Journal of clinical and diagnostic research

Mullerian Ducts Remnants in the 46 XY Disorder of Sex Development

Halder A

Objective: The objective of this study was to find out the prevalence of mullerian duct remnants in the 46 XY disorder of sex development due to disorders in androgen synthesis/action. Methods: Thirty eight cases of 46 XY disorder of sex development of disorders in androgen synthesis/action were evaluated for diagnosis and management, including mullerian duct remnants. Mullerian ducts remnants were found in nine of them (23.7%). The diagnostic evaluation consisted of pelvic ultrasonography, genitography, cystourethroscopy, genitoscopy and laparoscopy or laparotomy. Results: The common types were an abnormally large prostatic utricle communicating with the urethra and a rudimentary uterus. Conclusion: It is concluded that mullerian ducts remnants are common with the 46 XY disorder of sex development due to disorders in androgen synthesis/action. During evaluation of patients, this aspect should be kept in mind and during management, appropriate measures should be undertaken to prevent future complications like chronic urinary tract infections, stones and voiding troubles.

Outcomes Of Cardiovascular Risk Factors Screening Programme Among Employees Of A Malaysian Public University

Background: The burden on cardiovascular disease in Malaysia is in the increasing trend and this is associated with a number of risk factors. Aim: This study aims to explore the prevalence of major cardiovascular risk factors among employees of Engineering Campus, Universiti Sains Malaysia. Design: A cross-sectional study was carried out from 19th February 2009 to 12th March 2009. Methods and Materials: Data on eight established risk factors were collected. Statistical Analysis: Descriptive statistic was used to describe the prevalence of risk factors among the study subjects. Multiple logistic regression analysis was used to explore the clustering of risk factors (having two or more risk factors). All data were analyzed using statistical software SPSS package version-16 and a two-tailed p-value  0.05 was considered to be statistically significant. Results: A total of 217 (27.7%) respondents participated in the screening exercise. Results from this screening showed that risk factors such as unhealthy diet (92.1%), overweight/obesity (73.3%) and physical inactivity (65.0%) were highly prevalent. The median number of risk factors was 3 (IQR=2). In addition, most of the subjects (n=203, 93.5%) were categorized as being in high risk for future cardiovascular events as according to the definition of National Cholesterol Education Program. Respondents with clustered risk factors were older, had lower intake of fruit and vegetables, less physically active, had a higher body mass index, systolic blood pressure, diastolic blood pressure and fasting blood glucose. Further analysis found that fruit and vegetable intake, physical activity and body mass index formed a good predictive model for prediction of clustered risk factor model with a Nagelkerke R-squared value of 0.529. Conclusion: There is a high prevalence of cardiovascular risk factors among USM employees and these risk factors tend to cluster. It is therefore recommended that prompt actions should be taken to overcome and modify these risk factors.

Incidence of Major Depression among First Year Pharmacy Undergraduates

Khan T M *, Humera T **, Khan A ***

The objective of this study was to determine the prevalence of major depression and the factors responsible for its incidence among first year pharmacy students at a private pharmacy college in Penang. Face to face interviews were conducted among the pharmacy first year students using a structured study tool. The entire fresh first year pharmacy students were approached for their potential participation in the study. The evaluation for the depression was done using the Diagnostic Statistics Manual Four Text Revision (DSM IV-TR) criteria for depression. All the data was analysed using SPSS® version 13®. Binary Logistic regression was applied in order to further predict the factors that had a major contribution in the resulting depression. The findings demonstrated that the incidence of depression was higher among female students in comparison to males, which was found to be significant (t=5.538, p=<0.001). Among all demographic factors, gender was found to significantly correlate with the incidence of the symptoms of depression (r=0.77, p=<0.001). The respondents were further evaluated in order to identify the stressors responsible for the depression. A majority 96.2% highlighted Assignments, Quizzes and Projects and work overload as the potential stressors for depression. However, the lecturer’s attitude and the work over load were the two main stressors identified, that are significantly (F=12.736, df=25, p=<0.042) found to be associated with the prevalence of depression. on the whole it was revealed that female students had a higher prevalence of depression (Odd ratio=1.250, CI 0.688- 2.271). However, on racial grounds, Malay students were found more likely to be at a higher risk (Odd ratio=1.618, CI 0.378- 6.923) than that of their Chinese classmates (Odd ratio=0.863, CI 0.570- 1.306. Overall findings demonstrated that Malay female students were at a higher risk of depression. The lecturer’s attitude and work overload were the stressors identified for the possible association with the depressive state of the students.

