Envirotype-based delineation of environmental effects and genotype × environment interactions in Indian soybean (Glycine max, L.).

Soybean is a rainfed crop grown across a wide range of environments in India. Its grain yield is a complex trait governed by many minor genes and influenced by environmental effects and genotype × environment interactions. In the current investigation, grain yield data of different sets of 41, 30 and 48 soybean genotypes evaluated during 2019, 2020 and 2021, respectively across 19 locations and twenty years' data on 19 different climatic parameters at these locations was used to study the environmental effects on grain yield, to understand the genotype × environment interactions and to identify the mega-environments. Through analysis of variance (ANOVA), it was found that predominant portion of the variation was explained by environmental effects (E) (53.89, 54.86 and 60.56% during 2019, 2020 and 2021, respectively), followed by genotype × environment interactions (GEI) (31.29, 33.72 and 28.82% during 2019, 2020 and 2021, respectively). Principal Component Analysis (PCA) revealed that grain yield was positively associated with RH (Relative humidity at 2 m height), FRUE (Effect of temperature on radiation use efficiency), WSM (Wind speed at 2 m height) and RTA (Global solar radiation based on latitude and Julian day) and negatively associated with VPD (Deficit of vapour pressure), Trange (Daily temperature range), ETP (Evapotranspiration), SW (Insolation incident on a horizontal surface), n (Actual duration of sunshine) and N (Daylight hours). Identification of mega-environments is critical in enhancing the selection gain, productivity and varietal recommendation. Through envirotyping and genotype main effect plus genotype by environment interaction (GGE) biplot methods, nineteen locations across India were grouped into four mega-environments (MEs). ME1 included five locations viz., Bengaluru, Pune, Dharwad, Kasbe Digraj and Umiam. Eight locations-Anand, Amreli, Lokbharti, Bidar, Parbhani, Ranchi, Bhawanipatna and Raipur were included in ME2. Kota and Morena constitutes ME3, while Palampur, Imphal, Mojhera and Almora were included in ME4. Locations Imphal, Bidar and Raipur were found to be both discriminative and representative; these test locations can be utilized in developing wider adaptable soybean cultivars. Pune and Amreli were found to be high-yielding locations and can be used in large scale breeder seed production.

H-atom site exchange in an iridium trans-dihydrogen/hydride complex, trans-[Ir(H)(η2-H2)(iPr)4(POCOP)(DMAP)].

Treatment of trans-[Ir(H)(N)2(iPr)4(POCOP)(DMAP)][BAr4f] (2) with H2 (1 bar) under ambient conditions (298 K) results in the formation of a trans-[Ir(H)(η2-H2)(iPr)4(POCOP)(DMAP)][BAr4f] (3) complex. Complex 3 exhibits H-atom site exchange between the bound H2 and the hydride ligands which are mutually trans to one another. A plausible mechanism of this exchange involves metal-ligand cooperativity as studied by computations.

A Retrospective Study on Profile of Patients with Faciomaxilary Fractures in a Tertiary Care Center.

