P–623 Comparative preliminary study of LPS, hs CRP and gut bacterial flora of women to support dysbiosis of gut microbiota (DOGMA) as cause of PCOS

Study question

Study the levels of endotoxin lipopolysaccharide , hs-CRP and gut bacterial flora in Polycystic Ovarian Syndrome to support hypothesis of Dysbiosis of Gut Microbiota (DOGMA) as a cause of PCOS

Summary answer

Increased serum levels of LPS and hs-CRP along with decreased levels of Bifidobacterium and Lactobacilli by quantitative PCR(qPCR) in women with PCOS.

What is known already

A hypothesis called DOGMA was proposed in the “pathogenesis of PCOS” as follows: (1) Obesity, high Carbohydrate , high fat and low fiber diet creat an intestinal flora imbalance, thus break in the intestinal epithelium, thus raising the permeation of the intestinal mucosa; 2) That cause lipopolysaccharide (LPS) to leak into the circulation and the subsequent activation of the immune system may affect the functioning of the insulin receptor resulting in insulin resistance; 3) IR/Hyperinsulinemia can facilitate testosterone synthesis, thus interfering with follicular development.

Study design, size, duration

A descriptive pilot observational study was carried from 1st February 2018 to 31 Dec 2019. The objectives of was to establish and compare basal serum levels of LPS and hs-CRP in 40 women with PCOS ( as per modified Rotterdams Criteria ) and control group of 40 fertile women and also to determine levels of Bifidobacterium and Lactobacilli by quantitative PCR (qPCR) in these two groups.

Participants/materials, setting, methods

A total of 80 consenting women underwent sonographic , laparoscopic and hormonal evaluation and were grouped into 40 with PCOS as per Rotterdams criteria and 40 healthy control group. The blood samples were taken for estimating hsCRP and LPS. The stool samples were also collected in transport medium and refrigerated . The qPCR was run on stool sample to determine levels of Bifidobacterium and Lactobacillus. The results obtained are compared and presented.

Main results and the role of chance

The mean age, weight, height and BMI in PCOS ( Grp 1 ) was comparable with controls group( Grp 2). Annovulation (33/40) was more prevalent in PCOS group along with bulky ovaries with raised ovarian volume ( Rt 12.86±2.25 mm, / Lt 12.77±1.43 mm.) . The mean serum FSH (4.51±0.95 / 4.80±0.81) were comparable between groups.The serum LH (10.56±1.28/ 5.18±1.19), AMH (7.72±1.62/ than group 2/ 4.77±1.10) and serum testosterone levels (39.39±7.47/20.46±3.09), were found to be increased in Grp 1 The hs-CRP ( 2.68±0.61/ 1.40±0.52 )and LPS levels 14.95±1.97/ 11.35±1.63) were significantly increased in Grp 1 ,while abundance of Bifidobacterium, and lactobacillus ( 4.39±0.80 & 4.33±1.11) in the control group as compared with the PCOS group (2.10±0.51 and 2.20±0.65) was also noted. The raised hs-CRP ( a non specific marker of inflammation ), raised endotoxin Lipopolysaccharide ( secreted by Gram negative bacteria which leak and react with receptors may cause inflammation in PCOS), and quantitative decreased bacterial load of Bifidobacterium, and lactobacillus as estimated by quantitative PCR in infertile women with PCOS and that of fertile women support dysbiosis as cause of PCOS.

Limitations, reasons for caution

The study was carried out on population with traditional high prevelance of diorrheal and other infective diseases which might confound the results given ibid. Addition of treatment arm with probiotics y a large multicentric study will give further insight to the dysbiosis and PCOS

Wider implications of the findings: The study elaborates the effect of dysbiosis as cause of PCOS and gives direction for alternative strategies like probiotics in management of PCOS.

Trial registration number

Not applicable

Health Professions' Digital Education: Review of Learning Theories in Randomized Controlled Trials by the Digital Health Education Collaboration

Background

Learning theory is an essential component for designing an effective educational curriculum. Reviews of existing literature consistently lack sufficient evidence to support the effectiveness of digital interventions for health professions’ education, which may reflect disconnections among learning theories, curriculum design, use of technology, and outcome evaluation.

Objective

The aim of this review was to identify, map, and evaluate the use of learning theories in designing and implementing intervention trials of health professions’ digital education, as well as highlight areas for future research on technology-enhanced education via the establishment of a development framework for practice and research.