Mast Cells in Odontogenic Cysts

SHYLAJA S

Background: Cysts of the jaws are probably the most common destructive bone lesions in the human maxillofacial skeleton. Odontogenic cysts are derived from the epithelium which is associated with the development of the dental apparatus and can be either developmental or inflammatory in origin. The most common odontogenic cysts are radicular cysts, dentigerous cysts and odontogenic keratocysts. However, the cysts of developmental origin may show inflammatory changes secondary to infection. Mast cell degranulation plays an important role in the inflammatory response and it is speculated that alteration in their number and distribution could contribute to the pathogenesis of odontogenic cysts. So, an attempt was made to evaluate the significance and distribution of mast cells in radicular cyst, odontogenic keratocyst and dentigerous cyst using toluidine blue staining. Materials and Methods: This retrospective study was undertaken by retrieving the records and the paraffin blocks of 40 confirmed cases of odontogenic cysts, out of which 19 were Radicular cysts, 12 were odontogenic keratocysts and 9 were dentigerous cysts. Sections of 5µm thickness were prepared and stained with haematoxylin and eosin, as well as with toluidine blue. The toluidine blue stained mast cells were then counted under a high power microscopic field (40X) for each specimen in three different zones and the mean value obtained. The mean number of mast cells was then compared between different zones by using the Relative Deviate ‘Z’ test. Results: In cases of radicular cyst, the highest mean number of mast cells per high power field was seen in the age group of 10-19 years. A statistically significant difference (p<0.05) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones. In cases of odontogenic keratocyst, the highest mean number of mast cells per high power field was seen in the age group of 20-29 years. A statistically significant difference (p<0.01) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones, as well as between the sub-epithelial and the intermediate zones. In cases of dentigerous cyst, the highest mean number of mast cells per high power field was seen in the age group of 10-19 years. A statistically significant difference (p<0.05) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones. Conclusion: In the present study, the maximum number of mast cells were noted in the sub-epithelial zone as compared to other zones. The number of mast cells were seen to decrease with age and there was no gender predilection. However, further studies using immunohistochemical techniques may help in the better understanding of the pathogenesis of these cysts.

Oxidative Stress Biomarkers in Obese Mothers and Their Appropriate For Gestational Age Newborns

Obesity during pregnancy affects maternal and foetal lipid and lipoprotein levels, but our knowledge on oxidative stress biomarkers is limited. The aim of this study is todetermine the oxidant and antioxidant status in obese mothers and their newborns. 43 obese and 50 normal weight mothers and their appropriate for gestational age newborns were consecutively recruited from the maternity of Tlemcen hospital. The plasma total antioxidant activity (ORAC), vitamins A, C and E, hydroperoxides, carbonyl proteins and erythrocyte antioxidant enzyme activities (catalase, superoxide dismutase, glutathione reductase and peroxidase) were measured in mothers and their newborns. Changes in serum lipid and lipoprotein levels were also determined. Obese mothers had low ORAC, vitamin C and E values, glutathione peroxidase and superoxide dismutase activities, high plasma triglycerides, hydroperoxide and carbonyl protein levels as compared to control mothers. Newborns of obese mothers also showed decreased ORAC, vitamins and increased hydroperoxides and antioxidant enzyme activities as compared to control newborns. There were no significant differences in plasma lipid and lipoprotein concentrations between newborns of obese mothers and those of control mothers. There were significant relationships between maternal and neonate oxidative stress biomarkers, thus, suggesting that maternal oxidant/antioxidant imbalance is an important causative factor in foetal stress in the obese group. In conclusion, obese mothers and their newborns are exposed to oxidative stress. Their oxidant and antioxidant status should be carefully considered and appropriate management should be organized during the pregnancy and the early postnatal period, including antioxidant supplementation.

A Prospective Study Of Hepatic Involvement In Plasmodium Falciparum Malaria

SINGH R*, KAUR M**, ARORA D***

Introduction: Malaria counts among the worst scourges of humankind. It amounts to an immeasurable health burden and inhibits economic prosperity in numerous tropical countries. Material & Methods: The study included adult patients with Plasmodium Falciparum malaria with evidence of jaundice conventional thick and thin Pbfs stained with geimsa were examined under oil immersion. Detailed clinical, biochemical, and radiological examinations were conducted to establish the diagnosis of malaria and the various clinical manifestations. Histopathological examination was conducted in the category B of the patients. Observations: About two thirds were male. The age of the patients ranged between 16-56 years (mean 28.14±7.23). Serum bilirubin levels ranged from 1 to 32 mg% (mean 5.65). 41.46% had serum bilirubin of <3 mg%, 40.24% had 3-10 mg% and 18.29% had >10 mg%. The most frequent sonographic finding of liver was normal sized liver with normal echogenicity. Swollen hepatocytes was seen in all the cases while hemozoin deposition seen in about three fourths.80% of the patients with serum bilirubin >10mg developed acute renal failure as compared to 17.65% in those with bilirubin level <3 mg. Conclusion: Hepatic involvement is a common accompaniment of acute P. Falciparum malaria, and hepatic dysfunction ranges from a mild elevation of liver enzymes to the range of acute hepatitis.the presence of hepatitis in patients with falciparum malaria indicates a more severe illness with a higher incidence of complications, multiorgan failure and supposedly a bad prognosis.

Factors Associated With Objective Wellbeing In Jamaica: Is Objective Index Still A Good Measure Of Health?

