Journal of clinical and diagnostic research

PCR Detection and Identification of Bacterial Contaminants in Ocular Samples from Post-Operative Endophthalmitis

Background: Bacterial endophthalmitis is a sight-threatening complication of ocular surgery which requires urgent medical consideration including comprehensive diagnosis. Polymerase chain reaction (PCR) as a sensitive molecular method has been extensively used for detection of microbial species in clinical specimens. Aim: The aim of this study was to identify the causative organisms of endophthalmitis in our patient population using a procedure based on PCR. Materials and Methods: Vitreous samples from 32 patients with post-operative endophthalmitis were collected. Total vitreous DNA was extracted and then assessed by agarose gel electrophoresis. Bacterial 16S rRNA gene was amplified from genomic DNA using PCR with a pair of HAD2 universal primers. Library of PCR products from 16S rRNA, cloned into the pTZ57R/T vector. The ligated products were then transformed into E. coli DH5a strain and grown in the LB-ampicillin/X-Gal/IPTG plate. Results: From the total of 32 vitreous samples, 18 specimens were positive, illustrating the presence of bacterial infection (56.4 %). Twelve species including Escherichia coli, Enterobacter cloacae, Bacillus subtilis, Neisseria gonorrhoeae, Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia trachomatis, Staphylococcus aureus, Neisseria meningitides, Staphylococcus epidermidis, Pseudomonas aeruginosa and Bacillus cereus were identified using BLAST for known 16S rRNA sequences. Conclusion: Polymerase chain reaction (PCR) accompanied with cloning and sequencing approved to be sensitive and specific. The rapid molecular technique was useful in detection of 12 major microbial species, in infectious endophthalmitis.

Auditing Analgesic Use in Post-operative Setting in a Teaching Hospital

Sumana Sen, Prapthi Bathini

Introduction: Managing postoperative pain efficiently is one important therapeutic challenge in the hospitals. Combination use of analgesics is in vogue, where in drugs from the opioid and non-opioid group are given synergistically. The aim of this study is to audit the use of different analgesics on the first postoperative day. Effort has been made to look into the drug or drug combinations used and other factors associated with their use. Materials and Methods: Retrospective, cross sectional observational study was conducted over a period of 11 months in a tertiary care teaching hospital at Hyderabad with approval from institutional ethics committee. Medical records of 649 patients on the first postoperative day were analysed for analgesics by various indicators. Results: Average number of drugs per encounter was 4.23. Percentage of patients prescribed drugs from national essential drug list/WHO was 81.94%. Most common analgesic (monotherapy) prescribed was tramadol followed by diclofenac and the most common combination drugs prescribed were tramadol+Paracetamol. The most common route of administration was intravenous. All the drugs except piroxicam, were in the lower limit of the recommended daily dose. Conclusion: The present study gives an idea of the overall pattern of analgesic drug use in postoperative patients. The drug combinations used, the most common single use drug can be made out. The health professionals can be encouraged to prescribe by generic name and from the National List of Essential Medicines NLEMs.

Feto-maternal Outcome Using New Screening Criteria of Serum TSH for Diagnosing Hypothyroidism in Pregnancy

Introduction: Evidence suggests that by using the classical non pregnant reference range for serum TSH (STSH), one might miss hypothyroidism in pregnancy. Therefore, upper normal cut off value of S TSH should be taken as <2.5 mIU/L in the first trimester and <3mIU/L in the second and third trimester. However, two Indian studies have reported higher trimester specific reference ranges in the Indian pregnant women. Objectives: To assess the maternal and fetal outcomes using new screening criteria with upper S TSH cut off as >3mIU/L, for diagnosing hypothyroidism in pregnancy. Materials and Methods: This study was a cross sectional study, carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, in collaboration with the Department of Endocrinology. Pregnant women with = 20 weeks gestation, attending antenatal OPD from December 2010 to January 2012 were included in the study. On the basis of S TSH level, women were divided into Study Group with S TSH level between 3.1 to 6.2 mIU/L, (new range to be studied) and an equal number of age and parity matched Control Group with S TSH levels between 0.4 to 3 mIU/L. The maternal and fetal outcomes were compared between study and control groups. Results: During the study period, a total of 66 women had S TSH between 3.1-6.2 mIU/L. Maternal and fetal outcomes in both the groups were comparable. There was no difference in the mode of delivery between study and control groups. Conclusion: The lower S TSH cut off recommended for diagnosing hypothyroidism in pregnancy may not be applicable to pregnant Indian women.

Fractional Excretion of Sodium and Its Association with Prognosis of Decompensated Heart Failure Patients

Dinanath Kumar, Rajeev Bagarhatta

Introduction: Diuretic resistance is a common problem in congestive heart failure patients. It has been defined clinically but can be defined objectively in terms of fractional excretion of sodium (FENa). Aim: Aim of the study was to find out the association of FENa with prognosis of decompensated heart failure patients. Materials and Methods: One hundred and seventy eligible patients with a primary diagnosis of decompensated heart failure were enrolled and patients were categorized into two groups on the basis of baseline FENa- Group A (65 patients) with diuretic resistance with FENa <0.2% and Group B (105 patients) sensitive to diuretics with FENa =0.2%. The patients were followed-up during the hospital stay for the time taken for improvement from NYHA functional class IV to class II. They were followed telephonically at 30 days post admission for all cause mortality. Result: The mean time taken to improve from NYHA functional class IV to class II were 146 hours for FENa<0.2% and 60 h for FENa=0.2% (p<0.0001). There was a fair negative correlation between FENa and time taken for improvement from NYHA functional class IV to class II with correlation coefficient being -0.4842. Multiple linear regression analysis showed FENa (standardized “B” is -0.480, p<0.001) and LVEF (standardized “B” is -0.182, p=0.007) as significant predictors of time taken for improvement from NYHA functional class IV to class II. The 30 days all cause mortality was significantly associated with level of Fena (p <0.001) and was inversely proportional. Conclusion: CHF patients with FENa <0.2% takes longer time to recover from NYHA functional class IV to class II. 30 days all cause mortality was also significantly higher among CHF patients with FENa <0.2%.Measuring baseline FENa and regulating diuretic dose accordingly at admission to hospital may probably improve the prognosis of CHF patients.

Outcomes for Emergency Severity Index Triage Implementation in the Emergency Department

Amir Mirhaghi, Hadi Kooshiar, Habibollah Esmaeili, Mohsen Ebrahimi

Introduction: Hospital triage scale in emergency departments needs to be valid and reliable. Lack of sufficient data exists on triage scale rigor in emergency departments of Iran. This study aimed to determine the impact of the emergency severity index (ESI) triage scale in the emergency department. Materials and Methods: A single-center study was conducted. Proportion of triage categories allocated to high-risk patients admitted to high-acuity departments was examined in observational period in June 2012 and May 2013. True triage score was reported based on patients` paper- based scenario questionnaire. Interrater reliability was assessed using unweighted kappa. Concordance among experts, nurses and physicians was examined. The Chi-square test and Kappa statistics was used for statistical analysis. Results: Triage decisions regarding high-risk patients before and after implementation period are independent from each other (?2= 22.254; df=1; p<0.05) and more high-risk patients were recognized after implementation of the ESI. Overall agreement and concordance were (79%) and (?=0.54) among nurses; (71%) and (?=0.45) among physicians, (85%) and (?=0.81) among experts, respectively. Correct triage decisions among clinicians were increased after implementation of the ESI. Conclusion: The ESI as valid and reliable tool improving desirable outcomes` in the emergency department has been recommended but it may not reveal optimal outcomes in developing countries comparing to what have been achieved in the developed countries. In addition, patient influx in ESI level II could create considerable controversy with clinicians.

Comparison Between External Rotation Method and Milch Method For Reduction of Acute Anterior Dislocation of Shoulder

Krishna Sapkota, Bhola Shrestha, Pratyenta Raj Onta, Pabin Thapa

Background: Anterior dislocation of shoulder account for more than 50% of dislocation that occur in our body. Several methods of reduction are described in literature which are painful or require anaesthesia. Aim: This study was undertaken to compare the External Rotation Method and Milch method for reduction of anterior dislocation of shoulder. Materials and Methods: There were total 52 patients with anterior dislocation of shoulder, distributed randomly into 2 groups. Reduction was done by External Rotation Method and Milch Method for each group and their outcome were compared. Statistical Analysis: The data was analysed by using SPSS for Windows (version 16.0) by applying the Chi-Square test. p-values of <0.05 was considered as significant. Results: Among each group of 26 patients, three patients required anaesthesia in External Rotation Method and eight patients required anaesthesia in Milch Method. There was no statistically significant difference in success rate between external rotation (88.46%) and Milch (69.23%) methods of reduction (p=0.09). Conclusion: Both methods of reduction can be used for reduction of anterior dislocation of shoulder without anaesthesia but external rotation method was found to be easier and less painful.

A Comparative Study of Colostrum Dressing Versus Conventional Dressing in Deep Wounds

Introduction: Deep wounds are extending deeper, across deep fascia into muscles or deeper structures. Understanding of nutrition, immunology, psychological issues, the physiology and the metabolic interactions require for optimal treatment of deep wounds. Wound dressing plays one of the important roles in wound healing. Newer type of wound dressings - Biological dressings like colostrum powder, collagen granules create the physiological interface between the wound surface and environment which is impermeable to bacteria. Aim: To compare the efficacy and safety of colostrum dressing and conventional dressing in deep wounds. Materials and Methods: Data was collected from all patients with deep wounds (stage II-IV), admitted during the period of April 2013 to March 2014, considering the inclusion and exclusion criteria. Results: Less number of dressings, short healing time, rapid healing and decrease pain seen in colostrum dressing group compared to conventional dressing group. Conclusion: Colostrum powder dressings are safe, promoter of wound healing, more patient compliance in terms of less pain, less number of dressing required. This treatment though found to be more expensive than conventional dressings; results indicate that colostrum powder dressings may be used as an adjunct in management of deep wound.

Evaluation of Serum Magnesium, Lipid Profile and Various Biochemical Parameters as Risk Factors of Cardiovascular Diseases in Patients with Rheumatoid Arthritis

Vilas U. Chavan, DVSS Ramavataram, Payal A. Patel, Mihir P. Rupani

Background: Rheumatoid arthritis (RA) is chronic inflammatory disease, associated with increased risk of cardiovascular diseases (CVD) than the general population. Chronic inflammatory conditions are likely to alter magnesium level and various biochemical parameters. Objectives: To study the probable changes in serum magnesium, lipid profile and various biochemical parameters and to assess risk factors of CVD in newly diagnosed RA patients compared to controls. Materials and Methods: We studied 50 newly diagnosed RA adult patients and 50 healthy individuals as controls. Serum magnesium, calcium, lipid profile, uric acid and other biochemical parameters were measured in study subjects. Results were expressed as Mean ± SD and compared between RA subjects and controls by Independent sample t-test and Pearson correlation. Results: We found decreased serum magnesium and calcium in RA subjects compared to the controls (p < 0.001). RA subjects had atherogenic lipid profile characterized by elevated total cholesterol (p = 0.054), LDL cholesterol (p = 0.008) and decreased HDL cholesterol (p < 0.001). Serum uric acid was higher in RA cases compared to controls (p = 0.025). Serum magnesium was negatively correlated with total cholesterol, LDL cholesterol and positively correlated with HDL cholesterol in RA cases. Conclusion: Decreased magnesium level, dyslipidemia and increased uric acid observed in our study together may be more potent risk factors for CVD in newly diagnosed RA subjects. We recommend that serum magnesium should be investigated as a part of cardiovascular risk management in RA. We suggest that decreased serum magnesium and increased serum uric acid may be considered as nontraditional risk factors of CVD in RA. Further prospective studies are needed to confirm the impact of inflammation on various biochemical parameters and cardiovascular outcomes in patients with RA.

Relationship Between Intracerebral Hemorrhage and Diabetes Mellitus: A Case-Control Study

Introduction: The role of diabetes mellitus in the pathogenesis of intracerebral hemorrhage (ICH) is controversial. Underlying comorbidities such as diabetes mellitus may increase the risk of intracerebral hemorrhage. In this study, we sought to assess the role of diabetes mellitus in the occurrence of intracerebral hemorrhage. Materials and Methods: In this case-control study, the prevalence of diabetes mellitus was evaluated in 120 patients presenting with intracerebral hemorrhage and in a control group of 135 patients with low back pain. All patients were treated at the Departments of Neurology and Neurosurgery, Shohadaye Tajrish University Hospital, Tehran, Iran between 2008 and 2012. T-test was applied for analysing the quantitative variables and chi-square and Fisher’s exact tests were used to analyse qualitative variables. Results: The mean age was 67.5±12.7 y in patients with intracerebral hemorrhage and 70.5±12.6 y in the control group (p=0.201). Diabetes mellitus was found in 39 patients with intracerebral hemorrhage (33.1%) and 30 (22.2%) control subjects (p=0.054). The prevalence of diabetes mellitus in patients younger than 60 y was 7.4% in the control group and 27.8% in the case group (p=0.042). Conclusion: In our study, no significant relationship was found between diabetes mellitus and intracerebral hemorrhage (except in patients younger than 60 years) and diabetes mellitus did not cause bleeding in certain brain areas. However, more studies are required on the correlation of diabetes mellitus and intracerebral hemorrhage in the same population to reach a definite conclusion.

Immunoglobulin E, Interleukin-18 and Interleukin-12 in Patients with Atopic Dermatitis: Correlation with Disease Activity

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Immunological/inflammatory reactions are reported to play a role in AD but their role in disease activity has not been fully investigated. This study was done to investigate the role of immunoglobulin E (IgE), interleukin (IL)-18 and IL-12 in AD patients with different disease severities. Materials and Methods: Sera from 50 AD infants with varying levels of disease activity according to the scoring index of atopic dermatitis (SCORAD) index and 30 age-matched healthy controls were evaluated for serum levels of IgE, IL-18 and IL-12/p40. Results: Serum analysis showed higher levels of IgE, IL-18 or IL-12/p40 in AD patients compared with controls. Interestingly, not only was there an increased number of subjects positive for IgE, IL-18 or IL-12/p40, but also the levels of these parameters were higher among AD patients whose SCORAD scores were higher. In addition, a significant correlation was observed between the levels of these parameters and SCORAD scores. Conclusion: These findings support an association between IgE, IL-18 or IL-12/p40 and AD. The stronger response observed in serum samples from patients with higher SCORAD scores suggest that IgE, IL-18 and IL-12/p40 may be useful in evaluating the progression of AD and in elucidating the mechanisms of disease pathogenesis.

To Study the Efficacy and Safety of Doxophylline and Theophylline in Bronchial Asthma

Sami Manzoor Margay, Samina Farhat, Sharanjit Kaur, Hilal Ahmad Teli

Objectives: Mobile phones are being widely used throughout the world. Electromagnetic waves generated from mobile phones have raised concerns as these may have adverse effects on human auditory system owing to the daily use of mobile phones. The purpose of current study was to evaluate the effects of long term mobile phone usage on auditory brainstem evoked responses (ABR). Materials and Methods: A retrospective, cross-sectional, case control study was carried out in a tertiary care hospital. Total 100 healthy subjects aged 18 to 30 years of both the genders were selected, out of which 67 subjects were long-term GSM mobile phone users (using mobile phone for more than 1 year) and 33 were controls who were mobile phone non users. Both the groups were investigated for ABR and changes were studied in both the ears of cases and controls to ascertain the effects of electromagnetic exposure. Results: No significant difference (p>0.05) was found in latencies, interpeak latencies and amplitudes of ABR waves between cases and controls. Conclusion: Our study shows that long term usage of mobile phones does not affect propagation of electrical stimuli along the auditory nerve to auditory brainstem centres.

Effect of Yoga on Blood Glucose Levels in Patients with Type 2 Diabetes Mellitus

Subhash Manikappa Chimkode, Sendil D. Kumaran, V.V.Kanhere, Ragunatha Shivanna

Introduction: In view of people embracing sedentary life style, and the effectiveness of treatment becoming less, the role of regular exercise especially ‘yoga’ seems to be a beneficial and economical adjuvant in the management of the Type 2 diabetes mellitus (T2DM). Objectives: To assess the beneficial effects of yoga on blood glucose levels in normal and T2DM volunteers. Materials and Methods: A prospective case-control study was conducted in the Department of Physiology and Diabetic clinic of a tertiary care teaching hospital over period of two years. The study subjects consisted of 30 male diabetic patients attending diabetic clinic and 30 non-diabetic male volunteers constituted control group. The patients in the age group of 36 to 55 years with T2DM of at least one year duration and those on diabetic diet and oral hypoglycemic agents were included in the study group. The age matched healthy male volunteers who had come to join yoga training at yoga centre were included in the control group. All the participants were trained by yoga experts and subjected to regular practice under supervision for six months. In all the participants fasting (FBS) and post-prandial blood sugar (PPBS) was estimated before, during (at three months) and after (six months) yoga training. Paired Student t-test was used to estimate difference in means calculated before and after yoga training in a same group. A p-value of <0.05 was considered as statistically significant. Results: The distribution of age, mean height and mean weight among both the groups were comparable. The reduction in mean values of FBS and PPBS at the end of six months was highly significant (p <0.001) in both the groups when compared with the mean values before and during (three months) yoga practice. The reduction in these values at three months during yoga was highly significant in T2DM group when compared with mean values before yoga (p <0.001), but it was insignificant (p>0.05) in control group. Conclusion: The results of the present study demonstrated that the yoga is effective in reducing the blood glucose levels in patients with T2DM.