Methods

We performed a systematic search of Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cochrane Central Register of Controlled Trials (Cochrane Library), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, and Web of Science for randomized controlled trials (RCTs) published between 2007 and 2016.

Results

A total of 874 RCTs on digital health education were identified and categorized into online-offline, mobile digital education, and simulation-based modalities for pre and postregistration health professions’ education. Of these, 242 studies were randomly selected for methodological review and thematic analysis. Data were extracted by one author using a standardized form, with a (48/242, 20%) random sample extracted by a second author, in duplicate. One-third (81/242, 33.4%) of the studies reported single or multiple learning theories in design, assessment, conceptualization, or interpretation of outcomes of the digital education interventions. Commonly reported learning theories were problem-based learning (16/81, 20%), social learning theory (11/81, 14%), and cognitive theory of multimedia learning (10/81, 12%). Most of these studies assessed knowledge (118/242, 48.8%), skills (62/242, 25.6%), and performance (59/242, 24.3%) as primary outcomes with nonvalidated assessment tools (151/242, 62.4%). Studies with reported learning theories (χ²₁=8.2; P=.002) and validated instruments (χ²₁=12.6; P=.006) have shown effective acquisition of learning outcomes.

Conclusions

We proposed a Theory-Technology Alignment Framework to safeguard the robustness and integrity of the design and implementation of future digital education programs for the training of health professionals.

Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration

BACKGROUND

Tobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education.

OBJECTIVE

The primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners' knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals' practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions.

METHODS

We searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies.

RESULTS

A total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as traditional or usual learning. There was some suggestion that blended education results in similar or greater improvements in knowledge (standardized mean difference, SMD=0.19, 95% CI -0.35 to 0.72), skill (SMD=0.58, 95% CI 0.08-1.08), and satisfaction (SMD=0.62, 95% CI 0.12-1.12) compared with digital education or usual learning alone. There was also some evidence for improved attitude (SMD=0.45, 95% CI 0.18-0.72) following digital education compared with usual learning. Only 1 study reported patient outcomes and the setup cost of blended education but did not compare outcomes among groups. There were insufficient data to investigate what components of the digital education interventions were associated with the greatest improvements in learning outcomes.

CONCLUSIONS

The evidence suggests that digital education is at least as effective as usual learning in improving health professionals' knowledge and skill for delivering smoking cessation therapy. However, limitations in the evidence base mean that these conclusions should be interpreted with some caution.

TRIAL REGISTRATION

PROSPERO CRD42016046815; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=46815.

Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action

BACKGROUND

Our aims were to evaluate critically the evidence from systematic reviews as well as narrative reviews of the effects of melatonin (MLT) on health and to identify the potential mechanisms of action involved.

METHODS

An umbrella review of the evidence across systematic reviews and narrative reviews of endogenous and exogenous (supplementation) MLT was undertaken. The Oxman checklist for assessing the methodological quality of the included systematic reviews was utilised. The following databases were searched: MEDLINE, EMBASE, Web of Science, CENTRAL, PsycINFO and CINAHL. In addition, reference lists were screened. We included reviews of the effects of MLT on any type of health-related outcome measure.

RESULTS

Altogether, 195 reviews met the inclusion criteria. Most were of low methodological quality (mean -4.5, standard deviation 6.7). Of those, 164 did not pool the data and were synthesised narratively (qualitatively) whereas the remaining 31 used meta-analytic techniques and were synthesised quantitatively. Seven meta-analyses were significant with P values less than 0.001 under the random-effects model. These pertained to sleep latency, pre-operative anxiety, prevention of agitation and risk of breast cancer.

CONCLUSIONS

There is an abundance of reviews evaluating the effects of exogenous and endogenous MLT on health. In general, MLT has been shown to be associated with a wide variety of health outcomes in clinically and methodologically heterogeneous populations. Many reviews stressed the need for more high-quality randomised clinical trials to reduce the existing uncertainties.