Maxillofacial injuries in general occur quite commonly following trauma and these injuries if not properly managed can negatively influence both the psychosocial and functional activities of the patient. This is as a result of the centrality of the facial region as a key factor in human identity, aesthetics, and general well-being. Fractures involving the facial skeleton may be isolated or complex. High velocity trauma is usually seen in urban and semi-urban areas while low velocity trauma is the common setting in rural areas. The pattern of faciomaxillary fractures vary with geographical area, socioeconomic condition, enforcements of law and order of a country. Trauma to the faciomaxillary region mandates special attention as important sensory systems are contained within the face (e.g. vision, auditory, somatic sensation, gustatory, olfaction and vestibular), also, vital structures in the head and neck region are intimately associated (airway, blood vessels, nerves and gastrointestinal tracts. It should be noted that the treatment outcome of maxillofacial fractures is mainly dependent among other things on the degree of injury, type of fracture, the expertise of the surgeon, and available technology. The aim of this study is to find out the incidence of faciomaxillary injuries resulting from various etiological factor Classification of facial bone fractures; Diagnosis and different treatment modalities. This is a prospective cross sectional study comprising of  75  patients who were having different faciomaxillary fractures and visited to L.G. hospital from December 2020 to April 2022. Patients were evaluated thoroughly by history taking, proper examination and routine investigations. In general examination consciousness, orientation to time, place and person, neck movements, and general mobility of the patients were checked. In local examination- facial oedema, facial asymmetry, skin lacerations, deep cuts, decreased mouth opening, improper teeth occlusion, teeth loss, nasal bleeding, black eye, eyeball movements and redness of eyes were checked. In specialized radiological investigations x- rays, 2D & 3D Computed Tomography (CT) of Facial bones were done in all cases. CT Brain and CT Cervical spine were done in patients if needed. From our study, it seems reasonable to assume that road traffic accident remains the leading cause of faciomaxillary fractures and is closely followed by fall especially among men in their productive years. It is necessary to diagnose faciomaxillary fracture at the earliest to prevent the complications of fractures such as infection and malocclusion, for that thorough clinical examination and radiological investigations are very important. 3D CT face is the gold standard investigation in case of different faciomaxillary fractures. In isolated fractures nasal bone fractures remains the most affected bone of the facial skeleton followed by mandible. Among the different sites of mandibular fractures body of the mandible is the most common site for mandibular fractures.

Identification and genetic diversity analysis of high-yielding charcoal rot resistant soybean genotypes.

Charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid is one of the most devastating diseases in soybean in India. During 2018, 226 diverse soybean genotypes were evaluated for genetic resistance under hot-spot conditions. Out of them, a subset of 151 genotypes were selected based on Percent Disease Incidence (PDI) and better agronomic performance. Out of these 151 genotypes evaluated during 2019, 43 genotypes were selected based on PDI and superior agronomic performance for further field evaluation and molecular characterization. During 2020 and 2021, these forty-three genotypes, were evaluated for PDI, Area Under Disease Progress Curve (AUDPC), and grain yield. In 2020, genotype JS 20-20 showed least PDI (0.42) and AUDPC (9.37).Highest grain yield was recorded by the genotype JS 21-05 (515.00 g). In 2021, genotype JS 20-20 exhibited least PDI (0.00) and AUDPC (0.00).Highest grain yield was recorded in JS 20-98 (631.66 g). Across both years, JS 20-20 had the least PDI (0.21) and AUDPC (4.68), while grain yield was highest in JS 20-98 (571.67 g). Through MGIDI (multi-trait genotype-ideotype distance) analysis, JS 21-05 (G19), JS 22-01 (G43), JS 20-98 (G28) and JS 20-20 (G21) were identified as the ideotypes with respect to the traits that were evaluated. Two unique alleles, Satt588 (100 bp) on linkage group K (Chromosome no 9) and Sat_218 (200 bp) on linkage group H (Chromosome no 12), were specific for thetwo resistant genotypes JS 21-71and DS 1318, respectively. Through cluster analysis, it was observed that the genotypes bred at Jabalpur were more genetically related.

The Sporisorium reilianum Effector Vag2 Promotes Head Smut Disease via Suppression of Plant Defense Responses.

Genome comparison between the maize pathogens Ustilago maydis and Sporisorium reilianum revealed a large diversity region (19-1) containing nearly 30 effector gene candidates, whose deletion severely hampers virulence of both fungi. Dissection of the S. reilianum gene cluster resulted in the identification of one major contributor to virulence, virulence-associated gene 2 (vag2; sr10050). Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) experiments revealed high expression of vag2 during biotrophic growth of S. reilianum. Using the yeast secretion trap assay, we confirmed the existence of a functional signal peptide allowing protein secretion via the conventional secretory pathway. We identified the cytoplasmic maize chorismate mutase ZmCM2 by yeast two-hybrid screening as a possible interaction partner of Vag2. Interaction of the two proteins in planta was confirmed by bimolecular fluorescence complementation. qRT-PCR experiments revealed vag2-dependent downregulation of salicylic acid (SA)-induced genes, which correlated with higher SA levels in plant tissues colonized by Δvag2 deletion strains relative to S. reilianum wildtype strains. Metabolite analysis suggested rewiring of pathogen-induced SA biosynthesis by preferential conversion of the SA precursor chorismate into the aromatic amino acid precursor prephenate by ZmCM2 in the presence of Vag2. Possibly, the binding of Vag2 to ZmCM2 inhibits the back reaction of the ZmCM2-catalyzed interconversion of chorismate and prephenate, thus contributing to fungal virulence by lowering the plant SA-induced defenses.