The Significance of Evalution of Haematocrit in Plateletpheresis Donors

Background: The collection of platelets by apheresis is considered as a very great progress in transfusion medicine. In present era, many automated cell separation are available each model has tried to improve productivity, quality of plateletpheresis. Further various studies have been done to correlate the quality of platelet concentrates. Also, various biochemical studies have been done on plateletpheresis donors. However, safety issue with regards to post procedure levels of biochemical parameters decreased in donors undergoing plateletpheresis have been only minimally explored. Objectives: Investigating Haematological and Biochemical parameters (Hematocrit value and Serum Calcium levels) pre and post in plateletpheresis donors. Materials and Methods: Sixty two healthy first time voluntary plateletpheresis donors at Apheresis unit in blood bank Bharati Vidyapeeth Deemed University Medical College & Hospital, Sangli, Maharashtra, India. Hematocrit value of plateletpheresis donors were analysed and based on mean value 43.2% considering this as standard in the present study. We categorized plateletpheresis donors in two groups (A) these having value less than 43.2% (n = 36) and Group (B) having haematocrit more than 43.3% (n = 26). Volume of ACD required for donors from both group were noted. Result: We observed mean of ACD infused in group A plateletpheresis donors was 347.7 ml ± 35.75 SD while group ‘B’ donors required mean volume ACD to be infused was 379.6 ml ± 46.24 S.D. was statistically significant (p < 0.005). Conclusion: Plateletpheresis induces marked metabolic effects, with sustained changes in serum calcium and haematocrit after ACD infusion, the results show, before procedure (Plateletpheresis) one must consider the haematocrit value along with serum calcium levels in Plateletpheresis donor to avoid severe symptoms of hypocalcaemia.

Role of Ultraosonography in Grading of Penile Fractures

Introduction: Penile fracture is an uncommon and less reported condition. Early diagnosis with corrective measures is the order of the day. Aim: To perform ultrasonography of penis and to understand its role in making correct diagnosis of fractures. To know how it will help surgeon in its management and in adopting a grading system. Materials and Methods: Emergency evaluation of 15 cases of penile fractures by ultrasonography before surgery. Entire penis was scanned all along its length and circumference. Tunica albugenia was seen as white covering of both corpora cavernosa and break in its continuity is seen as wedge shape defect. Hematoma on either sides of tunica was well appreciated. Results: After ultrasonography all patients underwent emergency surgery, the defect in corpora was well appreciated. Repair of tunica albugenia was done which confirmed our findings. Conclusion: Ultrasonography is the modality of choice for quick diagnosis, and no other radiological workup is required before surgery.

MRI Evaluation of Lumbar Disc Degenerative Disease

Pokhraj Suthar, Rupal Patel, Chetan Mehta, Narrotam Patel

Introduction: Lower back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 40 y. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes. Aims and Objective: To evaluate the characterization, extent, and changes associated with the degenerative lumbar disc disease by Magnetic Resonance Imaging. Study Design: Cross-sectional and observational study. Materials and Methods: A total 109 patients of the lumbar disc degeneration with age group between 17 to 80 y were diagnosed & studied on 1.5 Tesla Magnetic Resonance Imaging machine. MRI findings like lumbar lordosis, Schmorl’s nodes, decreased disc height, disc annular tear, disc herniation, disc bulge, disc protrusion and disc extrusion were observed. Narrowing of the spinal canal, lateral recess and neural foramen with compression of nerve roots observed. Ligamentum flavum thickening and facetal arthropathy was observed. Result: Males were more commonly affected in Degenerative Spinal Disease & most of the patients show loss of lumbar lordosis. Decreased disc height was common at L5-S1 level. More than one disc involvement was seen per person. L4 – L5 disc was the most commonly involved. Annular disc tear, disc herniation, disc extrusion, narrowing of spinal canal, narrowing of lateral recess, compression of neural foramen, ligamentum flavum thickening and facetal arthropathy was common at the L4 –L5 disc level. Disc buldge was common at L3 – L4 & L4 – L5 disc level. Posterior osteophytes are common at L3 - L4 & L5 –S1 disc level. L1- L2 disc involvement and spondylolisthesis are less common. Conclusion: Lumbar disc degeneration is the most common cause of low back pain. Plain radiograph can be helpful in visualizing gross anatomic changes in the intervertebral disc. But, MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes.

Salivary Visfatin Concentration in Response to Non-surgical Periodontal Therapy

Introduction: Visfatin is a pro-inflammatory cytokine that has been associated with several immunomodulating processes. The relationship between visfatin and periodontitis has been the subject of a few studies that have described visfatin as an inflammatory marker for periodontitis. However, studies on visfatin as a potential therapeutic target in periodontal diseases are scarce. In the present study, we evaluated the alterations in salivary visfatin levels in response to non-surgical periodontal treatment. Materials and Methods: Twenty individuals with moderate to severe chronic periodontitis and twenty periodontally healthy individuals were selected for this study according to clinical parameters. Patients with chronic periodontitis were treated by non-surgical periodontal therapy. Clinical parameters were recorded and saliva samples were obtained from the control group and test group before (T1 group) and one month after periodontal treatment (T2 group). Salivary visfatin concentrations were measured by standard enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with the statistical software SPSS, version 18. Results: Visfatin was detectable in all samples. T1 and control groups were significantly different in terms of clinical parameters and visfatin levels. Visfatin concentrations were reduced significantly after non-surgical periodontal therapy. Periodontal treatment also resulted in significant reductions of all clinical parameters with the exception of clinical attachment level. Conclusion: The results demonstrated that salivary levels of visfatin are reduced after non-surgical periodontal therapy to the levels comparable with those found in healthy individuals. Therefore, the salivary visfatin level may have the potential to be a target marker for assessment of responses to non-surgical periodontal therapy. However, more studies with larger sample sizes are necessary to validate these findings.

Hinged Single Piece Putty Index for Preclinical Demonstration of Tooth Preparation for Fixed Partial Dentures and Crowns

Leoney, Shallabh kumar

Introduction: Different types of indices are being used for assessment of tooth preparation. All these indices are used to visualize tooth preparations in a particular plane. A single versatile index which could help to visualize tooth preparations in different planes is non-existent. The need for fabrication of such an index and its reliability is of utmost important to provide quality tooth preparations. Purpose: The purpose of the study is to fabricate a hinged single piece sectioned index which could be used to visualize tooth preparation in different planes and check its reliability in-vitro on phantom models. Materials and Methods: Ten preclinical students were selected in random for preparing three teeth each. The three teeth preparations are classified as Group A, Group B and Group C based on the non-usage of index, usage of sectioned index and hinged single piece sectioned index respectively. Students were made to do provisional restorations after the tooth preparations. Then a questionnaire was given to students to score the duration/accuracy/comfort during tooth preparation and duration/accuracy of provisional restorations for each of the Groups A,B and C. Results: In Group C, 90% of students found the final preparation to be very accurate. The time taken for fabrication of provisional restoration using sectioned hinged index by 60% of Group C students was 20 to 30 min. Conclusion: This hinged index is a viable option when accuracy of tooth preparation and speedy fabrication of provisional restoration is required.

Efficacy and Tolerability of Levosulipride, Domperidone and Metoclopramide in Patients with Non-Ulcer Functional Dyspepsia: A Comparative Analysis

Harminder Singh, Ritu Bala, Kamalpreet Kaur

Objective: This is a prospective, randomized study designed to demonstrate the efficacy of three study drugs (Levosulpiride, Domperidone and Metoclopramide) in Functional Dyspepsia. Subject recruitment was done from medicine outpatient department of the teaching hospital from June 2013 to November 2013. Materials and Methods: The data collection was performed by the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), a question instrument for assessing the dyspeptic symptoms of functional dyspepsia in patients enrolled for the study. The symptoms were assessed at base line (Prior to initiation of therapy) and at 4 weeks, on a 5-point scale. Result: Among 120 patients 113 patients completed this study in three groups (G-1 Levosulpiride 40 patients, G-2 Domperidone 35 patients and G-3 Metoclopramide 38 patients) were followed up. Female gender dominated (75), occupation wise most of patients belonged to labour class (49). Highly significant improvement in symptoms scale was noticed in G-1 Levosulpiride 40 patients’ group. Conclusion: Functional Gastrointestinal disorders are not serious ailments but have a key impact on quality of life. Overall dyspeptic symptom relief rates were significantly high in the Levosulpiride group (p<0.004) as compared to Domperidone and Metoclopramide groups. A proper understanding of disease process by health care personnel and by sufferer is obligatory to enhance the quality of life and daunt the self/over the counter medication in this condition.

Impact of Music Therapy on Breast Milk Secretion in Mothers of Premature Newborns

Jayamala AK, Preethi Bangalore Lakshmanagowda, Pradeep G C M, Jaisri Goturu

Introduction: The promotion of breastfeeding is a simple and efficient strategy in reducing morbidity and mortality in neonates worldwide. Milk from the mother of a Preterm New Born (PTNB) infant contains a higher concentration of nutrients and energy than that produced by mothers of a full-term infant. Studies have shown that music therapy can reduce maternal anxiety, helping mothers cope with the hospitalization of their newborns in Neonatal Intensive Care Unit (NICU). Objective: To evaluate the impact of music therapy on amount of breast milk secretion among mothers of premature newborns by reducing maternal stress. Materials and Methods: Mothers of premature babies who were admitted to NICU at a tertiary health care centre were included as subjects. Mothers of premature infants were enrolled in the study once they came to NICU to express breast milk from Dec 2012 to May 2013. Each subject was assessed for 4 sessions on MT (Music Therapy) and 4 sessions on NMT (No Music Therapy) over 4 days. Breast milk was expressed using breast milk pump and quantity was measured for two sessions each day once at 11.00am and other at 4.00pm. Raga malkauns and yaman by flute was used for music therapy. MT was administered for 4 sessions in a randomized manner during the study period of 30mins (15mins prior to and 15mins during Breast milk amount). To assess the psychological stress, PSS questionnaire was administered on day 1 and day 4 of MT. Mother’s saliva was collected to estimate salivary cortisol level on the last day of study during the sessions with MT and NMT. Results: Music therapy was associated with a significant reduction in stress level as shown by improved PSS score and reduced salivary cortisol. Subjects who received music therapy had significant increase (p-value- 0.033) in breast milk expression when compared to mothers who didn’t. Conclusion: Music therapy can be easily used in the breast milk expression room as a method to increase breast milk secretion in mothers who are stressed because of their neonates being admitted in NICU.

Assessment of Tooth Proportions in an Aesthetically Acceptable Smile

Introduction: Aesthetic facial animation is mostly reported to be due to a close relationship between soft and hard tissue i.e. dynamic smile with appropriate tooth proportions. But variations in tooth size have been seen among various ethnic populations globally. Aim: To evaluate the size and morphology of maxillary anterior teeth, the tooth with maximum variation both mesiodistally and cervicoincisally. Also, the tooth to tooth ratio in percentage of the mean tooth sizes in both genders in patients with aesthetically acceptable smile decided by a panel in North Indian population. Materials and Methods: A total of 100 subjects (50 males and 50 females) were taken and a video clip of their dynamic smile was captured .The smiles were analyzed by a panel and the tooth proportions of the selected attractive smiles were evaluated in both males and females separately. Statistical analysis: Data obtained was subjected to statistical analysis using Microsoft Excel 2007 software; test used was Unpaired t-test and also Mean ± S.D., Variance, Ratio of W/L and its ranges were calculated. Significance is assessed at 5% level of significance. Results: The mesiodistal width and cervicoincisal length of maxillary central incisor was greater compared to lateral incisor and canine in both males and females. There was a statistically significant difference between the width/length ratio of maxillary anterior teeth between males and females.Canine and Lateral incisor showed maximum variation mesio-distally and cervico-incisally. Conclusion: A smile is more pleasing if the visible teeth are in proper morphological proportions. Thus, it relates that teeth play a vital role in increasing the attractiveness of a smile. The mean coronal width/length ratio displayed a more square like tooth form for both males and females.

Free Radicals and Antioxidant Status in Chronic Osteomyelitis Patients: A Case Control Study

Introduction: Osteomyelitis (OM) is a local or generalized infection of the bone and bone marrow which may be multifactorial in its causation. Chronic infection is characterised by sequestrum and involucrum formation. Aim: The present study has been carried out for assessing the oxidative stress in chronic OM by measurement of serum oxidants {such as malondialdehyde (MDA), protein carbonyl (PC), nitrite} and the serum antioxidants {such as ascorbic acid, superoxide dismutase (SOD), ceruloplasmin (Cp), blood glutathione} by spectrophotometric method. Materials and Methods: This was a case control study. About 5 ml of venous blood was collected for the estimation of biochemical parameters. This study comprised of 50 OM patients diagnosed at SSLH Hospital, Varanasi and 50 healthy ages (15-35 y) and sex matched individuals. Results: Significantly increased (p<0.0001) levels of serum oxidants and significantly decreased (p<0.0001) levels of all serum antioxidants except ceruloplasmin indicated significantly increased (p<0.0001) levels in response to infections in chronic OM patients as compared to the healthy controls. Conclusion: These results suggest that there occurs an imbalance between oxidants and antioxidants, especially an increase in oxidative stress, as measured by the levels of the parameters: serum MDA, serum protein carbonyl and serum nitrite.

Quantification of Selenomonas sputigena in Chronic Periodontitis in Smokers Using 16S rDNA Based PCR Analysis

Background and Aim: Selenomonas species have been associated with chronic periodontitis and have been implicated in converting periodontal health to disease. Scanty literature is available in Indian population. Hence, the objective of the study was to detect the prevalence of Selenomonas sputigena in healthy and chronic periodontitis by polymerase chain reaction (PCR) in Indian population and to check whether smoking affects the subgingival microflora of this organism in chronic periodontitis. Materials and Methods: A total of 60 subjects with severe chronic periodontitis with or without smoking and periodontal healthy subjects underwent clinical and microbiological assessment. A deep subgingival plaque sample was collected and genomic DNA was extracted from each sample and analysed for detection of Selnomonas sputigena using PCR. The frequency and quantification of bacteria were also estimated. Results: All groups differed statistically significant in the frequency of detection of Selenomonas sputigena. On comparison of patients with chronic periodontitis in smokers and non-smokers, there was no statistically significant difference. When the results were quantified, statistically non-significant results were seen among all groups. Plaque index, gingival index, probing pocket depth and clinical attachment level were statistically non-significant in chronic periodontitis with smokers and non-smokers. Conclusion: Prevalence of Selenomonas sputigena showed significant differences with respect to the frequency of detection when comparing the disease group to the healthy population. But no significant difference was seen when the results were quantified. Smoking has no influence on number of Selenomonas sputigena. This study highlights presence as well as quantity of the organism is very important in elucidating its role in causation and progression of the disease.

Comparative Effect of Cinnamon and Ibuprofen for Treatment of Primary Dysmenorrhea: A Randomized Double-Blind Clinical Trial

Molouk Jaafarpour, Masoud Hatefi, Ali Khani, Javaher Khajavikhan

Background and Aims: Primary dysmenorrheal has a negative impact on women's quality of life. The purpose of this study was to compare the effect of Cinnamon and Ibuprofen for treatment of primary dysmenorrheal in a sample of Iranian female college students from Ilam University of Medical Sciences (western Iran). Materials and Methods: In a randomized, double-blind trial, out of 114, control group received placebo (empty capsules contain starch, TDS, n= 38) a test group received Ibuprofen (capsule containing 400mg Ibuprofen, TDS, n=38), or another test group received Cinnamon (capsule containing 420 mg Cinnamon, TDS, n= 38) in 24 h. To determine severity of pain, we used the VAS scale. Pain intensity and duration of pain were monitored in the group during first 72 h of cycle. Results: The mean pain severity score and mean duration of pain in Ibuprofen and Cinnamon were less than placebo group respectively (p< 0.001). Of 4 hours after the intervention there were no statistically significant differences between the Cinnamon and placebo group (p> 0.05). Of eight hours after the intervention, the mean pain severity in the cinnamon group was significantly lower than placebo group (p< 0.001). At various time intervals the mean pain severity in the Ibuprofen group were significantly less than Cinnamon and placebo groups (p< 0.001). Conclusion: Cinnamon compared with placebo significantly reduced the severity and duration of pain during menstruation, but this effect was lower compared with Ibuprofen. Cinnamon can be regarded as a safe and effective treatment for primary dysmenorrhea. More researches are recommended to study the efficacy of Cinnamon on reducing menstrual bleeding.

Effect of Platelet Rich Fibrin (PRF) on Peri-implant Soft Tissue and Crestal Bone in One-Stage Implant Placement: A Randomized Controlled Trial

Priyanka Boora, Manu Rathee, Mohaneesh Bhoria

Introduction: The viability of Platelet Rich Fibrin (PRF) on enhancement of osseous and associated tissue healing has been substantiated well in literature. However, paucity in the applicability of PRF to enhance peri-implant healing in oral region is not well-corroborated. Purpose: This prospective study evaluated the effect of Platelet PRF on peri-implant tissue response following one-stage implant placement with non-functional immediate provisionalization in maxillary anterior region. Materials and Methods: A Prospective, Randomized Controlled Trial (RCT) was conducted across 20 (15 male, 5 Female) systemically healthy subjects with maintainable oral hygiene. Subjects were broadly divided into two groups i.e. Study group (PRF group) and Control group (Non-PRF group). Twenty standard SLA- AB/AE (alumina oxide blasted/acid etched surface treated) tapered threaded dental implants were randomly placed with and without PRF and immediately provisionalized. The subjects were evaluated clinically and radiographically at baseline (at time of implant placement), one month and three month post-operatively for peri-implant soft tissue and crestal bone responses. Results: At 3 months, all implants remained osseointegrated. The mean marginal bone changes were observed from baseline to 3 months in both groups with lesser changes observed in PRF Group. No significant differences in probing depth and bleeding on probing were noted during follow-up. Conclusion: Within the limitations of this study, PRF could be considered as a healing biomaterial with potential beneficial effect on peri-implant tissue and can be used as a therapeutic adjuvant in clinical scenario of one stage, single tooth implant placement procedure in maxillary anterior region.

