Journal of clinical and diagnostic research

Postoperative Malignant Hyperthermia- A Medical Emergency: A Case Report and Review of Literature

Malignant hyperthermia is a rare life threatening pharmacological disorder. Preoperative clinical diagnosis is not possible. Due to its rarity and severity, it must be taken as an important differential diagnosis for postoperative hyperthermia. We hereby report a case of postoperative malignant hyperthermia in a four-year-old female child, who was operated for type 1 choledochal cyst and had difficult postoperative sequel. We lost that child due to unavailability of Dantrolene sodium in emergency drug cart.

A Successfully Treated Case of Criminal Thallium Poisoning

Tetsuya Yumoto, Kohei Tsukahara, Hiromichi Naito, Atsuyoshi Iida, Atsunori Nakao

Thallium was once commonly used as a household rodent or ant killer, but many countries have banned such use due to unintentional or criminal poisonings of humans. A common initial clinical manifestation of thallium poisoning is gastrointestinal symptoms followed by delayed onset of neurological symptoms and alopecia. These clinical characteristics can provide important diagnostic clues regarding thallium poisoning. Here, we report a 23-year-old woman who was poisoned by a business colleague when she unknowingly drank tea containing the toxic substance several times. The patient was treated with multi-dose activated charcoal with airway protection and Prussian blue.

Spontaneous Intracerebral Bleed Post Snake Envenomation

Girish Menon, Lakshman I Kongwad, Rajesh Parameshwaran Nair, Anmol Nagaraj Gowda

Snakebite envenomation is a commonly encountered emergency in tropical countries with potentially fatal complications. Life threatening neurosurgical complications are rare and infrequently documented in literature. We discuss the case of 28-year-old gentleman, managed successfully for an intracerebral haemorrhage following a viper bite and attempt to obviate some management dilemmas often encountered in viperine envenomation.

Bilateral Synchronous Paratesticular Leiomyoma - A Rare Entity

Paratesticular region is an obscure anatomical region that includes spermatic cord and its contents, tunica of the testes, epididymis and appendices of epididymis and testis. Paratesticular tumours may closely resemble and be clinically indistinguishable from testicular tumours, resulting in a diagnostic dilemma. Preoperative distinction between the benign and malignant paratesticular tumour is extremely difficult, resulting in difficulty in diagnosis and management. We hereby present a case of a 56-year-old male who reported with a painless bilateral scrotal mass and underwent surgical excision of the same. The final biopsy report was paratesticular leiomyoma. The main purpose of this manuscript is to emphasize on the fact that it is imperative for the treating urologists to be aware of such potentially benign rare entity. A high index of clinical suspicion is mandatory, as lack of knowledge about this condition would result in an unnecessary radical orchidectomy.

Extramedullary Solitary Plasmacytoma: Demonstrating the Role of 18F-FDG PET Imaging

An Extramedullary Plasmacytoma (EMP) is characterized by a neoplastic proliferation of clonal plasma cells outside the medullary cavity. EMPs are a rare occurrence compared to other malignant plasma cell disorders and account for approximately 3-5% of plasma-cell neoplasms. Although most cases of EMP are not immediately life threatening at diagnosis, EMPs can progress to Multiple Myeloma (MM) and thus, warrant monitoring. Currently, there are no standard guidelines for when and how to monitor patients who are diagnosed with or treated for a solitary plasmacytoma. We present a case of solitary EMP who was treated adequately and definitively but developed a distinct, non-contiguous subsequent solitary EMP and was only discovered due to surveillance 18F-Fludeoxyglucose Positron Emission Tomography (18F-FDG) (PET) scan. Uniform surveillance guidelines should be developed and the potential benefits of PET and other imaging techniques as well as their cost should be considered.

Evaluation of Periapical Healing of Apicomarginal Defect in Mandibular First Molar Treated with Platelet Rich Fibrin: A Case Report

Jitesh Wadhwa, Alpa Gupta, Suruchi Hans

The presence of an apicomarginal defect is one of the reasons for the failure of endodontic treatment. The best treatment option to treat an apicomarginal defect is to perform endodontic surgery using Guided Tissue Regeneration (GTR) membranes. The present case report evaluated the healing of periapical lesion along with apicomarginal defect using Platelet Rich Fibrin (PRF) as membrane in periapical surgery of mandibular first molar. Recall examination was performed at 3 and 18 months post surgery. A satisfactory periapical healing was evident using PRF in apicomarginal defect of mandibular first molar. PRF may be considered as an alternative treatment for GTR membranes in the treatment of apicomarginal defects.

Recurrent Longitudinally Extensive Myelitis and Aquaporin–4 Seronegativity – The Expanding Spectrum of Neuromyelitis Optica

Ravi Anadure, Coimbatore Sivasubramanian Narayanan, Govindaraj Varadraj

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a recently proposed unifying term for Neuromyelitis Optica (NMO), also known as Devic's disease and related syndromes. It is a relapsing inflammatory demyelinating disease that most commonly affects optic nerves and the spinal cord, leading to sudden vision loss or weakness in one or both eyes, and loss of sensation and bladder function. Though inflammation may also involve the brain, the lesions seen in NMO are different from Multiple Sclerosis (MS) which has a similar clinical course. Attacks of NMOSD tend to be more severe and often different in nature from MS. MS and NMOSD are often confused but require a different course of treatment for optimal results. Here, we describe a patient who had clinical features suggestive of NMO but showed seronegativity for anti-aquaporin antibodies, done twice. Initially he was managed on the lines of MS but showed a deteriorating clinical course on initiation of treatment with interferons. Later, his diagnosis was revised to seronegative NMO and he was started on immunosuppressive therapy with azathioprine to which he showed optimal response and achieved disease stabilization.

Giant Leiomyoma of the Oesophagus

Dhamodaran Kandasamy, Niyas Ahamed, Sujatha Kannan, Vasundaran Samuel

Leiomyomas are rare benign tumours of the oesophagus that remain silent in more than 50% of the cases. Giant leiomyomas measuring more than 5 cm are very rare. A 47-year-old female presented with chest pain, cough and dysphagia for two months. Imaging studies were indicative of a 12.1x11.9 cm mass lesion in the distal oesophagus, CT guided biopsy confirmed leiomyoma. The patient being taken up for surgery was found to have a 20x19x17 cm irregular lobulated and encapsulated mass lesion arising from distal oesophagus encapsulating submucosally. En bloc resection of the tumour along with distal oesophagus with a clearance of 4 cm above and below the oesophagogastric junction was done followed by gastro-oesophageal anastomosis. Histopathologically, leiomyoma was confirmed. The patient had a smooth postoperative recovery.

Bilateral Cervical Lymphadenopathy Atypical Presentation of Malaria-A Rare Case Report

Dwijen Das, Kallol Bhattacharjee, Surinder Ghintala, Amit Kr Kalwar

Malaria, the most common parasitic disease of humans, remains a major health and economic burden in most tropical countries. An 18- year-old male from rural north eastern India presented with four days fever with chill. The patient was conscious, oriented but confused. Physical examination revealed bilateral multiple, discrete cervical lymphadenitis without organomegaly or sternal tenderness. Blood parameters were normal except transient thrombocytopenia. Blood smear and antigen were positive for both Plasmodium vivax and falciparum with negative viral markers. Fine Needle Aspiration Cytology (FNAC) of cervical lymph nodes showed non-specific reactive lymphadenitis which subsided with antimalarial treatment. Lymphadenitis is an extremely rare presentation in malaria and is considered as an important negative finding. We reported this case to highlight that such unusual manifestations may present in malaria in endemic areas which may baffle the clinicians.

Primary Pulmonary Artery Intimal Sarcoma Case with Elevated Coagulation Markers

Koshiro Sakai, Yoshino Minoura, Taiju Matsui, Kyoichi Kaneko, Yoichi Kobayashi

Primary Sarcoma of the Pulmonary Artery (PAS) is a very rare and miserable disease. The clinical signs and symptoms of PAS are non- specific, which usually prevents diagnosis before surgery or autopsy. The current guidelines for the diagnosis and treatment of PAS have not been well established. Several reported cases of PAS have been mistaken for Pulmonary Artery Thromboembolism (PTE), because the clinical signs and symptoms of PAS are non-specific. Elevated coagulation markers are generally absent in PAS and therefore, support a differential diagnosis of PTE. We herein report a patient with PAS who presented with elevated coagulation markers and later showed rapidly improved values mimicking response of PTE to anticoagulant therapy.

Unicystic Ameloblastoma of Mandible with an Unusual Diverse Histopathology: A Rare Case Report

Kanu Jain, Gaurav Sharma, Priyanka Kardam, Monica Mehendiratta

Ameloblastomas of jaws are benign odontogenic tumours with four clinical variants being solid multicystic type, unicystic type, extra osseous type and desmoplastic type. Unicystic ameloblastoma accounts for only 13% of all the known cases in the scientific literature. Follicular and plexiform patterns are the commonly seen histopathological patterns in unicystic ameloblastoma. Though rare in itself, presence of granular cells along with acanthomatous changes occurring in unicystic ameloblastoma is a rare phenomenon. We present a rare case report of unicystic ameloblastoma of right mandible with an unusual histopathology. It exhibited both luminal and mural types as well as both acanthomatous and granular cell changes found together. As occurrence of unicystic ameloblastoma of jaws with such varied histopathology is rare, their course, clinical outcome, prognosis and recurrence rate are not clear. Documentation of more such cases in literature may make pathogenesis and nature of these lesions more insightful.

Leiomyosarcoma of Renal Vein - A Rare Case Report

Sandeep Ojha, Ramarao Nilkanthe, Jyoti Valecha, Farah Meenai, Amit Haritwal

Leiomyosarcomas (LMS) arising from vascular channel are rare and more often arise from inferior vena cava and pulmonary arteries. Primary renal vein LMS are even rarer and occur predominantly in females with peak in fifth and sixth decade. Preoperative diagnosis is difficult because these are rare tumours and present with symptoms and radiological findings similar to Renal Cell Carcinoma (RCC). We report a case of 55-year-old female who presented with abdominal discomfort with radiology showing a renal mass with features of RCC, radical nephrectomy was done and resected tumour showed an attachment to the wall of renal vein with morphology resembling LMS.

Psychogenic Belching: A Case Report

Conversion symptoms usually appear with emotional conflicts of the patient. Belching’s psychogenic aetiology is not unheard of and can be a manifestation of conversion disorder though rare. Current case is of a middle aged woman presenting with belching unresponsive to medical management. The patient improved after supportive psychotherapy sessions and placebo medication.

Oncogenic Osteomalacia: An Approach to Diagnosis with a Case Report

Biswajit Dey, Debasis Gochhait, Hema Subramanian, Madhusudhanan Ponnusamy

Oncogenic osteomalacia, also known as tumour induced osteomalacia, is a rare paraneoplastic syndrome caused by mesenchymal tumours secreting Fibroblast Growth Factor-23 (FGF-23). The characteristic biochemical findings include hypophosphatemia and low 1,25-dihydroxy vitamin D. The differential diagnosis for hypophosphatemia are varied. We present a case of oncogenic osteomalacia in a 29-year-old female, who presented with complaints of generalized diffuse bone pain and walking difficulty for six months duration. Thus, we have discussed the approach to diagnosis in such a case.

Staged Hard and Soft Tissue Reconstruction Followed by Implant Supported Restoration in the Aesthetic Zone: A Case Report

Harinath parthasarathy, lakshmi ramachandran, anupama tadepalli, Deepa ponnaiyan

Alveolar ridge deficiency is a common clinical consequence following tooth loss due to chronic periodontitis complicating ideal implant placement. Advanced hard and soft tissue augmentation procedures have been developed in the recent past with predictable clinical outcomes. A male patient presented with a Grade III mobile upper right central incisor associated with advanced bone loss and soft tissue deficit. Following extraction of tooth #11, socket augmentation was done using an autogenous cortico-cancellous block graft and subsequent soft tissue augmentation was done with palatal connective tissue graft. At the end of six months, a tapered self tapping implant fixture was placed with adequate primary stability and after eight weeks, second stage implant surgery was done with the Misch technique in order to recreate papillae and the implant was prosthetically restored. The alveolar ridge was adequately recontoured following the staged surgical protocol. The implant was well integrated at the end of 15 months. Execution of sequential surgical procedures in a highly deficient edentulous site made it possible to achieve of optimal pink and white aesthetics with stable implant supported fixed prosthesis.

Osteosarcoma Arising in Carcinosarcoma De Novo Parotid Gland in a Young Man: An Unusual Case with Review of Literature

Vidya Jha, Sachin Kolte, Surbhi Goyal, Ashish Kumar Mandal

Carcinosarcoma of the parotid gland, a true malignant mixed tumour is extremely rare. It may occur in a pre-existing pleomorphic adenoma or arise de novo. We report a case of carcinosarcoma de novo harbouring an osteosarcomatous element in a 35-year-old man along with review of the reported cases. Excision was done and histopathologic examination confirmed the diagnosis. Long term follow up has been recommended for these tumours owing to their high propensity of recurrence and metastasis. Our case discusses the importance of histopathology and limitation of preoperative imaging in the diagnosis of such an aggressive neoplasm; emphasizing the fact that possibility of carcinosarcoma should be kept in mind while dealing with salivary gland lesions even at a younger age.

Fraternal Twin Tumours of the Oesophagus and Stomach Presenting in the Advanced Stage – A Rare Case with a Fatal End

Synchronous primary tumours of the aerodigestive tract presenting with different histologies is a very rare event. A case with such an association is presented here. A 50-year-old lady presented with symptoms of abdominal obstruction like abdominal pain, distention and vomiting since one month. Her radiological imaging and biopsies revealed a primary oesophageal squamous cell carcinoma and primary gastric adenocarcinoma. Western medical literature has shown the occurrence of multiple synchronous cancers; however, cases from India have seldom been reported. Early screening, correct diagnosis and appropriate plans of management are crucial to reduce the morbidity and mortality of such patients who bear the burden of not just one, but multiple primary cancers.