Comparison of Expression of Chemokine Receptor 4 in Maternal Decidua and Chorionic Villi in Women with Spontaneous Miscarriages and Women Opting for Termination of Viable Pregnancies.

BACKGROUND: Early pregnancy losses can be a distressing experience both for the parents and the treating clinician. We aim to explore the role of chemokine receptor 4 (CXCR4) in early pregnancy losses by comparing its expression among patients with spontaneous miscarriages and patients undergoing termination of viable pregnancies for unwanted pregnancies. AIM: The aim of the study was to investigate the expression of CXCR4 in early pregnancy losses and correlate the various clinical parameters with differential expression of the above receptor in the chorionic villi and maternal decidua. STUDY AND SETTING: The present study is a case-"control study done in a tertiary care center. METHODOLOGY: Fifty patients attending outdoor and antenatal clinic of the hospital aged 18-40 years with spontaneous miscarriage under 20 weeks of gestational age were included as cases and compared with fifty females of comparable age group (18-40 years) seeking medical termination of pregnancy as controls. Chorionic villi and decidua obtained from the cases and controls were analyzed for CXCR4 expression. STATISTICAL ANALYSIS: The results were analyzed using mean ± standard deviation, percentiles values, Chi-square test, and P value to determine the association of CXCR4 expression in decidua and chorionic villi of cases versus controls. RESULTS: CXCR4 expression was significantly downregulated in cases as compared to the controls with P < 0.001. The mean normalized ratio of CXCR4 expression to housekeeping gene (ß Actin) expression in the case group was 1.607 ± 1.108 and in the control group, it was 2.506 ± 1.457. There was a strong correlation between the expression of CXCR4 and maternal age. With increasing age, the expression of CXCR4 was more downregulated in both the cases and control groups (P < 0.001). The expression of CXCR4 was elevated in controls as compared to cases in <30 years age group (P = 0.009). CXCR4 expression was higher in primigravida than in multigravida (P = 0.001), and as the number of previous miscarriages increased, the expression of CXCR4 was found to be decreased (P = 0.021). CONCLUSION: CXCR4 expression is significantly reduced in women with spontaneous miscarriages in comparison with viable pregnancies. and possibly, therapies targeted at increasing the expression of CXCR4 can be used as a treatment modality for management of spontaneous miscarriages.

Hyperhomocysteinemia and low vitamin B12 are associated with the risk of early pregnancy loss: A clinical study and meta-analyses.

One-carbon metabolism is crucial for the maintenance of healthy pregnancy and alterations in this pathway have been associated with various pregnancy-related complications. Therefore, the present study was conducted to test the hypothesis that the altered folic acid, vitamin B12 and homocysteine levels are associated with the risk of early pregnancy loss (EPL). Plasma folic acid, vitamin B12 and homocysteine levels were analyzed in 83 females with EPL and 70 healthy pregnant females in their first trimester. Further, meta-analyses of folic acid, vitamin B12 and homocysteine were also performed involving various eligible studies. Results from our case-control study and meta-analysis showed that folic acid deficiency is not associated with the risk of EPL. On the other hand, low vitamin B12 and hyperhomocysteinemia were individually found to be significant risk factors for EPL in the present study (P < .01, P < .05, respectively) and meta-analysis as well (P < .001, P < .05, respectively). Vitamin B12 deficiency in combination with hyperhomocysteinemia was a more serious risk factor for EPL (Odds Ratio = 4.98, P = 0.002). Therefore, we conclude that vitamin B12 deficiency and elevated homocysteine levels are independent risk factors for EPL, and of higher risk when combined. The assessment of vitamin B12 and homocysteine levels may serve as a good screening marker for EPL risk.