Medicolegal Death Investigation in India: An Overview

Every suspicious death in India is investigated, with one of the objectives being determining the manner of death. The autopsy is an integral part of the death investigation. Death investigations are accomplished in the form of inquests, which are conducted and directed by the police or, in some cases, by a magistrate. The police and the autopsy physician generally share their findings before opinions are reached, and the courts rely on autopsy physician testimony. In general, the autopsy physician opines only on the cause of death. In the Indian legal and medicolegal systems, manner of death is determined by the police. Unlike in the United States, where the certifier of death must record a manner of death on the death certificate, in India the manner of death is largely a legal (rather than medical) determination.

Autoimmune lymphoproliferative disorder in an adult patient

A 50-year-old male patient presented with fever, epistaxis and multiple lymphadenopathy since 15 days. In the light of the above presentation a complete workup was initiated to exclude common conditions like tuberculosis, acquired immunodeficiency syndrome, lymphoid malignancy and sarcoidosis. After excluding common conditions a biopsy of cervical lymph node demonstrated reactive lymphadenitis with paracortical hyperplasia. Immunohistochemistry demonstrated double negative lymphocytes (CD4-, CD8-). A diagnosis of autoimmune lymphoproliferative disorder syndrome (ALPS) (probable) was made and patient was started on 1 mg/kg of steroids. Patient showed a dramatic improvement with respect to general wellbeing, fever and regression of lymphadenopathy. This entity of ALPS has been recently identified and classified; most of the reports are from the pediatric population. To the best of our knowledge ours is one of the few cases of this entity being reported in an adult patient from India.

Human leucocyte antigen class II DRB1 and DQB1 associations in human immunodeficiency virus-infected patients of Mumbai, India

The pathogenesis of human immunodeficiency virus (HIV) infection clearly involves immunoregulatory host factors and products of major histocompatibility complex class II genes, which present antigenic peptides to the T-cell receptor on CD4+ cells, which in turn increase the production of specific antibodies and cytotoxic T lymphocytes. The main objective of this study was to determine the associations of human leucocyte antigen (HLA) DRB1 and DQB1 alleles and their haplotypes in 210 HIV-1-infected patients and compare them with 129 healthy normal individuals with same ethnic background. The HLA DRB1 and DQB1 alleles were genotyped using polymerase chain reaction product and sequence-specific probes for reverse line hybridization, analysed with the Invitrogen Dynal PMP software. Our results revealed a highly significant increase of HLA DRB1*0902 [odds ratio (OR) = 17.12; P = 0.004], DQB1*030103 (OR = 53.53; P = 4.61E-07) and DQB1*050201 (OR = 16.26; P = 0.0002) alleles while in contrast highly significant decrease in frequency of HLA DQB1*030101 (OR = 0.36; P = 0.0002), DQB1*050301 (OR = 0.22; P < 0.0001) and DQB1*060101 (OR = 0.43; P < 0.0001) among the HIV-1-infected patients when compared with the controls. The haplotype DRB1*0902-DQB1*030103 (OR = 10.65; P = 0.06) was significantly increased in HIV1 patients, while haplotypes DRB1*150101-DQB1*060101 (OR = 0.386, P < 0.0001), DRB1*030101-DQB1*020101 (OR = 0.197, P = 0.004) and DRB1*070101-DQB1*0202 (OR = 0.167, P = 0.001) were significantly decreased. Our results indicate clearly that there are HLA class II alleles involved in the susceptibility to and protection from HIV-1 infection in our study group and further they vary in different ethnic groups reported in literature.

Deccan volcanism, the KT mass extinction and dinosaurs

Recent advances in Deccan volcanic studies indicate three volcanic phases with the phase-1 at 67.5 Ma followed by a 2 m.y. period of quiescence. Phase-2 marks the main Deccan volcanic eruptions in Chron 29r near the end of the Maastrichtian and accounts for approximately 80% of the entire 3500 m thick Deccan lava pile. At least four of the world's longest lava flows spanning 1000 km across India and out into the Gulf of Bengal mark phase-2. The final phase-3 was smaller, coincided with the early Danian Chron 29n and also witnessed several of the longest lava flows. The KT boundary and mass extinction was first discovered based on planktic foraminifera from shallow marine intertrappean sediments exposed in Rajahmundry quarries between the longest lava flows of the main volcanic phase-2 and smaller phase-3. At this locality early Danian (zone P1a) planktic foraminiferal assemblages directly overlie the top of phase-2 eruptions and indicate that the masse extinction coincided with the end of this volcanic phase. Planktic foraminiferal assemblages also mark the KT boundary in intertrappean sediments at Jhilmili, Chhindwara, where freshwater to estuarine conditions prevailed during the early Danian and indicate the presence of a marine seaway across India at KT time. Dinosaur bones, nesting sites with complete eggs and abundant eggshells are known from central India surrounding the hypothesized seaway through the Narmada-Tapti rift zone. A Maastrichtian age is generally assigned to these dinosaur remains. Age control may now be improved based on marine microfossils from sequences deposited in the seaway and correlating these strata to nearby terrestrial sequences with dinosaur remains.