Addison’s Disease Mimicking as Acute Pancreatitis: A Case Report

Sayani Chaudhuri, Karthik N Rao, Navin Patil, Balaji Ommurugan, George Varghese

Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison’s disease. Adrenal insufficiency (Addison’s disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison’s disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis.

Carcinoma Cervix Presenting as Ischaemic Stroke in Young Female: A Case Report and Review of Literature

Suruchi Gupta, Nikhil Gupta, Shilpa Singhal, Nikhil Nair

Stroke is a disabling disease which increases the burden of already suffering cancer patients. Several mechanisms of stroke exist in cancer patients which includes - metastatic or non-metastatic such as coagulation disorders, infections or therapy related. Increased risk of ischaemic stroke has been validated for several cancers. However, there is scarce literature reported in carcinoma cervix patients. Review of literature suggests that stroke occurs more frequently in cancer patients than in the average population. We report an unusual case of a patient who presented with stroke but was later diagnosed as a case of carcinoma cervix.

Neonatal Hyperthyroidism with Fulminant Liver Failure: A Case Report

Mohammed Hasosah, Khalid AlSaleem, Mansour Qurashi, Abdullah Alzaben

Neonatal hyperthyroidism is a rare disease that is seen in infants born to mothers with Graves’ disease. Hepatic manifestation of neonatal hyperthyroidism is extremely rare. We describe a neonate with fulminant liver failure secondary to neonatal hyperthyroidism caused by maternal Graves’s disease. The baby was admitted with low birth weight and hepatosplenomegaly. At day 2 of life, the baby was irritable and he developed respiratory distress and fulminant hepatic failure which required mechanical ventilation. All investigations of obstructive, infectious and metabolic causes of hepatic failure were negative. His hepatic dysfunction improvement was correlated with initiation carbimazole as anti-thyroid medication. The conjugated hyperbilirubinemia, liver enzymes and International Normalised Ratio (INR) were gradually improved with normalization by eight weeks. This case has been reported to illustrate lessons learnt for early identification of neonate with hyperthyroidism as potential cause of cholestasis is important, because delayed treatment of hyperthyroidism might lead to irreversible consequences such as mental retardation or even death due to liver failure.

Juvenile Nasopharyngeal Angiofibroma: A Case Report

Soubhagini Acharya, Choubarga Naik, Siddharth Panditray, Subha Soumya Dany

Juvenile nasopharyngeal angiofibroma is tumour almost exclusively seen in adolescent males, constituting less than 1% of all neoplasms in head and neck. They are benign and locally spreading and are highly vascular in nature and thus prove to be a surgical challenge because of its complex anatomical location. Here, we present a case report of a 18-year-old male presenting with a mass in his left nasal cavity, with recurrent epistaxis and nasal obstruction. Computed tomography imaging revealed a non-encapsulated lobulated heterogeneous mass lesion in the naso-pharynx and left posterior choana of the nasal cavity, extending to pterygopalatine and infratemporal fossa, masseter space of left side. The approach to its surgical management was a combined multi-disciplinary effort of otorhinolaryngology surgeons and maxillofacial surgeons.

A Case of Bilateral Corneal Perforation in a Patient with Severe Dry Eye

Jyoti Deswal, Sudesh Kumar Arya, Amit Raj, Anubha Bhatti

Dry eye is a common problem affecting mainly the adult population. In severe cases, it can result in sterile corneal ulcer and perforation. We report a rare case of a 26-year-old male, a known patient of severe dry eye who presented with sterile corneal ulcer with corneal perforation in both the eyes. The patient was managed by applying cyanoacrylate glue and bandage contact lens in both eyes and topical antibiotic, topical cyclosporine and preservative free artificial tears at two hourly intervals. The patient was investigated for the systemic cause of severe dry eye but no cause could be ascertained. On follow up, the patient reported marked relief in photophobia. On examination, both eyes showed sealed perforation with well formed anterior chamber. In conclusion, one should examine a dry eye patient carefully and detect corneal ulcers and perforations in time so as to prevent its sequelae.

Pseudo Aneurysm of Aberrant Right Gastroepiploic Artery Mimicking Pseudocyst of Pancreas– A Rare Case Report

Abhinav Jauhari, Ambuj Shrivastava, Rajesh Kumar Soni, Ashutosh Darbari

Pseudoaneurysm of peripancreatic vessel is a rare complication of pancreatitis. The splenic artery is the most commonly affected vessels close to the pancreas. Pseudoaneurysm of right gastroepiploic artery is rare. It can rupture into Gastro Intestinal (GI) tract, retroperitoneum, peritoneal cavity, biliopancreatic duct or pseudocyst. Clinical diagnosis of unruptured pseudoaneurysm is rarely possible because there are no specific signs and symptoms. We hereby report a case of pseudoaneurysm of aberrant right gastroepiploic artery in 30-year-old male which presented with history of epigastric pain and lump with episode of haematemesis and malena. Diagnosis was suspected on Doppler Ultrasonography (USG), which was later confirmed by CECT and angiography. Patient was treated by coil embolization. The pain and lump in epigastrium disappeared within five to six days. Patient is symptom free after six months of follow up.

Metastatic Renal Cell Carcinoma Causing Small Intestinal Polyps with Intussusception: A Report of Two Cases

M Vani, Ajit Nambiar, K Geetha3, Byju Kundil

Renal cell carcinomas have diverse clinical presentations. Patients may present with metastatic symptoms at the time of diagnosis or years after resection of primary tumour. Small intestine is a rare site for metastatic renal cell carcinoma. Presentation as polypoid metastasis with intussusception is extremely rare. Here, we report two cases with this rare presentation. Case 1 was a 65-year-old male with multiple polypoid metastasis causing intussusception while on palliative chemotherapy for renal cell carcinoma. Case 2 was a 68-year-old female with history of nephrectomy presenting with single polypoid metastasis causing intussusception.

Cardiac Amyloidosis, An Infiltrative Heart Disease Presenting as ArrhythmiaA Case Report

B Magesh, Deepak Kadeli, Sunil Bohra, V Kris hnaprasath, R Keshava

Cardiac amyloidosis is a manifestation of amyloidosis which is a multisystem disorder. This is difficult to diagnose, rare disease which eventually leads to the mortality. Diagnosis requires a high index of clinical suspicion along with echocardiographic clues like, diastolic dysfunction, bi-atrial enlargement and ventricular thickening. Treatment is mainly supportive with disappointing outcomes. We present a case of systemic amyloidosis with negative congo red staining, presenting with predominantly cardiac features.

Central Variant of Posterior Reversible Encephalopathy Syndrome – A Rare Case Report

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiological condition associated with headache, altered mental status, dizziness and white matter vasogenic oedema in parieto-occipital region. It is often associated with hypertension but can also occur in diverse clinical settings like immunosuppression, eclampsia, etc. It is due to failure of autoregulatory mechanism of posterior circulation in response to change in blood pressure. We hereby report a rare case of central variant of PRES secondary to severe hypertension diagnosed with 3T MRI. Objective of reporting this case was to describe the imaging findings of typical and rare atypical patterns of PRES. A 71-year-old male hypertensive patient was referred for brain imaging with history of short period of loss of consciousness, headache and dizziness. MRI brain showed central variant pattern of PRES with preferential involvement of brainstem, thalami and periventricular white matter with sparing of frontal, parietal and occipital lobes. The patient was treated with anti-hypertensive after which patient`s symptoms subsided. The patient was followed up conservatively. Atypical variants of PRES should be borne in mind when pontine hyperintensity is encountered in hypertensive patient.

Preinguinal Splitting and Reunion of Femoral Nerve Entrapping the Fleshy Fibres of Iliacus Muscle - A Case Report

LS Ashwini , S Nagabhooshana Somayaji , Mohandas Rao , Sapna Marpalli

Division of nerves close to their origin and muscular entrapments by nerves in the limbs is not very common. Femoral nerve is the largest branch of the lumbar plexus and arises from dorsal divisions of ventral rami of L2 to L4 spinal nerves. During routine cadaveric dissection for first year medical students at Melaka Manipal Medical College (Manipal Campus), Karnataka, India, we observed a variation in the division and course of left femoral nerve in about 65-year-old male cadaver. The femoral nerve was split into two divisions above the inguinal ligament after its origin from the lumbar plexus. The lower division of the nerve passed deep to the iliopsoas muscle fibres and the upper division ran superficial to iliacus muscle deep to fascia iliaca. Both the divisions joined just above the inguinal ligament to form the trunk of the femoral nerve. Further course and distribution of the nerve was normal. The reports have shown that compression neuropathies of femoral nerve in the limbs are caused by neoplastic masses, vascular abnormalities and also by different anomalous muscles. Such neuropathies may also result from indirect compression of femoral nerve between the fibres of psoas major muscle and lateral pelvic wall. The potential clinical importance of above mentioned variations in the division of femoral nerve would emphasize the surgeons to diagnose the neuromuscular entrapments and consequent alterations of sensation in the anterior and medial aspects of the thigh.

A Custom Made Skeletal Class II Corrector Appliance in Late Adolescent Phase

Navneet Singh, Tulika Tripathi, Priyank Rai, Shilpa Kalra, Neha

Skeletal Class II correction in deceleration phase of growth is both a challenge and dilemma with choice between extraction and myofunctional therapy. With marginal growth remaining the convenient choice is extraction for camouflage of the skeletal discrepancy. On the other hand, the treatment with Fixed Functional Appliances (FFAs) helps in resolution of the problem without sacrificing the dentition. However, the conventional FFAs requires a phase of alignment which results in further loss of time to utilize any remaining growth. The present report proposes the use of a novel custom made functional appliance for Class II skeletal correction which is simple to fabricate and convenient to use.

Membranous Basal Cell Adenoma – A Rare Entity in an Unusual Location

Basal cell adenoma is a rare benign salivary gland neoplasm exhibiting an isomorphic basaloid tumour cell pattern, commonly occurring in the parotid. Membranous variant warrants separate consideration because of its recurrence and rate of malignant transformation. We report a case of membranous type basal cell adenoma occurring in minor salivary gland in a 61-year-old female patient. The histopathological diagnosis was supported by immunohistochemical analysis and serum Carcinoembryonic antigen level.

Leprosy in an Eight–Year–Old Child – An Exceptional Case with Unusual Oral Manifestation

Mayuri Jain

Leprosy is a contagious and granulomatous disease which is caused by Mycobacterium leprae. The incubation period for leprosy is five to seven years and it can take as long as about 30 years before signs and symptoms of leprosy develop in some patients. It is a chronic systemic disease which mostly affects the skin and peripheral nerves. It has been seen that indeterminate leprosy is the most common type seen in childhood followed by tuberculoid variant. Borderline lepromatous and lepromatous leprosy are only occasionally encountered in children and rarely affects the oral cavity. Here, we report a rare case of an eight-year-old female child patient who presented primarily with oral manifestations and was subsequently diagnosed as having lepromatous leprosy

Oral Spindle Cell Sarcoma: A Rare Case Report and Review of Literature

Spindle cell lesions of the head and neck region are diverse in nature by means of clinical and biological heterogeneity. Though few lesions are found to be malignant, several others are benign or merely reactive in nature. Although these lesions are fairly common occurring in other parts of the body, they are very rare in the oral cavity, accounting for less than 1% of all tumours in the oral region. Herein, a case of 48-year-old man who presented with a polypoid lesion of the maxilla has been reported. Histopathological examination and immunohistochemistry revealed spindle cell sarcoma of the left maxillary sinus. We present this rare tumour to contribute to the better understanding and awareness of this rare malignancy where diagnosis can be very challenging.

Management of Severely Atrophic Mandibular Ridge using Hollow Denture with an Analytical Discussion: A Clinical Case Report

A severely resorbed edentulous mandibular ridge, although fairly common in occurrence, its rehabilitation poses a challenging clinical situation for the prosthodontist. This has implored prosthodontists to seek for ingenious modifications in the conventional prosthetic forms so as to gratify patient’s expectations who have difficulty in wearing the mandibular complete dentures. Opting for the most suitable treatment modality mandates equilibrating the retention, stability and support triad to the fullest. Extreme resorption of the denture bearing tissue bed may lead to problems with achieving adequate levels of prosthetic satisfaction for the patient. One such entrusted treatment option, that has proven its mettle over tides of time in such a scenario, the hollow denture by virtue of its reduced excessive acrylic resin weight, efficaciously replaces the lost voluminous alveolar ridge in the increased inter-ridge space of the denture wearer.

Cow Urine Keratopathy: A Case Report

Sumeet Khanduja, Prachi Jain, Sumit Sachdeva, Jitender Phogat

Injury to the ocular surface has been described to occur with a wide variety of chemicals. In most cases the cause is industrial injury with acids or alkalis. We are reporting a case of ocular surface injury due to “Cow urine” which to the best of our knowledge is been reported for the first time. Cow urine is a well-accepted medicinal ingredient in ancient Indian medicine. However, wrong formulation and inadvertent prescriptions by quacks can lead to severe ocular surface injury and morbidity. Here, with this case report we have discussed the possible culprit and possible mechanism of ocular injury due to instillation of a concoction containing cow urine as an active ingredient and also discuss legal aspects of quackery in India.

A Rare Presentation of Metastasis to the Thyroid Gland

Mekala Lakshminarayanan, Ann Kurian

The thyroid gland has a rich vascular supply. However, metastasis to the thyroid is exceedingly rare. The most common tumours that metastasize to the thyroid are breast and lung. The incidence of metastasis is on the rise due to better imaging techniques as well as procedures such as Fine Needle Aspitation Cytology (FNAC) and Immunohistochemistry (IHC). Secondaries from a prostate cancer are most commonly seen in bone, lung and liver. To our knowledge, metastasis from the prostate gland to the thyroid is exceedingly rare. Here, we report a case of metastatic prostatic adenocarcinoma to the thyroid gland two years after prostatectomy.