Risk Factors Associated with Meibomian Gland Dysfunction: A Hospital Based Study.

INTRODUCTION: Meibomian Gland Dysfunction (MGD) is a chronic diffuse abnormality of the Meibomian glands often found as a result of precipitating factors like dyslipidemia, infections, hypertension, diabetes, etc. This study aims to find the prevalence of various risk factors of Meibomian Gland Dysfunction (MGD) which will ultimately help in managing the disease and explaining the prognosis. MATERIALS AND METHODS: A hospital based cross-sectional study. A total of 400 patients with MGD over the age of 30 were examined. Patients with a history of taking lipid altering drugs, pre-existing ocular comorbidities were excluded from the study. RESULTS: Severity of MGD increased with ageing. There was a significant risk of higher grades of MGD in hypertensives, diabetics & post-menopausal women. Higher levels of LDL cholesterol showed significant risk. CONCLUSION: Blood sugar, blood pressure, blood cholesterol were seen to be the risk factors in the study and thus, should be kept within normal limits to reduce the severity of disease. Alcohol & cigarette consumption should be avoided even if they didn't show a significant relationship.

Outcome of Non-drainage Scleral Buckling in Primary Rhegmatogenous Retinal Detachment.

INTRODUCTION: Scleral buckling (SB) was the principal surgical intervention for patients with rhegmatogenous retinal detachment (RRD) until the development of pars plana vitrectomy. The study aims to evaluate the outcome of SB without subretinal fluid (SRF) drainage in RRD. MATERIALS AND METHODS: A retrospective observational study was conducted at a tertiary eye care center. Charts of patients operated with SB without SRF drainage for RRD between January 2014 and December 2015 were evaluated. The main outcome measure was the primary reattachment rate at 1 month after single SB surgery. Other outcome measures were final reattachment rate after further intervention, visual improvement and relation of various parameters with retinal reattachment. RESULTS: One hundred and seventeen patients were included of which 90 (76.9%) were men. Mean age was 26.68±12.6 years (Range 9-60). All eyes were phakic. Only 1 patient had a macula on RD. The primary reattachment rate was 84.6% (n=99). Mean LogMAR (±SD) visual acuity (VA) improved from 1.92(±0.46) to 1.02(±0.42). Extent of RD, number of breaks, and type of break was found to have no association with retinal reattachment. Association between type of PVR and status of retina post buckling was found to be significant (p=0.026) with retinal reattachment seen in 100% in PVR-A and only 60% in PVR-C2. Final reattachment rate was 98.2%. Complications encountered were postoperative diplopia (n=1), suture granuloma (n=1) and buckle infection (n=2). CONCLUSION: Scleral buckling without SRF drainage, an exclusively extra ocular procedure, is an effective and safe treatment modality for non-complicated RRD.

Intra-operative scleral rupture during 23 gauge pars plana vitrectomy: a case report.

BACKGROUND: Use of perfluorocarbon liquid (PFCL) has been increasingly growing as an adjuvant in vitreo-retina surgeries. Some commonly encountered complications with its use include subretinal migration, formation of sticky silicone oil or retained PFCL in vitreous cavity and anterior chamber. Scleral rupture during PFCL injection has a rare occurrence. We report an unexpected event of scleral rupture during PFCL injection and discuss the management challenges faced by the surgeon. CASE PRESENTATION: A 66 year indo-aryan male was undergoing pars-plana vitrectomy (PPV) with diagnosis of subtotal rhegmatogenous retinal detachment (RD) with Proliferative Vitreo-retonipathy (PVR)-B. After near total vitrectomy PFCL was being injected and then there was sudden poor visualization of fundus with development of bullous RD and globe hypotony. The surgeon was not able to figure out the cause of hypotony and air was switched on in the infusion cannula. This further complicated the situation resulting in migration of air in the anterior chamber, posterior dislocation of intraocular lens complex, 180° inferior retinal dialysis and ballooning of the conjunctiva which gave a clue of probable scleral rupture. Conjunctival peritomy was performed superiorly and scleral defect was noted. Intraocular tissue incarceration and air leak was visible from the wound. This confirmed scleral rupture during PFCL injection. Repositioning of incarcerated retina was not possible and retinectomy was performed followed by repair of scleral rupture with lots of difficulty in a vitrectomised eye. CONCLUSION: PFCL injection, a crucial step of vitreoretina surgery, should be performed slowly with extreme caution maintaining an optimal intraocular pressure to prevent devastating complications like scleral rupture.

