Prevalence of Molecular Subtypes in Operated Cases of Breast Cancer and Its Clinicopathological Correlation: A Single Institute Study from a Tertiary Cancer Centre in North India.

Breast cancer has emerged as a major health problem among women in India. There are few Indian studies which have looked at prevalence of molecular subtypes of breast cancer in Indian population. The primary objective of our study was to find out the prevalence of various molecular subtypes in operated cases of breast cancer patients presenting to us. Three hundred sixty patients who were operated in our department were analysed. Clinicopathological features of all cases were recorded. Classification into various molecular subtypes was done using St. Gallen 2013 criteria. Luminal B HER2 negative was the predominant molecular subtype in our study population constituting 30.3% of patients. The percentage of aggressive subtypes, viz. triple negative breast cancer and HER2 enriched, were 21.7% and 11.4% respectively. Only 19.4% of patients in our study population had tumour size ≤ 2 cm with nodes being positive in 56.9% of our patients at presentation. Data from our study and other studies published from India show that the two most aggressive subtypes of, viz. triple negative breast cancer and HER2 enriched, may be more prevalent in our population as compared to western population.

Fungicide and Cultivar Management of Leaf Spot Diseases of Winter Wheat in Western Canada.

A complex of leaf-spotting diseases-tan spot, the Septoria complex, spot blotch, and powdery mildew-are frequently observed on winter wheat in western Canada; however, there are few studies indicating varietal differences in reaction to these diseases or the benefit of fungicide application. To determine the benefit of varietal improvement and multiple fungicide treatments and application timings, field experiments were conducted at six site-years in western Canada. Two cultivars varying in reaction to leaf spot diseases were used in combination with fungicide treatments. Disease severity ranged from trace to 64% of the combined flag and penultimate leaf area diseased, differed between cultivars, and was reduced from the check by some fungicide treatments. Yield improvement by fungicide treatment varied from 3.3 to 13.2% greater than the nontreated check. At two site-years, the split application of two half rates of fungicide resulted in the greatest yield; however, in both cases, the yield benefit did not differ from a single application at the flag leaf growth stage. Cultivar selection and fungicide use under environments conducive to disease are beneficial components of an integrated leaf spot disease management program for winter wheat in western Canada.

Race Characterization of Puccinia striiformis f. sp. tritici, the Cause of Wheat Stripe Rust, in Saskatchewan and Southern Alberta, Canada and Virulence Comparison with Races from the United States.

Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici, has been common across Saskatchewan, Canada since 2000. Fifty-nine isolates of P. striiformis f. sp. tritici, the majority of which were collected between 2011 and 2013 from Saskatchewan and southern Alberta, were analyzed for virulence frequency and diversity and compared with isolates characterized in the Pacific Northwest and Great Plains regions of the United States. In all, 31 wheat differentials, including 20 near-isogenic lines and 1 triticale variety, differentiated 59 P. striiformis f. sp. tritici isolates into 33 races, of which one race, C-PST-1, represented 31% of the isolates. None of the races were virulent on Yr5, Yr15, or YrSP. Virulence frequency ranged from 65 to 98% on YrA, Yr2, Yr8, Yr9, Yr27, Yr29, Yr32, YrSu, 'Heines VII', and 'Nord Deprez'. Race C-PST-6 was virulent on the greatest number of the differentials (n = 25) and C-PST-18 on the fewest (n = 14). Discriminant analysis of principal components and multivariate cluster analyses detected three and four major groups, respectively, which differed from each other in terms of virulence spectrum and year of collection. The diversity of the P. striiformis f. sp. tritici population in southern Alberta was greater than in Saskatchewan, which indicated that, although P. striiformis f. sp. tritici is primarily windborne over great distances and does not usually overwinter, there are detectable differences in virulence between these regions of western Canada. Comparative analyses of virulence frequency of Saskatchewan or southern Alberta isolates with isolates representing races from the Great Plains and the Pacific Northwest of the United States indicated greater similarity of Saskatchewan races to the Great Plains despite strong correlations with both parts of the United States. This suggests that the P. striiformis f. sp. tritici population in Saskatchewan is a mixture of inoculum from both parts of the United States.