Effect of Silymarin in the Prevention of Cisplatin Nephrotoxicity, a Clinical Trial Study

Ali Momeni, Ali Hajigholami, Shohreh Geshnizjani, Soleiman Kheiri

Background: Reno-protective effect of Silymarin was studied in some studies mainly on rats. In some of these studies, Silymarin was shown to have positive effects on preventing or decreasing severity of Cisplatin nephrotoxicity. Objective: The aim of this study was to evaluate the protective effect of Silymarin on Cisplatin nephrotoxicity in adult patients with malignancy. Materials and Methods: In this clinical trial study, 60 patients with malignancy, candidate of Cisplatin treatment were randomly enrolled in two equal groups. In patients of case group, Silymarin tablet 140 mg/bid was administrated seven days before Cisplatin administration together with Cisplatin, and in control group, Cisplatin was prescribed. Blood Urea Nitrogen (BUN) and serum Creatinine (Cr) were checked at the same day and 3 and 7 days after administration of Cisplatin. Results: Mean age of the patients in case and control groups were 51.1±14.3 y and 51.1±13.7 y respectively (p=0.99). There was no significant difference based on BUN and serum Cr in the beginning of study and three days after administration of Cisplatin in two groups of patients, however, after two weeks, BUN and serum Cr were significantly lower in the case group compared to the control group. Also, in the case group, BUN and serum Cr decreased and in the control group, they increased after two weeks after Cisplatin administration. Conclusion: This study showed that Silymarin can decrease Cisplatin nephrotoxicity, so because of safety profile and minor adverse effect of Silymarin, we can use it as prophylaxis against Cisplatin nephrotoxicity in various Cisplatin-contained chemotherapy regimens.

The Changes in Dentists’ Perception and Patient’s Acceptance on Amalgam Restoration in Kurdistan-Iraq: A Questionnaire-based Cross-Sectional Study

Bestoon Mohammad Faraj., Hawzhen Masoud Mohammad, Kale Masoud Mohammad

Background: There has been considerable controversy concerning the health risks and benefits of utilizing mercury-containing amalgam. Across the developing countries, a reduction in the use of dental amalgam in oral health care provision is expected. Purpose: Assessment of dentists’ and patient’s attitude of dental amalgam regarding attractiveness, perceived health, and treatment preferences in Kurdistan, Iraq. Materials and Methods: A 4-page questionnaire comprised two parts, specific for dentist and patient were structured and delivered to each dentist oneself. Both open-ended and close-ended questions about the treatment needs of patients, uses of amalgam and its alternative, the properties and usefulness of different materials. Patient’s acceptance was assessed by means of structured questionnaire prepared based on commonly asked questions from routinely daily practice. Questions on the type of filling material in their mouth, previous knowledge of mercury in dental amalgam and disappointment due to mercury hazard and toxicity. They were to indicate their acceptance with filling their cavities by dental amalgam with or without prior information about its mercury content. This part was also accomplished by the dentists participated in this survey. Results: Out of 185 dentists shared, only 39 (21.1%) indicated that amalgam presents no harm for the dentists and patients. While majority of dentists 85 (45.9%) were uncertain about this issue. Amalgam was selected most often 107 (57.8%) as the material of choice for restoring posterior teeth. About 94(50.8%) and 85(45.9%) of the practitioners primarily used glass ionomer/resin-reinforced glass ionomer and composite, respectively. Among 1850 patients received treatment, only 450 (24.32%) claimed to have heard about adverse reactions to dental amalgams. Those who believed it to be safe were 200 (10.82%).Acceptance towards amalgam was 62%. Conclusion: While amalgam was the most common material used for posterior restorations, direct tooth-coloured restorative materials were also popular among dentists participated in this study. Awareness of toxicity of mercury in dental amalgam was slightly low among the respondents studied. This may be suggested to be a reflection of devoid of planetary amalgam controversy in Kurdistan. The level of acceptance toward amalgam appears to be related to economics, dental education, and aesthetic orientation of the residents.

Comparative Changes Noted in Renal Biopsies on Light Microscopy of ANCA Positive Vs ANCA Negative Serology

Objectives: Pauci-immune glomerulonephritis is the commonest cause of rapidly progressive glomerulonephritis (RPGN) which is associated with increased mortality and morbidity. More than 90% of these patients have serological presence of either antineutrophil cytoplasmic antibodies (ANCA), of cytoplamic (C) or perinuclear (P) type. “Immunofluoresence studies” exhibiting minimal or no fluorescence is diagnostic in all such cases. The present study aims to study the differences between renal biopsies of serologically ANCA negative versus ANCA positive individuals. Materials and Methods: One hundred and twenty renal biopsies (of clinically suspected cases of systemic vasculitis) were sub-divided sub-divided under the heading of serologically ANCA positive and serologically ANCA negative; and scoring them by means of a semi-quantitative scoring system devised at the beginning of the study to identify statistically significant, specific light microscopic features in the sub-components of renal biopsy. Results: Fifteen parameters were found to be statistically significantly (p-value < 0.05) in ANCA positive serological cases. These were glomerular capillary loop infiltration by neutrophils, cellular crescents, fibro-cellular crescents, glomerular fibrinoid necrosis, glomerular sclerosis, peri-glomerular infiltration, interstitial oedema, interstitial eosinophils, tubular atrophy, tubular necrosis, tubulitis, arterial hyalinization, arterial necrosis, arterial vessel wall polymorpho nuclear infiltrate and myointimal hypertrophy. Conclusion: The presence of above parameters in a renal biopsy report of a patient (in absence of facilities of autoimmune serology and immunofluoresence) can alert both nephrologist and nephropathologist to keep a possibility of renal symptoms arising out of systemic vasculitis.

Comparison of Contamination of Low-Frictional Elastomeric Rings with That of Conventional Elastomeric Rings by Streptococcus mutans - An In-vivo Study

Introduction: The presence of brackets and ligatures has been shown to be related to an increase in gingival inflammation and increased risk of decalcification. The various measures were taken to reduce the plaque accumulation and also lot of efforts were made by manufacturers that reduced the binding friction between the ligature rings and arch wire that facilitated easy sliding of the tooth through the wire. The low frictional ligatures rings manufactured by different manufacturers presumed to attract fewer bacteria due to greater reduction in surface roughness. Our study aimed to evaluate whether the low frictional elastomeric rings accumulate fewer bacteria than conventional ligature rings. Materials and Methods: Thirty patients (15 males and 15 females) who underwent fixed appliance therapy were selected. The study was done using split-mouth design. In each volunteer, synergy low frictional elastomeric rings were tied to brackets bonded to the maxillary premolar on the right side and mandibular premolar on the left side. Conventional elastomeric rings that served as control group were tied to the contralateral teeth, with the same design. Samples were collected after four weeks (28 days) and cultured for bacteria Streptococcus mutans. Results: There was no statistical difference between Streptococcus mutans count in low frictional elastomeric rings with that of conventional rings. Conclusion: We concluded that adherence of Streptococcus mutans is similar in both synergy low frictional elastomeric rings and conventional clear elastomeric rings and thus the manufacturer’s claim of minimal bacterial adherence was discarded.

Multi-Detector Computed Tomography in Evaluating Locally Aggressive and Malignant Bone Tumours

Kumar Venu Madhav Ramavathu, Swapndeep Singh Atwal, U.C. Garga

Objective: To evaluate the ability of Multi-Detector Computed Tomography in preoperative evaluation of locally aggressive and malignant bone tumours in correlation with histopathological findings. Materials and Methods: Twenty patients suspected of malignant bone tumours on the basis of their clinical profile were selected. Following a plain radiograph evaluation, all of them were subjected to CT scan examination. Multi Planar Reconstruction (MPR) was done in sagittal and coronal planes and also three-dimensional Volume Rendering (VR) and Maximum Intensity Projection (MIP) images were obtained. Results: Of the 20 patients, 18 underwent surgery, and their histopathological findings were compared and correlated with MDCT findings. MDCT was 92.8% sensitive and 100% specific in determining the vascularity of the tumour and also can detect displacement/ encasement/ involvement of adjacent vessels. It has a sensitivity and specificity of 100% in determining cortical break, calcification and periosteal reaction. However, it is less sensitive in detecting joint involvement. Post contrast enhancement gives details of the extent of the soft tissue component. Conclusion: Although MRI is a preferred modality in preoperative evaluation of bone tumours, CT may be used an alternative in case of non-availability of MRI, which has faster acquisition time and better resolution. Using three dimensional MPR imaging, the location and extent of the tumour can be studied. It is also useful in determining cortical discontinuity, periosteal reaction, and calcification. By virtue of MIP and VR imaging, vascularity of the tumour and its relationship with the adjacent vasculature can be established. However, it is inferior to MRI in soft tissue characterization and has poor sensitivity in detecting marrow and joint involvement.

Phenotypic and Molecular Characterization of Plasmid Mediated AmpC among Clinical Isolates of Klebsiella pneumoniae Isolated from Different Hospitals in Tehran

Introduction: Klebsiella pneumoniae is one of the main opportunistic pathogens which can cause different types of infections. Production of beta-lactamases like AmpC and ESBL mostly lead to beta-lactam resistance in these Gram-Negative bacteria. The aim of this study was the detection of AmpC-producing K. pneumoniae in clinical isolates. Materials and Methods: Three hundred and three isolates of K. pneumoniae were identified. Double disc method including cefoxitin with cefepime and using boronic acid with cloxacillin were performed as two phenotypic methods for detection of AmpC. Amplification of AmpC gene was performed by PCR. Results: Eight and three isolates showed positive results in double disc method and by using boronic acid with cloxacillin, respectively. Five isolates had specific band for AmpC gene after electrophoresis. Conclusion: Our results were indicated the low prevalence of AmpC-producer-K. pnemoniae in Iran. On the other hand these two tested phenotypic methods showed low sensitivity for detection of AmpC.

Validation of the Malaysian Versions of Parents and Children Health Survey for Asthma by Using Rasch-Model

Context: In recent years, health-related quality of life (HRQOL) has become an important outcome measure in epidemiologic studies and clinical trials. For patients with asthma there are many instruments but most of them have been developed in English. With the increase in research project, researchers working in other languages have two options; either to develop a new measure or to translate an already developed measure. Children Health Survey for Asthma is developed by American Academy of Paediatrics which has two versions one for the parents (CHSA) and the other for the child (CHSA-C). However, there is no Malay version of the CHSA or the CHSA-C. Aim: The aim of this study was to translate and determine the validity and reliability of the Malaysian versions of Parent and Children Health Survey for Asthma. Materials and Methods: Questionnaires were translated to Bahasa Malayu using previously established guidelines, data from 180 respondents (asthmatic children and their parent) were analysed using Rasch-Model, as, it is an approach that has been increasingly used in health field and also it explores the performance of each item rather than total set score. Results: The internal consistency was high for the parent questionnaire (CHSA) (reliability score for persons = 0.88 and for items was 0.97), and good for child questionnaire (CHSA-C) (reliability score for persons = 0.83 and for items was 0.94). Also, this study shows that all items measure for both questionnaires (CHSA and CHSA-C) are fitted to Rasch-Model. Conclusion: This study produced questionnaires that are conceptually equivalent to the original, easy to understand for the children and their parents, and good in terms of internal consistency. Because of the questionnaire has two versions one for the child and the other for the parents, they could be used in clinical practice to measure the effect of asthma on the child and their families. This current research had translated two instruments to other language (BahasaMalayu) and evaluated their reliability and validity hence will help researchers from the same country to use these translated instruments in their studies.

Evaluation of Single File Systems Reciproc, Oneshape, and WaveOne using Cone Beam Computed Tomography –An In Vitro Study

Annil Dhingra, Nidhi Ruhal, Anjali Miglani

Background: Successful endodontic therapy depends on many factor, one of the most important step in any root canal treatment is root canal preparation. In addition, respecting the original shape of the canal is of the same importance; otherwise, canal aberrations such as transportation will be created. Aim: The purpose of this study is to compare and evaluate Reciprocating WaveOne ,Reciproc and Rotary Oneshape Single File Instrumentation System On Cervical Dentin Thickness, Cross Sectional Area and Canal Transportation on First Mandibular Molar Using Cone Beam Computed Tomography. Materials and Methods: Sixty Mandibular First Molars extracted due to periodontal reason was collected from the Department of Oral and Maxillofacial. Teeth were prepared using one rotary and two reciprocating single file system. Teeth were divided into 3 groups 20 teeth in each group. Pre instrumentation and Post instrumentation scans was done and evaluated for three parameters Canal Transportation, Cervical Dentinal Thickness, Cross-sectional Area. Results were analysed statistically using ANOVA, Post-Hoc Tukey analysis. Results: The change in cross-sectional area after filing showed significant difference at 0mm, 1mm, 2mm and 7mm (p<0.001, p =0.006, 0.004 & <0.001 respectively). There was significant difference between wave one and oneshape, oneshape and reciproc at 0mm, 1mm, 2mm & 7mm (p-values for waveone and Oneshape <0.001, 0.022, 0.011 & <0.001 resp. and for oneshape and reciproc < 0.001, p= 0.011, p=0.008 & <0.001).On assessing the transportation of the three file system over a distance of 7 mm (starting from 0mm and then evaluation at 1mm, 2mm, 3mm, 5mm and 7mm), the results showed a significant difference among the file systems at various lengths (p= 0.014, 0.046, 0.004, 0.028, 0.005 & 0.029 respectively). Mean value of cervical dentinal removal is maximum at all the levels for oneshape and minimum for waveone showing the better quality of waveone and reciproc over oneshape file system. Significant difference was found at 9mm, 11mm and 12mm between all the three file systems (p<0.001,< 0.001, <0.001). Conclusion: It was concluded that reciprocating motion is better than rotary motion in all the three parameters Canal Transportation, Cross-sectional Area, Cervical Dentinal Thickness.

Clinical Evaluation of Success of Primary Teeth Pulpotomy Using Mineral Trioxide Aggregate®, Laser and Biodentine™- an In Vivo Study

Introduction: Pulpotomy technique basically consists of removing the coronal pulp and fixing the radicular pulp with a medicament. It is the most waidely accepted clinical procedure for treating primary teeth with coronal pulp inflammation caused by caries with no involvement of the radicular pulp. Aim: To evaluate the success and efficacy of Mineral Trioxide Aggregate (MTA), Lasers and Biodentine as pulpotomy agents both clinically and radiographically. Materials and Methods: In the present study, 60 primary molars in children whose pulpal status warranted pulpotomy were selected and randomly assigned into three groups that included MTA, Laser and Biodentine allocating 20 teeth to each group. The pulpotomy procedure was then performed on all selected teeth followed by restoration with stainless steel crowns. Later the patients were recalled for 3 months and 6 months for clinical and radiographic evaluation. R esults: Statistical analysis was done using Fisher exact test to determine pair wise comparison of three agents with respect to clinical and radiographic criteria. Kruskal-Wallis ANOVA, Mc Nemars test was applied to evaluate the efficacy of each agent between 3 months and 6 months. The results showed that maximum success rate was found in MTA group. However, the comparison between three groups was statistically not significant (p>0.05). Conclusion: Pulpotomies performed with either MTA, Laser or Biodentine are equally efficient with similar clinical/radiographic success and hence can be considered as alternatives to Formocresol.

Comparative Assessment of Sagittal Skeletal Discrepancy: A Cephalometric Study

Background and Objectives: Evaluating the sagittal apical base relationship during orthodontic diagnosis and treatment planning is an important step. This study was aimed at comparison of Beta angle, ANB angle and Wit’s appraisal for assessment of sagittal skeletal discrepancy. Materials and Methods: Eighty six young adults (43 female and 43 male) were selected from the patient’s reporting to Department of Orthodontics, College of Dental Sciences, Davangere, India. Family lineage was studied to know the nativity of Davangere. The standardized pre-treatment lateral cephalogram of the chosen sample was traced. The sample was divided into three skeletal pattern groups: Class I, Class II and Class III, based on the ANB angle and profile, Beta angle was assessed in each group. Statistical Analysis: The data was subjected to statistical analysis student’s t-test, ANOVA test and correlation and regression analysis, using the software namely SPSS Software version 13. Microsoft word and Excel were used to generate graphs and tables. Results: In the local Davangere population, Class I skeletal pattern group exhibited Beta angle between 26º–34º, Beta angle less than 27º was found in Class II skeletal pattern, and Beta angle greater than 32º was seen Class III skeletal pattern. The coefficient of variation of Beta angle in all the three groups was significantly homogenous compared to ANB angle and Wits appraisal. The correlation and regression analysis of the total sample indicated a highly significant correlation between Beta angle and ANB angle (p<.001), and between Beta angle and Wits appraisal (p<.01). Conclusion: Beta angle can be used to classify subjects into different skeletal patterns. The Correlation and regression analysis for the total sample suggests a highly significant relation between Beta angle and ANB angle and, between Beta angle and Wits appraisal. It can be more reliably used to assess sagittal jaw discrepancies than ANB angle and Wits appraisal.

