1 The processing time does not apply to services where prior approval has to be obtained from authorities in India or elsewhere. For such cases, the processing time is a minimum of thirty (30) business days.  The Consular Officer can at any time call an applicant for a personal interview.
The simian crease is one of the listed signs in Down Syndrome which would imply there's some genetic factor at play. My eldest daughter has a simian crease on one hand and the other hand is 'normal'.
The most important predisposing factor for acute cholangitis is biliary obstruction and stasis. The most common causes of biliary obstruction in patients with acute cholangitis without bile duct stents are biliary calculi (28 to 70 percent), benign stenosis (5 to 28 percent), and malignancy (10 to 57 percent) [3].