Uranium: A Dentist's perspective.

Uranium is a naturally occurring radionuclide found in granite and other mineral deposits. In its natural state, it consists of three isotopes (U-234, U-235 and U-238). On an average, 1% - 2% of ingested uranium is absorbed in the gastrointestinal tract in adults. The absorbed uranium rapidly enters the bloodstream and forms a diffusible ionic uranyl hydrogen carbonate complex (UO2HCO3+) which is in equilibrium with a nondiffusible uranyl albumin complex. In the skeleton, the uranyl ion replaces calcium in the hydroxyapatite complex of the bone crystal. Although in North India, there is a risk of radiological toxicity from orally ingested natural uranium, the principal health effects are chemical toxicity. The skeleton and kidney are the primary sites of uranium accumulation. Acute high dose of uranyl nitrate delays tooth eruption, and mandibular growth and development, probably due to its effect on target cells. Based on all previous research and recommendations, the role of a dentist is to educate the masses about the adverse effects of uranium on the overall as well as the dental health. The authors recommended that apart from the discontinuation of the addition of uranium to porcelain, the Public community water supplies must also comply with the Environmental Protection Agency (EPA) standards of uranium levels being not more than 30 ppb (parts per billion).

Comparison of Scheimpflug imaging and spectral domain anterior segment optical coherence tomography for detection of narrow anterior chamber angles.

PURPOSE: To compare the performance of anterior chamber volume (ACV) and anterior chamber depth (ACD) obtained using Scheimpflug imaging with angle opening distance (AOD500) and trabecular-iris space area (TISA500) obtained using spectral domain anterior segment optical coherence tomography (SD-ASOCT) in detecting narrow angles classified using gonioscopy. METHODS: In this prospective, cross-sectional observational study, 265 eyes of 265 consecutive patients underwent sequential Scheimpflug imaging, SD-ASOCT imaging, and gonioscopy. Correlations between gonioscopy grading, ACV, ACD, AOD500, and TISA500 were evaluated. Area under receiver operating characteristic curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) were calculated to assess the performance of ACV, ACD, AOD500, and TISA500 in detecting narrow angles (defined as Shaffer grade ≤1 in all quadrants). SD-ASOCT images were obtained at the nasal and temporal quadrants only. RESULTS: Twenty-eight eyes (10.6%) were classified as narrow angles on gonioscopy. ACV correlated with gonioscopy grading (P<0.001) for temporal (r=0.204), superior (r=0.251), nasal (r=0.213), and inferior (r=0.236) quadrants. ACV correlated with TISA500 for nasal (r=0.135, P=0.029) and temporal (P=0.160, P=0.009) quadrants and also with AOD500 for nasal (r=0.498, P<0.001) and temporal (r=0.517, P<0.001) quadrants. For detection of narrow angles, ACV (AUC=0.935; 95% confidence interval (CI) =0.898-0.961) performed similar to ACD (AUC=0.88, P=0.06) and significantly better than AOD500 nasal (AUC=0.761, P=0.001), AOD500 temporal (AUC=0.808, P<0.001), TISA500 nasal (AUC=0.756, P<0.001), and TISA500 temporal (AUC=0.738, P<0.001). Using a cutoff of 113 mm(3), ACV had 90% sensitivity and 88% specificity for detecting narrow angles. Positive and negative LRs for ACV were 8.63 (95% CI=7.4-10.0) and 0.11 (95% CI=0.03-0.4), respectively. CONCLUSIONS: ACV measurements using Scheimpflug imaging outperformed AOD500 and TISA500 using SD-ASOCT for detecting narrow angles.

Posterior capsule rupture following closed globe injury: Scheimpflug imaging, pathogenesis, and management.