Study of Morbidity Pattern Among Salt Workers in Marakkanam, Tamil Nadu, India

Background: Salt workers are exposed to occupational hazards like contact with salt crystals and brine, physical stress, sunlight and glare due to sunlight reflected by salt crystals. Very few studies have documented the morbidity among the salt workers. Aim: To assess the morbidity pattern among salt workers in Marakkanam, Tamil Nadu, India. Materials and Methods: A community based cross-sectional study was undertaken in 4 randomly selected salt worker villages. Three hundred thirty one salt workers were reached by a house-to-house survey during April 2010 to March 2011. Demographic data was collected; clinical examination was conducted using a predesigned and pretested questionnaire. A pilot study was conducted to estimate the prevalence of morbidity before initiating the study. The data was analyzed using SPSS Version 11.5. Chi-square test and odds ratios (OR) with 95% confidence intervals (CI) were calculated to determine the association of morbidity levels with various factors. Results: Of the 331 salt workers in the study, 58% were females, mean age was 41.9 ± 10.8 y. Eighty seven percent salt workers had some or other morbidity. The observed morbidities include clinical pallor (44.4%), ocular morbidities including cataract, pterygium, conjunctivitis, pingecula and corneal ulcer (42%), caries teeth (41.7%), hypertension (23.3%), underweight (19.3%), goiter (19%), obesity (14.8%) and dermal conditions including dermatitis, thickening of palm and sole, tinea unguum, follicultitis (9.1%). The presence of morbidity did not show any significant association with increase in age, gender, duration of employment or the type of salt work involved with. However, the lower the education level, the higher is the morbidity level among salt workers (OR = 5.23, 95% CI= 2.07 to 13.21) Conclusion: Morbidity among salt workers is high. Intervention programs are needed to alleviate the health problems in the salt workers.

Using an Artificial Neural Networks (ANNs) Model for Prediction of Intensive Care Unit (ICU) Outcome and Length of Stay at Hospital in Traumatic Patients

Changiz Gholipour, Fakher Rahim, Abolghasem Fakhree, Behrad Ziapour

Introduction: Currently applications of artificial neural network (ANN) models in outcome predicting of patients have made considerable strides in clinical medicine. This project aims to use a neural network for predicting survival and length of stay of patients in the ward and the intensive care unit (ICU) of trauma patients and to obtain predictive power of the current method. Materials and Methods: We used Neuro-Solution software (NS), a leading-edge neural network software for data mining to create highly accurate and predictive models using advanced preprocessing techniques, intelligent automated neural network topology through cutting-edge distributed computing. This ANN model was used based on back-propagation, feed forward, and fed by Trauma and injury severity score (TRISS) components, biochemical findings, risk factors and outcome of 95 patients. In the next step a trained ANN was used to predict outcome, ICU and ward length of stay for 30 test group patients by processing primary data. Results: The sensitivity and specificity of an ANN for predicting the outcome of traumatic patients in this study calculated 75% and 96.26%, respectively. 93.33% of outcome predictions obtained by ANN were correct. In 3.33% of predictions, results of ANN were optimistic and 3.33% of cases predicted ANN results were worse than the actual outcome of patients. Neither difference in average length of stay in the ward and ICU with predicted ANN results, were statistically significant. Correlation coefficient of two variables of ANN prediction and actual length of stay in hospital was equal to 0.643. Conclusion: Using ANN model based on clinical and biochemical variables in patients with moderate to severe traumatic injury, resulted in satisfactory outcome prediction when applied to a test set.

Antimicrobial Efficacy of Ten Commercially Available Herbal Dentifrices against Specific Oral Microflora – In Vitro Study

Aim: To determine and compare the antimicrobial efficacy of ten commercially available herbal dentifrices against specific strains of oral microflora using a standard diffusion method at full strength and 1:1 dilution at 24 h. Materials and Methods: The standard strains of Streptococcus. mutans (ATCC 21293), Streptococcus sangius (MTCC 442), Actinomyces viscosus (ATCC 3268), Staphylococcus aureus (ATCC 2592), Streptococcus pyogenes (MTCC 442) and Candida albicans (ATCC 183) were obtained. Antimicrobial efficacy of the dentifrices was tested in triplicate, at full strength and 1:1 dilution with the sterile water using a standard diffusion method for 24 h at 37ºC. The antimicrobial efficacy was tested by observing the zones of inhibition in millimeters surrounding disk containing the dentifrice. Mean standard deviation and standard error of mean of the inhibitory zones was calculated for each herbal dentifrice. p<0.05 was considered statistically significant. Results: Danth Kanthi (DK) was the most effective against all the microorganisms producing larger zones of inhibition at 24 h (F.S – 40+1.5; 1:1 dilution – 40+2.71). Amar Premium (AP) also produced larger zones of inhibition against all microorganisms except S. aureus. Of all the dentifrices, least zones of inhibitions i.e., around 5 mm was observed against S. aureus by Amar Premium (AP) and Dabur Babool (DB) at 24 h. Conclusion: Based on the results of the present study, it can be concluded that all herbal dentifrices exhibited antimicrobial activity against the selected oral microorganisms, with DK being the most effective. Hence, it can be inferred that herbal dentifrices can also be recommended like the conventional formulations.

Married Men´s Involvement in Family Planning – A Study from Coastal Southern India

Background: Over the years, India has emerged as one of the most populous countries in the world, next only to China. Unregulated fertility can compromise the economic development and political stability of a country. Family planning was always thought to be a woman’s prerogative, especially in a male dominant society like India. Consequently, most of the studies on family planning focused on women as the subject of interest. Purpose: To assess the knowledge, attitude and practices of family planning amongst men who have been married for at least five years. Materials and Methods: A cross-sectional study was carried out in the teaching hospitals of Kasturba Medical College (Manipal University), Mangalore; India among 156 men who had been married for at least five years. They were selected using non-random sampling method and were interviewed using a pretested semi structured validated questionnaire. Chi-square test was used for statistical analyses. Results: Overall, 75.6% were aged between 26 and 34 years, 41.7% had one child, 92.3% subjects from upper and 86.9% from lower socio-economic status were aware about the male family planning services available in the market. Most husbands preferred that their spouse should be sterilized (53.8%). Family planning methods were actively practiced by 71.2 %. Conclusion: Most of the studies on family planning have focused mainly on females. This study throws light on the male perspective of family planning. Our study subjects were well aware about various family planning services and their attitude towards family planning was favorable, but the number of men practicing family planning was not high.

Bibliometric Analysis of Journal of Clinical and Diagnostic Research (Dentistry Section; 2007-2014)

Background: The role of scientific journals in diffusion of data concerning researches in the field of Public Health Dentistry is of premier importance. Bibliometric analysis involves analysis of publications reflecting the type of research work. Aim: The present study was conducted with an aim to determine the number and trends of published articles in Journal of Clinical and Diagnostic Research (JCDR) from Feb. 2007 to Oct.2014. Settings and Design: A retrospective observational study was conducted for JCDR. Materials and Methods: All issues of JCDR were electronically searched for the parameters : study design, area of interest of research, state /college where research was conducted, authorship pattern, source of articles published each year, changing study trends, disease under study and publication bias. Statistical Analysis used: The data was organized and analyzed using software SPSS - version 21.0; descriptive statistics was used. Results: Bibliometric analysis was done for 601 articles of JCDR published from Feb. 2007 to Oct. 2014. The total number of articles published under Dentistry section have tremendously increased from mere 2 articles in 2007 to 328 articles in 2014.Majority of the study designs published in both the journal were case reports (42.6%) followed by cross sectional studies (24.8%). 96.3% of the articles were from India. Majority of the articles published were of multi authors (65.2%) and from Educational institutes (98.4%). The trends of the articles published indicated that the case reports/series formed the major bulk (others=59.1%) followed by research studies (21.3%). Conclusion: It was concluded that most articles published were case reports followed by researches indicating an inclination towards better quality methodology. The SJR and the citation count of the articles published also indicated the quality of the scientific articles published.

Aerosols How Dangerous They Are in Clinical Practice

Background and Objectives: The purpose of the present study was to determine the microbial atmospheric contamination during initial periodontal treatment using a modern piezoelectric scaler and to evaluate the efficacy of two commercially available mouth rinses (0.2% Chlorhexidine mouth rinse and Listerine) in reducing bacterial contamination when used as a pre-procedural rinse, with and without high volume evacuation (Aerosol reduction device). Materials and Methods: Subjects for the study were selected from the outpatient Department of Periodontics, Sri Siddhartha Dental College and Hospital, Tumkur, India. Total 60 patients were taken for the study and on the basis of inclusion and exclusion criteria’s they were divided into three groups. The sampling was carried out in two stages before and after implementing a set protocol. Total duration of study was four months. Microbiological Evaluation: The samples (blood agar plates) were transported immediately to the Department of Microbiology, Sri Siddhartha Medical College, Tumkur for: • Identification of microorganisms as per standard procedures (Gram stain, Biochemical Test, Species Identification). • Counting the number of colonies formed on blood agar plates using colony counter unit. Results: Out of all the three pre-procedural rinses 0.2% w/v Chlorhexidine is the best in reducing aerobic bacteria (CFU) followed by Listerine and then Water. Conclusion: The following conclusion was drawn that the use of pre-procedural rinses along with the use of high volume suction apparatus significantly reduced the aerosol contamination and hence chances of cross-infection in the dental units.

Effect of Different Tube Potential Settings on Caries Detection using PSP Plate and Conventional Film

Purpose: To compare intraoral Phosphor Stimulable Plate digital system and intraoral film using different tube settings on incipient proximal caries detection. Materials and Methods: Five blocks, with five teeth each, were radiographically examined using phosphor plates and F-speed films. The images were acquired in 07 different tube potentials from 50-80 kV. The films were digitized. Three oral radiologists scored the images for the presence of caries using a 5-point rating scale. The areas under ROC curve were calculated. The influence of tube kilovoltage was verified by ANOVA and pair wise comparisons performed using Tukey test. Results: Mean ROC curve areas varied from 0.446-0.628 for digital images and 0.494–0.559 for conventional images. The tube setting of 70 kV presented the best result both for digital and conventional images. Considering the image type separately, 70 kV scored highest followed by 75 and 65 kV for digital images (p=0.084). For conventional image modality, even though 70 kV presented the best result, it did not differ significantly from 80 kV, not differing from 60 and 55 kV, which did not differ from 75, 65 and 50 kV (p=0.53). Conclusion: Phosphor plate digital images seem to be more susceptible to tube setting potential variations then digitized film images.

Role of 3D Ultrasound and Doppler in Differentiating Clinically Suspected Cases of Leiomyoma and Adenomyosis of Uterus

Introduction: Adenomyosis and Leiomyoma are common disorders affecting females in their reproductive age. They mimic each other in clinical presentation. Due to similarities in clinical symptoms and signs, missing one diagnosis in favour of the other is not very uncommon. Accurate diagnosis of these two conditions is important for their management. In this study we evaluated role of 3D Ultrasound and Doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. Materials and Methods: A total of 100 patients with symptoms of abnormal uterine bleeding (with or without dysmenorrhoea), lump abdomen, chronic pelvic pain or dysparaunia who were clinically diagnosed as leiomyoma of uterus and/or adenomyosis were enrolled in to the study. These patients underwent transvaginal sonography (TVS), trans abdominal sonography (TAS) along with color and spectral Doppler sonography. Scanning was done in follicular phase of the menstrual cycle to avoid bias due high vascularity of endometrium in secretory phase. The morphology of the lesion, its vascularity, and Pulsality Index (PI), Resistive Index (RI) and Vmax (maximum velocity) were measured. Only those patients who were chosen for operative treatment were included in the study. Radiological diagnosis was then correlated with intra-operative and histopathological diagnosis. Results: On imaging, while using morphological criteria and Doppler for diagnosing leiomyoma, it was found that “peripheral vascularity” was seen in 52 (89%) cases, which was the highest. Similarly while diagnosing adenomyosis it was, the criteria “central vascularity” was seen in 28 cases (93%) and “ill defined junctional zone in 3D ultrasound” was seen in 26 cases (86%), which was also observed to be highest. With the cut off values taken for PI,RI and Vmax, diagnosis of leiomyoma was found to be 93.4% sensitive, 95.6% specific and with a positive predictive value of 97.6% and negative predictive value of 88.6%. Diagnosis of adenomyosis showed a sensitivity of 95.6%, specificity of 93.4% and a positive predictive value of 88.6% and negative predictive value of 97.6%. Imaging dignosed the co-existence of both the conditions correctly in 8 (66%) cases. Conclusion: The parameters of blood flow impedance (that is PI, RI, and Vmax) of arteries within or around the uterine lesions revealed a consistent and significant difference between leiomyoma and adenomyosis. So apart from morphological criteria used in 3D TAS and TVS, aid of color Doppler can more accurately differentiate and diagnose these conditions.

Association of Angiotensin Converting Enzyme Gene Insertion / Deletion Polymorphism with Risk of Ischemic Heart Disease in A Population of Smokers in Southern India

Background: Ischemic heart disease (IHD) remains a major public health problem nationally and internationally. Smoking is a major risk factor for IHD.The deletion (D) allele of the angiotensin converting enzyme (ACE) gene polymorphism has been associated with hypertension, ischemic stroke and myocardial infarction. The present study was carried out to determine the association of the ACE gene insertion/deletion (I/D) polymorphism in IHD patients with and without smoking. Materials and Methods: One hundred seven male IHD patients admitted consecutively in the Cardiology unit of a Government Hospital and 100 age and sex matched healthy controls were enrolled in this study.The patients were further divided into smokers and nonsmokers. All the subjects were checked for I/D polymorphism of ACE gene, which is mapped to 17q23.3 with OMIM no 106180, by polymerase chain reaction (PCR). The subjects were also investigated for lipid profile and ejection fraction (EF). Results: We found significant difference in the distribution of D allele between patients and controls (p=0.009, OR 1.69, 95% CI 1.139 to 2.517).The significantly lower EF (p<0.001) was suggestive of greater cardiovascular compromise in smokers. The frequency of ID genotype was significantly associated with cases compared to controls (p=0.012, OR 2.054, 95% CI 1.1694-3.624) but was not significantly associated with smokers as compared to nonsmokers. Conclusion: We infer significant association of D allele with IHD. The smokers with ID genotype should be put on prophylactic ACE inhibitor therapy to prevent the morbidity and mortality associated with IHD.

Role of CT Colonography in Colonic Lesions and Its Correlation with Conventional Colonoscopic Findings

Background: Preoperative evaluation in patients with colorectal carcinoma is essential for a correct therapeutic plan. Conventional colonoscopy has certain limitations including its inability to detect synchronous lesions in case of distal obstructive mass and inaccurate tumour localization. CT colonography combines cross sectional imaging with virtual colonoscopic images and offers a comprehensive preoperative evaluation in patients with colorectal carcinoma including detection of synchronous lesions with accurate segmental localization and loco regional staging. Aim: The objective was to determine the role of CT colonography in various colonic lesions and to correlate the findings with conventional colonoscopy and histopathological findings. Settings and Design: This prospective study included 50 patients with clinical symptoms suspicious of colonic pathology. Materials and Methods: All the patients underwent both CT colonography and conventional colonoscopy on the same day. CT colonography was performed in supine and prone position. Considering histopathological and/or surgical findings as gold standard, sensitivity and specificity of both the modalities were calculated. Results: Conventional colonoscopy missed two synchronous lesions proximal to occlusive mass and one lesion proximal to the anastomotic site; all were detected with CT colonography. One carpet lesion in rectum and one case of mild ulcerative colitis were missed by CT colonography. Sensitivity and specificity for detection of colorectal cancer were 97.56% and 100%, resp. with PPV and NPV of 100% and 93.75%, for CT colonography and 92.68% and 100%, respectively with PPV and NPV of 100% and 83.3% for conventional colonoscopy. Sensitivity for correct detection of acute and chronic ulcerative colitis of CT colonography was 66.6 % and 100 %, resp. Conclusion: CT colonography has higher sensitivity than conventional colonoscopy for detection of colorectal carcinoma, including its ability to detect abnormalities proximal to obstructing lesion, accurate segmental localization of lesions and staging. However, some limitations of CT colonography were difficulty in detection of flat lesions and lack of information about hyperemia and superficial mucosal erosion, where conventional colonoscopy scored over CT colonography.

