lens capsule and pseudoexfoliation glaucoma. Selected cardiovascular diseases and risk factors for cardiovascular disease were identified using the appropriate medical codes. Patients with primary open-angle glaucoma, chronic sinusitis, and benign prostatic hyperplasia served as the comparison groups. A logistic regression model was used to control for age, gender, race, and major cardiovascular risk factors. Results: There were 6,046 case patients with pseudoexfoliation; approximately half were diagnosed with pseudoexfoliation glaucoma. Various stages of ischemic heart disease, cardiomyopathy, and aortic aneurysm were significantly associated with ocular pseudoexfoliation, after controlling for age, gender, race, and major cardiovascular risk factors. Associations, in general, were less demonstrable relative to the primary open-angle glaucoma comparison group. Conclusion: Associations of ocular pseudoexfoliation with cardiovascular diseases were generally fewer and less pronounced when compared to patients with primary open-angle glaucoma. These results add to the results of earlier studies, which suggest that open-angle glaucoma itself might be a risk factor for certain cardiovascular disorders.

Background: The adolescent girls are more vulnerable, particularly in developing countries including India, due to various adverse socio-cultural and economic reasons. Majority of the health problems affecting adolescent girls are preventable by promotion of hygienic practices through proper health education by the teachers. Aim: This study was designed to examine the various factors influencing the prevalence of morbidity among school-going adolescent girls of Lucknow district in north India. Materials and Methods: A cross-sectional study was carried out in urban and rural schools of Lucknow district from 2008 to 2009. Multistage random sampling was used to select the requisite number of girls. A total of 847 adolescent girls between 10 and 19 years of age were interviewed, and information regarding their socio-demographic characteristics was collected and clinical examination was carried out. Statistical analyses were done using percentage and Chi-square test. Results: Of 847 adolescent girls, around 64.8% were found to be sick at the time of the study. Significant association of morbidity was observed with caste, birth order, type of family, socioeconomic status (SES), living status with parents/guardian, and general personal hygiene (P<0.05). Conclusion: This study reveals a high prevalence of morbidity. A strong need exists for planning and programming intervention activities for health needs in the area.

Background: Pneumocystis jirovecii, formerly known as P. carinii, is an opportunistic fungus causing Pneumocystis carinii pneumonia especially in immunocompromised patients. Aim: The aim of this study was to detect P. jirovecii in sputum samples from patients suspected of having respiratory tract infections. Materials and Methods: In this study, 230 acid fast bacilli negative sputum samples from 230 patients presenting with respiratory tract infections submitted to three teaching hospitals' medical microbiology laboratories in Osun and Oyo States, Nigeria for routine investigation were examined for P. jirovecii by microscopical and polymerase chain reaction methods. Results: P. jirovecii cysts were observed in 15 (6.5%) samples and polymerase chain reaction was positive for 29 (12.6%) samples out of 230 samples examined. It was observed that the detection of P. jirovecii was associated with age (P < 0.05) while there were no associations between diagnosis, sex, and prevalence of P. jirovecii (P > 0.05). Polymerase chain reaction was showed to be a better method for the detection of P. jirovecii based on the 51.7% sensitivity and 100% specificity of the microscopy. Conclusion: The study concluded that P. jirovecii is prevalent in patients with respiratory tract infections in hospitals from the southwestern part of Nigeria and should be included in diagnosis of these infections in this part of the world.

The immune response in metastatic melanoma is not well established and therefore is of particular interest to test for recruitment of immune cells to the tumor. A 46-year-old Caucasian female was evaluated for an asymptomatic right forearm mass. The lesion had been present for at least 4 years and had become painful 4 months ago. Biopsies for hematoxylin and eosin (H and E) staining, as well as immunohistochemical analysis were performed on the primary tumor and on sentinel lymph nodes. The H and E staining was consistent with metastatic melanoma. Positive staining was noted on the tumor cells with S-100, Mart-1/Melan A/CD63, PNL2, HMB45, and tyrosinase. Peritumoral and intratumoral inflammatory cells stained positive for CD8, CD45, PCNA, myeloid histoid antigen, antihuman plasma cell antibody, and focal BRCA1. The staining patterns of CD8/CD45, myeloid histoid antigen and plasma cell antibody on inflammatory cells around the melanoma cells suggest an unusual type of immune response.