Plasmodium vivax Induced Acute Respiratory Distress Syndrome – A Diagnostic and Therapeutic Dilemma in Preeclampsia

Richa Sharma, Amita Suneja, Anu Yadav, Kiran Guleria

Malaria during pregnancy can cause various feto-maternal complications. Life threatening respiratory involvement is rare with vivax malaria but common with Plasmodium falciparum. In most of the cases severe respiratory involvement occurs, after beginning of anti-malarial treatment. We are reporting a case which involved a diagnostic and therapeutic challenge, as the pregnant woman with severe preeclampsia developed acute respiratory distress, actually caused by Plasmodium vivax.

Cytomorphology of Basaloid Squamous Cell Carcinoma: A Diagnostic Dilemma

Tanya Sharma, Garima Goel, Kaushik Majumdar, Deepti Joshi, Neelkamal Kapoor

Basaloid Squamous Cell Carcinoma (BSCC) is an unusual and high grade variant of Squamous Cell Carcinoma (SCC) with a predilection for the upper aerodigestive tract. The cytomorphologic diagnosis of this tumour is challenging as it shares common cytomorphologic features with its differential diagnoses. However, a careful examination of the cytology can help in delivering a diagnosis of BSCC. In this case report we present the imprint cytology findings of histologically proven BSCC in a 60-year-old male who presented with an ulcerated lesion at the umbilical region.

Deep Cerebral Vein Thrombosis: A Clinical Masquerader

Prabhat Kumar, Gargi Sasmal, Subodh Kumar Mahto, Shreya Gupta, Harish Gupta

Cerebral Vein Thrombosis (CVT) is an uncommon cause of stroke. Thrombosis can occur in superficial veins, deep venous system or cortical veins of brain. The term Deep Cerebral Vein Thrombosis (DCVT) is used for thrombosis of internal cerebral vein, vein of Galen and basal vein of Rosenthal. Only 10% cases of CVT are because of thrombosis of deep cerebral vein. The diagnosis of DCVT is often missed because of its heterogenous presentation. Herein, we present a case of DCVT which was initially treated as meningoencephalitis. A timely advised brain imaging helped in making the diagnosis and patient recovered completely after institution of anticoagulation.

Anaplastic Pleomorphic Xanthoastrocytoma in a Case of Neurofibromatosis Type 1: A Case Report

K Thara, Reetika Sharma, G Thiagarajan, Anita Ramdas, Renu Gboy Varghese

Pleomorphic Xanthoastrocytoma (PXA) is a rare brain tumour comprising only <1% of primary brain tumours which is seen in children and young adults. Only 9-20% of the PXA shows anaplastic features and this has a bad prognosis. PXA is a WHO grade II tumour while anaplastic PXA is a WHO grade III tumour. Neurofibromatosis type 1(NF1), which is an autosomal dominant condition, predisposes to tumours of the central nervous system; most of which are pilocytic astrocytomas. Association of PXA with NF1 is very rare and only a very few cases have been reported. Here, we present a case of 42-year-old male, a known case of NF1, with multiple neurofibromas, who presented with right sided hemiparesis, seizures and vomiting. The histopathology and immunohistochemistry features were suggestive of anaplastic PXA.

A Rare Case of Digoxin Associated Gingival Overgrowth

Sanjeela Rakshith Guru, Aparnna Suresh, Shyam Padmanabhan, Adithya Reddy

This case report presents a case of drug induced gingival overgrowth in a 28-year-old female patient with history of Coronary Artery Disease (CAD) and was prescribed digoxin in combination with furosemide and acitrom for the same. On clinical examination, the patient presented with severe gingival overgrowth. The volume of enlargement seen did not correlate solely with the diagnosis of inflammatory Gingival Enlargement (GE), hence an added drug induced component to the Gingival Overgrowth (GO) was suspected. It was decided to treat the condition using initial therapy {meticulous Scaling and Root Planning (SRP)} followed by a period of observation and maintenance. On recall, since there was no marked improvement, surgical intervention was planned. Periodic treatment combining surgery and maintenance ultimately produced the desired results clinically. Thus, this article within limits highlights that because of time-relationship between the starting of the medication that is digoxin and manifestation of GO, a causal relationship is likely.

Dental Avengers: Taking Retainer Stability and Aesthetics into Next Era

Sayam Patil, Sanjeev Jakati

Adult patients are realizing that practical, realistic options now exist to “straighten” their teeth because the cosmetic dentistry revolution has begun to include even “adult short-term cosmetic orthodontics” as an integral part. Previously, the patients were bound to select between either the aesthetic benefits of ceramic or the bondability characteristic of composite, however this can now be fabricated in such a manner that still allows placement of a lingual splint so as to steady the orthodontic movement. This article describes a case study whereby the patient can attain the aesthetic benefits of an all ceramic crown or a veneer which was retained by incorporating/reinforcing a metal framework of crown itself. Orthodontic treatment was initiated to correct the alignment, overjet and overbite which were followed by endodontic, periodontic and prosthodontic rehabilitation with full ceramic crowns to achieve ideal aesthetics, and an improved occlusion and stable function.

Waldmann’s Disease (Primary Intestinal Lymphangiectasia) with Atrial Septal Defect

Shrikiran Aroor, Suneel Mundkur, Shravan Kanaparthi, Sandeep Kumar

Waldmann’s disease or Primary Intestinal Lymphangiectasia (PIL) is a rare disorder of gastrointestinal tract characterized by dilated lymphatics and widened villi causing leakage of lymph into intestinal lumen. Loss of lymph leads to hypoalbuminemia, hyogammaglobulinemia and lymphopenia. Secondary lymphangiectasia occurs secondary to an elevated lymphatic pressure as in lymphoma, systemic lupus erythematosus, constrictive pericarditis, cardiac surgeries (Fontan’s procedure), inflammatory bowel disease and malignancies. We, hereby present a five-year-old male child who presented with abdominal distension and poor weight gain. He had hypoalbuminemia, lymphocytopenia and hypogammaglobulinemia. Upper gastrointestinal endoscopy showed normal gastric mucosa and punctate white lesions in duodenal mucosa with biopsy confirming intestinal lymphangiectasia. Secondary causes of intestinal lymphangiectasia were ruled out. Echocardiography revealed atrial septal defect which is an uncommon association with Waldmann’s disease. He was started on low fat, high protein diet and medium chain triglyceride supplementation following which he improved symptomatically. High index of suspicion, early diagnosis and appropriate dietary treatment are necessary to alleviate symptoms as well as to achieve a sustainable growth and development in these children.

Maxillary Second Molar with Fused Root and Six Canals- A Case Report

Mitthra Suresh, Kittappa Karthikeyan, Sekar Mahalaxmi

One of the known aberrations in root canal morphology of maxillary second permanent molars is the presence of collateral mesiobuccal canals. This case report describes the endodontic management of a maxillary second molar that had a single fused root with six canals that was successfully managed with the aid of dental operating microscope. Six canal orifices were located namely MB1 (Mesiobuccal), MB2, MB3, DB1 (Distobuccal), DB2 and palatal. During the cleaning and shaping, instrument separation occurred at the apical third of the palatal canal which was removed with ultrasonics. After cleaning and shaping, the canals were obturated with resin sealer and laterally condensed gutta-percha. The patient was recalled for periodic review. After two years of follow up the patient remained asymptomatic. Cone Beam Computed Tomography (CBCT) evaluation revealed satisfactory periapical status.

An Unusual Case of Eosinophilia

Aashika Sunil Janwadkar, Jitendra Rajendra Ingole

Various inflammatory markers have been used to show an association between welding and respiratory tract disorders due to inhalation of fumes. We hereby present a case of 19-year-old male, welder by occupation who presented with upper respiratory tract infection and was documented to have persistent moderate eosinophilia on serial Complete Blood Count (CBC) examination. This was also confirmed by bone marrow examination which was suggestive of increased eosinophilic precursors. Eosinophils are an inflammatory marker and are increased most commonly in respiratory tract of welders due to inhalation of metal fumes. Treatment with steroid is gratifying and provides short term symptomatic relief. Avoidance of metal fumes and/or change of job is the long term preventive measure. Welding occupation, as a risk factor, should be considered for causation of persistent respiratory tract inflammation with eosinophilia.

Meckel’s Diverticulum Enterolith: An Extremely Rare Cause of Intestinal Obstruction

Meckel’s diverticulum is usually asymptomatic but occasionally presents with complications. Formation of an enterolith inside a Meckel’s diverticulum is very uncommon and dislodgement of such a stone causing obstruction is extremely rare. We herein present a case of a 48-year-old man who presented with small bowel obstruction. Preoperative radiologic studies revealed a stone-like lesion in the right lower quadrant. Upon laparotomy, an inflamed Meckel’s diverticulum was found as well as a 2.5 cm stone obstructing the terminal ileum. The stone was removed and the diverticulum was excised. The differential diagnosis of acute intestinal obstruction should include this extremely rare clinical entity especially when the combination of small bowel obstruction with radiopaque stone-like finding on preoperative x-rays is present.

Prosthetic Rehabilitation of an Insidiously Enlarged Traumatic Palatal Perforation after Orotracheal Intubation in a Young Diabetic Child

Kopal Garg, Namita Kalra, Rishi Tyagi, Amit Khatri, Gaurav Panwar

This report describes an unusual case of an insidiously enlarged traumatic palatal perforation after orotracheal intubation in a four-year-old female child with Insulin Dependent Diabetes Mellitus (IDDM). The child was first diagnosed with diabetes at 10 months of age when she was hospitalized for pneumonia. Severe respiratory distress warranted assisted ventilation via orotracheal intubation. Multiple factors namely infection, relative immunodeficiency, poor wound healing, trauma via orotracheal intubation as well as uncontrolled glucose levels, all contributed to the formation and deterioration of the palatal perforation. A palatal obturator was fabricated as an interim treatment until surgical closure could be performed.

Cloves Syndrome: Severe Neonatal Presentation

Silvana Acosta, Viviana Torres, María Paulos, Ignacio Cifuentes

Congenital Lipomatous Overgrowth, Vascular Malformations, Epidermal Nevi and Spinal Abnormalities (CLOVES syndrome) is a newly described and rare overgrowth disorder with serious morbidity. The course of this disease is not well understood and few cases have been reported among neonates. Moreover, not all of the signs of this syndrome are present at birth, making a high index of suspicion necessary. We present a cohort of three newborns with CLOVES syndrome who died due to septic and hemodynamic complications directly related to extensive vascular malformations. We discuss the clinical presentation in the neonatal period and propose a clinical classification.

Slingshot – An Easy Way Out

SHILPA M KENDRE, KHUSHBU D AGRAWAL, SURESH K KANGANE, ANAND S AMBEKAR

Orthodontic alignment of ectopically placed incisors or canines can be challenging and time consuming. A variety of techniques are used to align such palatally or lingually placed teeth including indirect ties with ligature wires, E-chains, piggy-back methods. This article presents two case reports to describe an effective technique using ‘slingshot’ method. It is a relatively simple and rapid method which is operator friendly and easily tolerated by the patients.

Comparison of Ultrasonography, Magnetic Resonance Imaging and Cone Beam Computed Tomography for Detection of Foreign Bodies in Maxillofacial Region

Introduction: Foreign Bodies (FBs) entrapped in the maxillofacial region have a high prevalence due to trauma and accidents. Accurate localization of FBs and verifying their type and size are critical to assist the surgeon in their fast retrieval with minimal tissue damage. Aim: To assess and compare the imaging modalities including MRI, ultrasonography and Cone Beam Computed Tomography (CBCT) for detection of different types of FBs. Materials and Methods: In this study, four types of FBs including pieces of normal glass, barium glass, wood and pebbles with equal sizes were placed randomly in two sheep heads in different locations such as upper lip, maxillary sinus and body of mandible as FBs and subjected to MRI, ultrasound and CBCT. The images were interpreted by expert observers and the data was analysed using the stata 11 software, kappa test and chi-square test. Results: Sensitivity of CBCT, MRI and ultrasound for detecting foreign bodies was 79.19%, 20.83% and 33.33%, respectively. None of the imaging modalities could clearly visualize wooden FBs. Among different FBs, pebbles and barium glass were detected more accurately by radiographic imaging technique. The sensitivity of CBCT, ultrasound and MRI for pebbles was 100%, 33.33% and 16.67%, respectively. The sensitivity of CBCT, ultrasound and MRI for barium glass was 100%, 33.33% and 41.69%, respectively. The sensitivity of CBCT, ultrasound and MRI for wood was 33.33%, 33.33% and 16.67%, respectively. Specificity of all three imaging modalities was 100%. Diagnostic accuracy of all three imaging modalities was higher for detection of FBs in the upper lip than those in the body of mandible, and FBs in the latter location had higher detection accuracy than those in the maxillary sinus. Conclusion: Among the three imaging modalities, CBCT had the highest diagnostic sensitivity for the examined FBs. The highest diagnostic sensitivity was noted for pebbles and barium glass.

Successful Surgical Outcome for an Endodontic Failure using Biodentine™ as Retrograde Restoration in Conjunction with Platelet Rich Fibrin (PRF) for Progressive Healing

Ajinkya Mansing Pawar, Suraj M. Pawar, Bhagyashree Thakur, Sharad Kokatate

Primary Hypothyroid and Secondary Adrenal Insufficiency-Searching the Missing Link

Subhodip Pramanik, Sayantani Chandra, Pradip Mukherjee, Subhankar Chowdhury

Images in Medicine – An Atypical Presentation of Unilateral Tongue Angioedema Caused by Acetaminophen

Angeline Deepthi, Shaheen, Hari Kumar, Sajna Ashraf, John Hearty Deepak

Vocal Hoarseness in Rheumatoid Arthritis: Early Recognition is Critical

James Benjamin Gleason, Anas Hadeh

Anaemia in CD5 Negative Chronic Lymphoproliferative Disorder: Importance of Bone Marrow Examination

Mili Jain, Ayush Shukla, Ashutosh Kumar, Rashmi Kushwaha, Anil Kumar Tripathi

Emphysematous Pyelonephritis with Human Immunodeficiency Virus Infection

Molecular Investigation of a Suspected Myeloproliferative Neoplasm in Patients with Basophilia

Stephen E Langabeer, Karl Haslam

Correspondence: Level of Motivation during Cardiac Efficiency Test; A Confounding Factor to Consider

Himel Mondal

Ergonomically Designed Patient Drape

Amrita Chawla, Amrita Sujlana, Devika Dhawan

Incidence of Natal Teeth in Newborns in Government Medical College and Hospital, Chengalpattu: A Pilot Study

Vidya Albert Yen, Niraimathy Kuppuswami

Introduction: Natal teeth are teeth which are seen at birth and neonatal teeth erupt during the first thirty days after birth. Exact cause is however unknown but trauma, malnutrition, infection or environmental factor can be the causitive factor. Different studies have shown different incident rates. Aim: To find the incidence of natal teeth in neonates born in the hospital over a period of seven months and also to find out the most commonly occurring natal teeth among them. Materials and Methods: The present study was conducted in the Government Medical College and Hospital, Chengalpattu, Chennai, Tamil Nadu, India, for a period of seven months. A questionnaire was given to the mothers for gaining relevant information regarding the age, gender of neonate, type of delivery, etc. The cohort of neonates delivered in the hospital was examined clinically to note the presence of natal teeth. Results: Out of 4,341 children four neonates were born with natal teeth. Our study showed female preponderance and most commonly erupted teeth were mandibular anteriors. The type of delivery had no significant relation with the presence or absence of natal teeth. Conclusion: The presence of natal teeth was very rare in our study group. The neonates with natal teeth should be thoroughly examined and parent counselling is also important in these cases.