PAUL A. BOURNE*, DONOVAN A. MCGROWDER**, ONIEL JONES***

Objective: To investigate the factors that influenced the wellbeing of Jamaicans. In addition the study sought to ascertain the power of each factor that influenced wellbeing. Method: The current study used one of the World Bank’s Living Standard Measurement Surveys (LSMS) - the Jamaica Survey of Living Conditions (JSLC). The JSLC was conducted between June and October 2002, using a detailed administered questionnaire. The survey was a nationally representative stratified random sample of 25 018 respondents. For the current work, descriptive statistics were used to provide background information on the sampled population; chi-square for bivariate associations and stepwise technique in multiple regressions was utilized to establish the parameter of the explanatory variables and to determine their influence on the general model. The subsample used to established the current model was 21 740 respondents (i.e. 86.9%). Results: It was found that 16 factors were used to predict the economic wellbeing of Jamaicans, and there was 92.1% variability in economic wellbeing. Moreover, four factors accounted for 82% of the variability in economic wellbeing. The factors were assets owned, number of children ages 14 years and less, consumption per head, and living arrangement. Assets owned and the number of children in the household accounted for 61% of the total explanation of the change in economic wellbeing of an individual. Individuals in the two wealthiest quintiles had greater economic wellbeing than their counterparts in the two poorest quintiles; but, those in the latter had better health status. Conclusion: The number of children and access to economic resources had a strong influence on wellbeing with the former being a future economic investment for the parents. This suggests that that objective wellbeing is still a better measure of wellbeing in Jamaica than subjective indexes.

Histological Recovery Profiles Of Patients With Celiac Disease- An Indian Perspective.

ABSTRACT Aim Celiac disease is characterized by malabsorption, abnormal small bowel structure and intolerance to gluten. The present study was planned to determine the histological recovery profiles of patients with celiac disease especially, north Indians who consume wheat as the staple diet. Methods 56 patients were selected for the present study, who were diagnosed to have celiac disease on the basis of their clinical profiles (according to the criteria enumerated by the European society for pediatrics gastroenterology and nutrition), serological examination and confirmation on endoscopic biopsy. Repeat biopsies were taken in all 56 cases. Marsh classification was employed to score the biopsies. Results The most common histological presentation at the first biopsy was total villous atrophy (Marsh stage IIIc, 83.9%) followed by subtotal villous atrophy (Marsh stage IIIb, 12.5%) and partial villous atrophy (Marsh stage IIIa, 3.6%). At the end of minimum one year of gluten free diet it was observed that 42 cases (75%) of showed some degree of histological down staging. Of these, 26 (46.42%) recovered completely i.e. to marsh stage 0 (normal villous pattern). Also, 14 out of 56 (25%) cases did not down stage, implying a lack of histological recovery. Conclusions The study adds to the limited literature which is available on the histological recovery profiles of patients with celiac disease in the Indian population. The study emphasizes on two facts, one, a time dependency of the response of gluten free diet and second, the importance of proper categorization at the initial biopsy, as higher grades lead to therapeutic refraction.

Drugs And Suicide By Young Adults (Gorgan- Northern Iran)

SAIFI A* , MANSOURIAN A R** , MARJANI A** , MANSOURIAN H R***

Objective : Suicide is the leading cause of premature death world-Wide .This research project was designed to establish the role played by drugs to commit suicide among teenager and young adults in Gorgan- in northern Iran. Methods: This investigation was a descriptive study and the patients consisted of all acute poisoned subjects referred to the emergency department of Gorgan Main General hospital during one year duration. The data was gathered using a questionnaire which was filled for each patient at the time of admission. Results : The findings of this investigations showed that 61.3% of all acute poisoning happened by drugs and drug were used by 72.1% to commit suicide with the age group of 14-19 years with highest prevalence. Conclusion : Young adults of 14-19 years are the age group with highest incidence of committing suicide and drugs with 72.1% are the main substance for attempting suicide.

The Views of Medical Students about the Purpose and Objectivity of Assessment in a Medical College in Western Nepal

ABSTRACT Context: Previous studies had shown problems with the different methods of assessment in medical schools. However, studies in Nepal are lacking. Objective: The present study was carried out to obtain information on the purpose of assessment in an ideal world and at the Manipal College of Medical Sciences (MCOMS) and the perception of student respondents regarding the objectivity of assessment at MCOMS. Methods: The study was carried out among the second to seventh semester students during February 2006, using a three part semi-structured questionnaire. The first part collected basic demographic information, the second was related to the purpose of assessment in an ideal world and at MCOMS, and the third dealt with the perceived objectivity of assessment at MCOMS. Percentage agreement scores were compared among the basic science (semesters II, III and IV) and clinical science students (semesters V, VI and VII) using the 2 test (p<0.05). The median total scores were compared among different subgroups using appropriate non-parametric tests (p<0.05). Findings: 340 students participated in the study (overall response rate- 74.1%). 165 respondents (48.5%) were basic science students. 166 students (49.9%) were Indians, 145 (43.5%) were Nepalese and 22 (6.6%) were Sri Lankans and others. Basic science students were significantly more likely to agree that assessment at MCOMS ensured competence, provided feedback and guided student learning. The median total score was 22 (maximum score -32). The score was higher among basic science and Sri Lankan students. Conclusions: The overall perceived objectivity of assessment at MCOMS was not high. Modifications in the assessment system may be considered. Further studies are required.