POSSUM: A Scoring System for Perforative Peritonitis

Ambarish S. Chatterjee, D.N. Renganathan

Background and Objectives: Perforative peritonitis carries considerable morbidity and mortality with the postoperative period unpredictable most of the times. It therefore becomes necessary for a scoring system that predicts the post-operative outcome. POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity) helps in predicting the post-operative morbidity and mortality in these patients. POSSUM scores are based on 12 physiological factors and 6 operative factors. In our study, we included two more factors, which are specifically important in perforative peritonitis, they are, perforation to operation time and the presence of co-morbidity. The presence of these factors significantly affects the post-operative status. Through this prospective study, we can predict which patients are at a higher risk of death or complication and give appropriate management as necessary. Materials and Methods: Our sample size was 50 patients with perforative peritonitis. The study was conducted in single unit from September 2013 to August 2014. Data was collected based on POSSUM scoring system. Outcome of the patients was recorded as death / alive; complicated / uncomplicated and statistical analysis was done by comparing the expected and observed outcomes. Results: By applying linear analysis, an observed to expected ratio of 1.005 was obtained for mortality and 1.001 for morbidity. There was no statistically significant difference between the observed and expected mortality rates (?2 = 3.54, p = 0.316) and morbidity rates (?2 = 2.40, p = 0.792). It was found to be comparable with other studies. The factors independently studied, perforation to operation time and presence of co-morbidity were statistically significant with respect to outcome (p<0.05). Conclusion: Although a small sample size is the limitation of this study, POSSUM scoring system is a good indicator of postoperative outcome in patients with perforative peritonitis and was applicable in our setup. It is useful in identifying high risk patients and give preferential care to them for better outcome. Inclusion of factors like perforation to operation time and co-morbid status can improve the scoring system and better care can be provided.

GCF Resistin As A Novel Marker in Patients with Chronic Periodontitis and Rheumatoid Arthritis

Background: The associational studies between periodontitis and rheumatoid arthritis are less documented, although they are found to have similar inflammatory pathogenesis. Resistin, a novel adipokine is suggested to be a common link between periodontitis and rheumatoid arthritis. The aim of the present study was to reinforce the inter-relationship between periodontitis and rheumatoid arthritis by using resistin as a potent inflammatory marker. Materials and Methods: Hundred patients (aged >30 y) of either sex were selected for this study and were divided equally into four groups of 25 patients each. Group A consisted of healthy individuals, Group B consisted of patients with chronic periodontitis, Group C of patients with rheumatoid arthritis and Group D had patients suffering from both arthritis and periodontitis. Periodontal parameters assessed were plaque index (PI), modified gingival index (GI) and probing depth (PD). Panoramic radiographs were taken to confirm the diagnosis of periodontitis. Rheumatoid arthritis was confirmed by the rheumatologists and seropositivity for rheumatoid factor (RF) was checked. Resistin levels were analysed in GCF collected from all the four groups and statistical analysis was done by using Pearson correlation coefficient. Results: The GCF of all the patients showed presence of resistin. The level of resistin was highest in Group D patients and least in Group A patients. On analysing the samples together positive co-relation was found between GCF resistin and PD, PI, GI and RF. Conclusion: Resistin levels are increased in both chronic periodontitis and rheumatoid arthritis. Therefore, the increased level of GCF resistin can be regarded as potential inflammatory marker for periodontitis and rheumatoid arthritis.

Assessment of Burden of Depression During Pregnancy Among Pregnant Women Residing in Rural Setting of Chennai

Introduction: Depression during perinatal period leads to adverse pregnancy outcome and of child growth. Our study aimed to examine the burden of antenatal depression and associated risk factors among pregnant women living in rural settings of Chennai, a southern state of India. Materials and Methods: A pilot cross-sectional study was conducted in the rural settings of Chennai, one of the Southern States of India during August through September 2013. Hundred pregnant women who agreed to participate were enrolled in this study. Edinburg postnatal depression scale was used to assess the depression level of the study participants. Information was also gathered about socio-demographics, obstetric and disease history, social support and marital satisfaction was gathered. Descriptive analysis was performed using univariate statistics to report means and standard deviations for the continuous variables and frequency distribution for the categorical variables. Results: Majority of the participants (65%) had scored 13 or higher on the Edinburg Depression Scale reflecting high likelihood of depression. Majority of the participants (66%) had been bothered due to low feeling, depressed or hopelessness during the previous month. Enriched marital satisfaction scale (p=.025) had shown significant association with Edinburg depression scale. Conclusion: Pregnancy is very crucial period not only for mother but whole family. This study has shown very high frequency of depression among the participants. There is a need for a longitudinal study to design interventions that can address emerging burden of antenatal depression among pregnant women living in rural settings.

Anaesthetic Efficacy of 4% Articaine Mandibular Buccal Infiltration Compared To 2% Lignocaine Inferior Alveolar Nerve Block in Children with Irreversible Pulpitis

Veena Arali, Mytri P

Background: Lidocaine is the gold standard anaesthetic solution that has been used since its inception into dentistry till date. Around 80% of failures have been reported when lignocaine has been used for inferior alveolar nerve block in children and adults with irreversible pulpitis. There is a need to use newer drugs which are available which have been reported to be effective like lignocaine, such as articaine. Although articaine has been used in adults, literature supporting its use in children is sparse. Aim: The purpose of this study is to compare the anaesthetic efficacy of 4% articaine buccal infiltration and 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis. It also aims to assess the need for supplemental intrapulpal injections. Materials and Methods: This study was designed as a randomized double-blind cross over trial comparing the anaesthetic effectiveness of 4% articaine with 1:100,000 epinephrine in buccal infiltration and 2% lignocaine IAN block anaesthesia. The study subject and the pediatric dentist performing the pulpectomy procedures were blinded to the study. A sample size of 40 subjects in the age group of 5-8 y was included in the study. Results: The onset of anaesthesia with 4% articaine was faster as compared to 2% lignocaine. The duration of anaesthesia with articaine infiltration was shorter. The need for supplemental injection in the articaine group was less. Conclusion: Four percent articaine infiltration can be used in children with irreversible pulpitis. It can be used to replace the IAN block in children thereby reducing the post anaesthetic complications like lip biting.

Comparative Evaluation of Tensile – Bond Strength of An Orthodontic Adhesive with and without Fluoride Application, After Acid Etching -An Invitro Study

J Chandulal, G Yugandhar, I Venkata Ramana, K Srinivas, S.Sarjeev Singh Yadav

Background: Fixed appliances hinder the effective control of plaque accumulation and white spot lesions may develop under the ill fitting bands or adjacent to the stainless steel brackets during orthodontic treatment particularly the etching process. Aims and Objectives: Comparative study of tensile bond strength of an orthodontic adhesive with and without fluoride application after acid etching to know the effect of fluoride on bond strength. Materials and Methods: This study is carried out on 90 non carious human premolar teeth, and divided in 6 groups with each group of 15 specimens. In those Groups I and IV were control group acid etch treatment, Group II and V is 1.23% APF gel (acid etch plus APF gel treatment,) and group III and VI is 8% SnF2 (acid etch plus SnF2 treatment). Samples of Group I, II and III bond strength were tested after 24 h and groups IV, V and VI after one month on microtechtensometer machine. The scanning electron microscope (SEM) investigation was carried out for the 2 specimens for the control group after acid etch and 4 specimens after acid etch with fluoride application for fluoride groups. Results: Control and SnF2 treated groups was found to be nearly similar to the control group whereas APF treated group showed less focal holes than the other 2 groups. Conclusion: Fluoride application after acid etching without having an adverse effect on bond strength but we can prevent the white spot lesions and caries.

Effect of Short Term CPAP Therapy in Obstructive Sleep Apnea Patients with Metabolic Syndrome

Kanimozhi S., Balaji C., Saravanan A., Ravi K.

Background: Patients of obstructive sleep apnea (OSA) with metabolic syndrome (MetS) are at increased risk of cardiovascular morbidity and mortality. The role of oxidative stress in pathogenesis of OSA and MetS has been widely reported. Continuous positive airway pressure (CPAP) therapy remains the first-line of treatment in OSA. The beneficial effect of long term CPAP therapy in OSA is well-known. However, the effect of short term CPAP on the components of MetS and oxidative stress-antioxidant levels is still unclear. Aim: The present study explored the effects of one night of CPAP therapy on the oxidant-antioxidant status and components of MetS in patients of OSA with MetS. Materials and Methods: Twenty adult males and postmenopausal females with MetS and symptoms suggestive of OSA were enrolled in the study. None of the subjects were smoker or alcoholic. They did not consume any drugs that would alter their antioxidant levels. Overnight polysomnography was done to confirm diagnosis and assess CPAP pressure. Following which they spent one night in the sleep lab for CPAP therapy. Blood pressure data and blood samples were collected at baseline and after CPAP. Collected samples were transferred immediately to the laboratory for analysis of serum thiol, lipid peroxidation, insulin resistance (HOMA-IR) and lipid profile. Results: Paired t-test with two-tail significance was used to compare the changes in study parameters in the same patient before and after treatment. The antioxidant level increased and oxidative stress decreased as evidenced by serum thiol concentration (204.2±65.7 vs 254.9±72 µmol/L, p<0.001) and lipid peroxidation levels (13.1±6.2 vs 8.4±3.1 µmol/L, p<0.01).There was a significant decrease in both systolic (132.1±16.1 vs 127.2±14.3 mmHg, p<0.01) and diastolic blood pressure (86.4±9.4 vs 81.2±9.8 mmHg, p<0.01) after one night of CPAP. However, there was no change in lipid parameters and the reduction seen in insulin resistance was not statistically significant. Conclusion: One night of CPAP therapy seems to be helpful in reducing oxidative stress, improving antioxidant levels and decreasing the severity of various components of MetS.

Endometrial Osseous Metaplasia—A Rare Presentation of Polymenorrhagia: A Case Report

Asma Nigar, Yogesh Kumar Yadav, Seema Hakim

Endometrial ossification is a rare entity in which bones are found in the uterus. Exact aetiopathogenesis is not known but the most accepted theory is metaplasia of stromal cells into osteoblast cells result in the formation of bones. The possibility of malignant mixed mullerian tumour should be in the mind of clinician and pathologist while making diagnosis. We hereby report an extremely rare case, which is among very few reported cases in the world, in which endometrial ossification presented in a perimenopausal female with polymenorrhagia. A 41-year-old multiparous patient presented with irregular bleeding per vaginum for the past two years. She was found to be a case of endometrial calcification with osseous metaplasia with presence of bones varying from 7mm – 1.5 cms size in the uterine cavity. She was successfully managed by total abdominal hysterectomy.

A Rare Case of Mucopolysaccharidosis: Hunter Syndrome

Jayaprasad Anekar, Deepa Narayanan C., Raj A.C., Sandeepa N.C., Deepika Nappalli

Hunter syndrome, or mucopolysaccharidosis type II (MPS II), is a member of a group of inherited metabolic disorders together termed mucopolysaccharidosis (MPSs). It is a rare, X-linked disorder caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase. The prevalence of this syndrome is 1:100,000 births. Insufficient enzyme activity results in accumulation of glycosaminoglycans (GAGS) in the lysosomes of various tissues and organs and leading to progressive multisystem pathologies. Here, we report a case of 13-year-old boy who presented with typical facial, skeletal and dental features without corneal clouding. It is possible that thorough and systematic clinical and radiological examination alone can help in diagnosis of this complex disorder.

Ekbom Syndrome Occurring with Multi Infarct Dementia

M.S. Bhatia, Priyanka Gautam, Jaswinder Kaur

Ekbom Syndrome is characterized by delusion that small living being infests skin. The clinical profile of this disorder has shown it to be associated with organic conditions. Neuroimaging studies implicate putamen as the brain structure involved in the pathophysiology. These are also known as organic delusional disorder and provide an opportunity to study biological causation of delusional disorder. We report a patient presented with a complaint of insects crawling on her body for last two years. She collected the peeled skin in a jar and claimed that these are insects. CT scan (brain) revealed multiple infarcts involving basal ganglia. She responded to Risperidone 4 mg daily.

Posterior Reversible Encephelopathy Syndrome Presenting as Quadriparesis in Pregnancy Induced Hypertension

Pranita, Ajit Kumar, Seema Shahi, Debasish Choudhary

Pregnancy Induced Hypertension (PIH) is a condition characterised by raised blood pressure in pregnancy. It affects approximately one out of every 14 pregnant women. Although PIH more commonly occurs during first pregnancy, it can also occur in subsequent pregnancies. It can present with variable complications related to vasospasm. But focal neurologic deficits are extremely rare in patients with PIH. We report a case of quadriparesis due to posterior reversible encephalopathy syndrome (PRES). A 36 year old full term pregnant female was admitted for emergency lower segment caesarean section (LSCS) as a result of uncontrolled PIH with early clinical signs of left ventricular failure. She was recovering well from pulmonary oedema after being provided with mechanical ventilation. However on 4th day she developed sudden onset quadriparesis without any alteration in sensorium, bladder & bowel disturbance or any sensory deficit. Diffusion weighted neuroimaging (DWI) was carried out which revealed finding suggestive of PRES. The patient was treated with antihypertensive which followed improvement in neurological deficit. Although rare, PRES should be considered as a potential cause of acute onset focal neurological deficit in pregnant females with PIH. With this case report we have tried to create awareness and vigilance about rare but potentially serious yet salvageable condition like PRES.

Colovesical Fistula: A Rare Complication of Diverticulitis in Young Male

Mayank Jain, Snehjeet Wagh, Dharmesh J. Balsarkar

Herniation of colonic mucosa through the circular muscles at the point of penetration of blood vessels results in diverticuli formation. It is seen most commonly in the large bowel in sigmoid colon. Common complications of diverticular disease are inflammation and bleeding per rectum and rarely fistula formation which are seen mostly in elderly patients. A case of colovesical fistula with diverticulitis in young male aged 30 years is reported.

Case of Cerebral Venous Thrombosis with Unusual Venous Infarcts

Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed.

Is Interstitial Pregnancy Clinically Different From Cornual Pregnancy? A Case Report

Mehmet Akif Sargin, Niyazi Tug, Selçuk Ayas, Murat Yassa

Interstitial pregnancy is a rare form of ectopic pregnancy with significant risk for morbidity. A 32-year-old woman, was brought to the emergency department with severe abdominal pain and syncope. There was no history of menolipsis and usage of any contraceptive methods. Serum ß hCG arrival was 11224 IU/L. Trans-vaginal ultrasound scan showed an empty uterus with a displaced 16 × 26 mm gestation sac on the left corn of the uterine cavity which surrounded by a thin myometrium. Free abdominal fluid and coagulum were also detected in the cul-de-sac. She was haemodynamically unstable. A ruptured ectopic pregnancy was diagnosed in the left uterine cornu during emergency laparotomy. Cornual resection was performed. Interstitial and cornual pregnancies should be considered as two different clinical situations. It is important to enhance the clinician’s suspicion about interstitial/cornual pregnancy. Thus, more detailed examination by transvaginal ultrasonography may contribute for accurate localization and diagnosis.

Post Traumatic Delayed Bilateral Facial Nerve Palsy (FNP): Diagnostic Dilemma of Expressionless Face

Rakesh kumar, Radhey Shyam Mittal

Bilateral facial nerve palsy [FNP] is a rare condition. Mostly it is idiopathic. Post traumatic bilateral FNP is even more rare and having unique neurosurgical considerations. Post traumatic delayed presentation of bilateral FNP is socially debilitating and also having diagnostic challenge. Due to lack of facial asymmetry as present in unilateral facial paralysis, it is difficult to recognize. We are presenting a case of delayed onset bilateral FNP who developed FNP after 12 days of head injury with a brief discussion of its diagnostic dilemma and management along with literature review.

A Rare Case Report of Neurofibromatosis I in HIV Positive Individual

Neurofibroma is an uncommon benign tumour of neural tissue origin rarely presenting in the mouth and jaws and thereby attracting the attention of oral physicians. A 22-year-old male patient reported with a complaint of swelling in left middle one third region of face since 8-10 y which was slowly progressive in size. He had history of multiple dark brown pigmentation on skin associated with progressively enlarging multiple small nodular growths over the body and single firm nodular growth in left side of maxilla intraorally. He had history of tuberculosis at the age of one year which was treated completely and since last 2-3 y he was suffering from recurrent episodes of sore throat, fever, diarrhea, abdominal pain with vomiting and excessive weight loss. Radiographic findings showed irregular osteolytic lesions involving ramus and angle of mandible, zygomatic bone and posterior part of maxilla with displacement of teeth with abnormal soft tissue enhancement observed by advance imaging. On serological investigation he was HIV positive and histopathologically, diagnosed with Neurofibromatosis-1. Oral manifestations of neurofibromatosis have been reported in only 4% to 7% of affected persons. This article presents a rarest of rare case report of neurofibromatosis-I in HIV positive individual also involving maxilla, mandible as well as zygomatic arch.

Nafcillin Implicated in A Case of Cutaneous and Gastrointestinal Leukocytoclastic Vasculitis

Changqing Xie, Suchita S Pancholi, Niti Armistead

Leukocytoclastic vasculitis (LV) is a rare hypersensitive reaction involving the small vessels, which is usually mediated by drugs. Very few cases of nafcillin -associated LV have been reported. Here, we reported a case of LV with the presentation of skin rashes and gastrointestinal bleeding after receiving nafcillin, evidenced by endoscopy and skin biopsy. The symptoms resolved after withdrawal of nafcillin and the addition of prednisone treatment. LV should be considered in the differential diagnosis of erythematous rash, especially with gastrointestinal symptoms after the exposure.

Fracture of the Medial Tibial Sesamoid Bone of the Foot-Case Report

The sesamoid bone ligament complex of foot contains two sesamoid bones one medial tibial sesamoid and other lateral fibular sesamoid bone, both embedded in the plantar ligament beneath first metatarsal head. The incidence of medial tibial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. We present a case of fracture medial tibial sesamoid bone in a young athlete who was diagnosed radiologically and treated conservatively with activity restriction and foot wear modification. Our case draws attention to this easily treatable fracture and outlines the investigative modalities in diagnosing this fracture.

An Early and Rare Second Malignancy in A Treated Glioblastoma Multiforme: Is It Radiation or Temozolomide?