A Teenager with Vernal Keratoconjunctivitis and Pellucid Marginal Degeneration, Presenting with Exotropia.

BACKGROUND: Vernal keratoconjunctivitis (VKC), an allergic disease, has a known association with ectatic disorders of the cornea. Pellucid marginal degeneration (PMD) is a bilateral, asymmetrical, ectatic disorder of the cornea characterized by inferior corneal thinning. We report a case of sensory exotropia due to PMD in association with VKC. CASE DETAILS: A 19-year old boy with a history of VKC presented with exotropia of the right eye of 3 years' duration. His unaided vision in his right eye was 1/60 and in his left eye it was 6/36. On examination, both eyes had high against the rule astigmatism, which was more in the right eye. There was exotropia of 15º (40 prism diopter base in) in the right eye with suppression (Worth four dot test). Corneal examination in both eyes showed inferior band thinning, 2 mm above the inferior limbus, extending from 4 to 8 clock hours, with bulging of the cornea just above the thinning. The clinical features were suggestive of PMD, which was supported by his corneal scans - Atlas, Pentacam, and Optovue. Although he was undergoing treatment for VKC, the onset of PMD and decrease in vision went unnoticed. The asymmetric error which was not corrected during the sensitive period of visual development led to sensory exotropia. CONCLUSION: A child with VKC should undergo regular refraction so as not to miss any ectatic changes occurring in the cornea. A delay in diagnosing corneal ectasia may negate the possibility of collagen cross-linking which prevents progression of ectasia. If visual rehabilitation is delayed beyond the age of visual maturation, it can lead to strabismus, suppression, and loss of binocular function.

Retinal Vasculitis with Macular Infarction: A Dengue-related Ophthalmic Complication.

INTRODUCTION: Dengue-associated ocular complications are increasing owing to the rising global burden of dengue fever. We intend to highlight a rare and sight-threatening complication of this disease. CASE DETAILS: A 44-year-old male, with prior history of dengue fever, presented with diminution of vision in both eyes for 10 days. At presentation, his best-corrected visual acuity was 1/60 in the right eye and 6/18 in the left eye. Anterior segment findings were unremarkable. Fundus examination revealed vitritis, perivascular exudates, intraretinal hemorrhages, macular edema, peripapillary retinal whitening and cotton wool spots in both eyes suggestive of vasculitis, with additional retinal whitening affecting the right macula. Fundus fluorescein angiography revealed disc and perivascular leakage limited to posterior pole along with patches of blocked fluorescence. In addition, there was capillary nonperfusion due to occlusion of multiple small arterioles supplying the macula of right eye confirming macular ischemia. Macular edema with subretinal fluid in both eyes was evident on optical coherence tomography. Treatment was attempted with intravenous methylprednisolone which was futile even after three days of administration. CONCLUSION: We report a case of retinal vasculitis with macular infarction attributed to dengue fever. Although uncommon, dengue-associated ocular complications can lead to irreversible visual loss. Therefore, clinicians should keep this disease entity in mind while evaluating febrile patients with visual complaints in dengue endemic regions.

A novel way of Subfoveal Perfluorocarbon liquid Removal using 26 gauge spinal anesthesia needle.