Cervical Spinal Cord Injury With And Without The Radiographical Evidence Of Trauma – A Retrospective Comparative Study In Adults

MAHMOOD N S *, RAJAGOPAL KADAVIGERE**, RAMESH AK ***

Background : Spinal cord injury without the radiographical evidence of trauma (SCIWORET) is a well described entity in children. This phenomenon is not well described in the adult population. There has been no study till date that compares the prognosis of SCIWORET in adults to those with bony injury. Aims: To compare the clinical and magnetic resonance imaging (MRI) findings ofcervical spinal cord injury (SCI) with the conventional radiographical evidence of trauma to those with cervical SCI, without the conventional radiographical evidence of trauma (SCIWORET) and to study the importance of MRI and the prevalence of SCIWORET in adult cervical spine trauma. Settings and Design:A retrospective study on patients who presented to the Department of Radiodiagnosis and Imaging with acute cervical spine trauma over a period of 5 years (between August 2002 and September 2007). Methods: 50 patients with acute cervical SCI were divided into two groups. Group A included those without radiographical abnormality and Group B included those with bony injury. The epidemiological factors, the total motor scores on admission as well as on follow up, the recovery rate, the average extent of spinal cord oedema and the prevalence of ligamentous injury were compared in both groups. Statistical Methods used : The statistical analysis was performed using the software SPSS Version 10.0 for Windows. The paired t test was used to compare the differences in the initial total motor scores, the final total motor scores and the mean recovery rates between both the groups. Results: SCIWORET was associated with better motor scores and recovery rate when compared with SCI which is associated with bony injury. Ligamentous injuries were significantly more commonly associated with bony injury. Conclusion: Cervical SCIWORET is not an uncommon phenomenon in adults. Theoverall outlook is better when compared to cervical spine trauma which is associated with bony injury, as SCIWORET is associated with better motor function and a lesser incidence of ligamentous injury.

Didactic Lectures And Interactive Sessions In Small Groups: A Comparative Study Among Undergraduate Students Of Pharmacology In India

Context: Small group teaching is considered to be more effective than didactic lectures. But is it sufficient just to reduce the size of the class? This study examines the effectiveness of two styles of teaching among a small group of students. Aim: To study and compare the effectiveness of two teaching methods in Pharmacology: Didactic lectures and interactive sessions in a small group of undergraduate students of physiotherapy. Settings: Five topics of Pharmacology on antimicrobial agents were taught by the didactic lecture method in five consecutive classes of one hour each and another five classes were conducted by interactive sessions, both by the same teacher to a group of twelve students of Physiotherapy of Manipal University. At the end of each class, the students were tested by a multiple choice type of questionnaire. Students also answered the same questionnaire in groups of four. The mean marks of each student were compared by using the Student’s t-test for statistical significance. Results: Difference in the mean marks scored by students in the didactic lecture group and in interactive sessions was found to be statistically significant. The difference in the mean marks obtained by individual students and the mean marks obtained in groups with the didactic lecture method were statistically significant [P<0.001], whereas the difference in the mean marks obtained by individual students and the mean marks obtained in groups when taught by interactive sessions were not significant [P>0.30]. Conclusions: The present study demonstrates that interactive sessions are responsible for the effectiveness of small group teaching. The results have also shown the importance of studying in groups to solve problems and to find answers in preparing for examinations.

Reliability of Capnometry in Neonates on Patient Triggered Ventilation

PARIKH T B * , NANAVATI RN**, UDANI R H***

Introduction: Capnometry is not well studied in neonates on Patient Triggered Ventilation (PTV). We conducted this study to determine the reliability of Main Stream (MS) and Side Stream (SS) Capnometry in neonates on PTV. Method: Neonates on PTV were enrolled in the study. Before each Arterial Blood Gas (ABG) assessment, MS and SS capnometer readings were recorded. Lung mechanics were recorded from the online graphics. ABG was collected from the arterial line. The EtCO2 – PaCO2 correlation was drawn for MS and SS capnometry under various disease conditions, ventilator settings and lung mechanics. Results: A total of 74 ABGs were collected from 18 patients. The EtCO2 – PaCO2 correlation was better with MS capnometry than with SS capnometry (r = 0.855 vs.0.68, p < 0.001 for both methods). Both methods correlated well with PaCO2 in Flow cycled SIMV (MS: r = 0.9 & SS: r = 0.82). However, in Flow Cycled Assist Control mode, SS capnometry correlated poorly (SS: r = 0.49 vs. MS: r = 0.76). The EtCO2 - PaCO2 correlation by MS capnometry holds good for RDS, Apnea, Pneumonia and Congenital cyanotic heart disease (r = 0.85, 0.97, 0.84, 0.84 respectively, p < 0.001), but not for PPHN(r = 0.37, p = 0.35). SS EtCO2 correlated well in RDS, Apnea, Pneumonia, (r = 0.75, 0.85, 0.94 respectively, p < 0.001), but not in PPHN (- 0.20, p = 0.629) and CCHD (r = 0.73, p = 0.1). At higher ventilator rates (> 60 /min), SS capnometry correlated poorly. The EtCO2 –PaCO2 correlation by both methods was better when lung compliance was > 1 ml / cmH2O than when lung compliance was < 1 ml / cmH2O. Conclusions: MS capnometry is superior to SS capnometry for neonates on patient triggered ventilation.

A Study of Drug Prescribing Practices at a Tertiary Care Hospital

VAZ F S *, ANTAO- PEREIRA I**, FERREIRA A M ***, KULKARNI M S ****

Objectives: To study the drug prescribing practices at a tertiary care hospital using some of the WHO core drug prescribing indicators. Materials and Methods: The study was conducted at a tertiary care hospital in Goa, in the year 2008. Drug prescriptions were randomly selected from the out-patient pharmacy of the hospital. Fifty prescriptions were selected per month, over a period of one year and a total of 600 drug prescriptions were studied. Data collection was done with the help of a pretested predesigned format. The data was entered in an excel spreadsheet to prepare a database. WHO drug use core indicators for out-patient facilities were used to study the various drug prescribing practices. Results: The average number of drugs per prescription was 2.9. Around 6.38 percent of the drugs which were prescribed were antibiotics, 2.58 percent of the drugs were injections, only 13.34 percent of drugs were prescribed with generic names and 60.98 percent of drugs were from the essential list of drugs. Conclusions: Periodic appraisal of drug prescribing practices at a health facility would eventually help to promote rational drug use.

