Association of anaemia with indoor air pollution among older Indian adult population: multilevel modelling analysis of nationally representative cross-sectional study.

INTRODUCTION: Anaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender. METHODS: Our study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis. RESULTS: More than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09-1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18-1.43), and household indoor smoking (AOR 1.17 (1.07-1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15-1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15-1.61) than females (AOR 1.21; 1.08-1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure. CONCLUSION: This study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.

DDX3-mediated miR-34 expression inhibits autophagy and HBV replication in hepatic cells.

HBV entry to the host cells and its successful infection depends on its ability to modulate the host restriction factors. DEAD box RNA helicase, DDX3, is shown to inhibit HBV replication. However, the exact mechanism of inhibition still remains unclear. DDX3 is involved in multitude or RNA metabolism processes including biogenesis of miRNAs. In this study, we sought to determine the mechanism involved in DDX3-mediated HBV inhibition. First, we observed that HBx protein of HBV downregulated DDX3 expression in HBV-infected cells. Overexpression of DDX3 inhibited HBx, HBsAg and total viral load, while its knockdown reversed the result in Hep G2.2.15 cells. Expression of miR-34 was downregulated in HBV-infected cells. Overexpression of pHBV1.3 further confirmed that HBV downregulates miR-34 expression. Consistent with the previous finding that DDX3 is involved in miRNA biogenesis, we observed that expression of miR-34 positively corelated with DDX3 expression. miRNA target prediction tools showed that miR-34 can target autophagy pathway which is hijacked by HBV for the benefit of its own replication. Indeed, transfection with miR-34 oligos downregulated the expression of autophagy marker proteins in HBV-expressing cells. Overexpression of DDX3 in HBV-expressing cells, downregulated expression of autophagy proteins while silencing of DDX3 reversed the results. These results led us to conclude that DDX3 upregulates miR-34 expression and thus inhibits autophagy in HBV-expressing cells while HBx helps HBV evade DDX3-mediated inhibition by downregulating DDX3 expression in HBV-infected cells.

Congenital Pseudodiphallia -A Rare Case Presentation.

Diphallia (penile duplication) is a rare congenital malformation with an incidence of about 1 per 5-6 million newborns. The severity of diphallia varies from a small accessory penile-like tissue to complete true penile duplication with other deformities, usually involving the urogenital, gastrointestinal, and musculoskeletal systems. Pseudodiphallia, as a rare kind of diphallia, is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. A 5.5-year-old male child was brought to the pediatric surgery outpatient department by the parents with complaint of difficulty in retracting the prepucial foreskin and the presence of some growth near the glans. There were no other complaints in specific. Clinical examination revealed foreskin retractable with difficulty and small conical lump smaller than the original glans approximately size ~1 cm diameter at the base attached horizontally at the left side of the original glans at the coronal sulcus and visible incomplete clefting in between the 2 glans visible from the aerial view. After approval from anesthetist, the patient was operated under general anesthesia by excision of pseudodiphallia. Urethral catheterization and circumcision of the penis after taking informed parental consent. Postoperatively, the period was uneventful. The patient responded well to the symptomatic treatment and was orally allowed on the same day evening. Urinary catheter was removed on 5th postoperative day. The patient was discharged on oral symptomatic medication and was advice for follow-up.

Trends in selected birth defects among parents from below poverty line population in Karnataka during 2010-2020.

The aim of the study is to reveal the common birth defects among parents of newborns belonging to the below poverty line (BPL) category in Karnataka state (South India) by analyzing Suvarna Arogya Suraksha Trust data. In the last 10 years, 3672 kids in BPL families have been born with various birth abnormalities. It is found that 50.3% of newborns have anorectal malformations, 33.1% have hypospadias, 6.0% have diaphragmatic hernia, 5.1% have esophageal atresia, and 2.8% have intestinal atresia and obstruct. As a parent's age rises, the likelihood of having a child with birth abnormalities raise as well, particularly anorectal malformations than diaphragmatic hernia. Male newborns have a higher risk of birth defects. We hypothesized that poverty, material deprivation, and low socioeconomic profile throughout the life course among the BPL community could be some of the key reasons for poor maternal health care and related neonatal outcomes.

Nature and sources of ionic species in rainwater during monsoon periods in and around sixteenth-seventeenth century CE monuments in Yamuna River basin, India.