PURPOSE: To report the Scheimpflug and clinical findings in a case of pediatric posterior capsule rupture due to blunt ocular trauma. METHODS: Interventional case report. Analysis of Scheimpflug findings and review of literature. RESULTS: An 11-year-old boy presented 2 days after blunt trauma to the left eye with a slingshot. On examination his best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left. Slitlamp examination (left eye) revealed a Vossius ring, traumatic cataract, and traumatic posterior capsular rupture (TPCR).The contour of the posterior bulge corresponded to the edges of the TPCR. Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany) confirmed traumatic cataract in region of TPCR evidenced by increased lens density at cortex-vitreous interface, absence of vitreous prolapse into the anterior chamber, and the amount of residual nucleus. The extent of the TPCR in the greatest and least dimensions was documented before and after intraocular lens (IOL) implantation. Intraoperatively, TPCR was evident and phacoemulsification with IOL implant was performed. Postoperatively, his BCVA improved to 20/20 in the left eye with a well-centered in-thebag IOL as found on slit lamp and Scheimpflug images. CONCLUSIONS: This report highlights the use of Scheimpflug imaging in isolated posterior capsule rupture following closed globe injury, to visualize and quantify the size of posterior capsule rupture and its role in management.

Intracameral amphotericin B: initial experience in severe keratomycosis.

PURPOSE: Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis. METHODS: Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases. RESULTS: All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient. CONCLUSIONS: Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.

Neodymium:YAG capsulotomy rates following phacoemulsification with implantation of PMMA, silicone, and acrylic intraocular lenses.

BACKGROUND AND OBJECTIVE: Posterior capsular opacification (PCO) is the most common visually disabling sequela of modern cataract surgery. Methods of reducing its incidence include the development of newer surgical techniques and intraocular lens (IOL) materials and designs. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a polymethylmethacrylate (PMMA), silicone, or acrylic IOL. PATIENTS AND METHODS: The data of 340 consecutive patients who underwent phacoemulsification and implantation ofa PMMA, silicone, or acrylic intraocular lens were analyzed. The aim of this study was to compare the incidence and time interval of development of PCO, and the requirement of laser capsulotomy in patients implanted with a PMMA, silicone, or acrylic IOL. RESULTS: The incidence of PCO was found to be significantly less in the acrylic group (6.5% as compared to 21.74% and 26.6% in the PMMA and silicone groups, respectively; P = 0.01297 and 0.0039). Most patients (65%) exhibiting PCO in the PMMA group developed it within the first six months. In the silicone group, development of PCO was delayed. In 60% of patients, it appeared 18 months after surgery. Neodymium:YAG capsulotomy was required in 45% and 60% of patients developing PCO in the PMMA and silicone groups, respectively, while it was required in only 1 of the 4 patients developing PCO in the acrylic group. CONCLUSION: This study indicates that implantation of an acrylic IOL helps reduce the incidence of PCO as well as the need for Nd:YAG capsulotomy. PMMA IOLs require Nd:YAG capsulotomy earlier in the postoperative period as compared to silicone IOLs.

Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification.

PURPOSE: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. SETTING: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. RESULTS: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test). CONCLUSIONS: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.

Postoperative complications and visual results in uniocular pediatric traumatic cataract.

BACKGROUND AND OBJECTIVES: This study was prospectively carried out to evaluate the postoperative complications and visual results following posterior chamber intraocular lens (PCIOL) implantation in children with unilateral traumatic cataract. PATIENTS AND METHODS: We prospectively evaluated 40 children, 12 years or younger, with traumatic cataract (blunt trauma, n = 22 eyes, repaired penetrating eye injury, n = 18 eyes) undergoing PCIOL implantation with a minimum follow-up period of one year. Children with posterior segment ocular injury were excluded. RESULTS: The postoperative complications were significantly higher in the penetrating eye injury group as compared to blunt trauma group (ie, pupillary capture 44.44% vs 9.09%, posterior capsulotomy rate 83.33% vs 40.90% and IOL decentration 27.77% vs 4.54%). The final visual acuity was 6/12 or better in 38.8% and 86.36% of eyes with penetrating eye injury and blunt trauma, respectively. CONCLUSION: Extracapsular cataract extraction (ECCE) with PCIOL implantation in traumatic cataract following blunt trauma results in better visual outcome and fewer complications compared to penetrating eye injury if the posterior segment is not involved.

Traumatic lens abscess with chornic endophthalmitis successfully treated with pars plana lensectomy and vitrectomy.