Glioblastoma Multiforme (GBM) is a high-grade brain tumour with the most dismal prognosis. There are very few reports on second malignancies occurring in GBM patients, as the survival has been short. Second malignancies have been reported after treatment of malignancies with radiation therapy and chemotherapy especially after 5 to 10 y of treatment. Here in, we present a very unique case where a patient succumbed to sinonasal carcinoma occurring one and half years after treatment of GBM. A 17-year-old boy was diagnosed to have GBM and underwent surgery followed by chemoradiation and adjuvant chemotherapy with Temozolamide. He presented with undifferentiated sinonasal carcinoma, in the sinonasal region outside the radiation field within two years of treatment. Here we discuss the histology and possible chances of it being a second malignancy.

Giant Cutaneous Horn Overlying A Verruca at an Uncommon Site: Medical Marvel vs Superstitious Dilemma

Cutaneous horn has been a matter of discussion to mankind since time immemorial and a subject of fascination for the layman. There have been instances where certain groups saw it with angst and disgust, with a person having a large cutaneous horn on an exposed area getting a dismal look. We present a case of a 64-year-old man with a giant cutaneous horn over his left gluteal region. Cutaneous horns more commonly present in the sun-exposed areas. In our case it has presented in an uncommon site. The patient had delayed and denied medical treatment due to his superstitious beliefs, after having sought advice from faith healers leading to progression of the disease. This case has been presented for its giant size (rare variety), its location being over the gluteal region (photo-protected site) and its benign histopathology suggestive of wart in spite of the giant size.

Unicentric Castlemans Disease: Unusual Disorder of the Neck a Case Review

Castleman’s disease (giant or angio follicular lymph node hyperplasia) was first described by Benjamin Castleman in the year 1957 and was named after him. It is an uncommon lympho proliferative disorder which is localised to single lymphnode (unicentric) or multiple lymph node level systemically (multicentric).It is a very rare disorder characterised by non-cancerous growths. The most common sites of this are mainly thorax (mediastinum or lung hilum) and abdomen. It rarely occurs in cervical area. We report a case of unicentric cervical castleman’s disease of neck in an 18-year-old female, who came to ENT OPD with history of right sided neck mass since 6-8 months. After thorough clinical examination and investigations, complete excision of the mass was done. Histopathological examination confirmed the diagnosis of Castleman’s disease. On follow-up for one year no recurrence has been seen.

Synchronous Diffuse Large B-Cell Lymphoma and Malignant Clonal Plasma Cells in Bone Marrow As Primary Presentation: A Diagnostic and Therapeutic Challenge

Ritesh Sachdev, Shalini Goel, Smeeta Gajendra, Nitin Sood

Coexistence of Diffuse Large B-Cell Lymphoma (DLBCL) with other morphologically and phenotypically distinct lymphoid neoplasm although unusual, has been reported in literature. The most common lymphoid neoplasms associated with DLBCL are Hodgkin’s lymphoma, mantle cell lymphoma and marginal zone lymphoma. However, they have been reported predominantly in the sites other than the bone marrow. Rarely, DLBCL associated with paraproteinemia of IgM type, result of monoclonal plasma cell proliferation, has also been reported in literature. There is either an associated increase in the free light chain levels or disruption in the normal kappa: lambda ratio. However, co-existence of DLBCL with malignant non secretory clonal plasma cells, diagnosed primarily in the bone marrow has not been reported in the literature.

Malignant Melanoma Arising in an Ovarian Mature Cystic Teratoma - A Rare Entity

Ranjini Kudva, Gauri Salgaonkar Ayachit, Anurag Ayachit

Mature cystic teratomas, also known as dermoid cysts, are composed of a mixture of tissues derived from all three germ layers and constitute about 20% of all ovarian neoplasms. However, malignant transformation in a mature cystic teratoma is an uncommon event occurring only in about 1.8% cases. A variety of tumours can arise within a mature cystic teratoma (most common being squamous cell carcinoma), with malignant melanoma being extremely rare among such tumors. While most authors believe that primary ovarian melanoma almost always arises within a mature cystic teratoma, the primary nature of an ovarian malignant melanoma can be ascertained only once metastasis from a cutaneous melanoma is ruled out. The first case of malignant melanoma arising in an ovarian mature cystic teratoma was reported in 1901 and only about 45 additional cases have been reported till date. We present another case of a primary malignant melanoma arising within a mature cystic teratoma.

Endodontic Management of Maxillary First Molar with Type I Canal Configuration– A Rare Case Report

Thorough knowledge about the root canal variations is essential for the predictable endodontic treatment outcome. The root and root canal anatomy of maxillary first molar varies greatly. A Pub-med literature search about single rooted single canalled maxillary first molar was done to know its details such as incidence, diagnostic method used, age, sex and ethnic background of patient. This article presented report of a single rooted single canalled maxillary first molar in a 27-year-old healthy Asian female.

An Infant with Nasal Regurgitation Since Birth and Failure to Thrive

Garjesh Singh Rai, Radha Sarawagi, Sakshi Sharma, Ashwin Apte

The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3rd of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive ‘bird beak sign’. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller’s Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.

Secondary Spontaneous Pneumothorax (SSP) with Bronchopleural Fistula in A Patient with COPD

Gautam Rawal, Sankalp Yadav, Nitin Garg, Umar Rasool Wani

The aim of this article is to report a case of secondary spontaneous pneumothorax (SSP) with bronchopleural fistula in a patient with chronic obstructive pulmonary disease (COPD). SSP is a common life threatening complication in a patient with COPD and usually creates confusion in the mind of the treating physician during an episode of acute exacerbation of COPD. A 52-year-old male presented with a three day history of dry cough and breathing difficulty. He had a history of COPD. A large pneumothorax on the left side was confirmed after chest X-ray. Tube thoracostomy was performed which showed a persistent air-leak suggesting a bronchopleural fistula. The patient was treated conservatively with patience and the leak sealed spontaneously. The patient recovered uneventfully. This case emphasizes that SSP should be considered in the differential diagnosis of patients having a history of long-term COPD who are in a relatively stable condition with non- critical respiratory distress and the importance of conducting a chest X-ray along with repeated clinical examination in a patient of COPD who does not improve with adequate therapy.

Pancreatic Extra-Gastrointestinal Stromal Tumour with Documentation of C-Kit Mutation: A Case Report

Preeti Joseph, Richa Goyal, Preeti Bansal, Rajni Parmar, Sarjana Dutt

Natal Tooth Associated with Fibrous Hyperplasia – A Rare Case Report

Eruption of tooth at about 6 months of age is a significant stage in child’s life and is an emotional event for parents. However, a tooth present in the oral cavity of newborn can lead to a lot of delusions. Natal and neonatal teeth are of utmost importance not only for a dentist but also for a paediatrician due to parent’s anxiety, folklore superstitions and numerous associated complications with it. This paper reports a rare case, wherein a natal tooth has led to the development of a reactive fibrous hyperplasia in an 8-week-old infant.

Osteochondroma of Maxilla Posterior Region: A Unique Case

Mayuri Jain, Sachin Singhal, Megha Goyal, Bhuvnesh Sharma

Osteochondroma is the most common benign neoplasm of the skeleton commonly affecting the long bones due to endochondral growth. In the craniofacial region this tumour is very rare. The sites of predilection are the coronoid process and the mandibular condyle. Here, we report an exceptional case of osteochondroma originating from the maxillary posterior region in a 26-year-old male patient, mimicking an odontome, not reported earlier in the literature. We also discuss the importance of various imaging modalities, most importantly, computed tomography (CT) in the evaluation of such lesions. However, histopathology remains the mainstay for definitive diagnosis in such conditions.

Conservative Management of a Large Neonatal Ovarian Cyst: A Case Repor

Mohd Aamir, Harish Punia, Poonam Dalal, Deepapak Sharma

We describe a case of a large simple neonatal ovarian cyst, which was managed successfully using “wait and watch” approach and serial ultrasound monitoring. A cystic lesion arising from right ovary was noted in antenatal ultrasound (USG) which was followed up with postnatal USG which revealed a large simple ovarian cyst without any complications. Patient was kept on expectant management with close clinical and USG monitoring. Cyst resolved spontaneously at 10 wk of age. A brief review of literature for likely aetio-pathogenesis and management is also presented.

Nerve Sheath Myxoma: Report of A Rare Case

Amoolya Bhat, Aparna Narasimha, Vijaya C, Sundeep VK

Nerve sheath myxoma defined by Harkin and Reed is an uncommon benign neoplasm with nerve sheath like features. It has several cytological and histological differential diagnoses. One such lesion is neurothekeoma, which can be differentiated using immunohistochemistry. In most of the previous reports nerve sheath myxoma and neurothekeoma were considered synonymous and were often confused for one another. This case report separates the two using immunohistochemistry. Also, the cytological features of nerve sheath myxoma are not well documented in the past. This case report attempts to display the cyto-morphology of nerve sheath myxoma. We report a rare case of nerve sheath myxoma diagnosed on cytological features confirmed by histopathology and immunohistochemistry in a 32-year-old lady who presented with an asymptomatic nodule over the left cervical area and discuss its cyto-histological mimics.

Post Electric Shock Reactive Thrombocytosis

Richa Katiyar, Shashikant C.U. Patne, Pranjal Pankaj

Thrombocytosis is defined as a platelet count greater than 400×109/L. Electric shock may lead to tissue injury and marked thrombocytosis. We herein report a case of 45-year-old woman, who was hospitalized with progressively increasing weakness, tingling sensation, and numbness of the bilateral lower limbs. She had a history of receiving electric shock during household work, 15 days prior to her admission. Her laboratory investigations revealed a markedly increased platelet count (1,570×109/L) along with increased level of serum uric acid (12 mg/dL), and mild increase in serum potassium (6.7 mmol/L), and serum alanine transaminase (50 U/L). She was treated with intravenous fluids, calcium, and multivitamins. Following hospitalization and treatment, condition of the patient improved, her symptoms resolved, and her platelet counts declined. We report this case because of rare presentation of marked thrombocytosis secondary to electric shock with a brief discussion on pathophysiology of this condition.

Congenital Interparietal Encephalocele: A Case Report

Ashok Nayak, Satyadeo Sharma, Rakesh Kumar Vadher, Sourabh Dixit, Rohan S. Batra

Encephalocele is a mesodermal defect in the skull bones and duramater. Parietal encephalocele is a rare congenital anomaly of newborn with variable prognostic value. The authors report a case of a very large inter parietal encephalocele with no associated other system malformations. A midline inter parietal encephalocele is much rare, earlier reported cases were posterior parietal in location. Such cases can be successfully operated upon with a very good outcome. A unique case of a 18 day neonate, with swelling over scalp was evaluated by the neurosurgical team and the patient underwent neurosurgery. In planning the strategy for management of encephalocele, one needs to take into consideration the site, size, contents, patency of CSF pathway, neurological status and other associated anomalies. Inspite of such a big encephalocele in an atypical location, excision and repair gave excellent results.

A Large Cystic Variant of Gastro-intestinal Stromal Tumour arising from the Jejunum: A Case Report

Gastrointestinal stromal tumours (GISTs) represent a mesenchymal neoplasm arising from the interstitial cells of cajal occurring mainly in the gastrointestinal tract. Here, we present a case of a large GIST arising from the jejunum with cystic presentation unlike the usual presentation as a solid mass. A 50-year-old male patient came with complaint of a painless mobile lump in abdomen of approximately 25 cm in size which had gradually increased over two years. Clinically mesenteric cyst was suspected. Intra-operatively the mass was a 30x25 cm cyst with approximately 2500 ml serous fluid present inside it arising from the anti-mesenteric border of the jejunum, adherent to the jejunum, appendix and the dome of the bladder. The fluid was aspirated and the mass excised along with resection of the involved jejunal segment and appendectomy was done. Diagnosis was confirmed on immunohistochemistry study. Imatinib Mesylate 400 mg OD was started as adjuvant therapy in view of the high risk of metastasis.

Keratomycosis Caused By Graphium eumorphum (Graphium State of Scedosporium apiospermum)

Graphium eumorphum is rarely associated with mycotic keratitis. We report the case of a 30-year-old female presented with complaints of redness and defective vision in the left eye for one month. Gram staining and 10% KOH wet mount of corneal smears revealed fungal filaments. On potato dextrose agar, fast growing greyish white colonies turning grayish black on maturity was obtained. Lactophenol cotton blue (LPCB) staining confirmed the isolate as Graphium eumorphum. The infection was resolved with the combination of natamycin, econazole and itraconazole.

Bronze Diabetes

Akshatha L.N., Mamatha T. Shenoy, Charu Yadav, Rukmini M.S., Nutan Kamath

Thalassemia is a group of disorders characterized by deficient production of the ß-globin sub unit of hemoglobin. The mandatory blood transfusions in patients with thalassemia to maintain adequate erythrocyte levels, leads to iron overload. The prevalence of diabetes in patients with thalassemia varies from 6 to 14%. We here by present a known case of thalassemia major in an 18 year old boy. He was diagnosed with thalassemia before the age of one year and is on regular blood transfusion every two weeks since then. The repeated blood transfusion is one of the common causes for haemochromatosis. Iron overload initially leads to glucose abnormalities such as insulin resistance and hyperinsulinemia, which is followed by impaired secretion of insulin. Diagnosed as a case of bronze diabetes, this patient is on insulin therapy for the last two years. Currently the patient is on iron chelation therapy at Kasturba Medical College Hospital, Mangalore, Karnataka, India.

Langerhans Histiocytosis in a Child – Diagnosed by Oral Manifestations

Shruti Golai, Basavaraj Nimbeni, Sandya Devi Patil, Madhu Kakanur, Santosh Paul

Langerhans Histiocytosis (LCH) is a rare reactive and proliferative disease of histiocytes with unknown etiology, characterized by excessive proliferation of histiocytes called Langerhans cells. It occurs mainly in children but occurrence in adults has also been reported. It manifests as punched out lesions in the skull, maxilla, mandible, sternum and other flat bones and causes rapid resorption of the alveolar bone leading to floating teeth appearance in the radiographs. This disease manifests initially in the oral cavity in most of the cases and can be diagnosed by careful clinical and radiological examination. Here, we present a case of LCH in a child which was diagnosed by a swelling in the mandibular region.

Microstomia—A Treatment Challenge to A Prosthodontist

Smriti Kapur Dewan, Aman Arora, Monika Sehgal, Anika Khullar

The branch of Prosthodontics is not only a science but also an art of handling patients who present with limitations in continuing with normal procedures. An abnormally small mouth opening is called as microstomia. The common reasons for this condition include scleroderma, orofacial malignancies, surgery, burns and TMJ ankylosis. Impressions can be made for patients with restricted mouth opening with a sectional impression tray that can be assembled and disassembled in the mouth and reassembled outside the mouth. This article describes a sectional tray system for making preliminary and secondary impressions. Also an innovative technique of fabricating a sectional complete denture for a microstomic patient has been described.

Morel-Lavallee Lesion (MLL) Mimicking A Soft Tissue Neoplasm

Morel-lavallee lesion (MLL) represents post traumatic subcutaneous cyst generally overlying bony prominences like greater trochanter, lower back, knee and scapula. A 51-year-old man presented with a swelling in left thigh since six years which was insidious in onset, gradually progressive in size and not associated with pain, fever or discharge. There was no history of trauma or any associated constitutional symptoms. Since there was no history of trauma recalled by the patient the clinical dilemma was between soft tissue sarcoma and cold abscess. We report a case of slow growing painless mass lesion of thigh, diagnosed on Magnetic Resonance Imaging (MRI) as morel lavallee lesion and describe its salient imaging features with treatment options.

Placenta Percreta in First Trimester Leading to Disseminated Intravascular Coagulopathy (DIC): A Rare Case Report

Charu Lata Bansal, Jyotsana Gupta, Deepti Asthana, Ankit Kayal

Placenta percreta is the most severe form of abnormal placental attachment. It is a variant of placenta accreta in which chorionic villi penetrate the entire thickness of the myometrium through the uterine serosa and may involve the adjacent structures. Literature review shows very few cases encountered during the first trimester of pregnancy. A-20-year-old woman with previous one cesarean section presented with continuous vaginal bleeding beginning after incomplete abortion at seven weeks and six days period of gestation for which she underwent dilatation and curettage. MRI revealed irregular heterogeneous signal intensity mass with large area of hemorrhage in lower anterior wall extending towards the endometrial cavity suggestive of morbid adherent placenta. Following continuous bleeding after repeated curettage for retained, adherent placenta her coagulation profile got deranged and DIC developed. Correction of coagulopathy and emergency hysterectomy as a life saving measure for placenta percreta was done in our case.

Unusual Foreign Body in Nose and Nasopharynx - A Rare Case

Lodgment of foreign body in the nose/nasopharynx in a sane adult person is unusual. Here, we present the case of a patient who came with an unusual foreign body (fish) lodged in the nose & nasopharynx. It was removed successfully in the outpatient department transorally with aid of nasal endoscopy.

Diagnostic Dilemma in Ovarian Pregnancy: A Case Series

Jasmina Begum, P.Pallavee, Sunita samal

Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg’s criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality.