INTRODUCTION: Perfurocarbon Liquid (PFCL) is an essential adjunct of retinal detachment surgery. Subfoveal migration of PFCL is a rare and vision threatening complication of its use. Various techniques have been described for its removal. However, no consensus on ideal technique of its removal has been established. We present a novel, relatively atraumatic and cost effective way of PFCL removal using a widely available 26Ga spinal anesthesia needle. CASE: An 18 years old myopic patient who had undergone left eye pars plana vitrectomy (PPV) for myopic Rhegmatogenous Retinal Detatchment (RRD) in the past presented after 1 month with retained subfoveal PFCL. Its subretinal location was confirmed by Optical Coherence Tomography (OCT). He was taken up for early Silicone Oil Removal (SOR) along with removal of retained subfoveal PFCL under high magnification by using a surgical disposable contact macula lens. A 26G spinal anesthesia needle tip was used to dissect a small separation parallel to the nerve fibers at the temporal edge of tense cystic PFCL bleb. Silicone tipped flute cannula was used to passively aspirate the sub retinal PFCL under fluid with no additional intervention. No barrage LASER was done. OBSERVATION: Anatomical restoration of the retina was noted both intraoperatively and post-operatively. SD-OCT showed complete restoration of anatomical layers with no presence of intraretinal cystic cleft both at day 1 and 30 days postoperatively. CONCLUSION: Safe removal of subfoveal PFCL can be done with 26Ga spinal anesthesia needle which is atraumatic, inexpensive and readily available. However, long term validity of this process needs to be established in a case series.

Inverted temporal internal limiting membrane flap technique for chronic large traumatic macular hole.

Various modifications of surgical techniques and surgical adjuncts are adopted with standard pars plana vitrectomy (PPV) to improve the outcome of traumatic macular hole (TMH) surgeries. We describe a successful closure of a chronic large TMH of three years duration with inverted temporal internal limiting membrane (ILM) flap technique. A 36-year-old male patient had an optical coherence tomography (OCT) documented chronic macular hole (MH) for three years following blunt trauma. Fundus examination also showed choroidal rupture scar temporal to fovea. The minimum MH diameter was 769 µ and the basal diameter 1431 µ in OCT. Standard PPV with inverted temporal ILM flap and gas tamponade was done. The postoperative period was uneventful. The best corrected visual acuity improved from 6/60 preoperatively to 6/18 six months postoperatively, and OCT showed a closed MH with anatomical type 1 closure. This case highlights that the inverted temporal ILM flap technique is a safe and effective technique for patients with even chronic and large TMH.

Screening of Secreted Proteins of Sporisorium reilianum f. sp. zeae for Cell Death Suppression in Nicotiana benthamiana.

Sporisorium reilianum f. sp. zeae (SRZ) is a biotrophic fungus causing head smut in maize. Maize infection with SRZ leads to very little cell death suggesting the presence of cell-death suppressinpg effectors. Several hundred effector proteins have been predicted based on genome annotation, genome comparison, and bioinformatic analysis. For only very few of these effectors, an involvement in virulence has been shown. In this work, we started to test a considerable subset of these predicted effector proteins for a possible function in suppressing cell death. We generated an expression library of 62 proteins of SRZ under the control of a strong constitutive plant promoter for delivery into plant cells via Agrobacterium tumefaciens-mediated transient transformation. Potential apoplastic effectors with high cysteine content were cloned with signal peptide while potential intracellular effectors were also cloned without signal peptide to ensure proper localization after expression in plant cells. After infiltration of Nicotiana benthamiana leaves, infiltration sites were evaluated for apparent signs of hypersensitive cell death in absence or presence of the elicitin INF1 of Phytophthora infestans. None of the tested candidates was able to induce cell death, and most were unable to suppress INF1-induced cell death. However, the screen revealed one predicted cytoplasmic effector (sr16441) of SRZ that was able to reliably suppress INF1-induced cell death when transiently expressed in N. benthamiana lacking its predicted secretion signal peptide. This way, we discovered a putative function for one new effector of SRZ.

Variable presentation of diabetic papillopathy and treatment dilemma- A case series.