Intralenticular abscess is a rare entity and has been infrequently reported after surgery, metastatic infection, or trauma. We report a case of post traumatic lens abscess with low-grade endophthalmitis following a penetrating eye injury with a splinter of wood. The patient was successfully treated with a pars plana lensectomy and vitrectomy. Despite thorough microbiological investigations, no causative organism could be isolated.

Curvularia lunata endophthalmitis with secondary keratitis.

PURPOSE: To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. METHODS: A 40-year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS: The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION: Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration.

Bacterial adherence to polymethylmethacrylate posterior chamber intra ocular lenses.

PURPOSE: Bacterial adherence to intraocular lenses (IOLs) has been incriminated in the pathogenesis of postoperative endophthalmitis. Staphylococcus epidermidis is the most common organism isolated. We studied the in-vitro adhesion of Staphylococcus epidermidis to Polymethylmethacrylate (PMMA) IOLs and the effect of duration of exposure to adherence. METHODS: Two groups of 10 IOLs each were incubated in Staphylococcus epidermidis suspension for 2 minutes and 20 minutes respectively. Adhesion of bacterial cells was determined by counting the number of viable bacteria attached to IOLs. RESULTS: The mean bacterial adherence with 2 minutes incubation was 12,889 +/- 7,150 bacteria/ IOL and with 20 minutes incubation was 84,226 +/- 35,024 bacteria/IOL (P< 0.01). CONCLUSION: Our results show that Staphylococcus epidermidis adheres to PMMA IOLs in vitro and the degree of adherence is less for shorter duration of exposure. We conclude that viable bacteria irreversibly adherent to IOLs may play a role in the pathogenesis of postoperative endophthalmitis. Shorter duration of operative manipulation and exposure to contaminating sources may decrease the chances of postoperative endophthalmitis.

Prevention of postoperative infections in ophthalmic surgery.

Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.

Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts.

PURPOSE: To evaluate the visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses (IOLs) for traumatic cataracts in children. SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: Twenty children (20 eyes) with traumatic cataracts had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. They were randomly divided into 2 groups. Capsular bag fixation was performed in 10 children (Group A) and ciliary sulcus fixation in the other 10 (Group B). Traumatic cataracts associated with large corneal lacerations (10.0 mm or more), hyphema, angle recession, or posterior segment involvement were excluded. The best corrected visual acuity (BCVA) as well as early and delayed postoperative complications were prospectively evaluated in both groups. RESULTS: The BCVA was 6/12 or better in 9 eyes (90%) in Group A and 8 eyes (80%) in Group B at the end of the mean follow-up (24.6 months +/- 10.6 [SD]). Amblyopia (1 eye in Group A) and corneal scar and commotio retinae (1 eye each in Group B) accounted for a visual acuity of worse than 6/12. The residual refractive error did not exceed 3.50 diopters in either group. The incidences of fibrinous anterior uveitis and pupillary capture were significantly higher in Group B (P < .05, Fisher exact test). CONCLUSION: Capsular bag fixation of posterior chamber IOLs provided visual results similar to those with ciliary sulcus fixation but was associated with fewer postoperative complications, particularly uveitis and pupillary capture. This represents another important reason to attempt in-the-bag fixation in cases of traumatic cataract.

Response of Soybean Lines to Differentially Selected Cultures of Soybean Cyst Nematode Heterodera glycines Ichinohe.

Eight soybean cyst nematode, Heterodera glycines Ichinohe, cultures were developed by their continuous selection on soybean lines with various level of resistance. Each soybean line was inoculated with eggs and larvae of the eight cultures. Female development was much higher on 'Essex' and 'Forrest' than the other lines. The development of nematode cultures selected on Essex and Forrest was low on the other six soybean lines compared with the lines on which they were selected. PI 89772 and PI 90763 had a high level of resistance to the culture selected on PI 88788, whereas cultures selected on PI 89772 and PI 90763 reproduced very little on PI 88788 and PI 209352. Cultures selected on PI 87631-1, PI 209332, and 'Cloud' gave response similar to that of PI 88788. The use of various sources for resistant variety development program is discussed.