Segmental Alveolar Osteotomy by Palatal Approach to Correct Excessive Angulated Dental Implants in Anterior and Posterior Maxilla

Ismail Akkas, Orcun Toptas, Yusuf Ziya Akpinar, Fatih Ozan

Dental implants have been used for a long time to achieve better prosthetic and health conditions in the mouth. With the increase in their usage, more complications have occurred, and methods of solving these problems have been developed. One complication is insertion of the implant in the wrong direction. The aim of this case report is to describe an osteotomy technique to reposition a malpositioned dental implant. A female patient, aged 38 years, and a male patient aged 48 years, were referred complaining of the malpositioned osseointegrated implants, which had been placed in the region of the left maxillary first premolar and molar tooth, and in the region of the left maxillary lateral incisor. Due to severe buccal positioning of the implant fixtures, acceptable prosthetic treatment was not possible. Alveolar osteotomy procedure was used to reposition the implants. Satisfactory results were obtained by osteotomy for 18-month of follow up. We conclude that inadequately axially inclined implants can be successfully treated by alveolar osteotomy. The preservation of marginal gingiva permits obtaining better prosthetic results. To avoid the recession of attached gingiva, palatal approach technique may help the clinicians.

Endodontic Treatment of the Mandibular First Molar with Six Roots Canals – Two Case Reports and Literature Review

Jorge N.R. Martins, Craig Anderson

The most common configuration of the mandibular first molar is the presence of two roots and three root canals. The objective of this work is to present two rare anatomic configurations with six root canals on two mandibular left first molars diagnosed during endodontic therapy. Root canal therapy was performed using a dental operating microscope. Ultrasonic troughing in the grooves in between the mesial root canals and in between the distal root canals was able to show the middle root canals. Large samples population characterization researches and systematic reviews were unable to detect a single case of six root canals configuration in a mandibular first molar in their investigations. Although it is a rare configuration, a six root canal configuration is possible to be found in the mandibular first molar. Three different pulp chamber configurations are possible to be found. Two or three roots may be present and the root configuration more common in the mesial root is the Type 8 and Type 12 for the distal root. Some concepts about the required technique to approach these cases are also debated.

Pulp Revascularization- It’s your Future Whether you Know it or Not?

Pulpal regeneration after tooth injury is not easy to accomplish. In teeth with immature apices and exposed vital pulp tissue, partial or complete pulpotomy is indicated to preserve pulpal function and allow continued root development. In many cases, injury causes loss of pulp vitality and arrested root development leading to a tooth with poor crown root ratio, a root with very thin walls, an open blunderbuss apex and development of apical pathosis. The ideal treatment in such cases would be to obtain further root development and thickening of dentinal walls by stimulating the regeneration of a functional pulp dentin complex. This outcome has been observed after reimplantation in avulsed immature permanent teeth but has been thought impossible in a necrotic infected tooth. This case series evaluates the efficacy of revascularization procedure in immature, non vital permanent teeth. Pulp regeneration was attempted in four patients at Department of Conservative Dentistry, ESIC Dental College, New Delhi using blood clotting approach. The cases were treated and followed up regularly at regular intervals ranging from 6 months to 3 years to assess the treatment response clinically and radiographically. The patients remained clinically asymptomatic with three out of four patients even responding positively to pulp responsiveness tests. Radiographic examination also revealed increased root formation and thickening of dentinal walls. It was concluded that the triad of a disinfected canal, a matrix (blood clot) in to which new tissue could grow and an effective coronal seal produced the desirable environment for successful revascularization.

Intramuscular Cavernous Haemangioma of Masseter Muscle – A Case Report of Surgical Excision

Satnam Singh Jolly, Vidya Rattan, Sachin Rai, kamaljit kaur, Akshat Gupta

Intramuscular haemangioma are rare benign congenital neoplasm of proliferative vascular in nature due to increased endothelial cell turnover. Less than 20% of these are found in head and neck region. The masseter muscle accounts for 5% of all intramuscular haemangioma of head and neck region. They are non metastasizing tumours which may suddenly start growing in later stages. The present article will discuss the clinical presentation, diagnostic modalities and surgical treatment of cavernous Haemangioma involving masseter muscle in a 15-year-old young female patient in whom a surgical excision of whole lesion was done under general anaesthesia and no reoccurrence of the lesion was observed after one year of follow up.

Neurofibroma at Unusual Locations: Report of Two Cases in Teenage Girls

Cheena Garg, Arjun Agarwal, Ranjan Agrawal, Parbodh Kumar

Solitary neurofibromas are rare occurrence in salivary gland region as well as mons pubis of females. We present two cases of teenage girls with swelling in parotid region and mons pubis. Fine needle aspiration cytology was inconclusive in both cases. They were both managed surgically and a diagnosis of neurofibroma was ascertained histopathologically and also confirmed with S-100 immunohistochemistry. The patients were followed up for a period of six months, however, no recurrence was noted. Though, one patient had a previous history of recurrence. We report these cases in view of their rarity of site and age as well as no correlation with neurofibromatosis and clitoromegaly.

Absence of Nails, Deaf-mutism, Seizures, and Intellectual Disability: A Case Report

Lal DevayaniVasudevan Nair, Benjamin Sagayaraj, Radha Kumar

Seizures coexists in children with intellectual disability and are often attributed to neural dysfunction associated with it. Often a careful clinical examination will unravel many diagnostic pointers as in this 8-year-old child with global development delay, deaf-mutism and moderate intellectual disability (mental retardation) who presented with seizures in the emergency department. General examination revealed dysmorphic features like anonychia, low set ears, long philtrum, large lower lips and abnormal dermatoglyphics with features of osteodystrophy on radiology. She was diagnosed as a case of DOORS syndrome, an extremely rare genetic condition affecting the TCA cycle, with just over 40 cases reported, worldwide till date, since its first description in 1961. Her genetic analysis did not reveal the common TBC1D24 mutation in 16p13.3 resulting often from substitutions affecting the arginine at position 242, in spite of all classical clinical features associated with it, suggesting genetic heterogeneity in DOORS syndrome. Though four year follow-up revealed changes in seizure pattern, there was no optic atrophy, change in IQ or peripheral nerve problem. This probably suggests that children with typical clinical features and TBC1D24 mutations may have more progressive deterioration than those without it and newer molecular techniques may identify unexplained phenotypic expressions.

Gastro Pleural Fistula: A Rare Entity Presenting as a Complication of Empyema Thoracis Following Stab Injury to the Chest

Gastro pleural fistula is an infrequently seen lesion. Here, a case of stab injury to the chest that led to the formation of a gastro pleural fistula has been presented. An intercostal drainage (ICD) tube was inserted after haemothorax was identified on this chest X-ray. The patient noticed the presence of ingested food particles at the site of ICD tube twelve days following the stab injury. The diagnosis of gastro pleural fistula was subsequently confirmed after a contrast enhanced computed tomography (CECT) of the chest and abdomen. Intraoperatively, a defect in the left hemi diaphragm with a fistulous tract between stomach and the left pleural cavity was identified. Closure of the gastric fundal perforation, excision of the fistulous tract and repair of the diaphragmatic defect was done.

Invasive Lobular Carcinoma of the Breast with Extracellular Mucin- A New Rare Variant

Vaibhav Bhika Bari, Sandhya Unmesh Bholay, Kavita Chandrahas Sane

Historically, extracellular mucin secretion is by default a feature of ductal carcinoma. Lobular carcinoma is known to be associated with only intracytoplasmic mucin production and signet ring cells. As ductal carcinoma and lobular carcinoma have different therapeutic and prognostic implications, it is important to classify them into respective groups. Here, we present a case of invasive lobular carcinoma with abundant extracellular and intracellular mucin in a 38-year-old female patient. Invasive lobular carcinoma with extracellular mucin is an extremely rare and new variant. Only 3 cases are reported in the literature so far.

Intraoperative BiPAP in OSA Patients

Bhavna P Singh, Kodandaram NS

Obstructive sleep apnea syndrome (OSA) is characterized by recurrent episodes of partial or complete upper airway obstructions during sleep. Severe OSA presents with a number of challenges to the anesthesiologist, the most life threatening being loss of the airway. We are reporting a case where we successfully used intraoperative bi level positive pressure ventilation (BiPAP) with moderate sedation and a regional technique in a patient with severe OSA posted for total knee replacement (TKR). A 55-year-old lady with osteoarthritis of right knee joint was posted for total knee replacement. She had severe OSA with an apnea-hypopnea index of 35. She also had moderate pulmonary hypertension due to her long standing OSA. We successfully used in her a combined spinal epidural technique with intraoperative BiPAP and sedation. She had no complications intraoperatively or post operatively and was discharged on day 5. Patients with OSA are vulnerable to sedatives, anaesthesia and analgesia which even in small doses can cause complete airway collapse. The problem, with regional techniques is that it requires excellent patient cooperation. We decided to put our patient on intraoperative BiPAP hoping that this would allow us to sedate her adequately for the surgery. As it happened we were able to successfully sedate her with slightly lesser doses of the commonly used sedatives without any episodes of desaturation, snoring or exacerbation of pulmonary hypertension. Many more trials are required before we can conclusively say that intraoperative BiPAP allows us to safely sedate OSA patients but we hope that our case report draws light on this possibility. Planning ahead and having a BiPAP machine available inside the operating may allow us to use sedatives in these patients to keep them comfortable under regional anaesthesia.

Mycobacterial Infection after Cosmetic Procedure with Botulinum Toxin A

Marcela Saeb-Lima, Gerardo-Victor Solis-Arreola, Angel Fernandez-Flores

We report a case of mycobacterial infection at the sites of previous injections of botulinum toxin A in a 45-year-old woman. She presented with erythematous, swollen, warm, and tender plaques and nodules at the points of injection from which a biopsy was taken, demonstrating a deep dermal and hypodermal abscessified epithelioid granulomatous inflammatory infiltrate in which some acid-fast bacilli were identified with Ziehl-Neelsen and Fite-Faraco stains. The lesion was first treated with clarithromycin plus azithromycin, to which rifampicin was later added. A good therapeutic response was obtained.

Aberrant Innervation of the Sternocleidomastoid Muscle By the Transverse Cervical Nerve: A Case Report

Two aberrant rami originating from the right transverse cervical nerve and innervated the midportion of the sternocleidomastoid muscle (SM) were detected during routine cadaver dissection. Although SM is commonly innervated by the accessory nerve, as well as by cervical nerves, it is likely to be innervated additionally by other nerves such as hypoglossal nerve, ansa cervicalis, facial or external laryngeal nerve. Some considerations as regards the possible composition of the aberrant rami of the transverse cervical nerve detected in the current study, as well as the relevant literature is discussed.

Valproate Induced Delirium due to Hyperammonemia in a Case of Acute Mania: A Diagnostic Dilemma

Siddharth Dixit, Mayank Namdeo, Sudip Azad

Divalproex sodium is commonly used drug to treat variety of psychiatric and neurological disorders. Hyperammonemia is infrequent adverse affect of treatment with divalproex sodium. It needs high degree of clinical suspicion or else can lead to delirium of non hepatic origin in some group of patients and to medication errors or even death. We hereby report a case of mania who developed hyperammonemia with normal sodium valproate levels and liver function tests where delirium lead to diagnostic and medication errors. Withdrawal of divalproex sodium led to clinical recovery but delirium prolonged his hospital stay. This case report cautions the clinicians about hyperammonemia as the uncommon side effects and emphasizes the need of doing blood ammonia testing in patients treated with divalproex sodium where recovery is halted or clinical condition worsens despite normal liver function test and EEG.

Left Sided Hydro-pneumothorax in a Operated Case of Left Diaphragmatic Hernia Repair: A Diagnostic Dilemma

Diaphragmatic hernia in adults often presents with overlapping respiratory and abdominal symptoms. They may be simple diaphragmatic eventrations or undiagnosed Bochdalek’s hernias or may even be of post traumatic variety. Diaphragmatic hernias may be asymptomatic, present only with respiratory symptoms, or may present with obstruction and strangulation of involved bowel loops with faeco-pneumothorax. The index case was operated for open diaphragmatic hernia repair six years back and admitted for breathlessness with absence of abdominal signs and symptoms. Patient subsequently developed hydro-pneumothorax during conservative management. Emergency laparotomy revealed a gastric ulcer which perforated into the left chest giving rise to hydro-pneumothorax. In present study we would like to report how this unusual presentation led to dilemma in diagnosis and surgical intervention thus increasing the morbidity and mortality of the patient at our institute.

Quadruplet Pregnancy Following Spontaneous Conception: A Rare Case Report

Setu Rathod, Sunil Kumar Samal, Sujata Singh, Sujata Swain

Quadruplets are a set of four offspring born at one birth which can be fraternal (multizygotic), identical (monozygotic) or a combination of both. Multizygotic quadruplets occur from fertilisation of four different sets of ovum and sperm. Monozygotic multiples are the result of a fertilized egg that splits into two or more embryos. Multizygotic quadruplets can be all male, all female, or a combination of both while monozygotic quadruplets will always be of the same gender. Here we present a case of 32-year-old G4P3L0 with previous history of three term intrauterine foetal death (IUFD) at 27 wk of gestation. After evaluation, she was found to carry three live foetuses with an IUFD. She was managed conservatively till 35 wk of gestation with regular monitoring of coagulation parameters. Elective caesarean section was done at 35 wk and three live female babies and one male still born were delivered. This case is unique due to the fact that our patient conceived a multizygotic quadruplet pregnancy spontaneously following a bad obstetric history (3 previous term intrauterine fetal deaths). One fetus died in utero and the pregnancy continued successfully resulting in 3 live born healthy babies.

Paratesticular Rhabdomyosarcoma in Young Adult- A Case Report

Navin Kumar Sinha

Para testicular rhabdomyosarcoma is a rare malignant tumour, which usually presents as a painless mass in the scrotum or groin. A case of para testicular rhabdomyosarcoma in a 17-year-old male is being reported here who presented with chronic scrotal pain. Paratesticular rhabdomyosarcoma is a rare non germ cell tumour of scrotal sac in children and young adult/teens which can invade testis at presentation. Embryonal variant is the most common type. 40% cases can have metastasis to retroperitoneal lymph node. Diagnosis can be done on high degree of clinical suspicion coupled with biopsy and immunohistochemistry. Multimodality approach of treatment is often beneficial for patients.

A Case of Autoimmune Polyglandular Syndrome (APS) Type II with Hypothyroidism, Hypoadrenalism, and Celiac Disease - A Rare Combination

Manoj Lakhotia, Hans Raj Pahadia, Harish Kumar, Jagdish Singh, Sandeep Tak

Autoimmune Polyglandular syndrome (APS) are rare condition characterised by presence of immune dysfunction of two or more endocrine glands and other non-endocrine organs. APS is divided into 2 major subtypes based on age of presentation, pattern of disease combinations and mode of inheritance. APS 1(juvenile) usually manifest in early adolescence or in infancy. It is characterised by multiple endocrinal deficiency with mucocutaneous candidiasis and ectodermal dystrophy. Of the endocrine diseases, hypoparathyroidism form an important component followed by Addison’s disease, type 1A diabetes, hypogonadism and thyroid disease. On the other hand APS II usually manifest in 3rd or 4th decade of life with female preponderance. Endocrine diseases commonly include autoimmune thyroid disease (graves or autoimmune thyroiditis), type 1A diabetes, and Addison’s disease. Hypoparathyroidism is of rare occurrence and there is no mucocutaneous candidiasis. We report here a case of APS type II in a 29-year-old male who initially presented with hypothyroidism, which was soon followed by Addison’s disease. The involvement of thyroid gland preceding the involvement of adrenal is of rare occurrence. The patient also had celiac disease which makes the combination further uncommon.

Treatment Paradox in Musculo-Skeletal Tuberculosis in An Immunocompetent Adult Male, A Case Report from A Tertiary Care Hospital

Priyanka Chaskar,Geetika Rana, Anuradha, Nandini Duggal, Jyoti Arora

Paradoxical reactions like immune reconstitution inflammatory syndrome (IRIS) as seen with patients on retroviral treatment in HIV infection, have also been identified in HIV sero-negative patients with extra pulmonary tuberculosis especially lymph-node tuberculosis. Musculo-skeletal tuberculosis presenting as a cold abscess of the anterior chest wall is a rare entity which poses diagnostic and therapeutic challenge. A 35-year-old immunocompetent male came with complains of painless lump on right side of his chest over 9th and 10th intercostal space which gradually increased and extended upto 11th rib area. Clinically, diagnosis of cold abscess was made and anti-tubercular therapy (ATT) was started. Despite of being on ATT for 3 weeks, patient developed pain and signs of inflammation. Fluid was aspirated and sent for biochemical and microbiological investigations. The aspirated fluid was positive for acid fast bacilli by ZN stain and grew Mycobacterium tuberculosis in culture, sensitive to first line ATT. Pyogenic and fungal culture was negative. This case presented as an anterior chest wall cold abscess which deteriorated on initiation of first line ATT, thus creating a suspicion of resistance to ATT which was cleared on ATT susceptibility testing. Hence, this case underlines the possibility of treatment paradoxes seen in immunocompetent musculo-skeletal tuberculosis.

Chromosomal Study is Must for Prepubertal Girl with Inguinal Hernia: Opportunity to Diagnose Complete Androgen Insensitivity Syndrome

The sufferers of complete androgen insensitivity syndrome (CAIS) are phenotypic females despite of having functional testes and normal male karyotype. They usually present late with primary amenorrhea but delayed diagnosis increases chance of gonadal malignancy. Alertness for this entity is crucial as with early diagnosis such disorder can be managed more appropriately for a better future. We hereby describe a case of CAIS in an 8-year-old girl presented with bilateral inguinal swellings. Endocrinological analysis, radiological investigations and cytogenetic studies were done. Investigations revealed absence of female internal genitalia. Karyotyping and molecular study confirmed the presence of Y chromosome. Parents were counseled regarding timely gonadectomy, fertility and other long term social issues.