The nature and sources of ionic species were studied in the monsoon rainwater collected from two monuments of the sixteenth-seventeenth century CE in the Yamuna River basin from 2016 to 2018. The results showed the acidic pH of the rainwater with high dissolved SO4-2 and NO3-, and soil-derived components (Ca+2, Mg+2, and K+). The anionic (SO4-2, NO3-, Cl-, F-, and HCO3-) and cationic (Ca+2, Mg+2, K+, NH4+, and Na+) concentrations showed regional differences in yearly contribution mainly from the fossil fuel combustion, soil dust, and farm residue burning. The rainwater analysis showed low dissolved ions at SCTK (Sheikh Chilli's Tomb, Kurukshetra) compared to KBMP (Kabuli Bagh Mosque, Panipat). The mean concentration of SO4-2 was 1.5 times higher than the NO3- apportioning the sulfate as a dominant acidifying constituent in rainwater. Pearson's correlation and principal component analysis (PCA) showed terrestrial and marine origins of dissolved ions in the rainwater. The Na-normalized molar ratios and the analysis of sea salt and non-sea salt fractions indicate the dominance of non-marine contributions in the precipitation. Based on neutralization factors, cations showed neutralization of rainwater acidity as follows: NFCa+2 > NFMg+2 > NFNH4+ > NFK+. The potential index showed the dominance of the neutralization potential (NP) on acidic potential (AP) at both locations.

Assessment of ozone toxicity among 14 Indian wheat cultivars under field conditions: growth and productivity.

Tropospheric ozone (O3) is a well-known threat to global agricultural production. Wheat (Triticum aestivum L.) is the second most important staple crop in India, although little is known about intra-specific variability of Indian wheat cultivars in terms of their sensitivity against O3. In this study, 14 wheat cultivars widely grown in India were exposed to 30 ppb elevated O3 above ambient level using open top chambers to evaluate their response against O3 stress. Different growth and physiological parameters, foliar injury and grain yield were evaluated to assess the sensitivity of cultivars and classified them on the basis of their cumulative stress response index (CSRI). Due to elevated O3, growth parameters, plant biomass, and photosynthetic rates were negatively affected, whereas variable reductions in yield were observed among the test cultivars. Based on CSRI values, HD 2987, DBW 50, DBW 77, and PBW 550 were classified as O3 sensitive; HD 2967, NIAW 34, HD 3059, PBW 502, HUW 213, and HUW 251 as intermediately sensitive, while HUW12, KUNDAN, HUW 55, and KHARCHIYA 65 were found to be O3-tolerant cultivars. Cultivars released after year 2000 were found to be more sensitive compared to earlier released cultivars. Path analysis approach showed that leaf area, plant biomass, stomatal conductance, net assimilation rate, and absolute growth rate were the most important variables influencing yield under O3 stress. Findings of the current study highlight the importance of assessing differential sensitivity and tolerance of wheat cultivars and response of different traits in developing resistance against elevated O3.

The Arabidopsis paralogs, PUB46 and PUB48, encoding U-box E3 ubiquitin ligases, are essential for plant response to drought stress.

BACKGROUND: Plants respond to abiotic stress on physiological, biochemical and molecular levels. This includes a global change in their cellular proteome achieved by changes in the pattern of their protein synthesis and degradation. The ubiquitin-proteasome system (UPS) is a key player in protein degradation in eukaryotes. Proteins are marked for degradation by the proteasome by coupling short chains of ubiquitin polypeptides in a three-step pathway. The last and regulatory stage is catalyzed by a member of a large family of substrate-specific ubiquitin ligases. RESULTS: We have identified AtPUB46 and AtPUB48-two paralogous genes that encode ubiquitin ligases (E3s)-to have a role in the plant environmental response. The AtPUB46, -47, and -48 appear as tandem gene copies on chromosome 5, and we present a phylogenetic analysis that traces their evolution from an ancestral PUB-ARM gene. Single homozygous T-DNA insertion mutants of AtPUB46 and AtPUB48 displayed hypersensitivity to water stress; this was not observed for similar mutants of AtPUB47. Although the three genes show a similar spatial expression pattern, the steady state levels of their transcripts are differentially affected by abiotic stresses and plant hormones. CONCLUSIONS: AtPUB46 and AtPUB48 encode plant U-Box E3s and are involved in the response to water stress. Our data suggest that despite encoding highly homologous proteins, AtPUB46 and AtPUB48 biological activity does not fully overlap.