Endovaginal Sonographic Evaluation of Postmenopausal Uterine Bleeding.

KAUR M *, SINGH R**, SHARMA M***

Aims and Objectives- To evaluate the role of endovaginal sonography (EVS) in postmenopausal women (PMW) with postmenopausal bleeding (PMB) and to correlate it with the histopathological diagnosis at curettage, so that unnecessary operations in postmenopausal women could be spared where sonography depicts normal findings. Materials And Methods-The present study was conducted on postmenopausal women (PMW) with postmenopausal bleeding, who were referred to the department of Radio diagnosis by the department of Gynaecology of Adesh Institute Of Medical Sciences and Research, Bathinda. A total of 112 patients were observed from 2006 to 2008. A written informed consent was taken. EVS was done to measure endometrial thickness in post menopausal women with postmenopausal bleeding (PMB). Results-The mean endometrial thickness in PMW with PMB was 8.21±6.88mm and in those without PMB was 3.83±2.14mm. With a cutoff value of 4mm endometrial thickness, EVS showed a sensitivity of 100%, specificity 73.33%, a positive predictive value of 76.47%, a negative predictive value 100% and an accuracy of 85.71%. Conclusion- EVS is a useful method for screening for endometrial abnormalities and we recommend its use in women with postmenopausal bleeding. Hence, unnecessary operations in postmenopausal women could be spared where the endometrium is ultrasonographically normal.

Prevalence Of Fixed Dose Drug Combinations In Nepal: A Preliminary Study

POUDEL A* , SUBISH P** , MISHRA P*** , MOHAMED IZHAM MI****, JAYASEKERA J *****

Background: Though fixed dose combinations (FDCs), offer certain advantages in terms of patient compliance, their use is highly debatable. Studies from Nepal have documented a high prevalence of prescribing FDCs. However, there are no extensive studies on FDCs. Hence, we aimed to study the registration status, availability and utilization pattern of FDCs in the Western region of Nepal. Methods And Findings: Primary, secondary and tertiary healthcare centers (one each) and ten retail pharmacies were randomly selected. Initially, the registration status of 50 FDCs in the national drug regulatory authority was evaluated. The availability of these 50 FDCs in ten retail pharmacies was studied following which, a total of 25, 50 and 75 prescriptions were collected from primary, secondary and tertiary health care (PHC, SHC, and THC) centers, respectively, from October 18th to December 15th 2008 and were studied. Among the 50 registered FDCs at the Nepal Department of Drug Administration, only 5 were listed in either the Nepalese National Formulary (NNF), the Essential Drug list of Nepal, or the WHO model list of Essential medicines (15th Edition). Four FDCs which were not registered in the national drug regulatory authority were found in the market. We found that seventy seven percent of FDCs were prescribed in PHC as ‘antimicrobials’. Twenty nine and 35 percent of FDCs prescribed in SHC and THC respectively were for respiratory diseases. We found that 68% and 73% of the total FDCs prescribed in secondary and tertiary health care centers were in the range of ‘less than NRs 100 (US$1.33)’. Conclusions: Although some FDCs are not registered in the national drug regulatory authority of Nepal, they are still available in the market. Large proportions of FDCs are widely utilized in different health care settings of Nepal. A study on the availability, utilization pattern and rationality of FDCs in different cities and health care centers of Nepal are urgently needed.

A Unique Cytological Approach In Diagnosing A Case Of Invasive Aspergillosis Masquerading As Retro-Orbital Neoplasm

KHANNA M*, MANNAN R, KHANNA A, MANNAN R, KAUR J.

Aspergillus is a fungal mould that is commonly present and may colonize the paranasal sinuses and lungs by virtue of large number of Aspergillus spores present in the inhaled air. Rare cases of invasive aspergillosis have been reported in immunocompetent individuals, although they are usually seen in immunocopromised individuals or diabetics. The following is the description of a simple technique in the present case report of a young immunocompetent agricultural worker who presented with invasive aspergillosis as exophthalmos; where the diagnosis was made by isolating the pathogenic organism by employing the remnant material in the needle hub as the incubating material. A 24 year old male presented to the ophthalmology OPD with the complaint of gradual and painless swelling of the right eye with accompanying loss of vision. A radiological opinion of orbital neoplasm was made, with differential diagnosis of benign fibrous histiocytoma and ?? lymphoma. A fine needle aspiration (FNA) was done and the May Grunwald Giemsa (MGG) stained smears revealed numerous foreign body type of giant cells, few epitheloid cell collections and scattered filamentous structures. To delineate the nature of the filamentous structures, Periodic acid Schiff (PAS) staining of the remaining smears was done, which showed that these filamentous structures were fragments of septate fungal hyphae with acute angle branching. A cytological diagnosis of fungal granulomatous lesion was given. It was suggested that an attempt would be made to retrieve the fungal organism by means of culture from the remnant material in the hub of the needle which was used in the procedure .Both the needles were sealed and were sent to the mycology section of the microbiology department. A microbiological diagnosis of Aspergillus flavus was given. The presentation of localized invasive aspergillosis can mimic infectious diseases such as mucormycosis and also neoplastic, vascular and neuro-ophthalmic diseases.