Microhardness and Penetration of Artificial White Spot Lesions Treated with Resin or Colloidal Silica Infiltration

Introduction: Infiltration of early enamel lesions by materials having remineralizing capacity seems to improve aesthetics and arrests caries progression. Aim: To evaluate and compare the surface microhardness and penetration depth of a low viscosity resin and colloidal silica nanoparticle infiltrates into artificially created white spot lesions. Materials and Methods: Forty extracted human central incisors were embedded in acrylic resin blocks exposing the labial surfaces of the crowns. The specimens were immersed in demineralizing solution for 96 hours to create white spot lesions on labial surfaces. The samples were then divided into two groups (n=20 each), where in Group 1-resin infiltration (ICON DMG, Hamburg, Germany) and Group 2-colloidal silica infiltration (Arrow Fine chemicals, Rajkot, Gujarat, India) was done. Samples were subjected to vicker’s microhardness testing at baseline, after demineralization and after treatment with resin or colloidal silica infiltrates. Then, the crowns were sectioned longitudinally and penetration depth of the infiltrants was measured using confocal laser scanning microscope and compared the readings to lesion depth. All the collected data was subjected to statistical analysis using t-test. Results: Resin infiltration group showed significantly greater increase in microhardness compared to colloidal silica infiltration (p=0.001). The percentage of penetration of the resin group was 67.14% and that of colloidal silica group was 54.53% indicating significant difference between the two. Conclusion: Resin infiltrates performed better in regaining the baseline microhardness and penetrating deep into the porous white spot lesions, when compared to colloidal silica infiltrates.

Immunohistochemical Study of MUC1, MUC2 and MUC5AC Expression in Primary Breast Carcinoma

Introduction: Breast Cancer (BC) is the second most common cancer among women in India and accounts for 7% of global burden of BC and one-fifth of all Cancers (CA) among women in India. Aim: This study was conducted for studying the expression of MUC1, MUC2 and MUC5AC in breast carcinoma. Materials and Methods: Fifty cases of primary breast carcinoma diagnosed between years 2013 to 2015 were included in the study. Manual tissue array technique was applied for cases subjected to Immunohistochemistry (IHC). An analysis of the expression of IHC markers (MUC1, MUC2, MUC5AC, ER, PR and HER2/neu) was attempted. Results were subjected to statistical analysis. They were considered to be significant when the p-value was less than 0.05. Results: The positivity for MUC1, MUC2 and MUC5AC in BC was 58%, 8% and 6% and for ER, PR and HER2 was 48%, 36% and 64% respectively. There was a significant correlation between MUC1 expression and ER and PR positivity. There was a significant correlation between MUC2 expression and ER positivity. No significant association was observed between MUC2 and PR expression, MUC5AC expression and ER and PR positivity. There was statistically significant correlation between negative MUC2 and MUC5AC expression and histopathological grade. It was noted that MUC2 and MUC5AC negative tumours were associated with higher tumour stage though not statistically significant. It was noted that MUC5AC negative tumours showed higher frequency of lymphovascular invasion though not statistically significant. Conclusion: Our experience with the present study highlights the role of mucins in the development and progression of BC.

Effect of Pre-Procedural Chair-Side Finger Stretches on Pinch Strength amongst Dental Cohort- A Biomechanical Study

Ninad Milind Padhye, Ashvini Mukul Padhye, Himani Swatantrakumar Gupta

Introduction: Ergonomics is the essential principle behind the health and successful practice for a dentist and dental hygienist. During the procedure of dental Scaling and Root Planing (SRP), a high level of pinch force is exerted by the finger muscles resulting in early muscle fatigue. Aim: This pilot study comparatively evaluated the Pinch Strength (PS) of the finger muscles, prior to and after SRP, amongst dental cohort performing chair-side hand and finger stretches to those not performing the same. Materials and Methods: Forty dental professionals were recruited by purposive sampling for the study and allocated into a test and control group. PS was recorded for both groups following which the test group performed finger stretches comprising of rubber band stretch, tendon glide, finger flexion and extension, thumb flexion and finger webbing. The subjects of both the groups carried out SRP for 30 minutes after which PS was again recorded. Inter-group difference was analysed for variability at baseline and 30 minutes after SRP using independent samples/unpaired t-test. Within group comparison of PS measurement was done using paired t-test. Results: The PS for the test group declined from 14.425±2.577 pounds (lbs) to 13.725±2.557 lbs, while for the control group, a decline in PS from 13.65±2.636 lbs to 10.675±2.478 lbs after SRP was noted. On comparing the difference of means of both groups, a statistically significant result was obtained. Conclusion: Work-related musculoskeletal disorders can be reduced by performing a few simple chair-side stretches. These stretches can help prevent the finger muscle fatigue during SRP and thus, increase its efficacy.

Cardiovascular Response and Serum Interleukin-6 Level in Concentric Vs. Eccentric Exercise

Introduction: Cardiovascular Disease (CVD) is a leading cause of morbidity and mortality in India. Resistance exercise is strongly recommended for implementation in CVD prevention programs. Dynamic resistance exercise comprises of concentric (muscle shortening) and eccentric (muscle lengthening) phase. The contraction of skeletal muscle promotes the synthesis and secretion of cytokines and peptides from myocytes, known as ‘myokines’. Interleukin-6 (IL-6) is the first myokine to be released in the blood in response to exercise. Aim: To compare the cardiovascular response and serum IL-6 level in concentric and eccentric exercise done at same absolute workload. Materials and Methods: In this non-randomised crossover study 24, apparently healthy and young male adults performed an acute bout of concentric and eccentric exercise. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate (HR), Mean Arterial Pressure (MAP), Pulse Pressure (PP) and serum IL-6 were measured just before and immediately after exercise. Paired t-test or Wilcoxon signed-rank test were applied to compare the data within-group and in-between group. Results: SBP, HR, MAP, PP, DBP and IL-6 level increased significantly after both, concentric and eccentric exercise. The mean change in SBP, HR, MAP, PP, and IL-6 after concentric exercise (18.54±3.06, 57.21±10.73, 8.35±1.40, 15.25±5.29, 5.40±3.13 respectively) was significantly higher than after eccentric exercise (13.38±1.72, 43.25±8.34, 6.50±1.0, 10.21±3.16, 4.36±2.54 respectively). A non-significant rise in DBP was obtained after concentric exercise (3.25±2.79) as compared to eccentric exercise (3.08±1.89). Conclusion: Eccentric exercise not only caused a lesser cardiovascular demand as compared to concentric exercise but also a significant increment in IL-6 level. Exercise-induced IL-6 may prevent the initiation and development of CVD. Hence, eccentric exercise training might be recommended for reducing morbidity and mortality in individuals with- or at a risk of developing CVD.

Bi-Pedicle Fixation of Affected Vertebra in Thoracolumbar Burst Fracture

Pravin Padalkar, Varshil Mehta

Introduction: Burst fractures of the spine account for 14% of all spinal injuries and more than 50% of all thoracolumbar trauma. However, there is ambiguity while choosing the right treatment plan. Short Segment Pedicle screw Fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation. Various biomechanical studies showed that the use of pedicle screws could achieve stable construct within short-segment fixation. Aim: To evaluate the efficacy of SSPF using longest possible screws in both pedicles of fractured vertebra. Materials and Methods: A retrospective chart review of 25 single burst thoracolumbar fracture patients, operated between May 2009 to 2015 in a tertiary care trauma center, was conducted. Preoperative and post-operative plain radiographs were evaluated for kyphotic angulations using the traditional Cobb method. Anterior Vertebral Height (AVH), Posteriors Vertebral Height (PVH) were measured preoperatively and immediate postoperatively. Average percentage loss of AVH and mid-sagittal height were calculated on preoperative and postoperative X-rays on follow up. Results: Fourteen men and 11 women with an average age of 42.92 years comprised the study population. Mean age at the time of operation was 34.5±14.2 years. Mean operation time was 168±72 (minutes). Average hospitalization time was 9±7 (days). Mean blood loss was 515±485 (ml). There were two cases of postoperative infection and implant failure each. A mean of 15.2° of kyphosis correction was attained from preoperation to post-operation (p<0.0001). Although, there was a 15° average improvement of kyphosis post-fixation, loss of correction over time was nearly 8°, resulting in a 7° mean correction of kyphosis. A mean loss of AVH on postoperative radiograph was 6.12% and maintained 12.4% at the time of review (p<0.001). Similarly, there was 32.8% mid-sagittal height loss at time of injury, which was improved to only 12.6% as compare to initial height loss (p<0.0001). Conclusion: In this study, we propose SSPF using longest possible screws in both pedicle of fractured vertebra. Bi-pedicular fixation gives significant radiological corrections.

Evaluation of Efficacy of 1% Curcuminoids as Local Application in Management of Oral Lichen Planus – Interventional Study

Introduction: Oral Lichen Planus (OLP) is a chronic inflammatory mucocutaneous disease affecting the oral cavity which has been associated with severe burning sensation which in turn affects the quality of life of the patients. Currently, the effective treatment of choice remains the use of corticosteroids. The chronicity and recalcitrant nature of the disease demand the long term use of these drugs with ensuing adverse effects. Turmeric and its active ingredient, “curcumin”, have been found to have anti-inflammatory, antioxidant and anticancer properties. Hence, this intervention study was done to evaluate the efficacy of curcumin oral gel in the management of oral lichen planus. Aim: The study was conducted to compare the efficacy of 1% curcumin gel with the conventional mid-potent topical corticosteroid, triamcinolone acetonide 0.1% in managing the signs and symptoms of OLP. Materials and Methods: An intervention study was conducted on 75 patients diagnosed with OLP divided into three groups, Group 1 (0.1% triamcinolone acetonide oral paste thrice daily in tapering doses), Group 2 (curcumin oral gel thrice daily) and Group 3 (curcumin oral gel six times daily). The patients were analysed for the symptom (burning) and sign (erythema and ulceration) using the numerical rating score and Modified Oral Mucositis Index (MOMI) for a period of three months on a bimonthly basis. The results were analysed using Students t-test and unpaired t-test. Results: Intragroup comparison using paired t-test showed statistically significant reduction in burning sensation (p<0.001) as well as erythema and ulceration (p<0.001) in all the three groups. However, when the three groups were compared Group 1 showed the maximum reduction in burning sensation (77%) and erythema and ulceration (67%). Among the curcuminoid group, increased frequency was found to be more beneficial. Conclusion: Curcumin oral gel can bring about clinical improvements in OLP patients; however it cannot be used as a mainstay drug. Instead, it can be used as a maintenance drug after the patient is treated with an initial course of corticosteroids. Further studies with larger sample size and increased drug concentrations may be required.

Study of Short and Intermediate Term Clinical Outcomes of Patients with Protected and Unprotected LMCA Stenting

Introduction: Significant unprotected Left Main Coronary Artery (LMCA) disease is detected in 5%-7% of cases undergoing Coronary Angiography (CAG). Present guidelines have revealed the significance of anatomical location in left main artery stenosis and syntax scores for determination of Major Adverse Cardiac Events (MACE). Debate still persists over the best treatment regarding outcomes of Coronary Artery Bypass Grafting (CABG) and LMCA stenting for patients with LMCA disease. Aim: Aim of the study was to evaluate short and intermediate term clinical outcomes of Percutaneous Coronary Intervention (PCI) in LMCA disease in respect to mortality, Cerebrovascular Accidents (CVA), reinfarction, stent restenosis and need for repeat target lesion revascularization. Materials and Methods: From July 2013 to February 2015, 50 patients underwent LMCA stenting. All patients underwent detailed clinical assessment, detailed 2D echocardiographic assessment. Syntax score was calculated in all patients. Clinical in hospital and outpatient follow up was obtained at one, three, six, nine months and one year. Results: Mean age was 53.14±9.60 years. On CAG 16 (32%) patients had ostial LMCA lesion, 8 (16%) had mid LMCA lesion, distal LMCA was diseased in 6 (12%). In emergency situation, two bail out LMCA stenting were done for treatment of LMCA dissection. A total of 42 (84%) patients had low syntax score, 6 (12%) had intermediate and 2 (4%) had high syntax score. Only LMCA stenting was done in 22 (44%) patients, LMCA to Left Anterior Descending (LAD) stenting was done in 22 (44%) and LMCA to Left Circumflex (LCX) stenting was done in 6 (12%) patients. Drug-Eluting Stent (DES) was used in 35 (70%) cases while Bare-Metal Stent (BMS) was used in 15 (30%). An 8% mortality and 8% target lesion revascularization rate were observed in our study. Conclusion: Our study revealed that LMCA stenting is a safe and feasible alternative mode of revascularization in selected patients. Patients most suitable for LMCA stenting in our study were those with isolated ostial/mid LMCA disease, with protected LMCA disease and those who underwent elective stenting procedure.