Differential sensitivity of barley (Hordeum vulgare L.) to chlorpyrifos and propiconazole: Morphology, cytogenetic assay and photosynthetic pigments.

The present investigation was performed to evaluate the effects of an insecticide and fungicide, namely, chlorpyrifos (CP) and propiconazole (PZ) on barley (Hordeum vulgare L. variety Karan-16). The seeds were treated with three concentrations of CP and PZ, i.e., 0.05%, 0.1% and 0.5% for 6 hours after different pre-soaking durations of 7, 17 and 27 hours. Different pre-soaking durations (7, 17 and 27 h) represent three phases of the cell cycle i.e., G1, S and G2, respectively. Double distilled water and ethyl methane sulfonate were used as negative and positive controls, respectively. As compared to their respective controls, treated root tip meristematic cells of barley showed significant reductions in the germination percentage, seedling height, mitotic index and comparative increase in chromosomal aberrations against both the pesticides, and the magnitude was higher in CP. After treatment with the pesticides, chlorophyll and carotenoid contents increased up to 0.1% but reduced at 0.5% and the decrease was more prominent in CP as compared to PZ. In treated cells, fragmentation, stickiness, bridges, multipolar anaphase and diagonal anaphase were observed as aberrations. As compared to control, chromosomal aberrations were higher in CP as compared to PZ. The results of the present study concluded that CP induced chromosomal aberrations were more frequent than PZ; hence it has higher probability to cause genotoxicity in barley.

Anomaly detection using deep convolutional generative adversarial networks in the internet of things.

Advanced 5 G and 6 G technologies have accelerated the adoption of the Internet of Things (IoT) and are a priority in providing support for high-speed communication and fast data analysis. One of IoT networks benefits is automated networking, which unfortunately increases the risk of security, integrity, and privacy breaches. Therefore, in this paper, we propose a weighted stacked ensemble model combining deep convolutional generative adversarial and bidirectional long short-term memory networks. The proposed model has been regularized, and hyperparameter tuning has been performed. The tuned model is then evaluated on four publicly available current IoT datasets. The proposed model exhibits significant improvement in standard performance measures for both binary and multiclass classification. Generalization error has been reduced by a rate of 0.005% and to overcome the issue of overfitting, a L2 regularization technique has been deployed. The overall Accuracy of the model on various datasets is 99.99% for BOT-IoT, 99.08% for IoT23, 99.82% for UNSWNB15, and 99.96% for ToN_IoT, respectively, alongside improvements in Precision, Recall, and F1-score.

Use of the subfascial plane in debulking an extensive lower extremity plexiform neurofibroma: A case report.

INTRODUCTION: Plexiform neurofibromas (PNs) are characterized by their diffuse masses with tortuous expansion along nerve branches. While surgery is the primary management for PNs, the optimal surgical approach remains unestablished. CASE PRESENTATION: A 35-year-old lady presented with a large hanging mass covering the medial aspect of the thigh and the leg. It caused discomfort, disfigurement, and occasional pain. The patient was planned for the debulking surgery under spinal anesthesia. Incisions were given on the normal-looking skin adjacent to the mass, through the skin layers, subcutaneous tissue and deep fascia until the muscles were seen. The mass was then approached and elevated in the subfascial plane (relatively avascular). Large, dilated, dense tortuous vessels could be seen in the suprafascial and subcutaneous planes. Maximum area that could be removed was marked and excised. The normal contour of the left lower extremity was restored close to achieving a thigh and a leg lift. DISCUSSION: PNs pose surgical challenges due to their vascularity and difficult locations. The subfascial debulking approach presented in the case aims to reduce intraoperative hemorrhage by avoiding highly vascular areas and preventing entry into blood sinuses within the neurofibromatous tissue. This technique also minimizes the risk of inadvertent injury to nearby neurovascular structures. CONCLUSION: The proposed subfascial approach, significantly reduces intraoperative hemorrhage during the debulking of a PN.

Growth, ultrastructural and physiological characteristics of Abelmoschus cytotypes under elevated ozone stress: a study on ploidy-specific responses.