The origin and early evolution of whales: macroevolution documented on the Indian subcontinent

The origin of whales (order Cetacea) from a four-footed land animal is one of the best understood examples of macroevolutionary change. This evolutionary transition has been substantially elucidated by fossil finds from the Indian subcontinent in the past decade and a half. Here, we review the first steps of whale evolution, i.e. the transition from a land mammal to obligate marine predators, documented by the Eocene cetacean families of the Indian subcontinent: Pakicetidae, Ambulocetidae, Remingtonocetidae, Protocetidae, and Basilosauridae, as well as their artiodactyl sister group, the Raoellidae. We also discuss the influence that the excellent fossil record has on the study of the evolution of organ systems, in particular the locomotor and hearing systems.

Developmental basis for hind-limb loss in dolphins and origin of the cetacean bodyplan

Among mammals, modern cetaceans (whales, dolphins, and porpoises) are unusual in the absence of hind limbs. However, cetacean embryos do initiate hind-limb bud development. In dolphins, the bud arrests and degenerates around the fifth gestational week. Initial limb outgrowth in amniotes is maintained by two signaling centers, the apical ectodermal ridge (AER) and the zone of polarizing activity (ZPA). Our data indicate that the cetacean hind-limb bud forms an AER and that this structure expresses Fgf8 initially, but that neither the AER nor Fgf8 expression is maintained. Moreover, Sonic hedgehog (Shh), which mediates the signaling activity of the ZPA, is absent from the dolphin hind-limb bud. We find that failure to establish a ZPA is associated with the absence of Hand2, an upstream regulator of Shh. Interpreting our results in the context of both the cetacean fossil record and the known functions of Shh suggests that reduction of Shh expression may have occurred approximately 41 million years ago and led to the loss of distal limb elements. The total loss of Shh expression may account for the further loss of hind-limb elements that occurred near the origin of the modern suborders of cetaceans approximately 34 million years ago. Integration of paleontological and developmental data suggests that hind-limb size was reduced by gradually operating microevolutionary changes. Long after locomotor function was totally lost, modulation of developmental control genes eliminated most of the hind-limb skeleton. Hence, macroevolutionary changes in gene expression did not drive the initial reduction in hind-limb size.

Vestibular evidence for the evolution of aquatic behaviour in early cetaceans

Early cetaceans evolved from terrestrial quadrupeds to obligate swimmers, a change that is traditionally studied by functional analysis of the postcranial skeleton. Here we assess the evolution of cetacean locomotor behaviour from an independent perspective by looking at the semicircular canal system, one of the main sense organs involved in neural control of locomotion. Extant cetaceans are found to be unique in that their canal arc size, corrected for body mass, is approximately three times smaller than in other mammals. This reduces the sensitivity of the canal system, most plausibly to match the fast body rotations that characterize cetacean behaviour. Eocene fossils show that the new sensory regime, incompatible with terrestrial competence, developed quickly and early in cetacean evolution, as soon as the taxa are associated with marine environments. Dedicated agile swimming of cetaceans thus appeared to have originated as a rapid and fundamental shift in locomotion rather than as the gradual transition suggested by postcranial evidence. We hypothesize that the unparalleled modification of the semicircular canal system represented a key 'point of no return' event in early cetacean evolution, leading to full independence from life on land.

2-CdA in the treatment of hairy cell leukaemia

INTRODUCTION

Hairy cell leukaemia (HCL) is a rare lymphoproliferative disorder. Treatment options available are splenectomy, interferon, DCF and 2-CdA. 2-CdA is considered to have curative potential as proved by the other studies.

METHODS

We gave 2-CdA in a dose of 0.09/kg/day as a continuous infusion in sixteen patients of hairy cell leukaemia.