INTRODUCTION: Diabetic papillopathy (DP) is a diagnosis of exclusion in type 1 and type 2 diabetics with transient disc edema. It was initially described in young patients with type1 diabetes mellitus (DM) as a bilateral disease with minimal visual symptoms which resolved spontaneously. Lately, DP has been a focus of controversy because of its wide clinical spectrum. CASES: We describe three variable cases of DP. These are unilateral DP with Proliferative Diabetic Retinopathy (PDR) with macular edema (ME), unilateral DP with severe Non Proliferative Diabetic Retinopathy (NPDR) with ischemic maculopathy and a case of bilateral DP with Moderate NPDR with ME. We also discuss viable treatment for the variable presentation. DP has been reported in this case series in moderate NPDR, severe NPDR as well as PDR. Macular involvement in the form of macular edema as well as ischemia has been demonstrated to result in diminution of vision. It shows both unilateral and bilateral presentation. Remarkable visual loss seen, in these cases, call for intervention. CONCLUSIONS: DP has a wide spectrum of presentation and its knowledge is eminent to make a complete diagnosis. Individualisation of treatment has to be done for variable presentation and realistic outcomes should be explained to the patients.

Central corneal thickness and intraocular pressure in patients of primary open angle glaucoma and normal population in Nepalese population: A hospital based study.

INTRODUCTION: Central corneal thickness (CCT) is a powerful predictor of primary open angle glaucoma. Individualized risk assessment is critical for early diagnosis and management of glaucoma. OBJECTIVES: To compare CCT and intraocular pressure in patients of primary openangle glaucoma (POAG) with those of normal population. MATERIALS AND METHODS: A Comparative Cross-Sectional Study was performed in Ophthalmology department of B. P. Koirala Institute of Health Sciences, Nepal. Newly diagnosed cases of primary glaucoma (open angle, normal tension) of 18 years and above, without known systemic diseases were included. RESULTS: Out of a total of 291 subjects (582 eyes), 105 subjects (210 eyes) were with primary glaucoma and 186 (382 eyes) were normal subjects. There was no significant difference in CCT between glaucomatous (533.57 µm) and normal (530.06 µm) eyes (p=0.1). Cornea was thinner (518.±18.03 µm) in eyes with severe glaucomatous damage (cup:disc ratio > 0.8) than in moderate glaucomatous damage (cup:disc ratio=0.5-0.8)(p=0.003). There was a statistically significant difference of 22.05 µm in CCT between POAG and NTG (p<0.001). A positive correlation was found between IOP & CCT in both cases and control group (p=0.000; r = 0.355, 0.254; r2 =0.126, 0.064 respectively). CONCLUSION: Majority of studied Nepalese population have CCT less than 550 µm, thus increasing the risk of POAG. CCT decreases with age, and females with glaucoma have significantly thicker cornea than men. There is a significant positive correlation between CCT and IOP, and IOP will have to be adjusted for CCT for proper diagnosis and monitoring of glaucomatous damage in Nepalese population too.

Breastfeeding Knowledge and Behavior Among Women Visiting a Tertiary Care Center in India: A Cross-Sectional Survey.

BACKGROUND: Breastfeeding is commonly practiced by a majority of mothers in developing countries, though there are widespread misconceptions about optimal breastfeeding traditions. In addition to culturally prominent rituals and social norms, incorrect and inadequate breastfeeding knowledge is major factors for this high-risk behavior. OBJECTIVES: To assess knowledge, attitude and practices of breastfeeding among girls and women visiting a tertiary care center in India and to find out the factors, which influence the breastfeeding behaviors. DESIGN/METHODS: It is a cross-sectional, questionnaire-based study done among women attending outpatient and inpatient Department of Obstetrics & Gynecology of S.S. Hospital, Banaras Hindu University, India. A face-to-face interview using a pre-designed, self-administered, standardized questionnaire regarding knowledge, attitude, and practices of breastfeeding was conducted. The information was collected and analyzed using SPSS statistical software. FINDINGS: Among 1000 women enrolled in the study, 89% were married, 25% were primiparous, and 52% were multiparous. More than 50% were illiterate, 91% unemployed, and 90% had hospital delivery. Of the total 770 mothers, only 55% received proper antenatal care during pregnancy, of which only 40% were counseled about breastfeeding. Regarding knowledge and attitude about breastfeeding, majority females (71.4%) considered breast milk as best food for a newborn, which was better in younger women <20 years (86%). Regarding breastfeeding behavior, only 45% mothers initiated breastfeeding within one hour of delivery, which was worse in home delivered mothers (25%). Most (82%) mothers fed colostrum to their babies but 27% of mothers gave pre-lacteal feeds. Illiterate mothers (56.3%), mothers with only primary education (70%), and unemployed mothers (53.85%) continued to do exclusive breastfeeding without initiating complementary feeds even after six months. CONCLUSION(S): Although breastfeeding is practiced by a majority of mothers in a developing country like India, there is a significant gap in knowledge and optimal breastfeeding behaviors. Healthy breastfeeding behavior can be encouraged among mothers by proper counseling by health care workers and organizing educational programs focusing women especially with low education and limited resources.