Tropospheric ozone (O3 ) is a significant abiotic stressor whose rising concentration negatively influences plant growth. Studies related to the differential response of Abelmoschus cytotypes to elevated O3 treatment are scarce and need further exploration to recognise the role of polyploidisation in stress tolerance. In this study, we analysed the changes in growth pattern, ultrastructure, physiology and foliar protein profile occurring under O3 stress in Abelmoschus moschatus (monoploid), Abelmoschus esculentus (diploid) and Abelmoschus caillei (triploid). Our findings showed that higher stomatal conductance in A. moschatus triggered higher O3 intake, causing damage to stomatal cells and photosynthetic pigments. Additionally, it caused a reduction in photosynthetic rates, leading to reduced plant growth, total biomass and economic yield. This O3 -induced toxicity was less in diploid and triploid cytotypes of Abelmoschus . Protein profiling by sodium dodecyl sulpate-polyacrylamide gel electrophoresis showed a significant decrease in the commonly found RuBisCO larger and smaller subunits. The decrease was more prominent in monoploid compared to diploid and triploid. This study provides crucial data for research that aim to enhance plant ability to withstand O3 induced oxidative stress. Our findings may help in developing a tolerant variety through plant breeding techniques, which will be economically more advantageous in reaching the objective of sustainable production at the high O3 levels projected under a climate change scenario.

Observational evidence of changing cloud macro-physical properties under warming climate over the Indian summer monsoon region.

The cloud responses to global warming are captured in various global climate models with distinct inferences on changes in cloud vertical structure as function of surface warming. However, long term observational evidences are scarce to validate the model outputs. Here, we have studied the changes in radiosonde derived cloud macro-physical properties and their association with other atmospheric variables during the period 2000-2019 in response to warming climate over the Indian summer monsoon region. We have observed a statistically significant increase in the frequency of cloudy days (~13 % decade-1), high-level clouds (HLCs ~11 % decade-1) and simultaneous decrease in low-level clouds (LLCs ~8 % decade-1) over the Indian region during the monsoon season. The multiple linear regression, principle component analyses and further correlation analyses suggest significant associations between cloud vertical structure variations and large-scale climate indicators, such as global warming and El Niño-Southern Oscillation. The vertical extension of the tropospheric column and the upward shift of clouds, attributed to global warming, explain the changes observed in both HLCs and LLCs. These results contribute to a deeper understanding of the dynamic interplay between global climate change and regional cloud dynamics, with implications for weather and climate modeling.

Individual and interactive effects of elevated carbon dioxide and ozone on tropical wheat (Triticum aestivum L.) cultivars with special emphasis on ROS generation and activation of antioxidant defence system.

The effects of elevated CO2 and O3, singly and in combination were investigated on various physiological, biochemical and yield parameters of two locally grown wheat (Triticum aestivum L.) cultivars (HUW-37 and K-9107) in open top chambers (OTCs). Elevated CO2 stimulated photosynthetic rate (Ps) and Fv/Fm ratio and reduced the stomatal conductance (gs). Reactive oxygen species, lipid peroxidation, anti-oxidative enzymes, ascorbic acid and total phenolics were higher, whereas Ps, gs, Fv/Fm, protein and photosynthetic pigments were reduced in elevated O3 exposure, as compared to their controls. Under elevated CO2 + O3, elevated levels of CO2 modified the plant performance against O3 in both the cultivars. Elevated CO2 caused significant increase in economic yield. Exposure to elevated O3 caused significant reduction in yield and the effect was cultivar-specific. The study concluded that elevated CO2 ameliorated the negative impact of elevated O3 and cultivar HUW-37 was more sensitive to elevated O3 than K-9107.

A rare case of recurring calcifying epithelial odontogenic cyst in the maxillary sinus: a case report and literature review.

Calcifying epithelial odontogenic cyst (CEOC) is an odontogenic cyst with epithelial lining. CEOC is a rare entity that occurs in a wide age range, does not show any gender predilection, and accounts for only 1% of all jaw cysts. The lesion generally occurs in the region anterior to maxillary and mandibular molars and either intraosseously or extraosseusly. This entity might present as a cystic or solid lesion. Enucleation is the recommended treatment for a simple, unicystic CEOC. A case of recurring CEOC in the right maxilla antrum is presented here. The patient presented to the authors after postsurgical recurrence. The case was evaluated thoroughly, and the cyst was resolved.

Chronic Granulomatous schistosomal cholecystitis in Non-endemic zone, a rare one: A case report.