A Large Mixed Radiolucent-Radiopaque Lesion In The Mandible- A Nobel Diagnostic Approach

RASTOGI S*, NIJHAWAN S**, MODI M***, KUMAR A****, ASLAM N *****, LATHEEF F******

Ameloblastoma is a true neoplasm of the enamel organ type tissue which does not undergo differentiation to the point of enamel formation. The term unicystic is derived from the macroscopic and microscopic appearance of the lesion. It is a well-defined, often large monocytic cavity with a lining focally, but rarely entirely composed of odontogenic (ameloblastomatous) epithelium. Predominant radiographical patterns for Unicystic Ameloblastoma are unilocular, scalloped, macromultilocular, pericoronal, interradicular, or periapical expansile radiolucencies. Some investigators believe that Unicystic Ameloblastoma arises from preexisting odontogenic cysts, in particular, from the dentigerous cyst, while others arise de novo. Immunohistochemical markers like lectins (Ulex europaeus agglutinin I and Bandeirea simplicifolia agglutinin I) and proliferating cells (proliferating cell nuclear antigen and Ki-67) may assist in their differential diagnosis. Hence, in our case report, we have tried to discuss in detail about the clinical, radiographical and histopathological features with differential diagnosis. The immunohistochemical importance has also been discussed.

Salmonella Typhi Septic Arthritis Of The Hip - A Case Report

FASEELA T S*, MALLI C S**, BALAKRISHNA A K*** , GOMES L****, NAYAK N*****,

Salmonella infection is endemic in developing countries. Although the commonest manifestation of Salmonella infection is acute gastroenteritis, the infection may spread through the blood stream and the illness can present with focal lesion in almost any organ with or without septicaemia. Isolation of Salmonella species from aberrant sites with a variety of clinical syndromes where they are hardly expected has been reported. We describe here, a case of rarely encountered Salmonella typhi septic arthritis of hip in a 16 years old female. She was treated with ciprofloxacin therapy to which she responded favourably.

An Interesting Case Of Compound Heterozygous Sickle Cell- Β+ Thalassaemia Presenting With Acute Chest Syndrome

Sickle cell disease is a hereditary disorder which is caused due to a mutation in the β-globin gene. Acute chest syndrome is a rare complication which is seen in sickle cell patients in India. Here, we are presenting an interesting case of compound heterozygous Sickle cell-β+ thalassaemia who presented at the age of 20 years with acute chest syndrome and massive hepatomegaly. The patient also typically had veno-occlusive crisis. The diagnosis was based on the presence of numerous sickle cells in the peripheral smear and also on the presence of a strong HbS (68%) band on cellulose acetate electrophoresis supported by increased HbA2>3.5% and decreased cell indices. His mother was reported to have Sickle cell trait, who was asymptomatic with HbS(35.7%) and HbF (1.1%).

Pseudomyxoma Peritonei –A Rare Clinical Entity

Pseudomyxoma Peritonei (PMP) is a rare, chronic, poorly understood disease that is characterized by disseminated mucinous ascitis and peritoneal implants. In order to diagnose PMP, viable epithelial glandular cells must be identified within the mucinous pools by histological analysis. We report here, two male patients and one female patient who presented to our hospital within a span of 4 months. Histopathology records of the last 10years do not reveal any case of PMP. In case1, the diagnosis of PMP was made after laparotomy, as the radiological findings suggested hollow viscus perforation. The case 2 patient had second debulking surgery after 11 years. The case 3 patient developed PMP 3 years after the first surgery. In this patient, preoperative diagnosis was made due to the typical CT findings and appendicial origin was confirmed by CK 7 negativity. All three patients underwent debulking surgery and were referred to the Oncology department for further treament. Histopathology reports of case 1 and case 3 revealed benign epithelium, whereas case 2 had foci of borderline epithelium, indicating disease progression. All three were symptom free after a short follow up of one, two and three months in case 1, 3 and 2, respectively. In all the three cases, PMP was secondary to tumours of the appendix.

Sausage In The Throat. A Case Of Giant Antrochoanal Polyp

BHAT M*, VAIDYANATHAN V**

We report a case of giant antrochoanal polyp, an unusual presentation in an elderly male of 60 years. He came with complains of right sided nasal obstruction and watery discharge since 9 years, accompanied with difficulty in swallowing since 2 years. The antronasal mass measured 15cm in length and 6cm in diameter extended upto pyriform fossa causing dysphagia. Patient underwent endoscopic removal of the polyp. Antrochoanal polyp is common in children and young adults but rare in elderly. With advent of newer diagnostic modalities it is rare to see such fascinating presentation. This case is reported as there are not many articles in world literature of large antrochoanal polyp in the elderly population.