RESULTS

Three patients developed neutropenia post transfusion. At the end of three months all patients were in remission. Two patients relapsed at the median follow-up of 15 months.

CONCLUSION

2-CdA in HCL can achieve complete remission, prolonged survival and care as well.

A new Eocene archaeocete (Mammalia, Cetacea) from India and the time of origin of whales

Himalayacetus subathuensis is a new pakicetid archaeocete from the Subathu Formation of northern India. The type dentary has a small mandibular canal indicating a lack of auditory specializations seen in more advanced cetaceans, and it has Pakicetus-like molar teeth suggesting that it fed on fish. Himalayacetus is significant because it is the oldest archaeocete known and because it was found in marine strata associated with a marine fauna. Himalayacetus extends the fossil record of whales about 3.5 million years back in geological time, to the middle part of the early Eocene [ approximately 53.5 million years ago (Ma)]. Oxygen in the tooth-enamel phosphate has an isotopic composition intermediate between values reported for freshwater and marine archaeocetes, indicating that Himalayacetus probably spent some time in both environments. When the temporal range of Archaeoceti is calibrated radiometrically, comparison of likelihoods constrains the time of origin of Archaeoceti and hence Cetacea to about 54-55 Ma (beginning of the Eocene), whereas their divergence from extant Artiodactyla may have been as early as 64-65 Ma (beginning of the Cenozoic).

Production & evaluation of a monoclonal antibody against human myeloperoxidase

We describe the production of a mouse monoclonal antibody (H2E1) against human myeloperoxidase antigen. After production and characterisation, this antibody was compared with commercially available monoclonal antibodies, cytochemical myeloperoxidase and previously produced polyclonal antibody. Reaction with various cell lines proved that this monoclonal antibody was specific for myeloid lineage. This monoclonal showed positivity in 81.8 per cent of acute myeloid leukaemias whereas the polyclonal antibody was 100 per cent positive. We found that the polyclonal antibody was more sensitive as compared to the monoclonal. This is probably due to the lack of recognition of individual epitopes on the antigen. We recommend the use of antibodies which have different epitope recognition as most specific for myeloperoxidase.

Calla positive acute lymphoblastic leukemia after etoposide-based therapy for Ewing's sarcoma

This is an unusual and interesting case report concerning a 10 year old boy with an initial diagnosis of Ewing's sarcoma of the right tibia. He was successfully treated with a chemotherapy regimen consisting of vincristine, cyclophosphamide (cumulative dose 7200 mg/m2), doxorubicin, etoposide (cumulative dose 2700 mg/m2) and cisplatin and local radiotherapy to the tibia. After an interval of 37 months he developed CALLA positive acute lymphoblastic leukemia with 11q23 chromosomal abnormality. The possible roles of etoposide and cyclophosphamide are discussed.

Hairy cell leukemia--an unusual presentation

Hairy cell leukemia is a chronic lymphoproliferative disorder affecting middle-aged adults, with the median age of 50-55 years. The majority of the patients present with cytopenia. A high count is usually a feature of the hairy cell leukemia variant. We report a case of a 23-year-old male who presented with fever and cough of 15 days duration. His peripheral blood count was 63 x 10(9)/l. His peripheral blood and bone marrow smear showed hairy cells which were positive for tartarate-resistant acid phosphatase stain. Surface markers and electron microscopic study on peripheral blood ruled out hairy cell leukemia variant as a differential diagnosis.

Inhibition of parathyroid hormone secretion correlates with increased incorporation of 32P into phosphatidylinositol and lysophosphatidylinositol

We have studied the incorporation of radioactive P (32P) into lipids of bovine parathyroid tissue under conditions of stimulated and inhibited hormone secretion. Utilizing low (0.5 mM) and high (3.0 mM) concentrations of calcium to regulate parathyroid hormone secretion, we initially found that the labeling of the cellular phospholipids with 32P was greater in those tissues incubated in high-calcium medium. Thin-layer chromatography of lipid extracts prepared from tissue incubated in either low- or high-calcium media revealed that the increased incorporation of 32P (high or low) was localized primarily to two phospholipids. To determine whether the increases were due directly to the different calcium concentrations, the experiments were performed in media containing normal calcium concentrations (1.25 mM) and low (0.5) or high (3.0) magnesium concentrations to modulate hormone secretion. The results were identical to those obtained using low and high calcium, indicating that the increased 32P incorporation was not an effect of high calcium but rather correlated with the inhibition of hormone secretion. The use of other secretagogues confirmed this correlation. The identity of the two phospholipids was established, by two-dimensional thin-layer chromatography, to be phosphatidylinositol (PI) and lysophosphatidylinositol (LPI). The correlation of increased 32P incorporation with inhibition of secretion led us next to examine isolated secretory granules from tissues exposed to either high-or low-calcium conditions. Thin-layer chromatography of granule lipid extracts yielded chromatograms containing PI and LPI, and the radioactivity of each was greater in the high-calcium sample than in the low-calcium sample.(ABSTRACT TRUNCATED AT 250 WORDS)