Rituximab: A Magic Bullet for Pemphigus

V. Anandan, W. Afthab Jameela, R. Sowmiya, M. Mani Surya Kumar, P. Lavanya

Introduction: Pemphigus, an autoimmune disease, was fatal before the era of corticosteroids. With the advent of steroids, mortality decreased but morbidity was present due to the side effects of high dose steroids. Newer drugs targeted at the molecular level are said to have fewer side effects and improved effectiveness. Aim: The aim of our study was to assess the effectiveness of one such drug, Rituximab, a biological, in treating pemphigus vulgaris and to identify common adverse events. Materials and Methods: It was an open label prospective interventional study, conducted from September 2013 to May 2015, in the Department of Dermatology, Stanley Medical College, Chennai, Tamil Nadu, India. Twenty patients with pemphigus were included in the study. Ten were refractory to conventional therapy and 10, new cases. Patients who satisfied inclusion and exclusion criteria were included in the study after informed, written consent. Rituximab was administered according to Rheumatoid arthritis protocol. The patients were followed up as out patients after discharge, end points and adverse events were noted. Results: There were 14 females (70%) and six males (30%). The mean age of the study group was 41.35 years. The mean disease duration was 11.7 months. The mean duration of follow up being 14.25 months. After rituximab, 13 patients remained in remission for varying periods of 3-22 months. The mean duration of complete remission off- treatment with Dexamethasone Cyclophosphamide Pulse (DCP) was 3.6 months; with rituximab it was 8.8 months. Seven (35%) patients relapsed during the study of whom six had received rituximab after being refractory to conventional treatment. Patients who relapsed had higher mean disease duration (21 months) than the remission group (6.384 months). Two patients (10%) developed immediate adverse events. Six patients (30%) developed late adverse events the commonest being reactivation of herpes labialis. Conclusion: Rituximab was effective in treating pemphigus vulgaris, was significantly better than conventional treatment, decreased the need for additional steroids and other immunosuppressants and induced prolonged remission. Rituximab was more effective when given early in the disease process. Further studies may highlight the need for additional cycles of rituximab to maintain sustained remission.

Influence of Central Obesity Assessed by Conicity Index on Lung Age in Young Adults

Usha Shenoy, Jagadamba

Introduction: Central obesity is an emerging public health problem in young adults which compromises lung mechanics. Conicity Index (CI) is a simple anthropometric measure to assess central adiposity. The concept of lung age relates to a person’s current lung function at which his/her lung function would be considered abnormal in relation to the present actual age. Aim: To determine the effect of central obesity by CI on lung age in young adults. Materials and Methods: A total of 319 young adults in the age group 18-25 years were recruited for this cross-sectional observational study. Written informed consent and Institutional Ethical Clearance (IEC) approval were obtained. Anthropometric parameters were measured and CI was calculated using the following formula: CI = Waist Circumference (WC) (m)/ [0.109 Xv {Bodyweight (kg)/ Height (m)}] where 0.109 is a constant. Spirometry was performed and all the lung volumes and capacities were obtained. Results: There was a significant increase in mean values of CI in obese young adults compared to non obese (1.36±0.15 and 1.16±0.08, p<0.001). The effect of central obesity on lung age in young adults was compared using an independent t-test. Mean of lung age was significantly higher in centrally obese young adults compared to non obese 23.87±3.03 and 21.30±2.6, p<0.001) which was statistically significant. Conclusion: Lung age is significantly increased in centrally obese young adults compared to non obese. Hence, lung age can be used as a potential psychological tool to show an individual with central obesity that there is premature aging of their lungs.

VEGF Expression to Support Targeted Therapy in Ovarian Surface Epithelial Neoplasms

Introduction: Vascular Endothelial Growth Factor (VEGF), a promoter of angiogenesis, is a promising target for antiangiogenic therapy in ovarian cancer. In our study, we examined the expression of VEGF in the spectrum of epithelial ovarian neoplasms (benign, borderline and malignant) by Immunohistochemistry (IHC). Aim: Diagnosing ovarian epithelial neoplasms, examining the expression of VEGF in benign, borderline and malignant neoplasms and correlating it with histological grade and stage of malignant cases. Materials and Methods: This is a cross-sectional, observational study where, total of 50 cases of surface epithelial ovarian neoplasms were examined for expression of VEGF by IHC. Scoring for VEGF expression was done for each case. Results: A total of 42 of the 50 cases (84%) showed VEGF expression. Out of the 42 positive cases, 19 were high VEGF expressors and 23 were low VEGF expressors. VEGF expression was significantly higher in carcinomas as compared to benign and borderline neoplasms (p=<0.001). All neoplasms of serous morphology were positive for VEGF. High VEGF expression was significantly associated with high grade (p=0.003) and stage (p=0.001) of disease. Conclusion: Ovarian surface epithelial neoplasms significantly express VEGF. Though, some VEGF expression was noted in benign and some borderline neoplasms, high VEGF expression was noted only in carcinomas and one case of borderline serous papillary tumour. Thus, these results suggest that epithelial ovarian tumours are candidates for VEGF targeting therapy as most of them are dependent on VEGF for progression.

Impact of Biliary Calculi on the Liver

Introduction: Gallstone is implicated for hepatocellular injury due to chronic extra hepatic large bile duct obstruction with or without repeated episodes of cholangitis. Aim: To study the liver changes in patients undergoing operative procedure for gallstone disease and to determine the relationship between severity of these changes with position of biliary calculus in biliary tree. Materials and Methods: Sixty patients who underwent operative procedure for gallstone disease between October 2013 and September 2015 were evaluated. The Liver Function Test (LFT) was done preoperatively and postoperatively. Intraoperative liver biopsy was taken. The histopathological changes of liver and their severity were noted. Results: The most commonly observed liver function abnormality both in cholelithiasis (12.8%) and choledocholithiasis patients (50%) was increased alkaline phosphatase. Most commonly observed liver histology changes in patients with cholelithiasis was nonspecific reactive hepatitis (46.9%) and in choledocholithiasis was chronic cholestasis (50%). Patient with choledocholithiasis showed significant changes (p<0.001) in liver histopathology and LFT as compared to cholelithiasis. Conclusion: Patients with gallstone diseases developed significant functional as well as structural hepatic changes. Though the change was more significant in patient with choledocholithiasis compared to cholelithiasis, early operative procedure is recommended in all gallstone disease patients to prevent potential liver damage, irrespective of position of biliary calculi in biliary tree to prevent morbidities associated with it.

In Vitro Cytotoxicity Evaluation of Novel Nano-Hydroxyapatite-Silica Incorporated Glass Ionomer Cement

Tahir Yusuf Noorani, Norhayati Luddin, Ismail Ab. Rahman, Saman Malik Masudi

Introduction: Glass Ionomer Cements (GIC) are among the most popular restorative materials, but their use in dentistry is limited due to their physical properties. The hardness of GIC was improved by incorporation of nano-hydroxyapatite-silica into GIC, to expand its applicability. Aim: To evaluate the cytotoxic effects of nano-hydroxyapatite-silica incorporated glass ionomer cement (HA-SiO2-GIC) on human Dental Pulp Stem Cells (DPSC) and compare it with conventional GIC and resin modified GIC. Materials and Methods: Material extracts of Fuji IX, Fuji II LC and HA-SiO2-GIC were prepared into seven serial concentrations and applied to 96-well-plates seeded with DPSC. The 96-well-plates were incubated for 24 and 72 hours. The morphology of DPSC was observed under the inverted phase contrast microscope, and the cell viability was determined using MTT assay at both time intervals. Kruskal-Wallis test was performed for statistical analysis. Results: At maximum concentration, DPSC appeared fewer in number, but the normal spindle morphology was maintained in all groups except for Fuji II LC. At lower concentrations, DPSC appeared normal and more confluent in all groups. The cytotoxic effects of all groups were dose dependent. Fuji IX demonstrated the lowest cytotoxicity, followed by HA-SiO2-GIC. Fuji II LC demonstrated the highest cytotoxicity. The difference was significant between all groups at 200 mg/ml concentration (p<0.05). At concentration <100 mg/ml, cytotoxicity of HA-SiO2-GIC was comparable to that of Fuji IX and lower than that of Fuji II LC. Conclusion: HA-SiO2-GIC showed a favourable cytotoxicity response and thus holds promise as a future potential restorative material in clinical dentistry.

Evaluation of ECG Abnormalities in Patients with Asymptomatic Type 2 Diabetes Mellitus

Sahil Gupta, Rajeev Kumar Gupta, Malini Kulshrestha, Rajib Ratna Chaudhary

Introduction: Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Disease (CVD) risk equivalent. Its macrovascular complications are associated with two-fold increased risk of premature atherosclerotic CVD. Most of the diabetics with cardiovascular involvement are asymptomatic. Electro Cardio Graph (ECG) abnormalities are found to be predictors of silent ischaemia in asymptomatic persons. An abnormal ECG response is associated with statistically significant high risk for cardiac mortality and morbidity. Aim: The aim of the study was to evaluate ECG changes in asymptomatic Type 2 DM patients. Materials and Methods: A cross-sectional comparative study was conducted in a tertiary care hospital in North India. One hundred diabetics presenting to Medicine OPD/IPD were included in the study who had no symptoms of heart disease and no diabetic complications. Fifty person with age and sex matched controls were included in the study. Relevant history and physical examination findings were recorded in a protocol. The variables studied were: gender, age, smoking, physical activity, and waist circumference, Body Mass Index (BMI) and blood pressure. Resting ECG was recorded. Results: Mean age of asymptomatic diabetic patients was 50.3±11.90 years (age range 25-75 years). In this study, none of the control group had ECG abnormality whereas, 26% asymptomatic diabetics had ECG abnormalities. Most of the asymptomatic cases with ECG changes had 5-10 year of duration of diabetes mellitus; 70% patients with ECG changes had poor glycaemic control, increased triglyceride and decreased High Density Lipoprotein (HDL) levels. Most common abnormality observed was ST-T changes, followed by Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH), Left Bundle Branch Block (LBBB) and Right Bundle Branch Block (RBBB). Conclusion: ECG changes are present in quarter of asymptomatic Type 2 DM patients. However, nonspecific ST-T changes, LVH and LAE are common.

Utilization Pattern of Potentially Inappropriate Medications in Geriatric Patients in a Tertiary Care Hospital: A Retrospective Observational Study

Introduction: Geriatric population is on the rise throughout the world, hence the quality and the safety of prescribing in the elderly is a global healthcare concern. It is important for the healthcare providers to be aware of the limitations in prescribing certain drugs to the elderly. This study was an attempt to shed light on the utilization pattern of Potentially Inappropriate Medications (PIMs) in elderly patients admitted in the medicine wards in a tertiary care hospital in Goa. Aim: To measure the percentage prevalence of PIMs prescribed in the admitted geriatric patients. Materials and Methods: In this retrospective observational study, 150 case records of patients aged 60 years or more were analysed. All the prescribed medications, for each case record, were then analysed by referring to the American Geriatrics Society (AGS) Beers Criteria 2015. Data was analysed using Statistical Package for Social Sciences (SPSS) software. Results: Of the 150 patients, 99 (66%) received at least one PIM according to the Beers Criteria 2015 (including drugs to be used with caution). However, after excluding the drugs to be used with caution, the prevalence of PIMs decreased to 44%. The most commonly prescribed PIMs were ranitidine (17.33%) and prazosin (8.66%) and the most commonly prescribed drug to be used with caution was furosemide (35.33%). Conclusion: As the medication needs of the geriatric population are unique, it is essential that the healthcare professionals are aware of these needs and also follow the available guidelines and tools. Formulation of hospital policies and protocols in this regard would help to improve the scenario. Increased education, awareness and reporting of drug-related problems along with more doctor-patient interaction in these situations are some of the factors that could play an important role in promoting better and safer prescribing practices and a better quality of life to the older generations of our communities.

Bacterial Contamination of Adult House Flies (Musca domestica) and Sensitivity of these Bacteria to Various Antibiotics, Captured from Hamadan City, Iran

Introduction: House flies (Musca domestica) have been known as a mechanical vector in spreading infectious diseases such as cholera, shigellosis, salmonellosis and skin infections. Aim: To investigate the bacterial contaminations of house flies and determine the resistance of these bacteria against various antibiotics. Materials and Methods: An analytical descriptive crosssectional study was conducted. The study was performed from July to September 2015 in Hamadan University of Medical Sciences, Hamadan, Iran. A total number of 300 house flies were collected from four places, 75 flies from each place, including two educational hospitals belonging to Hamadan University of Medical Sciences, a fruit and vegetables center, and a livestock slaughter. The body surface of house flies was washed using the physiological sterile serum and the obtained solution was centrifuged at 2000 rpm for five minutes. The identification of bacteria was carried out using the phenotypic methods. The resistance of bacteria against various antibiotics was determined using the disk diffusion approach. Data were analysed by the employment of SPSS software package version 20.0. Results: A total number of 394 bacterial strains were isolated from 275 house flies. The most prevalent type of bacteria was Bacillus spp which was detected in 31.1% of house flies. Moreover, Staphylococcus spp. (22.9%), Escherichia coli (11.6%) were other prevalent species, whereas, Enterococcus spp. was the least prevalent type of bacteria in the collected house flies. In terms of resistance to antibiotics, it was identified that bacteria extracted from house flies which were collected from hospital environments were more resistant to antibiotics compared with the resistance of bacteria extracted from house flies which were collected from non hospital environments. The maximum bacterial isolation was found in houseflies from hospital No.1 environment from around the accumulation of garbage. Conclusion: It is a well-known fact that house flies are a source of bacterial contamination and can act as a mechanical carrier and cause bacterial diseases. It can be postulated that house flies play a major role in spreading antibiotic resistant bacteria. However, the flies from hospital environments were more contaminated, mainly because the people referring to health center are normally ill and carrier of many pathogens. Further, hospital environments should be controlled using administrative procedures.