Bilateral Distal Radius Fracture in Third Trimester of Pregnancy with Accelerated Union: A Rare Case Report

Ravikumar TV, Rahul P, Amit Grover, Bheemsingh Samorekar

Bilateral distal radius fracture is a rare entity. There is no literature reporting a bilateral distal radius fracture in pregnancy. Fracture healing is influenced by hormones. Hormonal changes of pregnancy will affect the healing of a fracture. A 28-year-old female at 34 wk of pregnancy sustained a bilateral distal radius fracture after a self fall. One side was managed conservatively and open reduction was done for the other side. Both fractures united at four weeks. This case is unique in three ways. First distal radius fractures commonly occur in elderly postmenopausal females due to oestrogen deficiency. In this case a distal radius fracture occurred following a self fall in third trimester of pregnancy – a hyperestrogenic state. Second the time taken for union was only four weeks signifying the hormonal effects on pregnancy on fracture healing. Third the occurrence of bilateral distal radius fracture itself is very rare in adults. In pregnancy there is a faster rate of fracture healing due to effects of oestrogen and increased cardiac output. Fractures in pregnancy require special attention. Surgical intervention should be done with a multidisciplinary approach. While management of fractures in pregnancy, effect of hormonal and physiological changes should be kept in mind.

Disseminated Cryptococcosis with Adrenal and Lung Involvement in an Immunocompetent Patient

Piyush Ranjan, Manisha Jana, Shanmugam Krishnan, Devajit Nath, Rita Sood

Disseminated cryptococcosis usually occurs in immunocompromised patients. Occasionally, it affects immunocompetent persons and mimics tuberculosis in clinical presentation and radiological findings. Usually, it affects lungs and central nervous system. Rarely, it may affect adrenal glands. We present a case of 65-year-old gentleman with prolonged pyrexia. Computed Tomography (CT) scan of chest and abdomen showed miliary pattern in the chest with bilateral adrenal masses. On the basis of clinical and radiological findings, the case was initially diagnosed as disseminated tuberculosis and anti tubercular treatment was started. Subsequently, on histopathological examination, the diagnosis was confirmed as disseminated cryptococcosis. Even in a country with high prevalence of tuberculosis, other causes of miliary mottling should be considered and histopathological examination should be sought.

Total Acquired Vulval Synechia: An Unusual Presentation

Anji Reddy Kallam

An unusual case of Acquired Total vulval synechia due to vulvar Lichen planus is reported in an 18-year-old girl, which is an extremely rare condition. It has a potential for producing extensive scarring and narrowing of introitus resulting in dyspareunia and rarely carcinoma of vulva. Successful surgical management of total vulvar synechiae in patient suffering from Lichen Planus is being reported.

Primary Non Hodgkin´s Lymphoma of Left Adrenal Gland – A Rare Presentation

Primary adrenal lymphoma is rare and constitutes for 3% of extranodal lymphoma cases. Approximately 70% of patients present with bilateral disease and have adrenal insufficiency. Prognosis of primary adrenal lymphoma (PAL) is poor, most of patient die within one year of diagnosis. Moreover, there are no standard treatment protocols on such cases. Patients are generally treated with regimens similar to other nonhodgkin lymphoma which includes surgery, combination chemotherapy and or radiotherapy. We are presenting a successfully treated case of primary diffuse large B cell non Hodgkin lymphoma of adrenal gland in a 57-year-old patient. The patient had unilateral adrenal involvement (left adrenal gland), without adrenal insufficiency and normal Serum lactate dehyrogenase level. The patient was treated with left adrenalectomy followed by combination chemotherapy. Two years after diagnosis and treatment the patient is disease free on clinical and imaging studies.

Effect of Bisphosphonates on Orthodontic Tooth Movement—An Update

Sindhuja Krishnan, Saravana Pandian, Aravind Kumar. S

Bisphosphonates are a synthetic class of pyrophosphate analogues that are powerful inhibitors of bone resorption which are commonly used as a medication for the prevention and therapy of osteoporosis and osteopenia, also used to treat tumor diseases. As it affects bone metabolism, it is said to have an influence on orthodontic treatment and tooth movement. Also, this review gives an insight into the reported effects of Bisphosphonate medication in literature highlighting the status quo of scientific research regarding effects of Bisphosphonates on orthodontic tooth movement. A systematic literature search was done in Medline database (Pubmed) for the appropriate keywords. Manual handsearch was also done. From the available evidence it can be concluded that the duration of orthodontic treatment is increased for patients under Bisphosphonate therapy as they interfere with the osteoclastic resorption. However, they may be beneficial for anchorage procedures. Further long term prospective randomized controlled trials are required to assess possible benefits and adverse effects of bisphosphonate treatment, before Bisphosphonates can be therapeutically used in orthodontics.

Role of IL-25 in Immunity

Azar Valizadeh, Afra Khosraviavi, Layla Jafar Zadeh, Elaheh Gholami Parizad

IL-25 a 2o KDa protein mostly known as IL-17E, encoded by chromosome 14, and containing 117 amino acids. Cytokine IL-17 family consists of 6 members; IL-17A to IL-17F, among which IL-25 has a unique structure and function. The receptor of IL-25 (IL-17BR) is highly expressed in the main Th2 cells. IL-25 regulates the internal safety of adaptive immune responses which leads to begin allergic diseases and plays a role in stimulation of pulmonary mucosal cells and fibroblasts. IL-25 can also have some effects on production of other cytokines. For instance, production of IL-25 in human and mice or injection of IL-25 to animals has resulted in production of high concentrations of Th2 cytokines, including IL-4, IL-5, and IL-13. Pilot studies have shown that mRNA of IL-25 has a high expression in Th2 cells. However, the mechanism through which IL-25 leads to Th2 immune response is still unknown. Reaction between IL-25 and IL-17BR leads to activation of transcription factors, such as NF-KB, STAT6, GATA3, NF-ATC1, JUNNB, MAPK, and JNK. IL-25 has been used against the kidney damage in mice. A large number of researchers in various countries, including the U.S. and Taiwan, have stated that IL-25 is a strong inflammatory cytokine protein which is involved in allergic inflammations.

Temporomandibular Disorders (TMD) in Edentulous Patients: A Review and Proposed Classification (Dr. Bader’s Classification).

Bader K AlZarea

Temporomandibular disorders (TMD) are a collective term given to a number of clinical problems that involve the masticatory musculature, the temporomandibular joints and associated structures, or both. Although the aetiology of TMD has not been fully understood, in general it is considered to be multifactorial. The signs and symptoms of TMD which present in patients with natural teeth may also occur in edentulous patients. These symptoms may appear in various combinations and degrees. TMD has attained a prominent role within the context of dental care due to its high prevalence. The present paper is a review of the current literature on TMD in edentulous patients; with an attempt to propose a classification for the same.

Laboratory Diagnosis of Extra-pulmonary Tuberculosis (EPTB) in Resource-constrained Setting: State of the Art, Challenges and the Need

Manju Purohit, Tehmina Mustafa

During the last decade, remarkable progress has been made in the diagnostics of pulmonary tuberculosis; however, diagnostic challenges in extra-pulmonary tuberculosis (EPTB) remain to be addressed. Diagnosis of EPTB is difficult due to the pauci-bacillary nature of disease, the variable clinical presentation, and need for invasive procedures to secure appropriate sample, and lack of laboratory facilities in the resource-limited settings. A more accurate test to diagnose various forms of EPTB, which can easily be incorporated in the routine TB control programme, would contribute significantly towards improving EPTB case-detection and thus reducing the morbidity and mortality. In this overview, we describe the status of current conventional and newer methods available for laboratory diagnosis of EPTB and discuss the challenges in their implementation in the resource-limited settings, and suggestion for better EPTB diagnostic algorithms, which can be incorporated in the routine TB control programmes.

Lippes Loop Inserted 45 Years Back: The Dilemma to Remove It or Leave It in situ. A Case Report with Review of Literature

Maruti Sinha, Rekha Rani, Ridhima Gupta, Kishan Chand, Gurcharan Kaur

IUD’s like Lippes Loop (LL), intended for long term use are retained for years and menopausal ladies often present with LL in situ either deliberately or forgotten. We report a case of Lippes Loop removal inserted 45 years back in a woman complaining of post menopausal bleeding. The inserted LL thread was incidentally discovered during clinical examination and Ultrasonography. We also reviewed literature to determine the evidence for and against removal of an inert IUD.

Systemic Review of Dry Socket: Aetiology, Treatment, and Prevention

Our systemic review is to make a comprehensive review about the aetiology, treatment and the prevention of dry socket, the inclusion criteria were all the studies that discuss the dry socket and its etiology, treatment and prevention and exclusion criteria were all the studies that discuss the other complications of tooth extraction, the materials and methods used for this systemic review was to search in the Pub Medline database between 2008 to 2013, using specific words “dry socket, aetiology, treatment and prevention” and published in the English language, the articles were screened by abstract for relevance to aetiology, treatment and prevention of dry socket, 82 papers were identified in pub med but a total of 36 out of Publications were included in the final systemic review according to the specific keywords and materials mentioned above. The occurrence of dry socket in an everyday oral surgery or dental practice is unavoidable. The risk factors are smoking, surgical trauma, single extractions, age, sex, medical history, systemic disorder, extraction site, amount of anaesthesia, operator experience, antibiotics use prior to surgery, difficulty of the surgery and the previous surgical site infection in addition to oral Contraceptives, menstrual cycle and immediate postextraction socket irrigation with normal saline. The traditional options of treatment are directed toward palliative care, such as the irrigation of the surgical site, avoiding curetting the extraction socket, Packing with a zinc oxide– eugenol paste on iodoform gauze can be considered to relieve acute pain episodes, there is also new agents in the market can accelerate the healing of the socket such as PRGF and GECB. The prevention methods include avoiding smoking before and after surgery and a traumatic surgery, the use of antibiotics, such as, azithromycin, can be considered, the other preventive measures such as chlorhecidine rinse or gel can be effective in the reduction of dry socket incidence.

Effect of Diallyl Disulphide on Diabetes Induced Dyslipidemia in Male Albino Rats

Naveen Kumar Sambu, R.T.Kashinath, J.G.Ambekar

Background: Diabetes Mellitus is a chronic metabolic disorder which may lead to various complications, the important being dyslipidemia leading to Coronary Heart Disorders (CHD), the major cause for morbidity and mortality in diabetic patients. Diabetes Mellitus could be treated by nutritional therapy/drug therapy and others. But the drug therapy would have its own limitations and side effects. To overcome from this an herbal extract is recommended, such as Diallyl Disulphide (DADS) a principle compound of Garlic oil. A im: To assess the hypolipidemic effect of Diallyl Disulphide (DADS) in alloxan induced diabetic rats. Materials and Methods: Healthy adult wistar strain male albino rats weighing around 100-150 grams were randomly selected from the animal house at BLDE University’s Shri B.M.Patil Medical College, Hospital and Research Centre, Bijapur, India. Diabetes was induced using alloxan and was treated with DADS. After a stipulated time the rats were anesthetised and sacrificed to collect the blood and liver tissue. Various Lipid parameters, HMG CoA Reductase, Fecal bile acids were estimated in the blood, feces and homogenised liver tissue using standard procedures. S tatiscal Analysis: One-way ANOVA followed by post-hoc t-test is done. Result: There was significant decrease in the blood and liver tissue lipid parameters of DADS treated alloxan induced diabetic rats when compared to the alloxan induced diabetic rats. Conclusion: From this study it can be concluded that the DADS a principle compound of garlic, definitely has the hypolipidemic effect in diabetic rats, which is reducing the morbidity in diabetic cases due to dyslipidemia without the adverse effects.

Preventive Role of Indian Black Pepper in Animal Models of Alzheimer’s Disease

Lokraj Subedee, RN Suresh, Jayanthi MK, Kalabharathi HL, Satish AM, Pushpa VH

Introduction: Dementia is the clinical symptom of alzheimer’s disease. Brain cholinesterase levels and behavioural changes are the markers for Alzheimer’s disease and aluminium chloride is one causative agent for polymerization of tau protein and amyloid plaque formation in Alzheimer’s disease. Effect of piper nigrum and its role in prevention of alzhimer’s disease and symptoms are well linked in this study. Aim: To study the effect of piper nigrum for the prevention of alzheimer’s associated histopathological, biochemical and behaviour changes in rat model. Materials and Methods: Twenty four rats were taken in this study. Their baseline behavioural parameters were noted and group was separated randomly in four. Rats were pretreated with piper nigrum and Alzheimer’s disease was induced. Biochemical and histopathological changes were noted at the end of experiment. Results: There was marked decrease in cholinesterase level, amyloidal plaque formation in rats brain who were pretreated with piper nigrum. At the same time there was decrease in escape latency time (ELT) and increase in memory in piper treated rats. Conclusion: Piper nigrum prove to be effective for prevention of Alzheimer’s disease. This finding has to be confirmed with studies including larger population. Further research on cholinesterase inhibitors, role of flavonoids on prevention of neurodegeneration in Alzheimer’s disease can be encouraged.

Wrong Sample Dispensing May Cause False Positive Malaria Test

Naveen Agnihotri, Ajju Agnihotri

Both false positive (FP) and false negative are known limitations of any diagnostic test. Malaria parasite (MP) rapid diagnostic tests (RDTs) may give FP results due to interference by substance in blood sample. We detected a FP in a MP RDT for first time in 36-year-old female whole blood donor due to incorrect sample dispensing technique. As per manufacturer’s instructions, while allowing all kit components and blood specimen to come to room temperature before testing, blood samples usually separate into lower layer of red blood cells (RBC) and upper layer of plasma. Technician performing the test took the sample from the bottom of the vacutainer thus taking RBC instead of whole blood (WB-recommended by manufacturer). This test showed reactive result and as per our standard protocol was re-tested to confirm the result. This second test was performed after re-mixing the same sample, which now tested as non-reactive sample, buffer and other kit component mix-up were ruled out. Repeated test on another sample of same donor produced same results. Thick and thin peripheral blood smear examination for malaria was found negative. This case highlights wrong MP RDT result due to wrong sample dispensing.

Olfactory Agenesis in Kallmann Syndrome (KS)

Sahana Shetty, Nitin Kapoor, Reetu Amritha John, Thomas Vizhalil Paul

Cecal Volvulus-A Diagnostic Challenge

T.Anil balraj, M.Jagan Mohan, Sridhar Reddy.P

Tuberous Sclerosis

Giant Exophytic Renal Angiomyolipoma Mimicking as Retroperitoneal Sarcoma; A Case Report with Review of Literature

Channabasappa kori, Naseem Akhtar, P.N. Vamsidhar, Sameer Gupta, Vijay Kumar

Ovarian Struma - Report of A Rare Case

E Shanthi, Parimala, R Vimal Chander, Jayashree, Sonti Sulochana

A Rare Case of Prenatally Detected Craniopagus Twin

T. Arul Dasan, Basawaraj N.G., Sunitata Madhukar Anvekar

Anatomical Abnormalities in Multiple Permanent Teeth

Non Syndromic Bilateral Microdontia of Maxillary Second Molars: A Very Rare Finding

Manoj Kumar Hans, Subhash Chander, Amrit Singh Ahluwalia, Harleen Chinna

Dental anomalies are the formative defects caused by genetic disturbances or environmental factors during tooth morphogenesis. The term microdontia is defined as the condition of having abnormally small teeth. Clinically, microdontia in the permanent dentition, excluding the third molars, is found in 0.8-8.4% of the population. One of the commonest forms of localized microdontia is that which affects the maxillary lateral incisor, a condition called Peg laterals. The next tooth which can be affected is the third molars. Few cases of microdontia in canines have been reported. Localised microdontia of maxillary second molar has never been reported in literature before.

Endobronchial Foreign Body (FB): A Rare Cause of Empyema

Asmita Mehta, Amit Gupta, Aziz KS, Rajesh venkitakrishnan

Grade-III Paraplegia in Spinal Tuberculosis

Safak Ekinci, Omer Ersen, Gulbanu Horzum Ekinci

Correction

Sathyanarayana Baddam, Gautami S Penmetsa, Narendra Mandalapu, Sitaramaraju DV,Ravikanth Mannem, Rama Krishna Alla, Praveen Gadde,Immunolocalization of Cd34 Positive Progenitor Cells in Diabetic and Non Diabetic Periodontitis Patients – A Comparative Study (Published in Journal of Cilinical and Diagnostic Research. 2014 November: 8(11):). ZC96-ZC99 In this article a change has been done in Authorship. A conflict arose between the authors post publication and one of the deserving author was missed. This was finally resolved between the author and conveyed to the editorial. After assessing the case, editorial agreed upon the change as a rare exception

Correction

ViveK Kumar Sharma, Senthil Kumar Subramanian, Vinayathan A, Sarah R, Balasubramaniam SR, Velkumary S,Study of Effect of Age and Gender Related Differences on Common Paper and Pencil Neurocognitive Tests in Adolescents (Published in Journal of Cilinical and Diagnostic Research. 2014 November: 8(11):). BC05-BC10 In this article typo errors were noticed. A correction has been done in the Title and [Table/Fig-1a,b,c],[Table/Fig-8],[Table/Fig-9a,b] and [Table/Fig-10a,10b].