Pearl Pendant Around Her Neck: An Unusual Case Of Stone Seen In A Colloid Goitre

DHINGRA V*, MISRA V** , SINGH P A***,BHATIA R ****,SHARMA N *****

Stones are frequently seen in the gall bladder, kidney and the urinary tract. Rarely can a large stone be found in the thyroid. Only few cases of calcification in thyroid have been reported, especially in association with papillary carcinoma (thyroid). A case of a large stone (2.9 cm x 1.9 cm x 1 cm) in the thyroid, in association with colloid goiter in a 35 yrs old female is documented here.

The Successful Treatment Of Aluminium Phosphide Poisoning With Limited Resources

AGRAWAL A* , KAUR H**

Celphos (trade name for aluminium phosphide) poisoning is a major cause of morbidity and mortality in northwest and central India. The outcome is poor, largely due to delay in appropriate management and skepticism amongst physicians regarding the outcome. Things are further complicated by limited resources in tier 3 cities where most of the cases present initially. In this case, the favourable outcome was largely attributable to episodes of vomiting and aggressive gastric lavage done by an unacknowledged person, who first came in contact with the patient. Still, the patient presented with typical signs and symptoms of celphos poisoning and was managed well with saline lavage, IV Fluids, inj. Magnesium sulphate, inj. Hydrocortisone and broad spectrum antibiotics. In the absence of any specific antidote, management of celphos poisoning hinges on early aggressive gastric lavage and appropriate supportive measures dictated by the presenting sign and symptoms of the patient. The role of Magnesium Sulphate is not clearly documented, but it is used widely based on the membrane stabilizing action and hypo-magnesemia documented in some Aluminium Phosphide Poisoning cases.

Diagnostic Applications of Saliva

GHALAUT P* , GHALAUT V** , YADAV S*** , **** LEKHVANI S , YADAV A *****

Saliva is an easily accessible fluid that is rich in various proteins and enzymes. In addition to this, many drugs are also secreted in the saliva. It offers several advantages over blood as it is collected non-invasively and with much ease. In this article, the authors review various diagnostic applications of saliva.

Cryotherapy – A Review

SUNITHA J

Technical advances in recent years have made the application of controlled low temperatures a feasible proposition in many branches of surgery. In the last decade there has been a proliferation of reports on the uses of cryotherapy; nevertheless, many of the applications are still experimental, or await the test of time. Cryotherapy is the deliberate destruction of tissue by application of extreme cold. The mouth is reasonably accessible to cryotherapy apparatus. The warm moist surface of the oral mucosa is well suited to the application of a freezing probe. Recent advances in cryotherapy equipment have brought treatment by this means within the range of the dentist.

Research Bias: A Review For Medical Students

Krishna R*, Maithreyi R*,Surapaneni K M**

Bias can be defined as a systematic deviation from what would have been the most effective route to one goal because of commitment to another particular tendency or inclination, especially the one that prevents unprejudiced consideration of a question. A biased study loses validity with respect to the degree of the bias. There are two types of biases which are associated with most forms of research viz Random Bias and Systematic Bias. Random biases are those which occur due to sampling variability or measurement precision, they occur in essentially all quantitative studies and can be minimized but not avoided. Systematic biases are reproducible errors that produce a consistently false pattern of differences between the observed and the true values. Both random and systematic errors can question the validity of any research study. The most common categories of bias that can affect the validity of research include the following: Selection biases, which may result in the subjects in the sample being unrepresentative of the population of interest. Measurement biases, which include issues related to how the outcome of interest was measured. Intervention (exposure) biases, involve differences in how the treatment or intervention was carried out, or how the subjects were exposed to the factor of interest. The common methods that are used to reduce Bias in Research are – Randomization, Consecutive recruitment, Prospective versus Retrospective Studies and Blinding. Bias is a universal problem which is faced while designing the research study as well as during the execution of the designed research plan and it is well established fact that no study design is exempted from bias.

Management of Gingival Hyperpigmentation by the Surgical Scalpel Technique - Report of Three Cases

KANAKAMEDALA AK*, GEETHA A**, RAMAKRISHNAN T***, EMADI P ****

A smile expresses a feeling of joy, success, sensuality, affection and courtesy and reveals self confidence and kindness. The harmony of the smile is determined not only by the shape, position and the colour of teeth, but also by the gingival tissues. Gingival tissues form an important part of what we can consider to be a pleasing smile. Often, patients complain about dark gums being unsightly. Gingival pigmentation results from melanin granules which are produced by melanoblasts. Gingival melanin hyperpigmentation is not a medical problem, but black gums are a common complaint and fair skinned people with moderate or severe gingival pigmentation frequently request cosmetic therapy. Melanin is elaborated by specific cells called melanocytes which reside in the basal cell layer and is transferred to the basal cell where it is stored in the form of melasnosomes. Three cases of gingival hyperpigmentation which were treated by the surgical scalpel technique are described here. Also discussed here in brief, are the various other techniques that can be used for the same.

Oral Reconstruction Of Retromolar Trigone Carcinoma Using Buccal Fat Pad

GUPTA R * , ARORA D**

Guiding Flange Prosthesis for a Patient with a Hemi-Mandibulectomy Defect: A clinical report.

BANERJEE R*, BANERJEE S**

Rehabilitation of patients with maxillofacial defects is a difficult task. The denture fabrication for such a patient becomes extremely difficult due to the unavailability of attached keratinized supporting tissues. Pre-prosthetic plastic reconstructive surgery with or without implant therapy may improve denture retention and stability. But this treatment option sometimes cannot be accomplished because of the complexity of surgical reconstruction and the patient’s unwillingness to undergo further surgical interventions. Prosthetic rehabilitation alone, without plastic-surgical reconstruction for an edentulous patient who has undergone segmental mandibulectomy, is a challenging task.