Monitoring Microcirculatory Blood Flow during Cardiopulmonary Bypass in Paediatric Cardiac Surgery Patients as a Predictor for Anaerobic Metabolism

Introduction: Improving tissue oxygenation is one of most important tasks in management of low cardiac output. Central venous oxygen saturation (ScvO2) and lactate are established criteria for monitoring the adequacy of tissue oxygenation. The venous-to-arterial carbon dioxide difference [P(v-a)CO2] is inversely associated with cardiac output. Aim: To study the use of P(v-a)CO2/C(a-v)O2 ratio as a marker of low cardiac output during Cardiopulmonary Bypass (CPB) in paediatric cardiac surgical patients. Materials and Methods: The present study was a prospective observational study conducted over a period of nine months from 1st August 2015 to 30th April 2016. A total of 110 children were enrolled, who underwent CPB during cardiac surgery. The CPB time, Mean Arterial Pressure (MAP), flow rate, cross clamp time, were recorded for all the patients as well as Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) were checked at four different points of time: 1) Before CPB, 2) 10 minutes after initiation of CPB, 3) 30 minutes on CPB and 4) off CPB. Results: The results indicated that Receiver Operating Characteristic curve (ROC curve) at 30 minute of CPB time P(v-a)CO2/C(a-v)O2 was more specific and sensitive than lactate to detect anaerobic metabolism. Decrease platelet count was significant on second postoperative day. Conclusion: The present study suggests the use of P(v-a)CO2/C(a-v)O2 ratio as a marker to detect low flow on CPB. Our study was single centric and with a small size, studies involving large population and multiple centers are required to support the recent findings.

Effect of Oral Tissue Fluids on Compressive Strength of MTA and Biodentine: An In vitro Study

Divya Subramanyam, Madhusudhan Vasantharajan

Introduction: Over the past many years various root end filling materials have been used which have been tested for their physical properties but each of them had certain limitations. In clinical practice, root end filling materials are exposed to oral tissue fluids which may compromise their longevity. Aim: The aim of this study was to investigate the effects of oral tissue fluids on compressive strength of Mineral Trioxide Aggregate (MTA) and biodentine. Materials and Methods: MTA and biodentine cylinders measuring 6 mm × 4 mm were prepared using acrylic blocks. They were divided into six groups; (Group 1) (MTA) (n=3), (Group 2) MTA contaminated with saliva, (MTA-S) (n=3), Group 3: MTA contaminated with blood, MTA-B (n=3), Group 4: Biodentine (BD), Group 5: Biodentine contaminated with saliva (BD-S) (n=5), Group 6: Biodentine contaminated with blood (BD-B) (n=5). The mould was contaminated with saliva and blood and incubated at 37°C at 100% humidity for three days and compressive strength (MPa) was measured using universal testing machine and the data was analyzed statistically using one-way ANOVA test. Results: There was no significant difference in the compressive strength between the three groups i.e., MTA, MTA-S, MTA-B (p > 0.05). However, there was higher compressive strength in the MTA-B group when compared to MTA and MTA-S. Also, there was no statistical significant difference between BD, BD-S, BD-B (p>0.05). Conclusion: This study showed that the compressive strength of MTA and biodentine was not adversely affected by contamination with oral tissue fluids like blood and saliva.

Six Minute Walk Test: A Tool for Predicting Mortality in Chronic Pulmonary Diseases

MP Swathi Karanth, Nilkanth Tukaram Awad

Introduction: Six Minute Walk Test (6MWT) is a simple test used to measure exercise capacity in Chronic Pulmonary Diseases (CPDs). Decreased exercise capacity significantly affects the quality of life. The 6MWT is a known tool to measure exercise capacity and quality of life in CPD. However, the role of change in follow up Six Minute Walk Distance (6MWD) in assessing mortality and its correlation with known prognostic factors haven’t been tested to the best of our knowledge. Aim: To study the correlation of change in 6MWD with change in spirometry and to study the role of 6MWD in predicting mortality in CPD. Settings and Design: Prospective cohort study. Materials and Methods: A total of 139 CPD patients were grouped into obstructive, restrictive and post Tuberculosis (TB) sequelae. Optimized treatment was given and they were followed up regularly. Spirometry and 6MWT was done at the beginning and after one year. Mean decline in FEV1, FVC was correlated with mean decline in 6MWD. Statistical Analysis: With STATA 13.1 correlation between 6MWT and spirometric values were done using Wilcoxon signed rank test. Predictors of mortality were studied using multivariate analysis. Results: Overall mean decline in 6MWD was 16.07 m/year. There was no correlation between mean change in 6MWD and change in FEV1, FVC, and FEV1/FVC. On multivariate analysis, 6MWD was the better predictor of mortality than FEV1 (p<0.001), FVC (p<0.001). At cut off value of 240 meters, sensitivity and specificity of 6MWT in predicting mortality was 71.05% and 81.94% respectively. Conclusion: The 6MWD changes independently and has no correlation with change in spirometry, it is an independent predictor of mortality in CPD

A Comparative Study of Antegrade Air Pyelogram and Retrograde Air Pyelogram for Initial Puncture Access during Percutaneous Nephrolithotomy

Dharmendra K. Jangid, Govind Sharma, S. S. Yadav, Vinay Tomar, Rajeev Mathur

Introduction: Access into the collecting system is considered to be the most critical step for Percutaneous Nephrolithotomy (PCNL). Aim: The present study provides a comparative view into antegrade air pyelography and retrograde air pyelography procedures for percutaneous renal access. Materials and Methods: A cross-sectional study was conducted on 100 patients with radiopaque renal calculi indicated for PCNL procedure. These patients were randomly assigned to two groups namely antegrade air pyelogram group (Group I) and retrograde air pyelogram group (Group II). In antegrade air pyelogram group, the collecting system was delineated by targeting the renal stone using a 22 gauge spinal needle where the patients were in the prone position. In another group, the collecting system was delineated by retrograde air pyelogram under fluoroscopy guidance. The method of tract dilatation and stone extraction were the same in both groups for comparison of outcome and complication. Results: The mean age of patients was 41.7±13 and 41.4±13.6 years in Group-I and Group-II respectively. The male to female ratio in Groups I and II was 35/15 (70.00%) and 38/12 (76.00%) respectively. In Group-I the average duration of access was 2.66±1.0 minutes after prone positioning whereas it was recorded to be 19.48±5.0 minutes in Group-II, after lithotomy followed by prone positioning of the patient. Duration of radiation exposure was almost similar in both groups. Additional procedural cost was significantly higher in Group II. Conclusion: Our study indicated that access for PCNL using antegrade air pyelogram can be a cost-effective and acceptable alternative to retrograde air pyelogram with decreased access time.

The Effect of Metformin as an Adjunct Therapy in Adolescents with Type 1 Diabetes

Introduction: The strict control of blood glucose levels in adolescents with Type 1 Diabetes Mellitus (T1DM) is accompanied with a considerable long term decrease in microvasular and macrovascular complications. Aim: This study was conducted to investigate the effect of metformin as an adjunct therapy in adolescents with poorly controlled Type 1 diabetes. Materials and Methods: It was a quasi-experimental (an uncontrolled before and after) study. The study population consisted of the patients aged over 10 years with T1DM. Metformin tablet was added to patient’s insulin therapy for 12 months. Haemoglobin A1c protein was measured in the beginning of the study and repeated with three months intervals till the end of it. Insulin dosage, Body Mass Index (BMI), serum lipid, creatinine and lactate level were measured twice; in the beginning of the study and at the end of it (after 12 months). Data was analysed by SPSS (version 18) software. Paired- t-test, Wilcoxon signed ranks test and Repeated Measure ANOVA were used to examine the study’s hypothesis. A p-value <0.05 was considered as significant. Results: Twenty nine patients were included in the study. HbA1c level and insulin dosage was significantly reduced (p<0.001) after one month of metformin as an adjunct therapy. Serum lipid was decreased (p=0.7). Weight (p<0.001) and BMI (p=0.007) were increased. Conclusion: Adjunctive metformin therapy reduced HbA1c value and the insulin dosage received in adolescents with T1DM.

Correlation of Body Mass Index (BMI) with Thyroid Function in Euthyroid Pregnant Women in Manipur, India

Sumit Kumar, T. Chiinngaihlun, M. Rameswar Singh, O. Punyabati

Introduction: Body Mass Index (BMI) is significantly increased during pregnancy due to gain of weight with normal progression of pregnancy. The exact influence of thyroid function on BMI are ill defined in euthyroid pregnant women. Aim: To correlate serum levels of Free Triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid Stimulating Hormone (TSH) level with BMI of participant normal pregnant women in all the three trimesters. Materials and Methods: In this cross-sectional comparative study, total of 210 healthy pregnant women comprising of 70 participants in each trimester, attending Obstetrics Outpatient Department (OPD) for antenatal check-up were consecutively selected. Estimation of serum FT3, FT4 and TSH level was done by ELISA based methods. The correlation of BMI with serum levels of FT3, FT4 and TSH was done using Pearson correlation test (r) by SPSS version 21.0 software. Results: TSH level of participant normal pregnant women showed significant positive correlation with BMI during first (r=0.254 and p=0.034) and second trimester (r=0.263 and p=0.028) of pregnancy. FT4 level showed significant negative correlation in second (r= -0.454 and p<0.001) and third trimester (r= -0.351 and p=0.003) of pregnancy. Correlation between BMI and FT3 level showed no significant association in any of the trimesters. Conclusion: BMI correlates positively with TSH level in first and second trimesters while it correlates negatively with FT4 level in second and third trimesters, but, failed to demonstrate significant association with FT3 level in any of trimesters in euthyroid pregnant women. Serum TSH along with FT4 level appears more useful modality compared to serum TSH alone for targeted thyroid screening particularly in obese pregnant women

Expression of Alpha - Methylacyl - Coenzyme A Racemase (AMACR) in Colorectal Neoplasia

Nidhi Shukla, Amit Kumar Adhya, Jaysree Rath

Introduction: Red meat and dairy products have been implicated in colonic cancers. They are rich in branched chain fatty acids which require an enzyme Alpha-Methylacyl-Coenzyme A Racemase (AMACR) for their oxidation. Increased expression of AMACR in colorectal premalignant lesions and carcinomas suggests its possible role in carcinogenesis. Aim: To study the expression of AMACR in colorectal neoplasia and its correlation with the histological grade, stage and nodal status of colorectal malignancy. Materials and Methods: All cases of colorectal neoplasms were included in the study. AMACR expression was studied in 56 cases which included 44 cases of adenocarcinoma and 12 cases of adenoma and a normal colonic mucosal tissue was used as a control. A tissue microarray was prepared by manual method. AMACR expression was studied by Immunohistochemistry (IHC) and it was correlated with the grade, stage and nodal status of the cancer. Chi-square test was used for analysis or results. The p-value of <0.05 was considered significant. Results:Out of 12 cases of adenoma 25% (3/12) were negative; 50% (6/12) showed poor expression, 25% (3/12) had moderate expression and none showed strong expression. Nearly, 34.1% (15/44) case of carcinoma were negative; 45.45% (20/44) had poor; 13.63% (6/44) had moderate and 6.81% (3/44) had a strong expression. Normal colonic tissue showed no expression. There was no significant difference of AMACR expression between adenoma and carcinoma cases. AMACR expression was found to be increased in low grade carcinomas (G1 and G2). G1 showed AMACR positivity in 62% cases and G2 showed 71.4% positivity. No association was found between AMACR expression and different American Joint Committee on Cancer (AJCC) stages and nodal status of CRC. Conclusion: Increased expression of AMACR in adenomas and carcinomas as compared to non-neoplastic epithelium of colon implies that, it plays a role in colorectal neoplasia. Decreased expression of AMACR in high grade carcinomas suggests its role in differentiation of the tumour.

De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience

Introduction: Recurrent or de novo glomerulonephritis are one of the well-known causes for renal allograft dysfunction in early and late period after renal transplantation. Focal Segmental Glomerulosclerosis (FSGS) is a devastating lesion of the renal allograft. De novo FSGS is uncommon compared to recurrent FSGS. Aim: To find out the incidence of de novo fsgs . Materials and Methods: A retrospective evaluation of renal allograft biopsies was performed from 2007 to 2015, by light microscopy and immunohistochemistry including patient-donor demographics. Graft function status in terms of serum creatinine (SCr) and proteinuria were evaluated. Results: Out of 2,599 renal allograft biopsies performed, 1.6% biopsies were reported as de novo FSGS. Majority were live related females donors with mean age of 43.8 years. Mean time of biopsy was 1.1 years post-transplant with proteinuria of 2.95 grams/24 hours and SCr of 2.24 mg/dL. Histopathological variants were collapsing 47.6%, Not Otherwise Specified/ classical 35.7%, cellular 9.5% and perihilar 7.1% biopsies. Associated Antibody Mediated Rejection (AMR) with T-Cell Rejection (TCR) was observed in 35.7% biopsies, acute on chronic CNI toxicity (calcineurin inhibitor) in five biopsies. Majority of the patients were on CNI based maintenance immunosuppression regimen. Total 28.6% patients and 23.8% grafts were lost over a mean follow up of 2.40 years. The mean SCr of remaining patients was 1.98 mg/dL. Conclusion: De novo FSGS can occur after the first year of renal transplant with related Human Leukocyte Antigen (HLA)matched donors leading to poor allograft survival. Close monitoring of urinary proteinuria and evaluation of allograft biopsy help in appropriate therapeutic modification to improve long term outcome of graft function.