Altered crosstalk of estradiol and progesterone with Myeloid-derived suppressor cells and Th1/Th2 cytokines in early miscarriage is associated with early breakdown of maternal-fetal tolerance.

PROBLEM: Decline in myeloid-derived suppressor cells (MDSCs) and Th2 cytokines levels lead to early miscarriage (EM) but how the hormonal milieu of the body regulates MDSCs and Th1/Th2 cytokine balance is still a matter of investigation. METHOD OF STUDY: Peripheral blood and decidua samples were collected from 20 EM patients, and 20 healthy pregnant women opted for elective abortion. MDSCs and G-MDSCs levels were analyzed in peripheral blood mononuclear cells, and Th1/Th2 cytokines levels were determined in serum via flow cytometry. Estrogen (E2), Progesterone (P4), and Testosterone levels were measured via ELISA. Further, proliferation and apoptosis in decidual samples were checked via immunoblot/immunohistochemistry of estrogen receptor -α (ER-α), STAT-3/pSTAT-3, and caspase-3, respectively. RESULTS: Our results clearly indicate that in EM patients; decline in E2 and P4 significantly correlates with decline in MDSCs, particularly with subtype granulocytic MDSCs (G-MDSCs) and skewness of the Th1/Th2 cytokines balance toward Th1 response. Downregulation of ER- α and increased caspase-3 expression in endometrium decidua signifies poor endometrial receptivity in EM. STAT-3 activation regulates proliferation, differentiation and suppressive potency of MDSCs. In decidua of EM, significantly lower expression of pSTAT-3 indicates that these processes pertaining to MDSCs are compromised. CONCLUSION: Altogether, this unfavorable systemic milieu may drive toward early breakdown of maternal-fetal tolerance in EM. Therefore, regulated crosstalk of E2, P4 with MDSCs and balanced Th1/Th2 cytokines is prerequisite for successful pregnancy.

Intraoperative Ocular Decompression Retinopathy During 23 Gauge Transconjunctival Vitrectomy: A Case Report.

PURPOSE: To report an uncommon case of intraoperative ocular decompression retinopathy (ODR). CASE REPORT: A 48-year-old man presented with decreased vision and pain in the left eye (LE) for 10 days following trauma with a bamboo stick. He had visual acuity of counting finger close to face in the same eye, along with corneal edema, dilated pupil and posteriorly dislocated lens. Intraocular pressure (IOP) was 42 mm of mercury (Hg). He underwent 23-gauge pars plana vitrectomy with removal of the dislocated lens. Towards the end of otherwise uneventful surgery, blot hemorrhages appeared over the posterior pole and equator. The following day, his vision was counting finger close to face and IOP was 16 mm of Hg. Fundus examination revealed large blotches of hemorrhages at different levels of the retina, later confirmed by optical coherence tomography. Disc hyperfluorescence and blocked fluorescence corresponding to blot hemorrhages were seen on fundus fluorescein angiography. Blood investigations to rule out blood dyscrasias were within normal limits. CONCLUSION: Ocular decompression retinopathy, though not common, has been reported to occur following various types of surgeries, especially if associated with preoperatively raised IOP. The event can also occur intraoperatively and the preoperative control of IOP is of paramount importance in the prevention of ODR.