BACKGROUND: Moynihan's aphorism that "gall stone is a tomb stone erected in the memory of the organism with in it" is true even today. This case could be an example to reemphasise the forementioned axiom. We present here a case of Chronic Granulomatous Schistosomal cholecystitis which is an unusually rare cause of Cholecystitis and cholelithiasis, that too in a non-endemic area. The patient has never ever visited the known endemic zones of Schistosomiasis or Bilharziasis areas in India. In a way it could be the first case report of schistosomiasis in this area. CASE PRESENTATION: A 59-year-old female patient presented to the Out-patient department of SMS&R, Sharda university, with right hypochondriac region pain and dyspepsia of six months duration. Investigation revealed Chronic Cholecystitis with Cholelithiasis. After a thorough workup the patient was taken up for Laparoscopic cholecystectomy, which was converted to open cholecystectomy due to adhesions and to prevent any iatrogenic injury to the biliary tree. Histopathological examination revealed Chronic Granulomatous Schistosomal Cholecystitis with Cholelithiasis. Patient did well in the post-operative period with anti-helminthic treatment. CONCLUSION: Literature is still undecided whether the Schistosomal eggs deposition in the gallbladder can cause an episode of acute cholecystitis. However, a lithogenic outcome of schistosomiasis secondary to the induction of chronic granulomatous and fibrocalcific changes of the gallbladder and biliary ducts wall, seems probable.

Adrenal adenoma associated with raised metanephrine level: A case report.

INTRODUCTION AND IMPORTANCE: Adrenal adenomas are benign neoplasms of the adrenal cortex which can be functional or non-functional. The functional tumors manifest as Cushing syndrome. Rarely, they are associated with high levels of metanephrine due to pheochromocytoma. Here, we report an extremely rare case of adrenal adenoma associated with raised metanephrine, but no histopathological evidence of medullary changes. CASE PRESENTATION: A 30-year female with diabetes, hypothyroidism, and hypertension was admitted for resistant hypertension, severe refractory hypokalemia, decreased sleep, fearfulness, anxiety, and palpitation. Facial puffiness, ecchymoses on upper and lower limbs, and bilateral pedal edema were present. Laboratory investigation revealed raised 24-hour-urine cortisol (52.5 µmol/dL) and metanephrine (56.00 µmol/24 h), very low ACTH (<5.0 pg/mL), and negative dexamethasone suppression test. MRI brain findings were normal. CT scan of the abdomen revealed a well-defined soft tissue lesion in the right adrenal gland and diffuse osteopenia vertebrae. Hence, diagnosis of Cushing Syndrome secondary to adrenal adenoma, and pheochromocytoma was made, and laparoscopic adrenalectomy was done under pheochromocytoma protocol. The patient improved dramatically, thereafter. Histopathological findings showed adrenocortical adenoma only; no evidence of pheochromocytoma was found. CLINICAL DISCUSSION: We came across many articles reporting adrenal adenoma associated with high levels of metanephrine due to co-existing pheochromocytomas either in the ipsilateral or contralateral adrenal gland. But, in our case, the adrenal adenoma was associated with high metanephrine levels with no histopathologic features of pheochromocytoma. CONCLUSION: Cushing syndrome due to Cortisol secreting Adrenal adenoma can be associated with biochemical and clinical features suggestive of Pheochromocytoma which could resolve after adrenalectomy.

Security issues and challenges in cloud of things-based applications for industrial automation.

Due to the COVID-19 outbreak, industries have gained a thrust on contactless processing for computing technologies and industrial automation. Cloud of Things (CoT) is one of the emerging computing technologies for such applications. CoT combines the most emerging cloud computing and the Internet of Things. The development in industrial automation made them highly interdependent because the cloud computing works like a backbone in IoT technology. This supports the data storage, analytics, processing, commercial application development, deployment, and security compliances. Now amalgamation of cloud technologies with IoT is making utilities more useful, smart, service-oriented, and secure application for sustainable development of industrial processes. As the pandemic has increased access to computing utilities remotely, cyber-attacks have been increased exponentially. This paper reviews the CoT's contribution to industrial automation and the various security features provided by different tools and applications used for the circular economy. The in-depth analysis of security threats, availability of different features corresponding the security issues in traditional and non-traditional CoT platforms used in industrial automation have been analysed. The security issues and challenges faced by IIoT and AIoT in industrial automation have also been addressed.

Machine learning-based optimal crop selection system in smart agriculture.