Flat Foot in a Random Population and its Impact on Quality of Life and Functionality

Introduction: Flat foot is a common deformity in adults. It is characterized by medial rotation and plantar flexion of the talus, eversion of the calcaneus, collapsed medial arch and abduction of the forefoot. Aim: The aim of this study was to determine the prevalence of flat foot and its impact on quality of life, dependence, foot pain, disability and functional limitation among random population of 40-year-old and above. Materials and Methods: A cross-sectional study in a random population sample from Cambre (A Coruña-Spain) (n=835) was performed (a =0.05; Precision=±3.4%). The diagnosis of flat foot was stablished by the study of the footprint obtained with a pedograph. Anthropometric variables were studied, Charlson’s Comorbidity Index, function and state of foot (Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ)), quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). A logistic and linear multiple regression analysis was performed. Results: The prevalence of flat foot was 26.62%. Patients with flat foot were significantly older (65.73±11.04 vs 61.03±11.45- year-old), showed a higher comorbidity index (0.92±1.49 vs 0.50±0.98), had a greater BMI (31.45±5.55 vs 28.40±4.17) and greater foot size (25.16±1.66 vs 24.82±1.65). The presence of flat foot diminishes the quality of life, as measured by the FHSQ, and foot function, measured by the FFI. The presence of flat foot does not alter the physical and mental dimension of the SF-36 or the degree of dependence. Conclusion: Flat foot was associated with age, Charlson’s Comorbidity Index, BMI and foot size. The SF-36, Barthel and Lawton questionnaires remained unaltered by the presence of flat foot. The FHSQ and FFI questionnaires did prove to be sensitive to the presence of flat foot in a significant manner.

Comparison of Serum Levels of Endothelin-1 in Chronic Periodontitis Patients Before and After Treatment

Waleed Khalid, Sheeja S Varghese, M. Sankari, ND. Jayakumar
Introduction: Endothelin-1 (ET-1) is a potent vasoconstrictive peptide with multi functional activity in various systemic diseases. Previous studies indicate the detection of ET-1 in gingival tissues and gingival crevicular fluid. Aim: The aim of this study was to estimate the serum ET-1 levels in clinically healthy subjects and subjects with chronic periodontitis, before and after treatment, and correlate it with the clinical parameters. Materials and Methods: A total of 44 patients were included in the study. Group I comprised of 20 subjects with clinically healthy periodontium. Group II comprised of 24 subjects with chronic periodontitis. Group III comprised of same Group II subjects following periodontal management. Serum samples were collected from the subjects and an Enzyme Linked Immunosorbent Assay (ELISA) was done to estimate the ET-1 levels. The ET-1 levels were then correlated among the three groups with the clinical parameters namely, Plaque Index (PI), Sulcus Bleeding Index (SBI), probing pocket depth, clinical attachment loss and Periodontally Inflamed Surface Area (PISA). The independent t-test and paired t-test were used for comparison of clinical parameters and Pearson’s correlation coefficient test was used for correlating the ET-1 levels. Results: ET-1 levels in chronic periodontitis subjects were significantly higher compared to healthy subjects (p<0.001). However, the clinical parameters did not statistically correlate with the ET-1 levels. There was a significant decrease in ET-1 levels following treatment (p<0.001). Conclusion: Serum ET-1 is increased in chronic periodontitis and reduces after periodontal therapy. Further studies are required to establish ET-1 as a biomarker for periodontal disease.

Formulation and Evaluation of Sol-Gel Drug Delivery System for Intracanal pH Sensitive Controlled Delivery of Chlorhexidine

Kapil Gandhi, Radha Srikrishna Maganti, Harsimrankaur, Ks Vinod, Pratik Verma
Introduction: Persistence of viable micro-organisms even after thorough chemomechanical debridement has been cited as a major cause for endodontic failure. Chlorhexidine is a drug, which has shown marked efficacy against Enterococcus faecalis and Candida spp., which are mostly accounted for endodontic failure and it has demonstrated high degree of substantivity to dentin by adsorption. Another issue with chlorhexidine and other intracanal medicaments is the excessive or premature peaking of the drug leading to possible side effects. Aim: The objective of this experimental work undertaken was to formulate a pH sensitive sol-gel sustained drug delivery system containing chlorhexidine. Materials and Methods: The formulations were prepared using different concentrations of GELRITE® (0.1% and 0.2%) and Chlorhexidine (0.1% and 0.2%). The prepared solutions were evaluated for pharmacological properties like sterility test, viscosity, drug content, drug release characteristics, drug excipient compatible study. Results: The drug excipient compatibility studies showed no interaction between the excipient and the active constituent. The microbial analysis showed good efficacy against the test micro-organisms and Minimum Inhibitory Concentration (MIC) values against Candida albicans (ATCC® 14053™) was observed as 4 µl/ml for both formulation containing 0.1% and 0.2% of GELRITE® Gellan (polymer). Whereas, MIC values against Enterococcus faecalis was observed to be 3.2 µl/ml and 6 µl/ml for formulation containing 0.1% and 0.2% of GELRITE® Gellan (polymer) respectively. Conclusion: From the present study, it could be successfully demonstrated that sol-gel formulations can be simple, easy to administer mode of intracanal drug delivery system. Localized pH changes present within the canal can trigger sol-gel conversion thereby releasing the drug in sustained manner with less toxicity and side effects.

Effect of Autologous Platelet Rich Fibrin in Human Mandibular Molar Grade II Furcation Defects- A Randomized Clinical Trial
Introduction: The Furcation of multirooted teeth is difficult region to gain access for treatment due to their complex anatomy. Modifications have been made in the periodontal instrument armamentarium to facilitate treatment of furcations. Moreover, many new materials have been introduced to attempt regeneration in the furcation defects. Aim: This study evaluated the role of Platelet Rich Fibrin (PRF) in comparison with allograft and Guided Tissue Regeneration (GTR) in the treatment of Grade II mandibular molar furcations. Materials and Methods: This was a parallel arm prospective randomized, interventional trial (NCT 02430519) conducted on 22 patients, with Grade II mandibular furcation defects. Patients were divided into two equal groups. Group A, were treated by the placement of PRF as a graft and as a membrane while in Group B, the defects were treated by the placement of allograft and Healiguide collagen membrane. Clinical parameters {Plaque Index (PI), Probing Depth (PD), Relative Vertical Clinical Attachment Level (RVCAL), Relative Horizontal Clinical Attachment Level (RHCAL), Gingival Marginal Level(GML), and amount of Bonefill using Radio-Visiography (RVGBF)}, were estimated at baseline and nine months postoperatively. Comparison between the groups was analysed by using independent sample t-test, whereas, paired t-test was used to assess the mean values within the groups. Results: The intergroup comparison for PI, PD, RHCAL, GML, was statistically not significant. Pertaining to RVCAL, there was a statistically significant difference at nine months (p-value=0.04) in Group A. Also, there was a statistically significant difference related to RVGBF (p-value=0.006) in Group A at nine months. Conclusion: The efficacy of PRF should be ascertained by conducting more studies with a larger sample size, on a long term basis, in patients with molar Grade II furcation defects.

Disparities in Oral Health Behaviour among Young Adults in Mangalore, India: A Psychosocial Perspective

G Rajesh, Simi Seemanthini, Dilip Naik, Keshava Pai, Ashwini Rao
Introduction: Oral health inequalities imply unequal distribution of health and disease across socioeconomic gradients. Oral health related behaviour and its psychosocial antecedents can have a major impact on oral disease pathways in communities. Aim: To ascertain disparities in oral health behaviour and its psychosocial antecedents among young adults in Mangalore, Karnataka, India. Materials and Methods: Present study was carried out among 341 degree students at three randomly chosen institutions belonging to government, aided and private colleges in Mangalore. Oral health behaviour was assessed by a structured, pre-tested, self-administered questionnaire. Information about oral hygiene habits, tobacco use, sugar consumption, dental attendance patterns were collected. Respondent's self-reported gingivitis, perceived general and oral health, perceived need for care and locus of control were assessed. Information about demographic details was collected. Correlation analysis employed Pearson’s correlation coefficient and binary logistic regression analysis was employed with snacking as dependent variable. Results: Twice daily brushing was significantly associated with gender (r=0.142, p=0.009), type of college (r=-0.164, p=0.003) and father’s occupation (r=0.107, p=0.049), while tobacco use was significantly associated with gender (r=0.284, p=0.000), religion (r=-0.234, p=0.000), type of college (r=0.312, p=0.000), father’s education (r=0.130, p=0.017) and occupation (r=0.120, p=0.027). Self-perceived oral health was significantly associated with snacking (r=0.173, p=0.001) and tobacco use (r=-0.261, p=0.000), while locus of control was associated with snacking (r=0.140, p=0.009). Regression analysis revealed that father’s education (OR=0.399, p=0.014), self-perceived need for care (OR=0.354, p=0.009), and locus of control (OR=0.166, p=0.003) emerged as significant predictors of snacking behaviour. Conclusion: Psychosocial antecedents were significantly associated with oral health behaviour among the respondents. Policy and decision makers should consider causes of causes while tackling oral health problems. Present study may contribute towards addressing oral health inequalities in developing nations, where oral health issues are compounded by a definite paucity of resources.

Quality of Life in People with Diabetic Retinopathy: Indian Study
Introduction: Diabetic Retinopathy (DR) is a well-known consequence of long standing and poorly controlled Diabetes Mellitus (DM). Several studies have demonstrated both a qualitative and quantitative reduction in health related quality of life in persons with DR. But no such study has been done in the Indian population. Aim: To assess health related and vision related quality of life in people with DR. Materials and Methods: The present study included two groups of patients with Type 1 and Type 2 diabetes. Cases included 97 patients with DR. The control group (n=26) consisted of diabetic cases with no clinically detectable DR changes. After taking informed consent, health and vision related quality of life was assessed using National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). Demographic information, social history and diabetic history were also obtained from all patients. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Results: Of the 97 cases with DR, 42.3% were females. Of the 26 controls, 53.8% were females. The mean±SD age in years of the cases was 55.09±9.56 and controls were 54.12±13.01. The mean±SD of DM in years for the cases was 10.98±5.62 and for controls was 6.69±2.29. There were statistically significant (p<0.001) lower VFQ-25 composite and sub scale scores of the cases when compared with controls. As the grade of DR increased, VFQ-25 sub-scale scores decreased and this was statistically significant for composite and all sub scales (p<0.005) except ocular pain. Mann-Whitney test Z-value was highest in general health, general vision, composite score and mental health. Conclusion: Quality of life was significantly lower in diabetics with DR when compared with those without DR with maximum effect seen on general health, general vision and mental health. Quality of life decreased as the duration of retinopathy and severity of retinopathy increased.

Evaluation of Resting Tongue Position in Recently Extracted and Long Term Completely Edentulous Patients: A Prospective Interventional Study

K Rajeshwari, Shivani Kohli, Xavier K Mathew
Introduction: Presence of abnormal resting tongue position can lead to poor denture retention and stability. The prevalence of retracted tongue position has been found to be higher in partially edentulous subjects compared to dentate subjects and is greatest in completely edentulous individuals. Aim: To evaluate resting tongue position in recently extracted and long term completely edentulous patients, and to evaluate the efficacy of achieving retracted tongue position by simple modification in complete denture along with certain tongue exercises. Materials and Methods: A total of 62 study subjects were classified into two groups based on duration of edentulousness. Group A: Recently extracted completely edentulous subjects (<1 year), Group B: Long term completely edentulous subjects (>1-10 year). The patients with retracted tongue position were subjected to a simple modification in complete denture along with inclusion of certain tongue exercises. After eight months patients were recalled and evaluated. The data was analysed using SPSS statistical tests like mean, standard deviation, proportion, Chi square test and McNemar Test. Results: Among the study subjects, 54.9% had retracted tongue position. Group B showed high proportion of retracted tongue position (68.8%) as compared to Group A. After the intervention, 42.8% study subjects gained normal resting tongue position. Conclusion: Long term completely edentulous subjects presented retracted tongue position in higher percentage when compared to the recently extracted group. The interventional method employed for the subjects with retracted tongue position, played a significant role to assume normal resting tongue position and showed improvement in denture stability and retention.

Comparative Analyses of Smear Layer Removal Using Four Different Irrigant Solutions in the Primary Root Canals – A Scanning Electron Microscopic Study
Introduction: A clinician’s path to success is a clean root canal system with three dimensional seal. Mechanical instrumentation of root canals alone leaves behind a smear layer covering the dentinal walls. Instrumentation must always be supported by use of irrigants which are considered as an essential prerequisite for root canal debridement. Aim: The aim of this in vitro study was to compare the efficacy of four irrigating solutions in removing the smear layer in primary root canals after hand instrumentation. Materials and Methods: A total number of 40 human primary incisors were decoronated and split longitudinally. The specimens were divided randomly into four groups (n=10): Group I: 5.25% Sodium Hypochloride (NaOCl), Group II: 6% citric acid solution, Group III: smear clear and Group IV: 0.2% chitosan. Scanning electron microscopic analysis was performed to assess the presence or absence of smear layer at the coronal, middle and the apical portion of each canal. The data was analysed using Stastical Package For Social Sciences (SPSS) version 19.0 Armonk, NY IBM Corp soft ware. Results: The pictures from the scanning electron microscopy showed that Group II exhibited better efficacy in removing smear layer without altering the normal dentinal structures with lowest mean scores (p<0.001) followed by Group III, Group IV and Group I. The presence of debris was more evident in the apical third rather than in the middle and the coronal part of the root canal. Conclusion: A 6% citric acid removed the smear layer more efficiently than other test irrigants in primary root canals.

Effect of Different Ferrule Length on Fracture Resistance of Endodontically Treated Teeth: An In vitro Study

Sushil Kar, Arvind Tripathi, Chavi Trivedi
Introduction: A ferrule has been described as a key element of tooth preparation when using a post and a core. It is a vertical band of tooth structure at the gingival aspect of crown preparation. It lessens the stress transmission to the root which is due to forces from posts or bending during seating of the post. The incorporation of a ferrule can help to withstand the forces of occlusion, preserve the hermetic seal of the luting cement, and minimize the concentration of stresses at the junction of post and core. Aim: To evaluate and compare the effect of ferrule length on fracture resistance of endodontically treated mandibular premolar teeth, restored with prefabricated glass fiber post luted with resin cement, composite core and a full coverage metal crown. Materials and Methods: Forty freshly extracted mandibular premolars were treated endodontically. They were randomly divided into four groups according to their ferrule height: 3 mm, 2 mm, 1 mm and 0 mm (no ferrule). All specimens were restored with prefabricated glass fibre posts (Reforpost, Angelus) and composite resin (Filtek™ Z250xt). Standardized preparation was done on each specimen to receive a cast metal crown. The specimens were thermocycled and compressive static load at a crosshead speed of 1 mm/min was applied at an angle of 30° on lingual incline of buccal cusp of the crown until failure occurred. The load (N) at failure and mode of failure were recorded. Statistical analysis was performed with Kruskal Wallis test. Result: Fracture resistance values among the groups was found to be statistically significant (p<0.001). The 3 mm ferrule group had significantly higher failure load (971.99+133.07) compared to 2 mm (848.84+109.60), 1 mm (714.64+133.89) and 0 mm ferrule groups (529.36+119.95). More favourable failure modes were observed in almost all groups. Conclusion: The results of this study showed that fracture resistance of endodontically treated teeth increases as ferrule length increases.