The isolation and partial characterization of bovine parathyroid secretory granules

We have developed a procedure which allows the isolation of secretion granules from fresh parathyroid glands. Following collagenase digestion of the tissue, the cells were broken with osmotic shock and a crude granule/mitochondrial pellet was obtained by differential centrifugation. Before loading this fraction onto a metrizamide density gradient it was subjected to brief sonication to disrupt the mitochondria. This procedure was necessary in order to achieve separation of the granules from the mitochondria during ultracentrifugation of the gradient. When the fractionated gradient was analysed for PTH by radioimmunoassay, three bands containing parathyroid hormone were found, at densities of 1.0, 1.05 and 1.18. Upon electron microscopic examination of the gradient fractions, granules were found only in those fractions containing hormone. A typical granule appearance was observed for two of the populations, but the third population (density 1.18), consisted of granules without membranes and which appeared less electron dense than those of populations 1 (density of 1.0) and 2 (density of 1.05). Moreover, the lack of a limiting membrane imparted a fuzzy appearance to the population 3 granules. When fresh tissue sections were examined as control samples, granules with and without membranes were also observed. Standard marker enzyme assays further confirmed that populations 2 and 3 were relatively free of other cellular contaminants, but population 1 contained endoplasmic reticulum and lysosomal material. Because the number of granules contained in this population is very small, we have not been successful in achieving further purification of population 1. Based on radioimmunoassay of extracts of each granule population, PTH was concentrated in population 3, while the other two contained lesser amounts. Interestingly, results obtained with a radioimmunoassay for SP-1 revealed a striking difference in the distribution of SP-1 in the three granule populations. This protein, which is also secreted by the parathyroid gland, was concentrated in population 1 and 2. Only very low levels were found in population 3. Thus, the two major secretory products are localized in different granule populations. The isolated granules were stable to pH changes, cycles of freeze/thaw and sonication. The yields of PTH extracted from each of the granule populations by freezing and thawing in buffer or by Triton containing solutions were low. PTH was completely extracted from each population only by using 8 M urea in HCl. Lower concentrations of urea were less effective. These results indicate that the molecular architecture of the granules is highly resistant to disruption.

Some genetic markers among the Bodos of North Bengal, India

Some genetic markers have been examined among the members of the Bodo tribes, North Bengal, India. Gene frequencies have been estimated and comparison has been done to evaluate differentiation with the common population. The overall intergroup heterogeneity was not significant for Rabha and Mech and also in consideration with the local population. But the Totos showed a difference from the local population and differed slightly from Meches and Rabhas.

A rare case of virilizing adult granulosa cell tumor

A twenty eight year old lady, married for two years with no issue, presented at WesternRegional Hospital Pokhara on 8th July, 1999 with a history of amenorrhea for 1½years, lump abdomen 1 year, hoarseness of voice for 1 year and signs of hirsutism forthe same duration. She was taken up for laparotomy wherein a left ovariectomy withsalpingectomy was done and a large cystic ovarian tumor was removed. Post operativeperiod was uneventful and she was advised follow up. The histopathological diagnosiswas Adult Granulosa Cell Tumor. What made this case interesting is that mostGranulosa Cell Tumors (about 3/4th) are estrogenic or feminizing, but rare examples,including a disproportionate number of large thin walled cystic tumors are androgenic.This was one of those rare virilizing tumors with classical features of infertility,amenorrhea, hoarseness of voice, clitiromegaly, and breast atrophy, but we could notestimate testosterone levels due to lack of facilities available.Key Words: Granulosa Cell Tumor, Virilizing Ovarian Tumors, Sex Cord stromal tumors.