The cultivation of most crops depends upon the regional weather conditions. So, the analysis of the agro-climatic conditions of a zone contributes significantly to deciding the right crop for the right land in the right season to obtain a better yield. Machine learning algorithms facilitate this process to a great extent for better results. In this paper, the authors proposed an ML-based crop selection model based on the weather conditions and soil parameters, collectively. Weather analysis is done using LSTM RNN and the process of crop selection is completed using Random Forest Classifier. This model gives better results for weather prediction in comparison to ANN. With LSTM RNN, the RMSE observed in Min. Temp. prediction is 5.023%, Max. Temp. Prediction is 7.28%, and Rainfall Prediction is 8.24%. In the second phase, the Random Forest Classifier showed 97.235% accuracy for crop selection, 96.437% accuracy in predicting resource dependency, and 97.647 accuracies in giving the appropriate sowing time for the crop. The model construction time taken with a random forest classifier using mentioned data size is 5.34 s. The authors also suggested the future research direction to further improve this work.

Study of the Aetiology and Clinical Manifestations of Thrombocytopenia in a Tertiary Care Centre.

Introduction Thrombocytopenia is a commonly observed condition in clinical practice, and its diagnosis is often challenging due to numerous aetiologies and variations in clinical presentation. Early identification of thrombocytopenia and its causes can help prevent life-threatening haemorrhagic manifestations. Methodology A prospective observational study was conducted at a tertiary care hospital from February 2019 to January 2020. This evaluation aimed to determine the causes and prevalence of thrombocytopenia in a tertiary care setting. Patients aged 15 or older with a platelet count of fewer than 150,000/ µL were eligible for inclusion in this evaluation. Investigations for aetiology detection were recommended. Results During the one-year study period, a total of 100 patients, including 58 males and 42 females, with thrombocytopenia were selected for the study. The most common age group affected by thrombocytopenia in this study was between 46 and 55 years old. The most common clinical manifestations observed were generalised weakness (70%), haemorrhagic manifestations (60%), fever (50%), joint pain (37%), splenomegaly (35%), headache (30%), breathlessness (23%), lymphadenopathy (22%), hepatomegaly (24%), and abdominal pain (12%). The most prevalent causes of thrombocytopenia were megaloblastic anaemia (19 cases), dengue fever (15 cases), malaria (11 cases), enteric fever (nine cases), immune thrombocytopenia (ITP) (eight cases), and leukaemia (seven cases). Bleeding was reported as a symptom of thrombocytopenia in 60% of individuals in this study. Conclusion In the study, thrombocytopenia was more common in people aged 46-55 years, and males were more commonly affected than females. Megaloblastic anaemia and infectious disease were the most common causes of thrombocytopenia. Bleeding manifestations were found in 60% of patients with thrombocytopenia.

Complete small intestinal obstruction due to band formation in low-grade appendiceal mucinous neoplasm: A rare case report and literature review.

INTRODUCTION: Intestinal obstruction due to external compression is a rare condition, and those caused by appendiceal neoplasms like low-grade appendiceal mucinous neoplasms are extremely rare. PRESENTATION OF CASE: A 67-year-old post-menopausal female, with no history of prior abdominal surgery, presented to the emergency room with constipation for 2 days, and peri-umbilical pain and non-projectile bilious vomiting for 19 h. There was mild abdominal distension and diffuse tenderness. After ultrasonography and Computed Tomography (CT) of the abdomen and pelvis, a provisional diagnosis of complete small bowel obstruction secondary to perforated mucinous neoplasm of the appendix was made. An emergency exploratory laparotomy was performed followed by ileo-cecal resection and ileocolic anastomosis. Intraoperative findings revealed bands extending from the appendix to the ileum forming a closed loop with gangrenous spots in the distal ileum and ascitic fluid with mucin. Later, histopathological examination findings were consistent with low-grade appendiceal mucinous neoplasm (LAMN). DISCUSSION: We reviewed three cases of intestinal obstruction, caused by compression from a LAMN, including the presented case. Preoperative diagnosis of the cause of small intestinal obstruction on CT is sometimes challenging. Hence, in patients with intestinal obstruction with a transition point in the right lower quadrant of the abdomen on CT, a high index of suspicion for an appendiceal etiology is required. CONCLUSION: LAMN with an associated band should be considered as one of the differential diagnoses in the patient presenting with symptoms of complete small intestinal obstruction without prior abdominal surgery.