Table of Contents : Journal of clinical and diagnostic research : 2013 - August - 7 https://www.jcdr.net/back_issues.asp Table of Contents : Journal of clinical and diagnostic research : 2013 - August - 7 Anatomical Study of Variations in the Blood Supply of Kidneys Sharmila Aristotle1, Sundarapandian2, Christilda Felicia3 Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Each kidney is supplied by a single renal artery and a single renal vein, which accounts for about 20% of the cardiac output. However, variations in the form of level of origin and arrangement of renal arteries are so frequent. <b>Aim:</b> The present study aimed to note the vascular anatomy of kidneys with respect to the variations in their origin, course and any aberrant vessels which were present. <b>Materials and Methods:</b> The study material comprised of 15 formalin fixed human cadavers. During routine abdominal dissection for undergraduate students, the kidneys were exposed and the blood supply, along with its variations, were noted. <b>Results:</b> The following anatomical findings are observed in this study: (i) Accessory renal arteries (ii) Presegmental arteries (iii) Upper polar arteries (iv) Lower polar arteries (v) Inferior suprarenal artery from accessory renal artery and (vi) Accessory renal vein. <b>Conclusion:</b> Awareness of the normal as well variational anatomy is mandatory for the surgeons, radiologists and urologists, for doing any uroradiological procedures or angiographic studies. Hence, this study will serve a useful guideline for the above mentioned procedures. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1555-1557&id=3203 Facial indices of North and South Indian Adults: Reliability in Stature Estimation and Sexual Dimorphism Prasanna LC1, Bhosale S2, D’Souza AS3, Mamatha H4, Thomas RH5, Sachin KS6 Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Anthropological studies have document differences in craniofacial features as well as in body characteristics among different populations. The variations in the facial morphology arise through a differential growth and they help us in distinguishing one person from another. These are controlled by a number of factors which include genetic heritage, climate and environment in which we live. Very few researchers from India have worked on these facial features with respect to population and environment. The present work was undertaken to determine whether facial variations were subjected to sexual dimorphism. In addition, comparison of facial indices was made, in order to determine possible variations between south and north Indian populations. <b>Methods:</b> The sample consisted of 200 individuals, 100 each from north and south Indian regions. Various facial parameters were determined on the basis of international anatomical description and facial indices were calculated. <b>Results:</b> North Indian males and females had highest facial height and upper facial height. Facial width of south Indians was more as compared to that of north Indians in both sexes. Regression equation was calculated to compare the probable height with actual height. <b>Conclusion:</b> All the facial parameters and facial indices were found to be statistically highly significant and they showed inter-regional and gender variations. These indices will be beneficial in facial reconstruction surgeries, maxillofacial surgeries, and in forensic medicine, for estimating the stature and sex of an individual. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1540-1542&id=3204 Study of Mastoid Canals and Grooves in North Karnataka Human Skulls Gavishiddappa Andanappa Hadimani, Ishwar Basavantappa Bagoji Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> This study was undertaken to observe the frequency of mastoid canals and grooves in north Karnataka dry human skulls. 100 dry human skulls of unknown age and sex from the department of Anatomy were selected and observed for the present study. <b>Material and Methods:</b> The mastoid regions of dry skulls were observed for the presence of mastoid canals and grooves, if any. A metallic wire was passed through the canal for its confirmation and then the length was measured. <b>Results:</b> The Mastoid canals were present in 53% of the total 100 skulls observed either bilaterally or unilaterally. Mastoid grooves were present in 18% of the total skulls (100) observed. Double mastoid canal was found in 01% of total skull studied and both Mastoid canals & Mastoid grooves together were present in 02% of the total skulls (100) observed. <b>Conclusion:</b> The knowledge of mastoid canals and grooves is very important for otolaryngologists and neurosurgeons. Because they contain an arterial branch of occipital artery with its accompanying vein which is liable to injury resulting into severe bleeding. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1537-1539&id=3205 Evaluation of the Variant Anatomical Disposition of the Renal Hilar Structures in South Indian Adult Human Cadavers and Its Cinical Implications Naveen Kumar, Anitha Guru, Ashwini Aithal P., Surekha D. Shetty, Satheesha Nayak B., Narendra Pamidi Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Aim:</b> To evaluate the anatomical disposition of the renal hilar structures in human cadavers of south Indian origin, considering their antero–posterior distribution. <b>Materials and Methods:</b> Ninty–six renal hila of the isolated kidneys from adult south Indian cadavers were observed for the branching patterns and the distributions of the renal hilar structures. The number of branches of the renal artery and the divisions of the renal vein in the pre hilar region were noted, along with their pattern of arrangement with respect to the renal pelvis. <b>Results:</b> In the present study on the pre hilar region, we observed that the highest division of the renal artery was 8 and that the highest incidence was of 4 divisions of the renal artery in 30.2% cases. The highest number of venous divisions which was observed was 7. The highest incidence of 40.6 % cases showed 2 divisions of the veins. Regarding the patterns of arrangement of these structures, we observed 12 patterns of arrangement, with a higher incidence (45.8%) of the classical arrangement (V-A-P), as has been described in the standard text books of anatomy, which was followed by the A-V-P pattern (28.1%). <b>Conclusion:</b> An anatomical knowledge on the possible variant topography of the renal hilar structures is of great importance when urological surgical procedures are performed. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1543-1546&id=3206 The Morphometric Analysis of the Mental Foramen in Adult Dry Human Mandibles: A Study on the South Indian Population K. Udhaya, K.V. Saraladevi, J. Sridhar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Aim:</b> The mental foramen is a small foramen which is located in the antero-lateral aspect of the body of the mandible. It is situated midway between the upper and the lower border of the mandible and it transmits the mental nerve and the vessels. The knowledge on the anatomy of the mental foramen is very important in clinical dentistry and in surgical procedures which involve that area. <b>Material and Methods:</b> Our study was conducted on 90 adult dry human mandibles from the south Indian population, irrespective of age and sex. The location, shape, orientation and the presence of the accessory foramen were studied by visual examination. The size and position of the mental foramen were measured by using a digital vernier caliper. The SPSS, version 15 software was used for the statistical analysis, to calculate the minimum, maximum, incidence, mean and standard deviation. <b>Results:</b> In a majority of the mandibles, the mental foramen was located at the level of the root of the 2nd premolar, midway between the inferior margin and the alveolar margin of the mandible. Most of the mental foramina were oval in shape. The orientation of the foramen was postero-superior in 83% of the mandibles. The accessory foramens were noted in five mandibles. <b>Conclusion:</b> The knowledge on the variations in the position and size of the mental foramen and the presence of the accessory foramen may be of much use to dental surgeons. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1547-1551&id=3207 Histopathological Changes in the Liver of Rabbits Exposed to High Nitrate Ingestion in Drinking Water Manoj Kumar Sharma, Hemlata Sharma, Neelam Bapna Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> In India, especially in Rajasthan, people drink water which contains high level of nitrates and the possibility of finding concentrations of up to 500 mg of nitrate ions per litre of water is not unusual. Excessive use of nitrate fertilisers and herbicides results in accumulation of nitrate in plants and methemoglobinaemia in cattle as consequences of nitrate poisoning. The ingested nitrate is converted to nitrite in the digestive system and it is absorbed in blood, thus causing methemoglobinaemia. Methaemoglobinaemia is not restricted to infants alone, but it is prevalent in higher age groups also. <b>Methods:</b> Therefore, an experimental study was conducted on 10 rabbits which were between three and a half months to four months of age, which had weights which ranged from 1.310 kg to 1.720 kg. Five groups A, B, C,D and E were formed, with two rabbits in each group. The control Group A was given water orally, which had 45 mg/litres of nitrate. Groups B to E (experimental groups) were administered water orally, which had concentrations of 100mg/litre, 200mg/litre, 400mg/litre and 500mg/litre of nitrate respectively, for 120 days. During experimental period, the differences in general behaviour of rabbits were noted. After this, rabbits were anaesthetised and sacrificed according to guidelines of ICMR and their livers were removed and processed for making paraffin sections,.Hematoxyllin and eosin staining was done for microscopic observations. <b>Results:</b> During experimental period, the animals were found to be lethargic on 75th day. Quantity of intake of food and water was not altered in the rabbits which were undergoing experiments in different groups. Rabbits of all groups i.e. A to E showed a continuous increase in heart rate (up to 218/minute in Group E) and respiration rate (up to 84/minute in Group E) respectively. The microscopic study showed mild necrosis of hepatocytes, with infiltration of inflammatory cells in between hepatocytes. In higher groups, the liver showed bridging necrosis and portal triditis. Dilatations of central vein with eosinophilic degeneration were observed in Group E only. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1552-1554&id=3208 Correlation of the Osteogenic Protein-1 (OP-1) with Age, Cartilage metabolic Markers and Antioxidants in the Osteoarthritic Patients of Sikkim Sonam Choden Bhutia, T.A. Singh, Mingma Lhamu Sherpa Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Age and oxidative stress have been implicated as the main causes of the cartilage damage in osteoarthritis (OA). The osteogenic protein–1(OP–1), a member of the bone morphogenetic family (BMP), plays a major role in cartilage repair. <b>Aim:</b> To correlate the OP–1 in the synovial fluid with the age and antioxidants like superoxide dismutase (SOD), glutathione peroxidase (GPx) and uric acid (UA) in the blood and with the cartilage metabolic markers like hyaluronic acid (HA) and keratan sulphate (KS) in the synovial fluid of osteoarthritic patients. <b>Method:</b> Seventy five osteoarthritic patients were taken up for the study. Heparinized blood samples were collected for the estimation of SOD, GPx and UA. Synovial fluid was aspirated for the estimation of HA, KS and OP–1. OP–1 was estimated by using a polyclonal antibody (anti–OP–1) which was produced against OP–1 in the mouse ascitic fluid by sandwich ELISA. <b>Result:</b> Age and UA showed a significant correlation with OP–1. On the other hand, the correlations between OP–1 and the antioxidants (SOD and GPx) and the cartilage metabolic markers (HA and KS) were insignificant in osteoarthritic patients. <b>Conclusion:</b> The study suggests about the important role of OP-1 in cartilage aging and degeneration, which may help us in understanding the potential for the therapeutic interventions in the treatment of cartilage degenerative processes. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1565-1567&id=3209 Evaluation of the Oxidative Stress in Chronic Alcoholics Mamta Singh, Seema Gupta, Udita Singhal, Rajesh Pandey, S.K. Aggarwal Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>AIM:</b> The present study was conducted to assess the activity of Gamma Glutamyl Transferase (GGT) and its association with oxidative stress in alcoholics. <b>Method:</b> Sixty male alcoholics with a history of alcohol abuse for more than five years were the subjects of this study. Twenty healthy male volunteers who matched in age and the socio-economic status, served as the control subjects. <b>Results:</b> GGT, reduced glutathione (GSH, a key intra-cellular antioxidant) and malondialdehyde (MDA, a marker of the oxidative stress) were assayed in the plasma of the two groups, and the results were statistically analyzed. The activity of the plasma GGT, known as a marker of Alcoholic Liver Disease (ALD); was significantly higher in the alcoholics as compared to that in the healthy controls. <b>Conclusion:</b> There was a significant positive correlation between the enzyme activity and the plasma levels of MDA and this indicated that there was an increased release of this enzyme with enhanced oxidative damage, due to the generation of oxygen free radicals in the study group. There was a significantly increased level of MDA and a decrease in the level of GSH in the alcoholics as compared to those in the controls. Significant negative correlations between GGT and GSH, and between MDA and GSH were observed. The present study demonstrates that alcoholics have a compromised antioxidant defense system. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1568-1571&id=3210 The Micronutrient Levels in the Third Trimester of Pregnancy and Assessment of the Neonatal Outcome: A Pilot Study Sheuli Paul1, Akila Prashant2, Chaitra T.R.3, Suma M.N.4, Prashant Vishwanath5, Devaki R.N.6 Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b> During pregnancy, an adequate intake of vitamins and minerals is recommended, to prevent the occurrence of adverse effects in the mother and the foetus. <b>Aim:</b> In our study, we aimed to study the levels of the micronutrients like iron, zinc and copper in the third trimester of pregnancy and to assess the neonatal outcome in them. <b>Materials and Methods:</b> Fifty pregnant women who were aged 20-30 years, who had completed 24 weeks of gestation, who were on regular antenatal checkups, were included. The collected venous blood samples were used for the estimation of haemoglobin, serum ferritin, zinc and copper. They were followed up till their deliveries and the neonatal outcomes were noted. The gestational ages, weight of the babies, the lengths of the babies and their head circumferences and any complications which had occurred during and after the deliveries, were noted in the proforma. <b>Results:</b> The serum ferritin levels did not significantly correlate with the other study parameters. The zinc levels decreased with an increase in the parity (p<0.05). The copper levels decreased with an increase in the BMI (p<0.05). With an increase in haemoglobin, there was an increase in the levels of zinc and ferritin (p<0.05). With an increase in the parity, there was a decrease in the neonatal birth weight. <b>Conclusion:</b> Our study clearly brought out a correlation between the microminerals such as iron, zinc and copper during late pregnancies. An improvement in the iron status brings out a positive effect on the ferritin and zinc levels, thus indicating better outcomes of the pregnancies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1572-1575&id=3211 Case Based Learning: A Method for Better Understanding of Biochemistry in Medical Students Sandhya Pillai Nair, Trushna Shah, Shruti Seth, Niraj Pandit, G.V. Shah Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Health professionals need to develop analytic and diagnostic thinking skills and not just a mere accumulation of large amount of facts. Hence, Case Based Learning (CBL) has been used in the medical curriculum for this reason, so that the students are exposed to the real medical problems, which helps them in develop analysing abilities. This also helps them in interpreting and solving the problems and in the course of doing this, they develop interest. In addition to didactic lectures, CBL was used as a learning method. <b>Methods:</b> This study was conducted in the Department of Biochemistry, S.B.K.S.M.I and R.C, Sumandeep Vidyapeeth ,Piparia, Gujarat, India. A group of 100 students were selected and they were divided into two groups as the control group and the study group. A total of 50 students were introduced to case based learning, which formed the study group and 50 students who attended didactic lectures formed the control group. <b>Results:</b> A very significant improvement (p<0.0001) was observed among the students after the CBL sessions and they were also motivated by these sessions. A 4 point Likert scale questionnaire which contained 8 questions was administered to the students, to know their perception on the usefulness of the CBL. 98% of the students reported that they found the CBL sessions to be an interesting method of gaining knowledge. 84% of them felt that they exposed them to an experience of logical application of the knowledge which was gained in cracking cases, which would be of great help in the future also. <b>Conclusion:</b> Case Based Learning (CBL) was used and it is effective in the medical curriculum for a better understanding of Biochemistry among the medical students. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1576-1578&id=3212 Evaluation of Body Mass Index (BMI) Percentile cut&#8211;off Levels with Reference to Insulin Resistance: A Comparative Study on South Indian Obese and Non&#8211;Obese Adolescents Mahendra Bhauraoji Gandhe, Lenin M., A.R. Srinivasan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> To investigate the relationship of Body Mass Index (BMI) percentile cut off with Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), a surrogate marker for insulin resistance in obese, overweight and non–obese adolescents. <b>Study Design:</b> A cross-sectional analysis of 120 adolescents (divided into sixty overweight/obese and an equal number of non–obese) was performed on nondiabetic, nonpregnant (11 to 18 year old school going) adolescents in south Indian (Puducherry) population. The main outcome measure of insulin resistance was calculated as HOMA-IR (greater than 3.16). Obesity was defined as per the BMI criteria, BMI greater than or equal to 95th percentile,overweight greater than or equal to 85th percentile and non–obese less than 84.9th percentile. All adolescents were subjected to analysis of anthropometric parameters that included weight, height and BMI (body mass index). Biochemical parameters, namely venous plasma glucose (fasting) and venous plasma insulin (fasting) were included for insulin resistance calculation by HOMA-IR. <b>Results:</b> Having a BMI of greater than or equal to 85th percentilewas associated with high HOMA-IR levels. As the BMI percentile increased, HOMA-IR levels also increased. Prevalence of insulin resistance for a BMI percentile of less than 84.9 was nil. Prevalence of insulin resistance for a BMI percentile of 85-94.9 was 26%.Prevalence of insulin resistance for BMI of greater than or equal to 95th percentile was 64%. <b>Conclusion:</b> Insulin resistance is highly prevalent in obese and overweight adolescents as compared to that in non–obese adolescents. The onset of Impaired Fasting Glucose (IFG) is associated with the development of severe hyper–insulinaemia in obese adolescents and early primordial and primary prevention can thus alleviate the burden of future cardiometabolic disorders. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1579-1582&id=3213 Morphological Study of Lumbricals &#8211; A Cadaveric Study Kaur Parminder Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X The apparently simple human function of closing the hand to grasp an object or opening the palm to release it are in reality tasks of considerable mechanical complexity requiring the contraction of many individual muscles Lumbricals are important part of intrinsic musculature of hand. Though several deviations from normal have been described in standard textbooks of anatomy, a review of basic anatomy of lumbricals will be helpful. <b>Aim:</b> proper knowledge about anatomy and variaitions prevalent in intrinsic musculature of hand is mandatory for various surgical procedure like cleft hand surgery, pollicization & other digital transposition procedures Present study was conducted to study morphology & variations prevalent in this region. The results were compiled and tried to find out commonest variations Phylogenetical & ontogenetical basis and clinical applications related to variations encountered were tried to know by correlating it with available literature. <b>Material & Methods:</b> For this study 50 hands of formalin embalmed cadavers were dissected The limbs were labelled R OR L for right or left, M or F for male or female. Cunnigham’s manual for dissection was followed for dissection. <b>Results:</b> Origin and nerve supply of lumbricals was normal in all hands. The variations were encountered in insertion of the 3rd lumbrical (32%) and 4th lumbrical (24%) were more confined to the right hand. Variations encountered commonly were split and misplaced insertion of third & fourth lumbricals. These variations are critically analyzed in the light of accessible literature. <b>Conclusion:</b> Lumbricals are more variable in the insertion rather than the origin & nerve supply. The variation commonly seen were split & misplaced insertion Split insertion was common in the third lumbrical whereas misplaced insertion is more common in the fourth lumbrical Variations are more common on right hands. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1558-1560&id=3214 Prevalence, Pattern and Familial Effects of Substance Use Among the male College Students &#8211;A North Indian Study Sorab Gupta, Sandeep Singh Sarpal, Dinesh Kumar, Tarundeep Kaur, Sumant Arora Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Substance use refers to the use of any psychoactive substance or drug, including licit and illicit drugs, other than when medically indicated. Psychoactive substance use poses a threat to the health, social and economic fabric of families, communities and nations. Chandigarh has more than 0.2 million students from across the country pursuing their courses in higher education institutions. There is a very little information about pattern of drug dependence among the college students of Chandigarh. <b>Objectives:</b> To study the prevalence and pattern of substance use among college students of Chandigarh and to study the psycho-social behaviour of youth and perceived reasons for using substances. <b>Material and Methods:</b> A Cross - sectional community based study. A stratified multi-stage random sample design was adopted in study. The study instrument was a questionnaire which was developed by reviewing relevant literature and previously used standardized instruments and protocols including the WHO questionnaire. On the basis of 60% prevalence anticipated on the basis of pilot study, 90% confidence coefficient and 10% permissible error – sample size came out to be 256. <b>Results:</b> Prevalence of substance use was seen in 52.7% students belonging to age group 19 to 21 years. More prevalence of substance use was found among law students (76.2%) followed by the students from Art stream (62.5%). Among the users alcohol was most commonly used (53.5%), followed by smokers (27.3%), tobacco chewers (8.2%), cannabis (6.8%).49% of the users were using substances on daily basis, followed by 23% who using weekly.29.3% of users had father using any substance. Relief from psychological stress (66.0%) followed by easy availability (46.9%) were the most common reasons of substance abuse. that substances use is common among college going male students irrespective of their social demographic characteristics like age [OR 0.76, 95%CI (.443-1.317) religion [OR.859 95%CI (.461-1.598), parental education, occupation and socio-economic status. Therefore, interventions in terms of health education/counselling for reducing substance use among them should be adopted, irrespective of their socio-demographic characteristics. <b>Suggestions:</b> This study suggested some life style related interventions in order to reduce the problem of substance use.There is an utmost need to educate and counsel young students regarding harmful effects of substance use. Health education may be imparted in the school curriculum. Parents should also be educated on discouragement of substance use and on taking proper care of their children. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1632-1636&id=3215 Prevalence and Pattern of Alcohol Consumption using Alcohol Use Disorders Identification Test (AUDIT) in Rural Tamil Nadu, India Ganesh Kumar S., Premarajan K.C., Subitha L., Suguna E., Vinayagamoorthy, Veera Kumar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> There is a paucity of information on prevalence and pattern of alcohol consumption in India. <b>Aim:</b> To assess the prevalence and pattern of alcohol consumption in a rural area of Tamil Nadu, India. <b>Material and Methods:</b> A community based, cross sectional study was conducted among 946 subjects who were aged 10 years and above, in rural Tamil Nadu, India. Data on alcohol use was collected by using ‘Alcohol Use Disorder Identification Test’ (AUDIT) scale. Data on pattern and associated factors like socio-demographic details, smoking, tobacco chewing and chronic diseases were collected by using a structured questionnaire. <b>Statistical Analysis:</b> Data was analysed by univariate and multiple logistic regression analysis and information was depicted in percentages or proportions. A p value of less than 0.05 was considered as significant. <b>Results:</b> Overall, the prevalence of alcohol use was found to be 9.4%. Prevalence was more among males (16.8%) as compared to that among females (1.3%). Mean age at initiation was 25.3 +9.0 years. Multiple logistic regression analysis revealed that middle age (15–44 years) (OR=3.56), male gender (OR=11.23), illiteracy (OR=6.16), lower education levels (OR=2.57) and smoking (OR=17.78) were independently associated with alcohol use. Among those who used alcohol, 29.2% (26) were possible hazardous drinkers, 33.7%(30) had a probable alcohol dependence and 56.2% (50) had experienced harmful effects, based on AUDIT item analysis. <b>Conclusion:</b> Prevalence of alcohol use is high, especially among males. Health educational interventions among those who are at a higher risk and management of alcohol dependent subjects, may help in reducing the burden of alcohol use in this area. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1637-1639&id=3216 Histomorphometric Study of Fructus Psoralea on Ethanol Induced Neurodegeneration of Hippocampus in Rat Sivanandan Ramar, Saraswathi P. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Aim:</b> The histomophometric study of Fructus Psoralea (FP) on ethanol induced neurodegeneration of hippocampus was investigated in a rat by using micrometry. <b>Material and Methods:</b> The study was conducted on thirty healthy female adult wistar albino rats with regular 4-day estrus cycles. The experiment was carried out for a period of 2–4 months. The rats were divided into- SHAM operated control group (Group I) and experimental groups - overiectomised vehicle control rat ((Group II), OVX and orally treated with FP(Group III) OVX and induced with ethanol (Group IV), OVX rats induced with ethnaol and orally treated with FP (Group V). ANOVA tool was used to test the mean positive behavioural activity of all the groups. The diameter, packing density and the total number of neurons were calculated from toluidine blue stained histological section by using micrometry. The statistical package SPSS (17.0 VERSION) was used. Statistical significance was defined as p < 0.05. Data was expressed as mean ± SEM. <b>Discussion:</b> In animal studies, ethanol was found to significantly inhibit neuronal activity in the CA1 and CA3 pyramidal cell layers of the hippocampus. FP increase the number of cholinergic neurons in the basal forebrain which in turn leads to increased function of hippocampus, a structure heavily implicated in behavioural activity and memory consolidation. <b>Conclusion:</b> People with extensive hippocampal damage may experience amnesia, learning and memory disabilities. Hence the herb FP may be used as an adjuvant to treat the above neurological disorders. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1561-1564&id=3217 Family Planning Practices Prior to the Acceptance of Tubectomy: A Study Among Women Attending a Maternity Home in Bangalore,India Srividya V, Jayanth Kumar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> The extent of acceptance of contraceptive methods still varies within societies. Reliance on sterilisation is appearing earlier in marriage and among ever-younger ages and lower parities. <b>Aim and Objective:</b> To study the family planning practices adopted by women who undergo tubectomy before the acceptance of tubectomy. <b>Material and Methods:</b> Cross–sectional study of tubectomy acceptors who attended a corporation referral maternity home in Bangalore, India by interview method using a pre–designed a pre–tested structured questionnaire. <b>Results:</b> Majority 295(73.9%) of the study subjects had not practised any method of contraception before they underwent sterilisation. Increase in the education levels of the study subjects was associated with an increase in the contraceptive use (temporary methods) before they accepted tubectomy; this association was found to be statistically significant (p<0.0001). ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1640-1643&id=3218 The Perceptual Preferences in Learning Among Dental Students in Clinical Subjects Nandita Shenoy, Ashok Shenoy K., Ratnakar U.P. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> VARK is a questionnaire which was developed by Neil Fleming (www.vark.learn.com), who was a teacher and an educator in New Zealand, with respect to the perceptual preferences in learning. V stands for Visual- the students learn best from pictures, graphs and diagrams. A stand for Aural – the students learn best from spoken words, lectures and discussions. R stands for Reading – the students learn best from reading and writing texts. K stands for Kinesthetic – the students learn best when they move their bodies and manipulate things with their own hands. <b>Aim:</b> The aim of the recent study was to investigate the learning styles among the dental students in our clinical set up. <b>Method:</b> The VARK-questionnaire contains 13 multiple-choice- questions with four possibilities to select an answer. Each possibility represents one of the four modes of perception. But, one can select more than one answer for each question, which is necessary for the identification of the poly modal modes of perception and learning. This is also a psychometric problem when an attempt is being made to state a measure of the reliability of the questionnaire. The VARK-questionnaire was distributed among 100 students and we received filled forms from only 70 students. This sample size represented a 70% response rate from the students in the class and it was markedly above the level which was required to make conclusions about the student preferences for receiving and processing information. The students spent about 10 minutes in an ordinary lesson to fill in the questionnaire. The students’ register numbers and names were used in the study and no blinding was practised. We analyzed their learning styles with their performances in the university exams. <b>Study Design:</b> This was a questionnaire based clinical study. <b>Results:</b> The responses from the students in our University where classified into the multi-modal (VARK), tri-modal (VRK, VAK, VAR, ARK), bi-modal (VR, VA, VK, RK) and the uni-modal (V, A, R.K) categories. The results showed that the subjects had a higher preference for multimodal learning. <b>Conclusion:</b> With our preliminary data, we conclude that the students in our clinical set up preferred a multimodal and a more of kinesthetic method of learning. To meet their needs, variations in the teaching, learning and the examination must be implemented. If not, the students with a high kinesthetic preference for perception and learning may be at the losing end. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1683-1685&id=3219 An Autopsy Study of Liver Injuries in a Tertiary Referral Centre of Eastern Nepal Nuwadatta Subedi, B.N. Yadav, Shivendra Jha3, Sharmila Gurung, Amshu Pradhan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Liver is the largest gland in the body and it frequently gets wounded. The objective of this study was to determine the patterns, types and severities of liver injuries which were caused by mechanical trauma and to study the organs associated with liver injuries. <b>Material and Methods:</b> This was a hospital based, cross sectional study which was conducted on the autopsies showing the evidence of liver injuries in the mortuary of a tertiary hospital in eastern Nepal. All consecutive autopsy cases which were handled within one year’s time (n=46) were included in our study. The cases were studied in detail for liver injuries, which included age, sex, severity, associated injuries, site of the injury, description of the injury, etc. <b>Results:</b> The mean age of the victims was 33.87 years and there was a male: female ratio of 3.6:1. The injuries had resulted from blunt trauma in 41 (89.1%) cases, the most common of which was road traffic accidents, constituting 37(80.4%) cases. Grade III injuries were seen in 14 (30.4%) cases. Laceration of the liver was the most frequent finding that was evident in 34 (73.9%) cases. Right lobe of the liver was injured in 30 (74%) cases. The sole presence of liver injuries among abdomino-pelvic organs was seen in 14 (30.4%) cases. In 40 (87%) cases, liver injuries were associated with other regional injuries. <b>Conclusion:</b> Laceration is the most common liver injury among autopsy cases. Right lobe is mostly affected and grade III injuries are the most common ones. Liver injuries are frequently associated with other abdomino-pelvic organs and multiple regional injuries. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1686-1688&id=3220 Herpes Simplex Encephalitis (HSE) and its outcome in the Patients who were Admitted to a Tertiary Care Hospital in Mashhad, Iran, over a 10-year Period F. Sheybani, H.R. Arabikhan, H.R. Naderi Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> The effective cure rate of acyclovir emphasizes the importance of an early diagnosis and treatment in reducing the considerable mortality and the morbidity in patients with Herpes Simplex Encephalitis (HSE). <b>Methods:</b> The demographic as well as clinical features, the lab data and the neuroimaging findings of the patients with HSE, which were confirmed by Cerebrospinal Fluid (CSF) PCR and/or brain MRI, were reviewed and analyzed statistically over a 10-year period. <b>Results:</b> Over a 10-year period, the characteristics of 45 patients with HSE were reviewed. 34 (76%) out of the 45 patients showed positive CSF HSV-1 PCR results. 8 (18%) had a normal CSF analysis and a CSF/blood glucose ratio of less than 0.5 was observed in 13 (29%) patients, while 14% had PMN-dominant pleocytosis. 68% of the patients for whom brain MRI was performed, had temporal lobe involvement. While 37 (83%) patients recovered completely, 6 (13%) survived with sequelae, and 2 (4%) died. <b>Conclusion:</b> Because of the increasing number of atypical forms of HSE and the great impact of an early diagnosis and treatment on a favourable outcome, the acyclovir therapy should be administrated for any type of febrile encephalopathy of unknown aetiology, until HSE can be excluded. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1626-1628&id=3221 The Association of Positive Chest Radiograph and Laboratory Parameters with Community Acquired Pneumonia in Children Dhairya Lakhani, Prasad Muley Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b> This study was designed to compare the sensitivities of different investigations for the diagnosis of Community Acquired Pneumonia (CAP). A A prospective study was carried out which compared the sensitivities of the chest radiographs, CRP, TLC, ESR and the blood cultures in sixty-six patients who were diagnosed with WHO defined CAP. <b>Method and Material:</b> The chest radiographs, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total leucocyte count (TLC) and blood cultures were determined in sixty-six patients who were amongst the age group of one month to five years of age, who were diagnosed with WHO defined CAP. <b>Statistical Analysis:</b> It was carried out by calculating the proportion, mean, standard deviation (SD) and the sensitivity of the test. <b>Results:</b> The chest radiographs were found to be positive in 93.9% (n=62) patients, CRP was positive in 90.9% (n=60) patients, ESR was positive in 72.7% (n=42) patients, TLC was positive in 48.5% (n=38) patients and the blood cultures were positive in 6.1% (n=4) patients. Hence, the sensitivity of the chest radiograph, CRP, ESR, TLC and the blood culture in the diagnosis of CAP were 93.9%, 90.9%, 72.7%, 48.5% and 6.1%. <b>Conclusion:</b> In view of the high sensitivity of CRP, which is almost similar to that of chest X-Ray in detecting CAP, CRP can be used as an alternative test to the chest radiographs at peripheral centres, where X-ray machines are not available. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1629-1631&id=3222 The prevalence of Inducible and Constitutive Clindamycin Resistance Among the Nasal Isolates of Staphylococci Baragundi Mahesh C., Kulkarni Ramakant B., Sataraddi Jagadeesh V. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b> One of the important sources of Staphylococci which causes nosocomial infections, is the nasal carriage of Staphylococci among Health Care Workers (HCWs). The commonest antibiotic which is preferred for the treatment of the methicillin and multi drug resistant Staphylococcal infections is clindamycin. The inducible clindamycin resistance in Staphylococci is not detected by the routine antibiotic susceptibility testing and it results in treatment failures. <b>Aim:</b> The present study was undertaken to know the prevalence of constitutive and inducible clindamycin resistance and its correlation with the methicillin resistance among the nasal isolates of Staphylococci which were obtained from different HCWs. <b>Material and Methods:</b> Nasal swabs were collected from 206 HCWs and they were processed. The Staphylococci which were isolated were tested for methicillin resistance by using cefoxitin (30 µg) discs. The inducible clindamycin resistance was tested by using erythromycin (15 µg) and clindamycin (2µg) discs and the D test according to the CLSI guidelines. <b>Results:</b> Inducible clindamycin resistance was seen in 21(16.40%) of the S.aureus and 14 (7.56%) of the coagulase negative Staphylococcal isolates. Constitutive clindamycin resistance was seen in 23(17.96%) of the S.aureus and 43(23.24%) of the coagulase negative Staphylococcal isolates. The inducible and constitutive clindamycin resistance was more common among the methicillin resistant Staphylococcal isolates. <b>Conclusion:</b> The prevalence of inducible and constitutive clindamycin resistance in the nasal Staphylococcal isolates which were obtained from the HCWs was high, especially among the methicillin resistant Staphylococci. The D test which is recommended by the CLSI should be routinely done to detect inducible clindamycin resistance, to prevent treatment failures. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1620-1622&id=3223 Umbilical Cord Coiling Index and Perinatal Outcome Nivedita S. Patil, Sunanda R. Kulkarni, Renu Lohitashwa Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> To evaluate the perinatal outcome with the abnormal umbilical cord coiling index. <b>Study Design:</b> This prospective study was carried out in the department of OBG at Adichunchangiri Institute of Medical Sciences, B.G.Nagara, Mandya, Karnataka, India from January 2008 to August 2010. 200 patients who were in active labour with term gestations, irrespective of their parities, who had singleton pregnancies with live babies who were either delivered by vaginal or LSCS were included in the study. Umbilical cord coiling index was calculated and it was correlated with various perinatal parameters like birth weight, meconium stained liquor, Apgar score, ponderal index and foetal growth restriction. Chi square and Fisher exact tests were used to find the significance of study parameters. <b>Results:</b> There was a significant correlation between the hypercoiled cords (UCI >90th percentile) and IUGR of the babies (p value of < 0.001) and low ponderal indices (a p value of 0.022) Hypocoiled cords ( UCI which was < 10th percentile) were significantly associated with meconium staining (p < 0.001), Apgar score at 1 min of <4 and at 5 min of <7 (p value 0.065), LSCS rates (p value of 0.008) and NICU admissions (p <0.001). <b>Conclusion:</b> Hypercoiled cords or UCI which was > 90th percentile was associated with IUGR and low ponderal indices. Hypocoiled cords or UCI which was <10th percentile was associated with meconium staining, Apgar score at 1 min of <4 and at 5 min of <7, more LSCS rates and more NICU admissions. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1675-1677&id=3224 The Incidence of Hyponatraemia and Its Effect on the ECOG Performance Status among Lung Cancer Patients Amitabha Sengupta, Sourindra Nath Banerjee, Nirendra Mohan Biswas, Debraj Jash, Kaushik Saha, Arnab Maji, Ankan Bandyopadhyaya, Sandip Agarwal Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b> Hyponatraemia is one of the common electrolytic disorders which are associated with lung cancer. Hyponatraemia may influence the ECOG performance status at presentation. Also, to the best of our knowledge, we found only limited Indian studies where the ECOG score was correlated with the serum sodium status in lung cancer patients on presentation. <b>Aim:</b> To assess the incidence of hyponatraemia among the patients of carcinoma of the lung before putting them into the specific treatment category for cancer and to check the effects on their ECOG performance status. <b>Settings and Design:</b> A cross–sectional, observational study was conducted on 116 consecutive patients of lung cancer during the period from November 2011 to October 2012. <b>Material and Methods:</b> The patients with a histologically proven diagnosis of lung cancer were grouped initially according to their ECOG performance statuses. The serum sodium value of each patient was measured and the hyponatraemic patients were given treatment according to the protocol. The correlation of the ECOG performance status with the serum sodium of the lung cancer patients was measured. To check for any laboratory error in serum sodium, we selected (n = 58) age, sex and socioeconomic matched control patients. Results: At presentation 44.8% of the lung cancer patients showed hyponatraemia (52/116). The ECOG score was significantly poor in the advanced clinical stages (ECOG =2 Vs ECOG = 3 in NSCLC cases, c2 =11.25, P=.0008). The ECOG performance status score at admission showed a negative correlation with the serum sodium status which was measured on admission among all the patients (Pearson correlation coefficient = – 0.186). The clinical stage of the lung cancer also showed a positive correlation with the ECOG score at admission in our study (Pearson correlation coefficient = 0.295). <b>Conclusion:</b> Hyponatraemia is not an uncommon condition and it should be suspected and screened in each patient, as it may influence the ECOG performance status score, which serves as an important factor in the prognosis of lung cancer. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1678-1682&id=3225 CSF Proteins as Discreminatory Markers of Tubercular and Pyogenic Meningitis Ravi Shekhar, J. Rama Rao, K. Ambika Devi, R Babu Rao Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Meningitis is still a major cause of illness in many parts of the world. Though substantial improvement has been occurred in the diagnosis of meningitis, conclusive differentiation between tubercular and pyogenic meningitis remains to be an unsolved problem. Patients with meningitis often have severe neurological deficit or die inspite of antibiotic therapy. Thus, improvement in diagnostic test and therapy is required. The objective of the present study was to find a simple biochemical marker for diagnosis of meningitis and differentiation of tubercular and pyogenic meningitis. <b>Material and Methods:</b> CSF samples were collected from 90 paediatric patients from Nilofer Hospital, Hyderabad, India, from age group of 4 months to 12 years. CSF samples were collected by performing Lumbar Puncture under aseptic conditions and with required precaution. CSF samples were divided into 3 groups where Group 1 included Control that was without CSF inflammation, Group 2 with Tuberculous Meningitis & Group 3 consisting of Pyogenic Meningitis with 30 samples in each group. Electrophoretic analysis of CSF proteins was performed which separated as bands of pre-albumin, albumin, alpha, beta and gamma globulins. <b>Result:</b> Protein content in CSF was 259 ± 409 mg/dl in tuberculous meningitis, whereas in pyogenic meningitis it was 111 ± 83.94 mg/dl and in control group was 19 ± 13.3 mg/dl. Electrophoretic analysis revealed pre-albumin band to be 2.8 ± 1.2 % in tuberculous meningitis, which was significantly decreased when compared with control and pyogenic meningitis. Albumin band in tuberculous meningitis was 34.8 ± 9.9 %, which was also significantly decreased when compared to control and pyogenic meningitis. Alpha band was 19.7 ± 6.9 % in pyogenic meningitis, but in control and tubeculous meningitis it was 10.4 ± 2.9% and 10.3 ± 5.2% respectively. Beta band was found similar in all the three groups. Gamma band was 33.2 ± 8.08% in tuberculous meningitis, 13.8 ± 4.55% in control and 16.7 ± 13.18% in pyogenic meningitis. <b>Conclusion:</b> Pre-albumin band was found to be decreased and gamma band was shown to be increased in tuberculous meningitis. Alpha band was increased in pyogenic meningitis. Thus, CSF protein fraction separated and quantitated by native Polyacrylamide slab gel electrophoresis, could be used as markers in differentiation of tubercular and pyogenic meningitis. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1586-1588&id=3226 Closed Reductions and Percutaneus &#8216;K&#8217; Wire Fixation for Adolescent Intercondylar Fractures of the Distal Humerus Julfiqar, Ajay Pant, N. Huda, Wasim Ahmed Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Intercondylar (T-Condylar) fractures of the humerus are very rare in children. The usual mechanism of the injury which is involved is a fall on a flexed elbow. The treatment options vary, depending upon the degree of the displacement and the amount of comminution and; they may range from a simple application of traction to open reduction and internal fixation with plates and screws. Open reduction is associated with significant post–operative stiffness of the elbow and subsequent less than satisfactory functional results. In this publication, we are presenting our experience of treating seven adolescent T–Condylar fractures of the distal humerus with closed reductions and internal fixations with the percutaneus Kirchner (‘K’) wire. <b>Method:</b> Seven patients (M:F-6:1) with an average age of 14(range 12–16) years were treated by closed reduction and internal fixation with a 2.0 mm ‘K’ wire fixation under an image intensifier. Following the surgery, all the elbows were immobilised in plaster of Paris (POP) splints for three weeks. At three weeks after the surgery, the pop splints were removed and gentle elbow exercises were started. Five weeks after the surgery, the ‘K’ wires were removed, based on the radiological evidence of a bridging callus formation. <b>Results:</b> Six patients (85%) out of seven showed satisfactory functional results on the Mayo Elbow Performance Score (MEPS), with a good range of motion at the elbow joint. Three (42%) patients had mild elbow stiffness, which resolved on subsequent treatment, while one (14%) had a mild pin tract infection, who was managed conservatively. There was one patient (14%) who was lost to follow–up, who ultimately had a painful and a stiff elbow. The remaining six patients were able to return to the premorbid sate. <b>Conclusion:</b> We recommend closed reduction and percutaneous ‘K’ wire fixation for adolescent T– Condylar fractures of the humerus as an easy and inexpensive procedure with satisfactory functional results. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1666-1668&id=3227 Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures in Elderly: A Prospective Study Kiran Kumar GN, Sanjay Meena, Vijaya Kumar N, Manjunath S, Vinaya Raj MK Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Intertrochanteric fractures in osteoporotic bones which are grossly comminuted are highly unstable and difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure with internal fixation, with dynamic hip screws has been found to be high, especially in osteoporotic bones. Revision osteosynthesis is technically demanding and it leads to complications. The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. <b>Material and Methods:</b> 20 patients (11 males and 9 females- all were 65 years old or above) who underwent bipolar arthroplasty for unstable intertrochanteric fractures were prospectively evaluated. Moore’s approach was used in all patients. Greater Trochanter encirclage was done in 10 (50%) patients. Harris hip score was used for the clinical evaluation. The mean follow up period was 9 months. <b>Results:</b> In our study which was done on 20 cases which had a mean age 72.4 years, 14 cases were of type 2 fractures, 3 were of type 3, 2 were of type 1 fractures and 1 was of type 4. The average Harris hip score was 75. Excellent to fair results were obtained at follow-up in 18 (90%) cases and in 2 (10%) cases, the results were poor. Average hospital stay was 13.3 days. There was one case of a superficial operative site infection and one case of a deep infection. There was no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis. <b>Conclusion:</b> The treatment of unstable intertrochanteric fractures in elderly patients with severe osteoporosis differs from the treatment of patients with other proximal femoral fractures. These fractures are better treated with cemented hemi-arthroplasty than with internal fixation. Besides an early ambulation and less hospital stay, cemented hemi-arthroplasty provides stable and mobile hips. Weight bearing can be started earlier than in other methods of treatment, which prevents any recumbency related complications. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1669-1671&id=3228 Platelet Functions and Coagulation Changes in Indian Children with Nephrotic Syndrome Aliza Mittal, Kailash Chandra Aggarwal, Sumita Saluja, Archana Aggarwal, Binit Sureka Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Only little is known on the effect of the platelet function in the paediatric nephrotic syndrome. The earlier studies which had been done on hypercoagulability have mainly featured the secondary forms of the nephrotic syndrome and the data on the minimal change type of disease is limited. We therefore, made an effort to study the platelet functions and the coagulation profile in children with the nephrotic syndrome,to find the relationship between the steroid response and the coagulation profile, and to look for the correlation between thromboembolism and the hypercoagulable states. <b>Methodology:</b> Twenty nine children with the steroid responsive nephrotic syndromewere studied to see the platelet aggregation and the coagulation parameters and their response to the steroid therapy. Doppler studies were done for the renal vein and the inferior vena cava (IVC) thrombus. <b>Results:</b> It was seen that an increased aggregability of the platelets occurred with Adenosine diphosphate (ADP) and collagen (out of the four agonists, ADP, Collagen, Ristocetin and Arachidonic acid) which were used as agonists for the assay. We also observed that the Partial thromboplastin time (PTT) had become prolonged and a significant decline in the high values of the procoagulant proteins (Protein C and Protein S) was seen after the steroid therapy and when the children went into remission. These findings were suggestive of a reversibility of the changes in the steroid responsive nephrotic syndrome with the steroid therapy. One child was found to have thrombosis of the inferior vena cava (IVC) on Doppler studies, which resolved with treatment subsequently. <b>Conclusions:</b> An increased platelet aggregability contributes to the hypercoagulable states, that may increase the incidence of thrombosis in such patients. Although the incidence of such complications is very low, in a given child with the hypercoagulable states, Doppler may be used to look for any evidence of a latent thrombus and, an early intervention could be instituted. A change in the coagulation parameters points to the reversibility of the changes which are produced in a diseased state. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1647-1650&id=3229 Antibiotic Resistance and Usage&#8212;A Survey on the Knowledge, Attitude, Perceptions and Practices among the Medical Students of a Southern Indian Teaching Hospital Afzal Khan A K, Gausia Banu, Reshma K K Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Examining the knowledge, attitude, perceptions and practices (KAP) of the medical students regarding antibiotic resistance (ABR) and use can help us in devising suitable educational interventions for them, tailored according to their earlier held knowledge, beliefs, capabilities and experience. <b>Methods:</b> A cross sectional, questionnaire based survey was conducted among the second year medical students of a teaching hospital, whereby their KAP regarding antibiotic use and resistance was assessed by using a five point Likert scale, whose responses ranged from ‘strongly agree’ to ‘strongly disagree,’ ‘always’ to ‘never and ‘very important’ to ‘unimportant’. The data was analyzed by using simple descriptive statistics. Wherever it was relevant, the Chi-square test was used to determine any significant difference. <b>Results:</b> The response rate was 100 per cent. The number of respondents who agreed that ABR was an important and a serious public health issue in our teaching hospital (n = 66, 68 per cent), was significantly less (p < 0.001) as compared to the number of respondents who agreed that ABR was an important and a serious issue which the country (n = 86, 88.65 per cent) and the world (n = 88, 90.7 per cent) were facing. Only 77.3 per cent (n = 75) of the respondents were aware that bacteria were not responsible for causing colds and flu, while the remaining 22.7 per cent (n = 22) were not knowledgeable about this fact. More than 80 per cent rated the adverse effect profile of the antibiotic and the risk of a superinfection as the important factors which deserved consideration. Cost of the antibiotic was considered to be an important factor deserving consideration by only 56.7 percent (n=55) of the participants. <b>Conclusions:</b> Our survey revealed that most of the students were aware of the antimicrobial resistance and its consequences. The only concern was their casual attitude regarding the antibiotic use. Further educational interventions are necessary to improve their understanding and perceptions on antibiotic resistance, as well as their attitude towards antibiotic use. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1613-1616&id=3230 Effect of Wood Dust on Respiratory Health Status of Carpenters Mamta Mohan, Aprajita, Neeraj Kant Panwar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Occupational lung diseases form an important part of clinical medicine. Exposure to various chemicals or toxins which are manufactured or processed in industries are lethal for the workers in industries. Although these chemicals at workplace are known to invariably affect all body systems, lungs are most vulnerable to airborne hazards which are caused due to exposure to wood dust in welding, cement and wood industrial sectors. <b>Aim and Objectives:</b> The aim of the present study was to establish the effect of wood dust on respiratory health of carpenters and to compare the measured values with those of age-matched controls. <b>Material and Methods:</b> This study involved 150 non–smoking carpenters, while 150 age–matched healthy non-smoking persons who were engaged in works other than carpentry, served as controls. The influence of age, height, body surface area (BSA) andduration of exposure on peak expiratory flow rate (PEFR) were determined in both cases and control subjects by using a Mini Wright’s peak flow meter. The statistical analysis was done by using paired Student’s t-test. A p-value of < 0.05 was considered as statistically significant. <b>Results:</b> The mean PEFR of study subjects was less than that of the control subjects in each sub group of age, height, weight and BSA and these results were statistically highly significant. <b>Conclusion:</b> The decrease in PEFR in carpenters was probably due to a continuous exposure to wood dust, which had caused an adverse effect on their respiratory status. In order to prevent the ill effects of wood dust on the respiratory health of carpenters, we suggest pre–employment medical check–ups and regular monitoring thereafter. Also, provision for a good ventilation at work place should be made. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1589-1591&id=3231 Evaluation of Salivary Profile among Adult Type two Diabetes Mellitus Patients in South India Prathibha K.M, Priscilla Johnson, Mathangi Ganesh, Arcot S. Subhashini Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> A lack of consensus on the possible association between diabetes and salivary dysfunction motivated us to conduct this investigation on the salivary parameters in diabetic and non diabetic subjects. This could also make the use of saliva as an alternative to that of blood in the diagnosis/monitoring of diabetes mellitus. <b>Objectives:</b> To compare the salivary flow rates and the salivary physical and biochemical parameters of diabetic (D) and non diabetic (ND) subjects. <b>Material and Methods:</b> The participants in this study included 30 non diabetic subjects and 30 diabetic volunteers who had Type 2 Diabetes mellitus for a minimum of 2 years. Unstimulated whole saliva was collected in the fasting state. Salivary pH, flow rate and organic and inorganic constituents were evaluated. Data which was collected was statistically analysed and interpreted. <b>Results:</b> Salivary pH (ND=7.09±0.29, D=6.69±0.35), flow rate (ND=0.67±0.07, D=0.46±0.02) and salivary amylase (ND=92.51±13.74, D=19.20±1.8) were significantly lower in diabetics. They had significantly higher levels of salivary glucose (ND=4.33 ± 0.29, D=17.31±2.05), total proteins (ND=424.46±237.34, D=877.29±603.84), sodium (ND=4.31±0.65, D=14.42±1.83) and potassium (ND=20.84±0.71, D=25.95±1.56) and lower levels of calcium (ND=6.39±0.5, D=4.22±0.12) in comparison to those in the non-diabetic group. <b>Conclusion:</b> Significant variations were observed in salivary physical and biochemical parameters between diabetics and non diabetics. Evaluation of salivary parameters can be a cost effective and a non invasive alternative for screening, diagnosis and monitoring of diabetes, to blood. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1592-1595&id=3232 Profile of Lesions in Cystoscopic Bladder Biopsies: A Histopathological Study Srikousthubha, Sukesh, Raghuveer C.V, Sanjay hingle Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Aim and Introduction:</b> Urinary bladder lesions, non-neoplastic and neoplastic, are collectively responsible for significant morbidity and mortality throughout the world. The present study aimed to study the histopathology of various lesions of the bladder through cystoscopic biopsies. <b>Material and Methods:</b> The present prospective study aimed to study the histopathology of various lesions of the urinary bladder through cystoscopic biopsies. All patients who visited Urology Outpatients Department for haematuria and dysuria were subjected to cystoscopy. <b>Results:</b> Histopathological examinations revealed an equal share of non neoplastic lesions and neoplastic lesions. Amongst the non neoplastic lesions, 84% were inflammatory lesions. Urothelial tumours (96%) formed the bulk amongst neoplastic lesions. <b>Conclusion:</b> This article has stressed upon the importance of histopathological examinations in evaluating bladder pathologies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1609-1612&id=3233 A Comparative Study of Lipid Profile and Oestradiol in Pre- and Post-Menopausal Women Srinivas Reddy Kilim, Srinivasa Rao Chandala Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> To investigate the relationship between the menopausal status and related hormonal variation of oestradiol with plasma lipid concentrations. <b>Material and Methods:</b> Fifty premenopausal women and fifty postmenopausal women subjects were selected. Data was collected through clinical evaluation from questionnaires and laboratory investigations. Plasma oestradiol and lipid profile determinations were done by using competitive binding immunoassay methods and enzymatic methods respectively. Student’s T test and Pearson’s test of correlation were used for the statistical analysis. P-values of < 0.05 were considered to be statistically significant. <b>Results:</b> There was a significant increase in serum Total Cholesterol (TC), Triglycerides (TG), LDL-cholesterol and VLDL-cholesterol levels in post-menopausal women. HDL-cholesterol level was significantly decreased in post-menopausal women. The calculated atherogenic index (Total Cholesterol/HDL ratio) was significantly increased in post-menopausal women as compared to that in premenopausal women. Oestradiol concentration was significantly lower (p<0.001) in post-menopausal women. <b>Discussion:</b> Oestrogen changes the vascular permeability by increasing nitrous oxide production. It maintains a healthy lipoprotein profile. It stabilizes the endothelial cells, enhances antioxidant effect and alters fibrinolysis protein. All these cardioprotective mechanisms are lost in menopause. Postmenopausal women develop an increased risk for cardiovascular disease. <b>Conclusion:</b> Menopause leads to changes in lipid profile by reducing HDL, and elevating Total Cholesterol (TC), triglycerides (TG), LDL-cholesterol and VLDL-cholesterol, thus increasing the risk for cardiovascular disease. These changes are caused by reduced oestrogen concentrations which are seen in menopause. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1596-1598&id=3234 Asymptomatic Obese Hypertensives and Need of Routine Echocardiography for Left Ventricular Mass Assessment and Treatment Bindu Garg, Nirmal Yadav, Harsha Vardhan, A.K. De Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Echocardiographic determination of Left Ventricle Mass (LVM) – an important marker of cardiovascular disease, has been given a lot of importance in clinical diagnosis and in planning of treatment. Clinically asymptomatic compensated hypertensives show some pathological findings which are indicative of left ventricular dysfunction. <b>Methods:</b> The study population of 106 males, after a detailed clinical examination, were evaluated by echocardiography and were classified as per the body mass index classification of WHO Western Pacific Region in 2000 for Asian population. Fasting blood samples were taken to estimate blood sugar and lipid profile. <b>Results:</b> It was observed that subjects in normal range of body mass index <45 years (23.68%) and >45 years (16.1%), subjects of overweight <45 years (15.7%) and >45 years (10.29%) and obese I and II<45 years (60.52%) and >45 years (73.52%). The comparison between left ventricular mass which was indexed to height2.7 in subjects who were <45 years and >45years was observed to be statistically significant (p<0.03). On comparing LVM/ht2.7 of normal BMI group with that of those with higher BMIs, it was noted to be significantly different (p<0.009), which was suggestive of adverse effects of increasing BMI on LVM. It was also observed that persons with increased BMIs showed changes in left ventricular geometry – 30.13% had concentric hypertrophy, 17.80% had concentric remodeling, 8.21% had eccentric hypertrophy and that 38.35% had normal left ventricle geometry. <b>Conclusion:</b> The present study therefore, indicated that it was better to do an echocardiographic screening of asymptomatic subjects who had even a marginal increase in blood pressure and BMI, to diagnose potential cardiac dysfunction. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1599-1603&id=3235 Variation of Reaction Time in Different Phases of Menstrual Cycle Sunil Kumar, Mehak Mufti, Ravikiran Kisan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objective:</b> To evaluate the influence of menstrual cycle on auditory and visual reaction times. <b>Method:</b> This study was conducted on thirty, healthy, regularly menstruating female subjects who were in the age group of 18-25 years. Influence of different phases of menstrual cycle on Auditory Reaction Time (ART) and Visual Reaction Time (VRT) was evaluated by using a portable audiovisual reaction time apparatus. <b>Result:</b> The statistical tests which were used were ANOVA and Students ‘t’ test, which showed that there were significant increases in ART and VRT during luteal phase, as compared to those in follicular phase. <b>Conclusion:</b> Changes in ART and VRT during different phases of menstrual cycle could be due to changes in the levels of female sex hormones, which in turn may lead to salt and water retention. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1604-1605&id=3236 Pulmonary Function Tests in Type 2 Diabetics and Non-Diabetic People -A Comparative Study Aparna A. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> The complications which are associated with type 2 Diabetes mellitus are mostly caused by macro vascular and micro vascular damages. The pulmonary complications of diabetes mellitus have been poorly characterised. The present study has focused on the mechanical aspects of lung dysfunction which are attributable to type 2 Diabetes Mellitus; maximal forced Spiro metric Pulmonary Function Tests (PFTs) like Forced vital capacity (FVC), Forced Expiratory Volume in 1sec (FEV1),. FEV1/FVC % and Peak expiratory flow rate (PEFR), to be specific. <b>Aims and objectives:</b> 1. To do a comparative analysis of the PFTs in type 2 diabetics and non-diabetics by using computerised spirometry. 2. To assess the effects of chronic hyperglycaemia on lung functions and functional limitations of activities of daily living which are ascribable to pulmonary complications, in patients with type 2 diabetes. <b>Material and Methods:</b> Spirometry was performed by using a computerised electronic spirometer, (RMS Helios 401, version 3-1-59, transducer number 4-16-1669) on 40 type 2 diabetics who were between 40-65 years of age and on 40 controls (who were matched for age, sex and BMI). Any person with a H/O smoking or any condition which affected the lung functions, was excluded from the study. The study was a cross sectional and a retrospective study. Data was analyzed and processed with the help of EPI INFO statistical software by using unpaired Student’s ‘t’–test (two-tailed). The level of significance was taken as a p–value of <0.025. <b>Results:</b> This study clearly showed a statistically significant reduction in FVC, FEV1, PEFR in type 2 diabetics as compared to those in the controls. FEV1/FVC% was increased in type 2 diabetics as compared to that in controls and the increase was statistically significant. <b>Conclusion:</b> This study concluded that type 2 diabetes adversely affects the mechanical functions of the lung, the pattern of disease being primarily restrictive in nature. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1606-1608&id=3237 Pattern of Psychiatric Referrals in a Tertiary Care Teaching Hospital in Southern India Narayana Keertish, M.T. Sathyanarayana, B.G. Hemanth Kumar, Nitesh Singh, Kaveri Udagave Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> There is a dearth of studies which are related to consultation-liaison psychiatry in India. The psychiatric referral rates in India are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a hospital. Studying the pattern of psychiatric referrals may pave the way for interventions to improve the current scenario. <b>Methods:</b> The study population comprised of all the patients who were referred for psychiatric consultation from other departments (both in-patient and out-patient) of the hospital over a period of two years. Data which was related to socio-demographic profile, source of referral, reason for referral and the psychiatric diagnosis were recorded and analyzed by using descriptive statistical methods. <b>Results:</b> A total of 520 patients were referred for psychiatric consultation, with a referral rate of 0.42%. A majority of the psychiatric referrals (59%) were from the department of medicine and the most common reason for referral was medically unexplained somatic complaints (23.1%), followed closely by anxiety (21%) and abnormal behaviour (13.1%). The most commonly diagnosed psychiatric disorders were neurotic, stress related and somatoform disorders (41.7%) followed by mood disorders (12.9%) and substance use disorders (12.7%). <b>Conclusion:</b> There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Further studies should focus on interventions that can improve referral rates through early recognition of the common psychiatric conditions, with particular emphasis on sensitizing the general physicians, who are the most common source of psychiatric referrals. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1689-1691&id=3238 Pregabalin in Chronic Post-thoracotomy Pain Atul Mishra, Amandeep Singh Nar, Ashvind Bawa, Gurinder Kaur, Sayesha Bawa, Seema Mishra Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Chronic post thoracotomy pain (CPP) has very high incidence and therefore it needs attention. Usually, it is burning, dysaesthetic and aching in nature and it displays many features of neuropathic pain. No one technique of thoracotomy has been shown to reduce the incidence of chronic post thoracotomy pain. <b>Objectives:</b> To evaluate the efficacy and safety of pregabalin in patients with chronic post thoracotomy pain. <b>Methods:</b> This prospective, randomized study was conducted on 50 consenting patients who underwent posterolateral thoracotomy. 25 patients were given pregabalin for 21 days (Group A). Another 25 were given diclofenac sodium (Group B) on demand and they escaped treatment. Visual Analogue Scale (VAS) scoring was performed on days 0, 1 and 7, then follow up was done at 3, 6, 12 and 24 weeks. The data was analyzed by using T-test and Chi- square test for various variables. <b>Results:</b> The pain VAS scores in group A were significantly low at all observation points except on day 0, day 1 and day 7 post-operatively, when the difference in pain scores in both the groups were comparable. The overall pain scores of group A were comparable at day 0, day 1 and at day 7 as compared to those of group B (p>0.9). Pain was significantly low at three weeks (p<0.05). Pain scores of group A were significantly low at 6 weeks,12 weeks and 24 weeks as compared to those of group B (p<0.001) and the difference was statistically significant. No significant adverse reactions were observed during study period. <b>Conclusion:</b> Pregabalin is a safe and an effective adjuvant which is used for reducing the chronic post thoracotomy pain, which has no side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1659-1661&id=3239 Necrotising Soft Tissue Infection&#8211;Risk Factors for Mortality Kalaivani V., Bharati V. Hiremath, Indumathi V. A Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Necrotising Soft Tissue Infection is a rapidly progressing fatal disorder, the prognosis of which depends on early diagnosis and management. <b>Objective:</b> In this study, our objective was to assess the factors contributing to mortality due to NSTI. <b>Methods:</b> A retrospective review of the records of all patients with NSTI involving fascia, skin or muscle between January 2007 and December 2011, was performed. The atiology, predisposing factors, risk factors, causative microbiological organisms and the clinical outcomes associated with mortality were studied. <b>Statistical Data:</b> Descriptive statistics comprising of proportion(%) presented. Chi–square test was employed to assess the statistical significance in the distribution of various known risk factors between the survivors and non–survivors. A ‘p’ value less than 0.05 was considered significant. <b>Results:</b> Sixty patients records were reviewed. Fifty-one patients (85%) were males and nine (15%) were females. Mean age was 46.57 years (+/- 20.60) ranging from 15–83 years. All the patients were treated by debridement & wide spectrum antibiotics. Mono-microbial atiology being found in 27 patients (63.3%) and polymicrobial culture was isolated in 13 patients (36.7%), with E-coli and staphylococci being the most common organisms to be isolated. In most patients, multiple debridements were done. The overall mortality rate was estimated to be 25%. Age, aatiology, diabetes mellitus, hypoalbuminemia, alcohol, site of infection, bacteriology etc. were the risk factors associated with mortality, that were evaluated. Diabetes mellitus was the most common associated risk factor found in 32 patients (53.3%), though not statistically significant. Increasing age (>50 years, p value = 0.016), raised Serum Creatinine (>1.2mg/dl, p-value = 0.023) and delayed surgical intervention(>24 hours p value= 0.006) were the risk factors associated with Mortality in NSTI that were statistically significant. <b>Conclusion:</b> Despite the use of appropriate antibiotic treatment, aggressive debridement & resuscitation, NSTI still leads to a high mortality & morbidity. In this series, there is high mortality associated with increasing age, raised serum creatinine and delayed surgical intervention. The mortality rate (25%) is comparable with other studies. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1662-1665&id=3240 Comparing the Efficacy of Tamsulosin and Silodosin in the Medical Expulsion Therapy for Ureteral Calculi Sandeep Gupta, Bijit Lodh, Akoijam Kaku Singh, Khumukcham Somarendra, Kangjam Sholay Meitei, Sinam Rajendra Singh Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Urolithiasis is a chronic disease of mankind, which has enormous public health importance and it accounts for a substantial economic burden on our society. Hence, it becomes all the more important to formulate cheaper and easier means for treating this condition. The past few years have seen a number of drugs being introduced and successfully used in the medical expulsion therapy of small, uncomplicated ureteral calculi, with each drug claiming to provide better results than the others. Ours is perhaps the first study which has compared the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. <b>Aims:</b> To compare the efficacy of tamsulosin (0.4mg) vs silodosin (8mg), both in terms of the stone expulsion rate and the time to stone expulsion. Settings and Design: A prospective and a randomized controlled study was conducted in the Department of Urology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. Material and Methods: From February to August 2012, 100 patients who were between the age group of 18–50 years, who had unilateral, uncomplicated middle or lower ureteral stones </= 1cm were enrolled and they were divided into two groups. Group 1 received tamsulosin (0.4mg) daily, whereas Group 2 received silodosin (8mg) daily for a maximum period of 4 weeks. The patients were followed up weekly or biweekly with imaging studies. The primary endpoint was the stone expulsion rate and the secondary endpoints were the stone expulsion time, the rate of the interventions and the side effects. <b>Statistical Analysis:</b> The statistical analysis was performed by using the Student’s t-test and the Chi–squared test. A p value of < 0.05 was considered to be statistically significant. The SPSS-16 software was used for the statistical analysis of the data. <b>Results:</b> A spontaneous stone expulsion was observed in 58% of the patients in group 1 and in 82% of the patients in Group 2, which was statistically significant. There was also a significant difference between the groups with regards to the mean stone expulsion time. A lower analgesic use was found in Group 2. <b>Conclusion:</b> In our study, silodosin was found to be clinically superior to tamsulosin, both in terms of the stone expulsion rate and the stone expulsion time. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1672-1674&id=3241 Determinants of Urea Production and Mineral Retention in Parenterally Fed Preterm Infants Christopher Geoffrey AlexAnder Aiken Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objective:</b> To determine how weight for gestational age affects urea and mineral excretion by preterm infants receiving total parenteral nutrition (TPN). <b>Study Design:</b> Daily urine samples were collected from all preterm infants given high calcium TPN, providing 30 kcal/g amino acids, during its first 44 months of use, and from all those given standard TPN, providing 25 kcal/g amino acids, over the previous 24 months. Urine urea and mineral excretion were measured as follows: Urea excretion mmol/kg/day = Urine urea/urine creatinine X creatinine production Creatinine production µmol/kg/day = -2.07 + 2.34 X gestational age in weeks. <b>Results:</b> High calcium TPN was evaluated in 52 infants. Urea excretion did not rise with increasing TPN intake. During the first week, urea excretion increased with weight for gestational age, with higher rates in above average than below average weight infants. It also increased with gestational age in above average but not below average weight infants. Below average weight infants had lower potassium and phosphate excretion than those above average. Standard TPN was evaluated in 20 infants. Urea excretion increased with TPN intake to higher levels than on high calcium, and also increased with weight for gestational age. <b>Conclusion:</b> Urea excretion was simple to measure, with remarkably consistent daily results in individuals. Below 30 weeks gestation infants on TPN providing 30 kcal/g amino acids had urea excretion < 0.1 g urea N/kg/day, < 3.5 mmol/kg/day if below average weight, and < 0.12 g urea N/kg/day, < 4.3 mmol/kg/day if above average weight. Below average weight infants retained more potassium and phosphate during the first week than those above average, and their greater requirements were provided by the TPN. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1655-1658&id=3242 Study on Neuromuscular Blockade Action of Verapamil in Albino Rats Jayashree Nagaral, Shashikala Gh, Jagadeesh K, Sharath Kumar K, Jayanth Gs, Chennaveerappa Pk, Rajani Patil Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b>Calcium Channel Blockers (CCBs) are now widely employed in the treatment of cardiovascular diseases and peri operative hypertension. It has been reported that calcium channel blockers inhibit neuromuscular transmission. They have been shown to increase the neuromuscular blockade produced by neuromuscular blocking agents in in-vitro muscle nerve preparations. The present study is undertaken to demonstrate the effect of calcium channel blocker, verapamil on neuromuscular transmission in albino rats. <b>Objectives:</b>To study the neuromuscular blockade action of verapamil in albino rats. <b>Methods:</b>Twenty four albino rats of either sex weigh 150- 250gms are selected and are randomly divided into 4 equal groups. The experimental rats are divided into four groups of 6 rats each and they are given the following treatment. Group 1(Control) - Normal saline (1ml/ kg), Group 2 (Standard) - Pancuronium (0.04 mg/kg) Group 3-Verapamil (2.5mg/kg), Group 4-given Verapamil (10mg/kg). The time of onset of hind limb paralysis and total duration of recovery are noted using inclined screen method. <b>Results:</b>Analysis of the results of group 3 that was received 2.5mg/kg of Verapamil, there was no onset of paralysis, in group 4 that received injection Verapamil 10mg/kg, showed neuromuscular blockade activity. The mean onset of hind limb paralysis was delayed compared to standard group and the mean duration of hind limb paralysis was shorter than standard group. It was statistically significant (P=0.05). <b>Interpretation and conclusion:</b>It is generally held that external calcium is not necessary for the contraction of mammalian skeletal muscle, the demonstration of inward calcium currents that can be abolished by CCBs in these muscles prompted to re-examine the effect of Verapamil on the neuromuscular transmission. The present study allows us to determine the neuromuscular blockade activity of Verapamil ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1617-1619&id=3249 Human Immunodefeciency Virus Associated Cryptococcal Meningitis At A Tertiary Care Centre: Diagnostic Tools And Antifungal Susceptibility Testing Rashmi Munivenkataswamy, Anjana Gopi, Shaik Mohammed Usman, Jagadeesh Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b>Cryptococcal meningitis has emerged as a leading cause of the infectious morbidity and mortality in HIV sero- reactive subjects and it is the second most common cause of the opportunistic neuroinfections in it. As this is a indistinguishable from other causes of meningitis, its early diagnosis is the key to the therapeutic success. <b>Objectives:</b>This study was undertaken to know the incidence of Cryptococcal meningitis in HIV sero–reactive individuals and to assess the role of the microbiological parameters in its specific diagnosis, with a perspective of evaluating the anti–fungal resistance. <b>Material and Methods:</b>A total of 66 CSF samples from suspected cases of meningoencephalitis were subjected to standard microbiological procedures. The Cryptococcal isolates were identified by microscopy, the cultural characteristics, melanin production on Niger Seed agar, urea hydrolysis, the Nitrate assimilation test and by capsular antigen detection by latex agglutination. The Cryptoccal isolates were further biotyped by using Canavanine–Glycine–Bromothymol blue agar. The Minimum Inhibitory Concentrations (MIC) of Amphotericin B and Fluconazole for the isolates were detected. <b>Results:</b>The incidence of Cryptococcal meningitis in our study group was 18.2% (12/66). The Cryptococcal antigen was detected in all the 12 cases, whereas microscopy was positive only in 9 cases and Cryptococcus was isolated by culture in 10 cases. All the isolates were sensitive to Amphotericin B and 90% of the isolates were sensitive to Fluconazole. The CD4 counts ranged between 22-138 cells /µl. <b>Conclusion:</b>A high incidence of Cryptococcal meningitis in HIV sero-reactive subjects necessitates the importance of a precise and an early microbiological diagnosis for better management of such subjects. Due to the growing concern of emerging drug resistance, the testing for the anti–fungal susceptibility has to be encouraged in all the cases ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1623-1625&id=3271 Thyroid Function In Type 2 Diabetes Mellitus and in Diabetic Nephropathy Srinidhi Rai, Ashok Kumar J, Prajna K, Shobith Kumar Shetty, Tirthal Rai, Shrinidhi, Mohamedi Begum, Shashikala Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Introduction:</b> Diabetic patients have higher prevalence of thyroid disorders than the general population which may have an influence on diabetic management. The present study compared the levels of thyroid hormones, serum creatinine, glycated haemoglobin and urine microalbumin between type 2 diabetics without any complications, type 2 diabetics with nephropathy and age and sex matched normal controls. <b>Result:</b> The mean serum T3 level in type 2 diabetics without any complications was 91.27 ± 14.56 ng/dl, in type 2 diabetics with nephropathy was 88.5320 ± 30.87 ng/dl and in controls was 134.98 ± 28.55 ng/dl. The mean serum T4 level in type 2 diabetics without any complications was 7.73 ± 1.42 µg/dl, in type 2 diabetics with nephropathy was 7.25 ± 2.72 µg/dl and in controls was 8.61 ± 1.73 µg/dl. The mean serum TSH level in type 2 diabetics without any complications was 3.99 ± 1.87 µIU/ml, in type 2 diabetics with nephropathy was 4.27 ± 1.62 µIU/ml and in controls was 2.07 ± 1.09 µIU/ml. Correlations between T3, T4, TSH with serum creatinine, glycated haemoglobin were not statistically significant in type 2 diabetes without any complications and diabetic nephropathy. We found a statistically significant correlation between T3 and urine microalbumin in patients with diabetic nephropathy. <b>Conclusion:</b> Failure to recognize the presence of abnormal thyroid hormone levels may be a primary cause of poor management of diabetes mellitus type 2. Therefore there is a need for the routine assay of thyroid hormones in type 2 diabetics and diabetic nephropathy in order to improve the quality of life and reduce the morbidity. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1583-1585&id=3299 Determination of Sites Involved, HIV Co&#8211;Infection & Utility of Diagnostic Modalities in EPTB Aruna Shanmuganathan, Srinivasan R, Thilagavathy G, Satishkumar D, Sidduraj C, Bonny James Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Tuberculosis remains a major global public health problem and an on-going epidemic. Though the chief objectives of the Revised National Tuberculosis Control Programme (RNTCP) in detecting and curing the infectious pulmonary cases is well taken, there has been a steady rise in the number of Extra Pulmonary Tuberculosis (EPTB) cases as documented in several studies. EPTB which usually constitutes around 15%-20% of the total TB cases is now being increasingly reported due to a combination of better diagnostic facilities, and the HIV pandemic. Though several studies have shown increasing prevalence of EPTB, only few studies are available, especially in the Indian scenario, that study the pattern and risk factors. Hence, this retrospective observational study was undertaken to determine the sites of the involvement, HIV co-infection and usefulness of various diagnostic modalities in EPTB affecting patients attending a medical college DOTS clinic. <b>Material and Methods:</b> 110 EPTB patients referred to the DOTS clinics of the TB & Chest department from the period Dec 2010– Mar 2012 were included in the study. The diagnosis of EPTB was established by combined clinical, microbiological, histopathological &/or imaging modalities. Their medical records were assessed to determine the age distribution, gender and anatomical sites of involvement. The presence of co-morbid conditions like smoking history, alcoholism, diabetic and HIV status were noted. BCG status and Mantoux test readings were recorded. The different diagnostic tests used in confirming EPTB at different sites were recorded. Chest x-ray was analysed for all patients to assess coexisting pulmonary involvement. All patients were followed to assess the outcome of treatment. <b>Results:</b> The mean age of patients was 34.4. The male to female ratio was 58:52 showing a slight male predominance. The most common site of involvement was lymph node followed by pleural effusion and abdominal TB. The prevalence of lymph node TB was noted to be higher in female patients as compared to other sites of EPTB. Mantoux test was positive in 57 (51.8%) patients. HIV co-infection was noted in only 3 (2.7%) patients. Concomitant pulmonary involvement was seen in 19 (17.3%) patients. <b>Conclusions:</b> Lymph node was the most common site involvement showing a significant female preponderance followed by pleural effusion and abdominal TB. The rates of HIV co-infection and diabetes mellitus were 2.7% and 20% respectively. The most useful diagnostic modality was tissue sampling followed by imaging. Mantoux test is not unequivocal for the diagnosis of EPTB. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1644-1646&id=3301 Cardiac Blood Flow Measurements in Stable Full Term Small for Gestational Age Neonates Nishant Banait, Pradeep Suryawanshi, Nandini Malshe, Rema Nagpal, Sanjay Lalwani Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Cardiac blood flow measurements are useful in the haemodynamic management of neonates. Cardiac blood flows can be estimated with functional echocardiography as follows; flow in Superior Vena Cava (SVC), Right Ventricular Outflow (RVO) and Left Ventricular Outflow (LVO). Studies in preterm infants have shown that abnormal superior vena cava flow is associated with poor neurodevelopmental outcomes. To date, normative data on LVO, RVO and SVC flows has been established for term appropriate for gestational age neonates and preterm neonates, but no data is available on RVO, LVO and SVC flows for term small for gestational age neonates. Objective: To determine Right Ventricular Output (RVO), Left Ventricular Output (LVO) and Superior Vena Cava (SVC) flow after the transitional period in stable full term Small for Gestational Age (SGA) neonates. <b>Design:</b> Observational study. <b>Setting:</b> A tertiary care, perinatal centre in western Maharashtra, India. <b>Participants:</b> Full term (37 to 41 weeks) small for gestational age (weight below 10th percentile for gestational age) infants who were born during the study period. <b>Methods:</b> RVO, LVO and SVC flows were measured by functional echocardiography on day 7 of life in stable full term SGA neonates from January 2011 to August 2011. Infants who required respiratory or cardiovascular support and intensive care unit admissions for any indication and those with a clinical suspicion of an infection within 48 hours after data collection were excluded from the study. <b>Statistical Analyses:</b> Unpaired t-test was used to compare SVC flow between symmetric and asymmetric SGA neonates. <b>Main Outcome Measure:</b> Measurements of RVO, LVO and SVC in term SGA neonates on day 7 of life. <b>Results:</b> We performed measurements in 52 term SGA neonates with a median (range) birth weight of 2.190 (1.600-2.410) kg. Fifty two measurements were analyzed on day 7. The mean (SD) RVO, LVO and SVC flows were 255.59 (57.42) , 214.61 (52.04) and 126.28 (31.23) mL/kg/min. <b>Conclusion:</b> This study provides RVO, LVO and SVC flow values in a cohort of stable term SGA neonates after the transitional period. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1651-1654&id=3302 Isolated Cutaneous Sarcoidosis: A New Insight into the Old Entity Sharath Kumar H K., Gayathri M N., Bharathi M., Ravikumar T. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Cutaneous lesions are a part of common manifestation in multi–systemic sarcoidosis and skin involvement occurs in 20% to 35% of the patients with systemic disease. An exclusive cutaneous involvement is rare and it is reported in about 4%-5% of the patients of sarcoidosis. These lesions have been classified into specific and non–specific, depending on the presence of non- caseating granulomas, on histopathologic studies. In the present study, we are reporting two cases of isolated cutaneous sarcoidosis without systemic manifestations, which is a rare presentation. Sarcoidosis will continue to challenge even the most experienced clinicians with respect to a high degree of suspicion and further investigations for diagnosing and treating this disorder. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1725-1726&id=3303 Multiple Hepatic Inflammatory Pseudotumours Diagnosed after Laparoscopic Excisional Biopsy Andre Costa–Pinho, Renato Bessa Melo, Luis Graca, Jose Manuel Lopes, J. Costa–Maia Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Inflammatory pseudotumours (IPTs) may occur in almost every organ of the human body, the liver being the second most frequent organ which is affected. Inflammatory pseudotumours of the liver are rare benign lesions of unknown aetiology, which usually present as solitary liver masses of variable sizes. The differential diagnoses of malignant liver tumours are challenging and they usually require biopsies and histologic examinations. We are presenting the case of a patient with multiple hepatic lesions which mimicked liver metastases. Two percutaneous biopsies were inconclusive. The definitive diagnosis of multiple hepatic inflammatory pseudotumours was made after a laparoscopic exploration with an excisional biopsy of liver lesions and their pathologic evaluation. All lesions disappeared after several months, without any further treatments. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1730-1731&id=3304 Infantile or Malignant Osteopetrosis: Case Report of Two Siblings Tarakeswara Rao P., Sunita V., Gandhi T.P., Sri Harsha Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Infantile or Malignant osteopetrosis is a rare congenital disorder of bone resorption. It is caused by failure of osteoclasts to reabsorb immature bone. Severe infantile or malignant osteopetrosis present at birth or develops within the first few months of life. We are reporting here a case of two siblings with malignant osteopetrosis. Prominent clinical features included marked pallor, noisy respiration, progressive blindness and developmental delay. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1759-1760&id=3305 Spontaneous Rupture of Pyometra &#8211; A Rare Cause of Peritonitis In Elderly Female Vijaya Patil, L.S. Patil, Shobha Shiragur, Ravi Ichalakaranji Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X The incidence of spontaneous perforations in pyometra is rare, being 0.01-0.5% in gynaecological patients. However, they are more common in postmenopausal females and their incidence is 13.6%. Here, we are reporting a rare case of peritonitis with a pneu­moperitoneum in an elderly female, which was caused by a spontaneous perforation of pyometra. A 74-years old post­menopausal female with uncontrolled diabetes mellitus was admitted to surgical emergency with signs of diffuse peritonitis and she was in shock. After resuscitation, an emergency laparotomy was performed because of suspicion of a hollow viscous perforation with peritonitis. At laparotomy, about 2000ml of purulent fluid was found to be present in peritoneal cavity, while alimentary tract was intact. A rent with a diameter of 0.8 cm was found on fundus of uterus. A total abdominal hysterectomy with a bilateral salphingo oophorectomy was performed. Patient got discharged on 12th post-operative day without major complications. Histopathological studies revealed endometritis and myometritis, with no evidence of malignancy. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1735-1736&id=3272 Spindle Cell Epithelioma: A Rare Vaginal Tumor &#8211;A Clinico Pathologic Report Nivedita K., Sowmya, Fatima Shanthini Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Spindle cell epithelioma is a very rare benign tumour of the vagina, which contains epithelial and mesenchymal components and co-expresses the markers for both. It has its origin in the epithelial cells of the remnants of the vestibular gland. The presence of glandular structures and the pattern of immunostaining, help in the differentiation of these tumours from the other common vaginal tumours. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1743-1744&id=3250 A Diagnostic Dilemma: A Young Boy with Loss of Weight, Pulmonary Infiltrates and Cervical Lymphadenitis Asmita A. Mehta, Sunil Kumar K., Rajesh Venkitakrishnan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Cervical lymphadenitis is a common finding in young adults in a country like India, where tuberculosis is endemic. We are presenting the case of a young boy who presented with low grade fever, dry cough, weight loss, and a cervical swelling. His chest X-ray showed diffuse reticulonodular infiltrates. Contrast enhanced CT of chest showed bilateral multiple ring shadows. Cervical lymph node fine needle cytology suggested a metastatic thyroid carcinoma. He was evaluated extensively and a final diagnosis of a familial medullary thyroid carcinoma was made. Medullary thyroid carcinoma should be considered in the differential diagnosis of cervical lymphadenitis with lung infiltrates in young adults. It may be sporadic or a part of an inherited autosomal dominant disorder like multiple endocrine neoplasia. Genetic testing should be done for all patients with a diagnosis of medullary thyroid carcinoma. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1745-1746&id=3251 Appendiceal Carcinoma with Krukenberg&#8217;s Tumour Mimicking Primary Ovarian Cancer Clement Wilfred D., Vijaya Mysorekar V., Sulatha Kamath, Saurabh Singla Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Appendiceal adenocarcinoma (AACa) is a rare tumour which represents 0.5% of all gastrointestinal malignancies. The prognosis is poor, because it is usually found at an advanced stage, that in turn, is partly due to a low threshold of suspicion and difficulties in diagnosis prior to surgery. It may occasionally demonstrate ovarian metastases that are large and which dominate the clinical and radiological presentations, leading to a misdiagnosis of an ovarian primary malignancy. We are reporting a case of an occult AACa which manifested clinically as a primary ovarian cancer which was at an advanced stage. Staging laparatomy revealed large bilateral ovarian tumours of clinical FIGO Stage III, with presumed appendiceal implants. Histological examination revealed a mucinous adenocarcinoma with a signet ring component, which involved bilateral ovaries and the appendix transmurally. Immunophenotypic analysis revealed a positive expression of CK 20 and CDX 2 and absence of CK 7 staining, which was compatible with appendiceal primary and ovarian metastases. The diagnosis was subsequently revised to AACa with Krukenberg’s metastasis, Stage IV. Although AACas are uncommon, they should be considered in the differential diagnosis of intraabdominal masses and the distinction between ovarian and appendiceal primary malignancies is critical, as the treatment modalities vary. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1747-1749&id=3252 Osteochondroma of the OsCalcaneum- A Case Report Ashok Kumar Patnala, M. Eswara Babu, M. Chandrasekharam Naidu, S Shyam Kumar, P. Varun Kumar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Osteochondromas are common benign bone tumours. They usually occur in the patients who are below thirty years of age. They probably are developmental malformations rather than true neoplasms. They are believed to originate within the periosteum as small cartilaginous nodules. The foot is rarely a common site of presentation for these tumours. The calcaneum is one of the most unusual regions for the occurrence of osteochondromas 1. The osteochondromas which arise from the calcaneum, especially those which project onto the plantar surface, pose considerable problem to the ambulation. Malignant transformations are seen in less than 1% to 2% of the patients with solitary osteochondromas 2. We herewith present a case of osteochondroma which arose from the calcaneum, which was surgically excised to improve the patient’s daily functioning. The patient was followed up for a period of one year. She is now able to walk comfortably. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1737-1739&id=3253 Aneurysmal Bone Cyst of the Pubis: A Case Report Ashok Nayak, Shreepad Kulkarni, Avinash Kulkarni, Natesh K., Monish Bami Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X An aneurysmal bone cyst is considered as a locally aggressive benign tumour. Intra-lesional extended curettage and bone-grafting is the mainstay of the treatment for aneurysmal bone cysts. Grafting is used usually in cases where the lesion compromises the mechanical strength of the bone. However, the massive size of the highly vascular tumour and the relative inaccessibility of its deeper extensions into the femoral vessels and the intra-abdominal structures, especially the urinary bladder, make it a relatively challenging case to perform excision and curettage. Presenting a case of a 15 years old male patient with the complaint of a right inguinal swelling since the past eight months. The swelling had started growing since the past two months and it was associated with pain. X-ray showed a lytic blowout legion of the entire right pubic ramus. An intra-lesional curettage was done. Complete tumour excision which was done by intra-lesional curettage and biopsy yielded satisfactory results with low complications and low recurrence of aneurysmal bone cyst of the superior ramus of the pubis. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1740-1742&id=3254 A Non&#8211;Resolving Consolidation which was Caused by a Bronchial Foreign Body in an Adult: A Case Report Gyanshankar Mishra, Jasmin Mulani Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A fifty year old female presented with cough, breathlessness and chest pain of eighteen months duration. She presented as a case of a non–resolving consolidation. Video bronchoscopy revealed a bronchial foreign body. This case is being reported here, to underline the role of bronchoscopy in a case of a non resolving consolidation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1750-1752&id=3255 Management of Giant Cystic Lymphangioma in an Infant Rajendra K. Ghritlaharey Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Lymphangiomas are benign lesions with a marked predilection for the head and neck region. Giant lymphangiomas of head and neck may occur and they may present with life threatening complications. The author is presenting here, a three month-old boy who presented with a giant cystic lymphangioma on left side of neck, which extended to the head as well. His clinical diagnosis of a cystic lymphangioma was confirmed on a Ultrasonography (USG) examination. Complete surgical excision of the lesion was achieved, without damaging any vital structures. His post-operative recovery was uneventful. A follow-up at two months after his surgery showed a cosmetically acceptable scar and no recurrence was noted. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1755-1756&id=3256 Parameatal Cyst: A Presentation of Rare Case and Review of Literature Lal S, Agarwal Ankur Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A parameatal urethral cyst is a very rare congenital anomaly. It was first reported in two males in 1956 by Thompson and Lantin. About 50 cases have been published since then. Most of the cases which have been reported were from Japanese population and on extensive literature search, few cases were found to have been reported from India. We are reporting a case of a parameatal urethral cyst in a 7-year-old boy. Complete excision of the cyst with total removal of the epithelium is required for treatment and for prevention of recurrence. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1757-1758&id=3257 Chondroid Choriostoma of Palatine Tonsil &#8211; A Rare Entity Jyotsna Naresh Bharti, Nivedita Ghosh, Prerna Arora, Vasudha Goyal Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A choristoma or heterotopias is an aggregate of microscopically normal cells or tissues which occurs in aberrant locations. A choristoma is a tumour like mass, whereas heterotopias refers to a displaced tissue which is necessarily not a swelling or a neoplasm. We are reporting a case of a 24 year old female who presented with recurrent tonsillitis and halitosis. On examination, the tonsils were found to be enlarged. Because of the persistent symptoms, a tonsillectomy was performed. The histopathological examination showed features of chronic tonsillitis, along with presence of mature islands of hyaline cartilage which were surrounded by lymphoid follicles and focal areas of calcification and osseous metaplasia. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1700-1701&id=3258 Solitary Plasmacytoma of Skull: A Rare Cytological Diagnosis Manmeet Kaur Gill, Manisha Makkar, Satinder Pal Singh Bains Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Solitary Plasmacytoma of the Skull (SPS) is very rare and only 35 cases have been reported in the English literature. It remains controversial whether a solitary plasmacytoma of the skull is essentially identical with a Solitary Plasmacytoma of Bone (SPB) or not. A solitary plasmacytoma of bone, which includes a solitary plasmacytoma of the skull, is characterized by a radiologically solitary bone lesion, neoplastic plasma cells in the biopsy specimen, fewer than 5% plasma cells in bone marrow, less than 2.0 g/dl monoclonal protein in the serum when it is present and a negative urine test for Bence Jones protein (monoclonal light chain). A solitary plasmacytoma of bone tends to disseminate or progress to multiple myeloma, even as long as 7-23 years after its presentation. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1702-1703&id=3259 Granulocytic Sarcoma Presenting as an Orbital Mass: Report of Two Cases Brijesh Thakur, Kachnar Varma, Vatsala Misra, Smita Chauhan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Granulocytic sarcoma is a rare variant of a myeloid malignancy, which shows an extra-medullary tumour mass which is composed of my - eloblasts and myeloid precursors with varying degrees of differentiation. It occurs most commonly in bone, periosteum, soft tissue, lymph nodes, and skin; although it can occur anywhere throughout the body. Here, we are reporting two cases of orbital granulocytic sarcoma in children, which presented clinically with proptosis and periorbital swellings, which were first diagnosed by Fine Needle Aspiration Cytology (FNAC). Later, peripheral blood and bone marrow aspirate examinations revealed the evidence of Acute Myeloid Leukaemia (AML). These cases are being documented to demonstrate the utility and diagnostic accuracy of FNAC in evaluation of this entity, in cases of unsuspected AML. Recognition of this rare entity is important, because giving an early aggressive chemotherapy can cause regression of the tumour and thus improve the patient survival ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1704-1705&id=3260 Lipoma on Palmar Aspect of Thumb: A Rare Case Report Hemlata T. Kamra, Santosh L. Munde Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Lipomas account for approximately 16% of soft tissue mesenchymal tumours. They are uncommon in hand and those which involve the fingers are very rare, with a reported incidence of 1%. In extremities, they often arise from the sub–fascial tissues of the hands and feet, where they may be mistaken for ganglion cysts. A careful dissection is necessary during the surgical procedure, in order to avoid recurrence. Here, we are presenting the case of an 8 years old boy who had Lipoma on palmar aspect of thumb. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1706-1707&id=3261 Knee Locking in Osteoarthritis due to Synovial Lipoma: A Case Report Kataria S. Amarjit, Shivali Budhiraja, K. Chandramouleeswari, S. Anita Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Intra–articular synovial lipomas are very rare and only few cases have been reported till now. We are reporting a rare case of a unilateral intra–articular lipoma of osteoarthritic knee joint in a 62 years old male. Patient had two episodes of sudden locking of knee joint, which resolved spontaneously. A plain X-ray showed changes which were suggestive of osteoarthritis. Clinically, patient was diagnosed as a case of loose bodies in left knee joint. An arthrotomy was performed. After a Histopathological Examination (HPE) of loose bodies, a diagnosis of an intra–articular synovial lipoma was made. Due to wide differentials and varied clinical behaviour of loose bodies, lipoma should be included in differential diagnosis of osteroarthritic patients who complain of episodic locking of knees. Intraarticular lipomas, on arthroscopic guided excision, get cured permanently, with no recurrence. The differentiation of an intra-articular lipoma from a relatively more common entity, Lipoma arborescens, has also been discussed. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1708-1709&id=3262 Primary Osteosarcoma of Breast, A Rare Case. Soumit Dey, Mrinal K. Chaudhury, Samar K. Basu, Asim K. Manna, Subir K. Dutta Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Mammary sarcomas are very uncommon and make up less than 1% of all primary breast malignancies.Primary osteosarcoma of the breast is extremely rare and represents 12.5% of mammary sarcomas. A secondary lesion from a primary osteosarcoma of the bone should be considered in the differential diagnosis. In addition, the absence of a direct connection between the tumour and the underlying skeleton is mandatory for the diagnosis.We report a case of primary osteosarcoma of the breast occurring in young patient with fatal evolution. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1710-1711&id=3263 A Hydatid Cyst of the Appendix which Mimicked a Tubo-ovarian Mass: A Case Report and Review of the Literature Deepti Agarwal, Farhan Huda, Arathi N., Seema Awasthi Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Hydatid disease, an endemic in the cattle grazing areas, particularly in the Asian region, is a parasitic infection which is caused by the cestode tapeworm, Echinoccocus granulosus. There is involvement of the intra–abdominal organs apart from the liver, in 10-15% of the cases. We are reporting a case, wherein the appendix was involved with this parasitosis and we have discussed the review of the literature regarding the diagnostic, surgical and the newer percutaneous approaches for the management of this disease. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1712-1714&id=3264 &#8220;Cannon Balls or Pus Balls&#8221; in Pap Smears: A Case Report Vijay Kumar Bodal, Sarbhjit Kaur, Ranjiv Bhagat, Rupinder Kaur, Manjit Singh Bal Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A 50–year old female presented with the chief complaint of a discharge per vaginum, which was there for the past 15 days. A routine PAP smear was received in the Department of Pathology, Government Medical College, Patiala, India. After its fixation and staining, it was examined under the microscope. It showed the Trichomonas vaginalis infection, with the neutrophils forming cannon balls at places. Neutrophils in the PAP smear are a nonspecific finding, particularly if they are low in numbers or if they are seen in the premenstrual and the menstrual phases. The neutrophils which are adherent to the squamous cells are called “cannon balls” or “pus balls”, which are common in the Chlamydia infection. This case is being presented because of the presence of these rare morphological structures i.e. “cannon balls” or “pus balls”. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1715-1716&id=3265 A Caliber Persistent Artery (Dieulafoy&#8217;s Lesion) which is Associated with an Early-Stage Gastric Stump Cancer Following a Distal Gastrectomy Simona Gurzu, Constantin Copotoiu, Leonard Azamfirei, Ioan Jung Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A 75–years old man was hospitalized with symptoms which suggested gastric cancer. Thirty-eight years ago, he had undergone a Billroth-II gastric reconstruction for a peptic ulcer. At the present admission, he had presented with an eight-month history of recurrent haematemesis, epigastric pain, vomiting, and fatigue. The emergent endoscopy showed a type 0-IIc (superficial depressed) early gastric stump cancer in the anastomotic area and total removal of the gastric remnant and the jejunal segment was performed. The histological examination of the surgical specimen showed a gastric adenocarcinoma that invaded the mucosa and the submucosa, without lymph node metastases (pT1bN0 stage). Besides the tumour, enlarged vessels were observed in the submucosa and the muscularis propria, some of which were thrombotic. The surrounding normal gastric wall also presented submucosal oversized vascular spaces, some of which were protruding through the muscularis mucosae in the mucosal layer. Based on these characteristics and the recurrent haematemesis, a final diagnosis of early gastric stump carcinoma which was associated with Dieulafoy’s lesion was made. This association has not yet been reported in the literature and it allowed us to diagnose the gastric stump cancer in a very early stage. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1717-1719&id=3266 Giant Inflammatory Variant of Well Differentiated Liposarcoma: A Case Report of a Rare Entity Manisha Sharma, Rahul Mannan, Tejinder Singh Bhasin, Mridu Manjari, Rajan Punj Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X An inflammatory liposarcoma is a rare variant of a well-differentiated liposarcoma. A case of a giant variety of an inflammatory well–differentiated liposarcoma is being reported. CT scan revealed a large abdomino–pelvic mass which had displaced the gut loops to left and posteriorly and urinary bladder and uterus to right. FNAC yielded mature adipocytes with no evidence of atypical cells. The large bossilated and irregular fibro–fatty mass which weighed 23 kg was excised. Microscopy revealed mature adipocytes with foci of fibrosis and abundant inflammatory cell infiltrates of eosinophils, lymphocytes, plasma cells and few neutrophils, along with few atypical cells. Only a few cases of a giant inflammatory variant of a well–differentiated liposarcoma have been reported in the world literature and this is first of its kind from the Indian sub–continent. A rare giant variant of a inflammatory well–differentiated liposarcoma with abundant eosinophils is being reported here, along with review of literature. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1720-1721&id=3267 Holoprosencephaly with Multiple Anomalies of The Craniofacial Bones-An Autopsy Report E. Aruna, V. Kalyan Chakravarthy, D. Naveen Chandar Rao, D. Ranga Rao Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Holoprosencephaly (HPE), a disorder which results from a failure of cleavage or the incomplete differentiation of the forebrain structures at various levels or to various degrees, is related to hereditary factors, chromosomal anomalies, cytogenetic abnormalities, and environmental teratogenic factors. We are reporting a case of a multiparous woman who was G3,P3,L2, who delivered a full term foetus with holoprosencephaly and multiple craniofacial anomalies. An autopsy was conducted. Multiple anomalies of the craniofacial bones, which include hypoplasia and synostosis of the frontal bone, anophthalmia, absence of the anterior cranial fossa, hypoplasia of the maxillae, an absent antrum, cleft palate, a central hare lip and arrhinia which includes absence of the nostrils and hypotelorism of the eye placodes, were noted. This case is being reported for its rarity and the available literature was reviewed in this respect. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1722-1724&id=3268 Asymptomatic Disseminated Cysticercosis Ashima Vaidya, Suman Singhal, Sonia Dhall, Ashish Manohar, Harsh Mahajan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Cysticercosis is a common problem world wide. However, disseminated cysticercosis is rare. Still rarer is asymptomatic disseminated cysticercosis. We are reporting here a rare case of asymptomatic disseminated cysticercosis which involved brain, face, orbit, lungs, heart, pancreas and spleen in a young Nigerian male, who sought medical attention for dysphagia which was diagnosed as achalasia cardia. Despite widespread dissemination of cysticercosis which involves multiple organs, the individual was asymptomatic for the same. Pancreatic and splenic involvement in disseminated cysticercosis has extremely rarely been reported in literature. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1761-1763&id=3269 Schwannoma of the Spinal Accessory Nerve: A Case Report Ritesh Kohli, Surinder Singh, Ashwani K. Gupta, Prithpal S. Matreja Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X We are reporting a rare case of a schwannoma which originated from the cervical portion of the spinal accessory nerve, which was located in the left posterior triangle of the neck and did not have any neurological deficit, which was diagnosed by the Magnetic Resonance Imaging (MRI) scan and confirmed histopathologically after surgery. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1732-1734&id=3270 The Prune Belly Syndrome in a Female Foetus with Urorectal Septum Malformation Sequence: A Case Report on a Rare Entity with an Unusual Association Dibyajyoti Goswami, Giriraj Kusre, Hemonta Kumar Dutta, Adity Sarma Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X The prune belly syndrome is a rare congenital anomaly which is characterized by the triad of an absent or a deficient development of the abdominal muscle, bilateral cryptorchidism and an anomalous urinary tract. In its full form, this condition occurs only in males. However, a similar condition occurs in females in the absence of cryptorchidism. On the other hand, the urorectal septum malformation sequence is a lethal congenital malformation which is characterized by the development of a phallus like structure, a smooth perineum and the absence of urethral, vaginal and anal openings. We are reporting a case of a female foetus with the prune belly syndrome, which was associated with a urorectal septum malformation sequence. A dead foetus with a protruded abdomen and ambiguous genitalia, was born at 32 weeks of pregnancy. On autopsy, it was found to have female internal genital organs. The left kidney, the urinary bladder and the rectum were absent. The sigmoid colon, the ureters and the fallopian tubes opened into a common cloacal sac. The histopathological examination of the ovary showed the presence of Leydig’s cells. The occurrence of the female counterpart of the prune belly syndrome is extremely rare and only few of such cases were found to be discussed in the details in the indexed English literature so far. Hence, we hope that this case report will contribute to the existing knowledge on the prune belly syndrome. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1727-1729&id=3243 Haemolymphangioma of Epiglottis S. Sundarapandian, Hafida K. Mohamed, S. Murugesan, Aberna V. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Lymphangiomas are congenital lesions of the lymphatic system which are most commonly found in the head and neck, with over 90 % of lesions manifesting in children who are less than 2 years of age. Haemolymphangiomas are rare variant of lymphangioma, with the presence of red blood cells within the lymphatic channels. Laryngeal sites are usually in continuity with foci of disease in the neck. In general, symptoms are non–specific and they vary with the site and size of the mass. Usually, they occur before 2 years of age. Isolated cases of lymphangiomas with involvement of epiglottis are rare and only a few cases have been reported so far. We are reporting the case of a six-year-old girl who presented with a mass in the epiglottis. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1753-1754&id=3244 Intra-Abscess Administration of Antibiotics Through Ultrasound&#8211;Guided Percutaneous Catheter for the Treatment of Pyogenic Liver Abscess Gerardo Alvarez-Uria, Raghavakalyan Pakam, Manoranjan Midde, Praveen Kumar Naik Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Pyogenic liver abscess is a potentially life-threatening disease. The treatment of a pyogenic liver abscess usually involves ultrasound guided percutaneous drainage because of the poor penetration of the systemic administration of antibiotics inside the abscess. However, a sizable proportion of patients will necessitate surgical interventions, which involves high peri- and post-operative risks. Theoretically, the local instillation of antibiotics inside the pyogenic liver abscess fluid could achieve a high concentration of the antibiotic for a long period of time. This could be especially beneficial for time-dependent bactericidal antibiotics such as beta-lactams, because their bactericidal effectiveness depends on the amount of time that bacteria are exposed to the antibiotic. We are reporting two patients with complicated pyogenic liver abscesses, who were successfully treated with systemic antibiotics and local instillation of meropenem inside the cavities of the abscesses. These cases suggest that the local instillation of the beta-lactam antibiotics could be an effective and a safe strategy for the treatment of pyogenic liver abscesses that cannot be completely drained through an ultrasound guided percutaneous catheter. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1698-1699&id=3245 A Pneumococcal Brain Abscess: A Case Report Rashmi Belodu, Nagarathna S., Ravikumar R., Rakesh Kumar, Chandramouli B.A. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X A brain abscess which is caused by Streptococcus pneumoniae is a rare entity. Here, we have described a gentle man who presented with the signs and symptoms of a mass lesion which was localized to the temporal lobe. The clinical examination and computerized tomography revealed the diagnosis of a temporal abscess. The loculated mass was tapped and it was sent for histopathology, which confirmed the presence of an organizing abscess. A laboratory investigation of the pus revealed Streptococcus pneumoniae. The treatment included total excision and the administration of prolonged antibiotics, which led to a good outcome in the patient. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1694-1695&id=3246 Kocuria Kristinae in Catheter Associated Urinary Tract Infection: A Case Report Rachna Tewari, Mridu Dudeja, Ayan K. Das, Shyamasree Nandy Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Kocuria kristinae is a gram positive coccus of the family of Micrococcacae. It inhabits the skin and mucous membranes, but it has rarely been isolated from clinical specimens and is thus considered to be a non-pathogenic commensal. However, it may cause opportunistic infections in patients with indwelling devices and severe underlying diseases. We are reporting an unusual case of a Kocuria kristinae urinary tract infection in a catheterized, 20-years old male. To the best of our knowledge, this is the first reported case of a catheter related urinary tract infection which was caused by Kocuria kristinae. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1692-1693&id=3247 Meningitis due to Stenotrophomonas maltophilia after a Neurosurgical Procedure Smita Sood, Vivek Kumar Vaid, Hemant Bhartiya Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Stenotrophomonas maltophilia is an aerobic, glucose non- fermentative, gram negative bacillus, which is being increasingly recognized as a cause of serious infections such as bacteraemia, urinary tract infections, respiratory tract infections, skin and soft tissue infections, endocarditis, meningitis and ocular infections in hospitalized patients. The treatment of invasive S. maltophilia infections is difficult, as this pathogen shows high levels of intrinsic or acquired resistance to different antibiotics, thus reducing the options which are available for treatment. Meningitiscaused by S. maltophilia is rarely encountered and so its experience is also limited. We are describing here a case of a six months old, male child who developed meningitis caused by Stenotrophomonas maltophilia, after he underwent a neurosurgical procedure. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1696-1697&id=3248 Hepcidin&#8211;Minireview Subha Palaneeswari M., M. Ganesh, T. Karthikeyan, A.J. Manjula Devi, S.V. Mythili Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Iron related disorders are encountered in daily clinical settings. Maintenance of stable extracellular iron concentrations requires the coordinate regulation of iron transport into plasma from dietary sources in the duodenum, from recycled senescent red cells in macrophages and from storage in hepatocytes. Hepcidin acts as a systemic iron-regulatory hormone. Many human diseases are associated with alterations in hepcidin concentrations. This review has focused on hepcidin structure, kinetics and function, its correlation with iron metabolism disorders, the therapeutic potential for modulating hepcidin expression and the diagnostic potential of hepcidin measurements in clinical practice. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1767-1771&id=3273 Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus Vighnesh Vetrivel Venkatasamy, Sandeep Pericherla, Sachin Manthuruthil, Shikha Mishra, Ram Hanno Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Diabetes Mellitus is a growing health concern projected to affect 366 million people worldwide by around 2030. Multiple approaches to address this health concern are documented; amongst which increased the habitual physical activity has been shown to be beneficial. Various mechanisms demonstrated show improvement of cellular insulin sensitivity. The interplay between insulin sensitivity and insulin resistance plays a key role in development and persistence of the diabetic state, which can be directly linked to the levels of physical activity. Regulation of adiponectin and leptin levels are also linked to physical activity via reduction of central obesity. Inflammatory markers, free radical reduction and up-regulation of physiological antioxidant processes are also observed in subjects with increased physical activity schedules, all of which play a significant role in the pathogenesis of Diabetes Mellitus. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1764-1766&id=3306 Digital Evaluation of Functional Occlusion Parameters and their Association with Temporomandibular Disorders Satheesh B. Haralur Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Context:</b> Dental researchers are contradictory in their opinion on the role of occlusion in TMD. Occlusal evaluation of both conventional and digital methods in TMD patients will provide the accurate information about the factors accountable for occlusal instability. Identifying the factors responsible will facilitate precise diagnosis and treatment for TMD. <b>Aim:</b> The Aim of the study was to determine the dynamic occlusal parameters strongly associated with the etiology of Temporomandibular disorders. <b>Material and Methods:</b> Study group consisted of 100 patients; it included 50 patients with normal TMJ(Group I) and remaining 50 patients had a minimum of one positive sign or symptom of Temporomandibular disorder (GroupII). The patient’s dynamic occlusal contacts were evaluated by both conventional and digital methods. The Articulating paper was utilized for conventional occlusion analysis. During conventional analysis centric, lateral and protrusive interferences were evaluated along with loss of vertical dimension. Digital occlusal analysis was performed with T-Scan III. Clusion time, disclusion times were recorded for both groups. Chi-square and Student‘t’ statistical analyses were performed to ascertain the association and statistically significant difference between the groups using SPSS19. <b>Results:</b> Group II patients predominantly (66%)had Group-function occlusion compared to Group I subject. Centric slide more than 2 mm found to have strong influence (P value 0.008) on the etiology of TMD. Among the occlusal interferences evaluated balanced side interferences had a strong correlation with TMD with P-value of 0.003. Working side interferences, protrusive interferences had a p-value of 0.157, 0.826 respectively, indicating weak association. T-Scan analysis showed Group I had 0.689, 0.9136, 0.7952, 0.9794 seconds of clusion, left, right, protrusive disclusion time respectively compared to corresponding 1.862, 1.7995, 1.6978, 1.9296 seconds for Group II. Statistically significant difference (p=0.05) was found between the mean values of both groups. <b>Conclusion:</b> Among the dynamic occlusal parameters evaluated centric slide and balancing side interferences were found to be highly influential in TMD etiology. TMD patients had prolonged clusion and disclusion times compared to healthy TMJ patients. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1772-1775&id=3307 Evaluation of Periodontitis as a Risk for Preterm Birth among Preeclamptic and Non&#8211;Preeclamptic Pregnant Women &#8211; A Case Control Study Jyoti I. Pattanashetti, Veeresh M. Nagathan, Subramaniam M. Rao Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Periodontal disease during pregnancy markedly increases the woman’s risk of developing preeclampsia. The aim of the present study was to evaluate and compare whether periodontal disease increases the risk of preterm birth among preeclamptic and non-preeclamptic pregnant women. <b>Methods:</b> A total of 200 pregnant women (100 preeclamptic and 100 non–preeclamptic) with periodontitis aged 20 to 30 years & < to 26th week of gestation. Maternal demographic and medical data was collected from concerned institutes. In both groups, blood pressure of more than 140/80 mm Hg, presence of protein in 24 hours urine, of more than 1gm per litre in 2 or more mid stream specimens obtained 6 hours apart in the absence of urinary tract infection, confirmed by 0.3 g proteinuria per 24 hours of urine specimens and ankle edema were measured. The periodontal status was categorised as healthy, mild, moderate/severe and worsening periodontal condition. Probing depth (PD), attachment levels and bleeding on probing were measured with UNC–15 probe at six sites per tooth. All the periodontal parameters were measured at second prenatal visit and within 48 hours post–partum. <b>Results:</b> The present study showed the Incidence of preterm birth in relation to periodontal status in preeclamptic patients were significantly high (p<0.001). Total incidence of preterm birth in relation to periodontal status in preeclamptic and non-preeclamptic had chi–square value of 17.7, which is highly significant (p< 0.001). <b>Conclusion:</b> The present study demonstrated that pregnant women with preeclampsia are at greater risk for preterm delivery if periodontal disease is present in pregnancy or progress during pregnancy and also rate of preterm delivery is more in preeclamptic patients having moderate/severe periodontal disease. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1776-1778&id=3308 Verruciform Xanthoma of the Oral Cavity &#8211; A Case Report Shyam Prasad Reddy Dorankula, Pratibha Ramani, Priya Premkumar, Anuja, Herald J Sherlyn Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Verruciform Xanthoma (VX) is a relatively rare benign mucocutaneous lesion of unknown aetiology. VX occurs predominantly in oral cavity which also occasionally affects skin and genital mucosa. It was first reported in the oral cavity in 1971. This rare harmless lesion usually presents as sessile or pedunculated, appear as a papule or single plaque showing verrucous or papillomatous mucosal growth with variable color from reddish pink to gray. In majority of oral cases, it affects gingiva and alveolar mucosa that may be mistaken for benign, premalignant and malignant conditions. VX is diagnosed with certainly only on histopathologic examination. Histologically VX is characterized by the presence of parakeratinized epithelium showing papillary or verrucous growth with thin rete ridges and connective tissue papillae extending up to the surface. The papillae characteristically consist of foam cells also called xanthoma cells. Here we describe a case report of verruciform xanthoma occurring on the buccal mucosa in a 42–years old male patient along with its clinical, pathogenesis, histological features and treatment modalities discussed. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1799-1801&id=3309 Fibrosarcoma of the Mandible: A Diagnostic Dilemma Kanwar Deep Singh Nanda, Anurag Mehta, Jasmine Nanda Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Fibrosarcoma is a malignant mesenchymal neoplasm of fibroblasts that rarely affects oral cavity and can cause local recurrences or metastasis. The aetiologic factors are still unknown, but many authors have reported the radiation therapy history as an important aetiological factor, followed by trauma and underlying conditions like Paget’s disease, fibrous dysplasia or chronic osteomyelitis. Fibrosarcoma of mandible is rare, with an incidence which ranges from 0-6.1% of all primary fibrosarcomas of the bone. This paper has described a case of a swelling in the mandible of a 17-years old female who had a radiolucency in association with crown of an impacted tooth and foci of radiopacity, which led to a misdiagnosis of either an odontogenic lesion or a bone tumour, but proved to be a fibrosarcoma on histopathological and immunohistochemistry investigations. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1804-1805&id=3295 Biometric Analysis &#8211; A Reliable Indicator for Diagnosing Taurodontism using Panoramic Radiographs Veda Hegde, Rajesh Trayambhak Anegundi, K.R. Pravinchandra Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Taurodontism is a clinical entity with a morpho–anatomical change in the shape of the tooth, which was thought to be absent in modern man. Taurodontism is mostly observed as an isolated trait or a component of a syndrome. Various techniques have been devised to diagnose taurodontism. <b>Aim:</b> The aim of this study was to analyze whether a biometric analysis was useful in diagnosing taurodontism, in radiographs which appeared to be normal on cursory observations. <b>Setting and Design:</b> This study was carried out in our institution by using radiographs which were taken for routine procedures. <b>Material and Methods:</b> In this retrospective study, panoramic radiographs were obtained from dental records of children who were aged between 9–14 years, who did not have any abnormality on cursory observations. Biometric analyses were carried out on permanent mandibular first molar(s) by using a novel biometric method. The values were tabulated and analysed. <b>Statistics:</b> Fischer exact probability test, Chi square test and Chi-square test with Yates correction were used for statistical analysis of the data. <b>Results:</b> Cursory observation did not yield us any case of taurodontism. In contrast, the biometric analysis yielded us a statistically significant number of cases of taurodontism. However, there was no statistically significant difference in the number of cases with taurodontism, which was obtained between the genders and the age group which was considered. <b>Conclusion:</b> Thus, taurodontism was diagnosed on a biometric analysis, which was otherwise missed on a cursory observation. It is therefore necessary from the clinical point of view, to diagnose even the mildest form of taurodontism by using metric analysis rather than just relying on a visual radiographic assessment, as its occurrence has many clinical implications and a diagnostic importance. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1779-1781&id=3274 The Oral Health Status and the Treatment Needs of Salt Workers at Sambhar Lake, Jaipur, India Sudhanshu Sanadhya, Ramesh Nagarajappa, Archana Jagat Sharda, Kailash Asawa, Mridula Tak, Mehak Batra, Hemasha Daryani Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Salt workers are exposed to the adversities of environmental conditions such as direct sunlight, salt dust and contact with brine, which have an impact on the health of workers. Since oral health is an integral part of the general health, we planned to determine its effect on the oral cavity. <b>Objectives:</b> To assess the oral health status and the treatment needs among the workers of Sambhar Salts Limited at Sambhar Lake, Jaipur, India. <b>Material and Methods:</b> A cross sectional, descriptive survey was conducted among 979 subjects (509 males; 470 females) who were aged between 19–68 years, who were the workers of Sambhar Salts Limited, Sambhar Lake, Jaipur, India. An interview on the demographic profile followed a clinical examination for recording the oral health status, based on the World Health Organization guidelines. The Chi–square test, t–test, One way Analysis of Variance and a Stepwise multiple linear regression analysis were used for the statistical analysis. <b>Results:</b> Females had a significantly greater prevalence of dental fluorosis (71.7%) and periodontal disease (96.4%) as compared to males (p= 0.001). The mean number of healthy sextants (0.71 ± 0.09) and the mean DMFT (5.19 ± 4.11) were also significantly higher in females as compared to those in males (p=0.001). One surface filling (78.2%), followed by pulp care and restoration (76.1%) were the most prevalent treatment needs. The gender and oral hygiene practices for dental caries and periodontal disease were respectively identified as the best predictors. <b>Conclusion:</b> Considerable percentages of salt workers have demonstrated a higher prevalence of oral diseases. Higher unmet treatment needs suggest a poor accessibility and availability of oral health care, in addition to a low utilization of preventive or therapeutic oral health services. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1782-1786&id=3275 Prevalence, Severity and Associated Factors of Dental Caries in 3-6 Year Old Children Sarumathi T, Saravana kumar B, Manjula Datta, Hemalatha V.T., Aarthi Nisha V Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> To determine the prevalence and the severity of dental caries in 3-6 year old children in Chennai and to elucidate the factors which affect the dental caries in 3-6 year old children. <b>Methods:</b> This study was a cross-sectional survey which was done on 527 children who were in the age group of 3 to 6 years, who were from 6 private and 6 corporation schools in Chennai, India. Two instruments were developed, pre–tested and validated for the study. One questionnaire which contained the various risk factors which had to be measured and the dental caries indices were used on children to collect the relevant data. A separate questionnaire was distributed to the parents to measure the socio economic status and to know the parents’ educational levels. <b>Results:</b> The prevalence of dental caries was found to be 63.4% in the study samples. The association between dental caries and the associated factors was determined by calculating the Odd`s ratio. Logistic regression was performed to test the magnitude of the association between dental caries and the factors which were associated with it, and linear regression was done for the continuous variables. There was a statistically significant high association between the oral hygiene practice, the eating habits of the children, the economic status and the parents’ literacy levels and the caries prevalence in this study. <b>Conclusion:</b> This study showed that preventive efforts should be focused on young children, as the benefits are cumulative. The oral health promotion should particularly be targeted to the areas of need, to redress the inequalities. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1789-1792&id=3277 A Subjective Assessment of Perceived Clarity of Indirect Digital Images and Processed Digital Images with Conventional Intra-oral Periapical Radiographs Suchetha N. Malleshi, Mahima V.G., Anudeepa Raina, Karthikeya Patil Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Objectives:</b> To compare and analyze the perceived clarity and diagnostic value of Conventional periapical Radiographs (CRs) with those of their Digitized Periapical Images (DIs) and Processed Digitized Periapical Images (PDIs) counterparts. <b>Material and Methods:</b> Forty two intraoral periapical radiographs of patients with clinically suspected periapical pathosis were made to constitute the group of CRs. These were photographed by using a Canon Power Shot SD500 (7.1 Megapixel) digital camera and the unaltered images were transferred to a computer laptop, to form the group of DIs. Subsequently, the contrast and brightness of these images were modified to represent the group of PDIs. Two experienced oral radiologists independently evaluated 5 specific apical and periapical region parameters of all the 42 CRs, DIs and PDIs for perceived image quality and diagnostic value and graded them on a three point grading scale. Conventional radiographs served as the control. Data were analyzed by using paired t-test and Kappa analysis. <b>Results:</b> The clarity and diagnostic quality of the PDIs were statistically significant as compared to those of their conventional counterparts. In comparison, the DIs group fared badly, with deterioration of the image quality. The interobserver agreement was good and all the results were statistically significant. <b>Conclusion:</b> Indirectly digitizing the radiographs by employing a digital camera and further digitally processing the images resulted in an improvement in their perceived clarity and they enhanced their diagnostic properties. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1793-1796&id=3278 The Effect of Al2O3 Addition on the Thermal Diffusivity of Heat Activated Acrylic Resin Jyothi Atla, Prakash Manne, A. Gopinadh, Anche Sampath, Suresh Babu Muvva, Krishna Kishore, Chiramana Sandeep, Harika Chittamsetty Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Aim:</b> This study aimed at investigating the effect of adding 5% to 20% by weight aluminium oxide powder (Al2O3) on thermal diffusivity of heat–polymerized acrylic resin. <b>Material and Methods:</b> Twenty five cylindrical test specimens with an embedded thermocouple were used to determine thermal diffusivity over a physiologic temperature range (0 to 700C). The specimens were divided into five groups (5 specimens/group) which were coded A to E. Group A was the control group (unmodified acrylic resin specimens). The specimens of the remaining four groups were reinforced with 5%, 10%, 15%, and 20% Al2O3 by weight. Results were analysed by using one–way analysis of variance (ANOVA). <b>Results:</b> Test specimens which belonged to Group E showed the highest mean thermal diffusivity value of 10.7mm2/sec, followed by D (9.09mm2/sec), C (8.49mm2/sec), B(8.28mm2/sec) and A(6.48mm2/sec) groups respectively. Thermal diffusivities of the reinforced acrylic resins were found to be significantly higher than that of the unmodified acrylic resin. Thermal diffusivity was found to increase in proportion to the weight percentage of alumina filler. <b>Conclusion:</b> Al2O3 fillers have potential to provide increased thermal diffusivity. Increasing the heat transfer characteristics of the acrylic resin base material could lead to more patient satisfaction. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1797-1798&id=3279 Teriparatide: A Novel Means to Ultimately Achieve True Regeneration!!! Harpreet Singh Grover, Shailly Luthra, Shruti Maroo Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X “Perioceutics” or the use of the pharmacological agents which are specifically developed to manage periodontitis, is an interesting and an emerging aid in the management of periodontal diseases, along with mechanical debridement. Host modulation therapies are being proposed and developed to bring down excessive levels of enzymes, cytokines, prostanoids, as well modulate osteoclast functions. Over the past two decades, many drugs have been investigated for their host modulating properties in both animal and early human clinical studies. These agents include non-steroidal anti-inflammatory drugs, sub antimicrobial dose doxycycline and systemic bisphosphonates. Recently, a new drug has been added to the list, namely, teriparatide, which is a bone forming drug. It is a biosynthetic human parathyroid hormone. Multiple clinical trials have shown that teriparatide is associated with increased bone mineral density. This review has focused on the mechanism of action of teriparatide and its potential role in the treatment of periodontal disease. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1820-1823&id=3280 Early Detection of Oral Squamous Cell Carcinoma (Oscc) &#8211; Role of Genetics: A Literature Review C. Seethalakshmi Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1824-1826&id=3281 Emerging Trends of Herbal Care in Dentistry Gunjan Kumar, Md. Jalaluddin, Purnendu Rout, Rajat Mohanty, C.L. Dileep Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Herbs are staging a comeback and herbal ‘renaissance’ is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1827-1829&id=3282 Multiple Mandibular Exostoses: A Rare Case Report Mansi Bansal, Sanjay Rastogi, Anamika Sharma Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Multiple maxillary and mandibular exostoses are common localized overgrowths of the bone. They are non-neoplastic and are thought to be reactive or developmental in origin. These exostoses need to be accurately distinguished from the other more diagnostically significant lesions, notably from the exosteal osteomas. The aetiology of exostosis has been investigated by different authors, but no consensus has been reached so far. We are reporting a rare case of an otherwise healthy 38 year old female with multiple exostoses in the mandibular anterior region, which correlated both clinically and radiographically. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1802-1803&id=3283 A Variation in Tooth Position-180º Rotated Maxillary Second Premolar Gurudutt Nayak, Inderpreet Singh Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Rotation of a tooth around an axis which is perpendicular to the occlusal plane through angles which approach 180° is a rare anomaly which is found in the human dentition. Such aberrations present a multi–factorial model in their origin. Both genetic and local factors seem to contribute to this abnormality. If the contribution of local factors could be identified, a way could open to an early treatment and prevention of secondary rotations of opposing and contiguous teeth. A case of a 180° rotation of maxillary left second premolar in a male patient of Indian origin has been described here. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1806-1807&id=3285 Dentinogenesis Imperfecta: A Family which was Affected for Over Three Generations Poornima Surendra, Rohan Shah, Roshan N.M., V.V. Subba Reddy Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Dentinogenesis Imperfecta (DI) or hereditary opalescent dentin is inherited in a simple autosomal dominant mode with high penetrance and low mutation rates. It generally affects both the deciduous and the permanent dentitions. DI corresponds to a localized form of mesodermal dysplasia which is observed in the histo-differentiation. An early diagnosis and treatment are therefore fundamental, which aim at obtaining a favourable prognosis, since at late intervention makes the treatment more complex. We are presenting here a case of DI in which the disease affected the three generations of a family in India. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1808-1811&id=3286 Non&#8211;Syndromic Bilateral Supplemental Maxillary Lateral Incisors: A Rare Case Ajay Nagpal, Manoj Kumar Hans, Shashit Shetty, Navpreet Kaur, Sunil Kumar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Supernumerary teeth or hyperdontia are defined as the teeth that exceeds the normal dental formula, regardless of their location and morphology. A supernumerary tooth is a developmental anomaly and it has been argued to arise from multiple aetiologies. Supernumerary teeth with orthodox shapes and sizes, that resemble the normal dentition are called ‘supplemental teeth’. The supplemental teeth are often overlooked because of their normal shapes and sizes. Supplemental lateral incisors are rare and bilateral cases are even rarer, with only two cases being reported in the literature till date. Therefore, we are describing a rare case of non–syndromic, bilateral, supplemental, maxillary, lateral incisors and we have discussed the management of supernumerary teeth. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1812-1813&id=3287 C Spine Fracture on OPG Kedarnath N.S., Mamatha N.S., Shruthi R. Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X Maxillofacial injuries are common and they occur in a variety of situations. All patients who undergo maxillofacial or head trauma, are presumed to sustain cervical spine injuries. Identification of cervical spine injuries is essential in management of trauma, because a missed injury can result in a catastrophic spinal cord injury. Advanced Trauma Life Support (ATLS) guidelines have suggested that routine use of cervical spine radiographs may not be required in an asymptomatic patient. We are presenting here a case with a cervical spine injury with no clinical deficits, found incidentally on panoramic radiographs which were advised for evaluation of the mandibular fracture. We suggest that importance has to be given to examination of the cervical spine on the panoramic radiographs as well. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1814-1815&id=3288 Radicular Cyst with Severe Destruction of the Buccal Cortical Plate Secondary to Endodontic Failure Rajdeep Pavaskar, Tarun Gera, Chandra Mohan Boyapati, Paul Chalakkal, Sushma Bommannavar Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X This case report highlights a massive radicular cyst with respect to the lower left premolars, that developed secondary to endodontic failure and resulted in buccal cortical bone destruction. It also discusses the investigation and the surgical approach which were carried out with regard to the cyst. Following surgical closure, the teeth were endodontically retreated. It also highlights the fact that mandibular true occlusal radiographs could be misleading with regard to the extent of bone destruction, which can otherwise be confirmed on CT scans. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1816-1817&id=3289 Natural Teeth Replacing Artificial Teeth in a Partial Denture: A Case Report Sukanta Kumar Satapathy, Ajay Pillai, Ramya Jyothi, P. Durga Annapurna Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X The aesthetic replacement of anterior teeth in cases of immediate partial denture is always a challenging work for prosthodontists. There is always problem of matching size, colour, shade and shape of the replaced tooth with those of the natural teeth. It was most difficult to satisfy the patients who have high aesthetic demands. Here is a report of a case where patient’s own natural tooth was used for replacement in an immediate partial denture. An immediate denture is defined as “any removable dental prosthesis which is fabricated for placement immediately, following the removal of a natural tooth/teeth” <a href=#fr1 name=ft1>(1)</a>. Patients with missing anterior teeth lack an impressive appearance aesthetically and as well as psychologically <a href=#fr2 name=ft2>(2)</a>. Tooth loss leads to a certain degree of loss of function. This loss of function might lead to an impairment of oral health which is related to quality of life <a href=#fr3 name=ft3>(3)</a>. An immediate denture can replace 1-16 teeth in either the maxillary or the mandibular arch, or in both arches <a href=#fr4 name=ft4>(4)</a>. The need for the immediate replacement of a missing tooth is more in case of an anterior tooth, where aesthetics is of prime concern. The replacement of an anterior tooth is most technique sensitive, as it includes the patient’s expectations, which include, matching with proper shade, shape and size as those of his/her natural teeth. So, here is a case presentation where modern day patient expectations were taken into consideration. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1818-1819&id=3291 Laser Gingival Retraction: A Quantitative Assessment Vamsi Krishna CH, Nidhi Gupta, K. Mahendranadh Reddy, N. Chandra Sekhar, Venkata Aditya, G.V.K. Mohan Reddy Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X <b>Background:</b> Proper gingival retraction improves the prognosis of crowns and bridges with sub gingival finishlines.Use of lasers assists the operator to achieve proper retraction with good clinical results. <b>Aims:</b> the present study was intended to assess the amount of lateral gingival retraction achieved quantitatively by using diode lasers. <b>Settings and Design:</b> study was carried on 20 patients attended to a dental institution that underwent root canal treatment and indicated for fabrication of crowns. <b>Material and Methods:</b> gingival retraction was carried out on 20 teeth and elastomeric impressions were obtained. Models retrieved from the impressions were sectioned and the lateral distance between finish line and the marginal gingival was measured using tool makers microscope. Retraction was measured in mid buccal, mesio buccal and disto buccal regions. <b>Statistical Analysis:</b> the values obtained were used to calculate the mean lateral retraction in microns. <b>Results:</b> mean retraction values of 399.5 µm, 445.5 µm and 422.5µm were obtained in mid buccal, mesio buccal and disto buccal regions respectively. <b>Conclusions:</b> Gingival Retraction achieved was closer to the thickness of sulcular epithelium and greater than the minimum required retraction of 200um. ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1787-1788&id=3292 A Study on the AmpC Production Amongst the Urinary Enterobacteriaceae Isolates Smita Uday Shevade, Gopal Nandlal Agrawal Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1831-1832&id=3293 The Red Cell Distribution Width May Be Affected by Many Factors in the Clinical Practice Sevket Balta, Sait Demirkol, Mustafa Cakar, Mehmet Aydogan, Muharrem Akhan Journal of clinical and diagnostic research : 2013 - August - 7:0973-709X ]]> http://www.jcdr.net/article_fulltext.asp?issn=0973-709X&year=2013&month=August&volume=7&issue=8&page=1830-&id=3294