Cleidocranial Dysplasia – Report Of a Case

TELKAR S R *, KERUDI V V**, *** DODAMANI A, ****PRASHANTH V K

Cleidocranial dysplasia is a rare congenital disorder of the bone, characterized by abnormalities of the clavicles, skull and jaw bones. It was first described by Pierre Marie and Paul Sainton in 1898 and since then, over 1000 cases have been documented in medical reports. It is a rare syndrome which is usually caused by an autosomal dominant gene, although 40% of the cases of CCD appear spontaneously, with no apparent genetic cause. The bony and dental features of CCD may be visualized on the radiographical images of the face and the skull and they are characteristic. We report here, a case of Cleidocranial dysplasia in an 18 year old patient, with emphasis on radiological findings.

Unethical Pharmaceutical Promotion: Now It Is Time to Act

SHAH V*

Development Of Post Tubercular , Bronchial Asthma –A Pilot Study

SHETTY A J , TYAGI A

Pulmonary impairment associated with obstructive airway disease is recognized as a common complication of advanced tuberculosis. Most patients suffering from tuberculosis with moderate to far advanced post treatment residual lung lesions exhibit symptoms of impaired pulmonary functions due to persistent airway obstruction but why do only a small proportion develop reversible airway obstruction to qualify for post tuberculosis bronchial asthma categorization? The present study was aimed to investigate if antitubercular drugs were involved in the pathophysiology of post-tubercular bronchial asthma. Asthmatic patients with past history of pulmonary tuberculosis who visited the hospital for treatment between Jan - Dec 2006 and 16 patients who had history of pulmonary tuberculosis and had successfully completed anti tubercular therapy but did not develop asthma were randomly chosen. During the study period there were 20 asthmatic patients with past history of antitubercular drug therapy. With 6 months of antitubercular therapy, 6 out of 20 pulmonary tuberculosis patients developed asthma (40%) and 9 out of 16 patients took 6 months of antituberculars but did not develop asthma (60%). p= 0.3, found not significant. With 8 months of antitubercular therapy, 14 out of 20 patients developed asthma (66.7%) and 7 out of 16 patients did not develop asthma (33.3%) . p= 0.5, found not significant. (Fishers test). Conclusion : Anti tubercular drugs do not appear to play a role in the development of post tubercular bronchial asthma.

Comparing the Prescription Pattern in the Treatment of Acute Insomnia among Urban and Rural Physicians as per the NICE Guidelines.

PRAVEEN R

Background: Insomnia is one of the most disabling disorders afflicting the society, with a staggering emotional and economical impact. Most of the patients consult physicians rather than consulting the psychiatrist at the first point of contact and hence, we have planned to take up this study to know as to how many physicians treat acute insomnia as per the guidelines. Objectives: To study and compare the prescription pattern among the urban and rural physicians in treating acute insomnia as per the National Institute for health and Clinical Excellence (NICE) guidelines. Methods: 75 physicians in the rural and 65 physicians in the urban areas were given a questionnaire and were given enough time to fill it. Later on, all the questionnaires were collected and analyzed. Results: Physicians in rural areas: 65 physicians prescribed the short acting benzodiazepine group, 9 physicians prescribed the z-class of drugs and 01 physician prescribed antihistaminics. Physicians in urban areas: 45 physicians prescribed the Z-class of drugs and 20 physicians prescribed the short acting benzodiazepine group for the treatment of acute insomnia. Conclusion: The NICE guidelines state that for the treatment of acute insomnia, the drug of choice is the Z-class of drugs. In our study, most of the physicians practising in the urban areas adhered to the guidelines in treating acute insomnia more than the physicians practising in rural areas. Hence, the physicians practicing in the rural areas needed to have awareness campaigns and medical educational programs regarding the treatment of acute insomnia.

Detection Of Human Papilloma Virus In Esophageal Squamous Cell Carcinoma In Guilan Province

MOHSENI MEHRAN S M *

Background: Despite many researches on the causes of Esophageal Squamous Cell Carcinoma (ESCC) many factors can cause but some types of HPV seem to be one of those factor. At the last studies the HPV cause 10 to 67% in some regions. Guilan is a region in Iran with high incidence of (ESCC) so it’s need to study more on (ESCC). Methods: In this study, we compared the prevalence of 3 kind of primers: general markers GP5+/GP6+ to show how much HPV are participated, mild oncogenic types of HPV 31,33,35,39,41,51,52 and high-risk oncogenic types of HPV 16 and 18 on E6/E7 gene in tumor tissues from 45 ESCC cases. Results: In 17 of 45 ESCC (37.7%) samples were positive for general markers ,GP5+/GP6+, the HPV presence was 4 of 45 and in respect of ESCC (8.8%) samples were positive for oncogenic types and 2 of the ESCC (4.4%) samples were high risk HPV 16,18 E6/E7 gene and the 22 samples were negative for HPV types. Conclusions: Our data are consisted with HPV DNA studies conducted in high–risk area (Guilan) for ESCC. HPV should be considered as a potential factor responsible for the increased incidence of ESCC, in spite of low incident in our study in Guilan .