Seroprevalence and Trends of Transfusion Transmissible Infections in Blood Donors in Andaman and Nicobar Islands- An Institutional Retrospective Study

Sahil Sehgal, P.S Shaiji, Rupinder Kaur Brar
Introduction: Transfusion Transmissible Infections (TTIs) such as Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C Virus (HCV) and syphilis pose a threat to blood safety in a developing country like India. Aim: To determine the prevalence of TTIs among healthy donors in Andaman and Nicobar Islands, India, and to further help in determination of the population subset to be focused on for enhancing blood donor pool. Materials and Methods: This retrospective cross-sectional study was conducted on all voluntary and replacement donors in a tertiary health care centre in Andaman and Nicobar Islands for a period of three years. Donor blood was screened for HIV, HBV, HCV, Syphilis and malarial parasite using rapid kits and ELISA. Results: Out of 12,118 donors, 97.01% were males and 2.99% were females. 9409 (77.64%) were voluntary donors and 2709 (22.35%) were replacement donors. Majority of the screened donors belonged to 25 to 40 age group. Out of 12,118 donors, 265 (2.18%) were seropositive. Among them, 8 (0.066%) were HIV positive, 15 (0.124%) HCV positive, 128 (1.056%) HBsAg positive, 30 (0.247%) Syphilis positive and 84 (0.693%) were positive for malarial antigen. Yearly prevalence of seropositivity was 2.370%, 2.113% and 2.082% for three consecutive years. Conclusion: With high prevalence of TTIs among healthy donors, safe blood transfusion is still a challenge in developing countries. This continues to place unacceptable burden on health sector. There is a need for encouragement of voluntary blood donation, strict donor selection criteria and sensitive screening tests to minimize TTIs in Indian setting.

Morphological Changes in Bone Marrow Post Imatinib Therapy in Chronic Phase CML: A Follow up Study on Sequential Bone Marrow Aspirates and Biopsies

Neha Chopra Narang, Usha Rusia, Meera Sikka, Mrinalini Kotru
Introduction: Imatinib mesylate is used extensively for first line treatment of Chronic Myeloid Leukemia (CML). However, not many studies have documented morphological changes in bone marrow biopsies produced during Imatinib therapy with reference to myelofibrosis. Aim: To document the morphological changes produced in the bone marrow during Imatinib therapy. Materials and Methods: This longitudinal study followed up 75 Philadelphia Chromosome Positive Chronic Myeloid Leukemia with chronic phase(Ph+ CML- CP) patients sequentially, receiving 400-600mg Imatinib over a period of 12 or more months. Haematologic parameters were measured at admission, 2 weeks, 1 month, 3 months, 6 months and 12 or more months. Morphologic changes in bone marrow aspirate and biopsy were evaluated at admission, 6 months and =12 months of treatment in accordance with National Comprehensive Cancer Network(NCCN) guidelines. Results: Complete Haematologic Response (CHR) was seen in 47.1%, 80%, 85.4%, 90.4% at =1 month, 3 months, 6 months and 12 months respectively after therapy. It was noted that patients not showing CHR by 3 months were less likely to show CHR at 6 months and beyond. Bone marrow aspirates and biopsies showed reduction in cellularity and myeloid precursors with regeneration of erythroid precursors in 70-83% at =12 months. A significant decrease in myelofibrosis (p-value< 0.04) was noted as early as 6 months. Mild to moderate hypoplasia was noted in 31.8% of biopsies within 6 months. Pseudo gaucher cells and benign lymphoid nodules were also seen. Conclusion: Sequential analysis showed that Imatinib reduced the grade of myelofibrosis significantly (p-value< 0.04). It also prevented development of myelofibrosis in patients who did not have it at presentation. Hence Imatinib is effective when used early in the course of CML-CP

Segregation of Patients for Intrapartum Monitoring, using Robson’s Classification
Introduction: Monitoring labour by intermittent or continuous foetal heart rate monitoring has been discussed widely in literature. Robson’s classification has categorized pregnant women in ten groups. The study proposes to examine in which patients one must recommend continuous or intermittent foetal heart rate monitoring. Aim: To study the effect of Continuous Electronic Foetal Monitoring (CEFM) on the overall rate of operative deliveries as well as the rate using Robson’s classification and the neonatal outcome. Materials and Methods: After Institutional Review Board approval, low risk parturients with a reactive foetal heart rate at arrival in labour were prospectively analysed. Women with a previous caesarean section, those requiring elective caesarean section and having high risk factors were excluded. Patient details, history, examination findings and the method of monitoring, whether continuous or intermittent was noted. 1803 women were monitored by CEFM and 2107 by intermittent auscultation. In both the groups of intrapartum monitoring, suspected foetal distress was followed by immediate intervention in the form of caesarean section or operative vaginal delivery without resorting to any other monitoring methods such as foetal scalp blood sampling, as per the institutional policy. Comparison was based on the need for operative deliveries in view of presumed foetal distress and the neonatal outcome between the two groups of monitoring and further in each Robson’s class. Results were assessed using IBM® SPSS Version 22.0, Chi-square test, considering p<0.05 as significant. Results: Operative deliveries in view of suspected foetal distress increased and the neonatal outcome was better with CEFM. Assessing in each Robson’s class, only class 4A, 7A and 10A results were consistent with the overall outcome. In others (class 2A), women experienced reduced rate of operative deliveries and better neonatal outcome with CEFM. In yet others, there was no benefit with CEFM as there were increased operative deliveries without any difference in the neonatal outcome. Conclusion: Segregation of patients for intrapartum monitoring using Robson’s classification would result in decreased operative deliveries and a better neonatal outcome.

The Relationship between Anxiety and Coping Strategies in Family Caregivers of Patients with Trauma
Introduction: Traumatic events are of high incidence and affect not only the patient but also their family members, causing psychological problems such as stress and anxiety for caregivers of these patients. Therefore, the application of appropriate coping strategies by them seems necessary in order to promote mental health. Aim: To study the relationship of anxiety with coping strategies in family caregivers of trauma patients. Materials and Methods: The present research was a descriptive-correlational study which was carried out on 127 family caregivers of patients with trauma in intensive care unit, surgery ward and emergency unit of Amir al-Mu'minin Hospital of Zabol, Sistan and Baluchestan Province. The respondents were selected based on the convenience sampling method. Demographics questionnaire, DASS-21, and Coping Strategies Questionnaire were used for data collection. The obtained data were statistically analysed using descriptive statistics, Analysis of Variance (ANOVA), t-test, and Pearson correlation coefficient in statistical package for the Social Sciences (SPSS) version 21.0. Results: Based on the results, 89.9% of family caregivers suffer from mild to severe anxiety. The most common type of coping strategy used by the respondents was emotion-focused. The results showed no relationship between anxiety and emotion-centrism, but an inverse relationship was found between problem-centrism and anxiety. Conclusion: The majority of family caregivers had anxiety. Given, the inverse relationship between the level of anxiety and the use of problem-based coping strategy, in addition to identifying and reducing the causes of anxiety in caregivers. It is recommended that appropriate coping strategies should be trained to them.

Efficacy of Dexmedetomidine in two Different Doses as an Adjuvant to Lignocaine in Patients Scheduled for Surgeries under Axillary Block
Introduction: The effect of adding dexmedetomidine (a2- adrenoceptor agonist) to local anaesthetics in brachial plexus blocks has been evaluated, however there has been no consensus regarding the ideal dose of dexmedetomidine. Without ultrasound axillary block has been considered as the safest approach for brachial block. Aim: To evaluate the efficacy of two doses of dexmedetomidine (0.5 µg/kg and 1 µg/kg) as an adjuvant to lignocaine in patients undergoing forearm surgeries under axillary brachial plexus block. Materials and Methods: This prospective randomized controlled study was conducted on 104 adult patients, American Society of Anaesthesiologists (ASA) physical status 1 or 2. They were randomized and given following drug formulations, Group L (n=35) received 23 ml of 2% lignocaine with adrenaline + 7 ml of saline, Group LD0.5 (n=34) received 23 ml of 2% lignocaine with adrenaline + 0.5 µg/kg of dexmedetomidine diluted in saline to make a volume of 7 ml, Group LD1 (n=35) was given 23 ml of 2% lignocaine with adrenaline + 1 µg/kg of dexmedetomidine diluted in saline to make volume of 7 ml, the total volume of drug being 30 ml in each group and concentration of lignocaine 1.5%. The duration of postoperative analgesia and demand for rescue analgesia were the primary outcomes and block characteristics taken as secondary outcome. Results: Sensory and motor block onset times were shorter in Group L than in group LD0.5, LD1 (p < 0.05). Sensory and motor blockade durations were longer in Group LD1 , LD0.5than Group L (p<0.01). Duration of analgesia was longer in Group LD1 than in group LD0.5 and least in Group L (p<0.05). Conclusion: Dexmedetomidine (0.5 µg/kg and 1 µg/kg) as an adjuvant in axillary brachial plexus increases the duration of postoperative analgesia and delays the requirement of first dose of analgesic in a dose dependent manner and 1 µg/kg seems to be the near ideal dose of dexmedetomidine as an adjuvant in axillary block.

Systemic and Local Effects of Warm Oxygen Exposure to the Lower Extremities in Healthy Volunteers

vidya sunil joshi, sunil subhash joshi, Maruthy
Introduction: Warmth to the extremity is known to improve the cutaneous blood flow and tissue perfusion. Oxygen is essential for healing of chronic wounds. Topical oxygen therapy has become standard therapy in management of lower extremity wounds. A combination of local heat and oxygen is likely to be beneficial in many clinical scenarios of non-healing wounds without any systemic effects. Aim: To evaluate the local and systemic effects of the exposure of extremity to warm oxygen in healthy volunteers. Materials and Methods: Thirty one volunteers were included in the study. The index foot was exposed to oxygen 7l/min, 93%-95% concentration at temperature of 43oC for 90 minutes with the device. The following parameters such as basal and periprocedural blood pressure, body temperature, heart rate, 24 lead ECG, temperatures at foot and plethysmographic waveforms from the index foot were measured. A NRS-11 questionnaire was asked to the patient to rate his or her pain from 0 to 10 and documented by health care worker at the end of the session. Results: The skin temperature of index foot reached to 34oC from 32.9oC, (p=0.011). The average pulse amplitude changed from 39.8 mV to 79.8 mV over the duration of the experiment (p< 0.001). Overall heart rate and core body temperature decreased and not much change in blood pressure. Conclusion: The result of the study can be extrapolated to the healing of chronic non healing wounds using warm oxygen therapy. Further studies are required on patient population to prove benefits in clinical settings.

Evaluation of Microleakage with Total Etch, Self Etch and Universal Adhesive Systems in Class V Restorations: An In vitro Study
Introduction: Adhesive dentistry is overwhelmingly evolving with respect to the dental surgeon’s and patient’s perspective. Embracing the concept of minimally invasive dentistry which follows minimum intervention performed to produce good adhesion and tooth coloured restoration, in turn makes the newer generation bonding agents more acceptable and appropriate withstanding the demand for stable restoration. Aim: To study and compare the extent of microleakage between tooth and restoration interface in class V composite resin restorations applying one Total Etch (AdperTM single bond), two Self Etch (AdperTM SE Plus, AdperTM Easy One) and Universal bonding agents using dye penetration method. Materials and Methods: A total of 120 freshly orthodontically extracted human maxillary and mandibular premolars were included in the study. Class V cavities were prepared with a cylindrical diamond bur on the facial surface of each tooth, having approximate dimensions of 3 mm × 2.5 mm × 1.5 mm. Teeth were divided into four groups (30 in each group). Group A AdperTM single bond 2 (3M ESPE), Group B AdperTM SE Plus (3M ESPE), Group C AdperTM Easy One (3M ESPE), Group D AdperTM Single Bond Universal (3M ESPE) bonding agents were applied as per the manufacturer’s instructions and the cavities were then restored with nanohybrid composite resin (Tetric N Ceram Ivoclar Vivadent). Teeth were then thermocycled for 200 cycles at 5°-55°C with 60 seconds of dwell time. Specimens were subjected to a dye leakage test. Microleakage was evaluated using a stereomicroscope. Data was analysed using Kruskal- Wallis, Dunn and Mann-Whitney test to assess the difference in microleakage among various adhesives. Results: The present study revealed that the microleakage was more at the gingival margin when compared with occlusal and this was found to be statistically significant. At the occlusal margin statistical significant difference was found only between AdperTM Easy one and AdperTM SE Plus, on the other hand at gingival margin no statistical significant difference was found. Conclusion: One step self etch agents showed less microleakage than total etches and universal adhesive at occlusal margin. Higher degree of microleakage was observed at gingival margin compared to occlusal margin.

The Effect of Accelerated Aging on the Colour Stability of Composite Resin Luting Cements using Different Bonding Techniques
Introduction: The main criterion of successful aesthetic restoration is to match the colour of the adjacent teeth. Porcelain laminate veneer is widely practiced indirect restoration in the contemporary aesthetic dentistry. The underlying luting cement colour influences the final outcome of the thin, translucent veneer shade. Hence, colour stability of luting cement is important criteria during their selection. Aim: The objective of the study was to assess the colour stability of the different dentin bonding techniques in composite resin luting cements. Materials and Methods: A total of forty intact, non carious teeth were prepared to receive Porcelain Laminate Veneers (PLV). The lithium disilicate PLV were fabricated, and fitting surface was conditioned with 5% hydrofluoric acid and silane application. According to the bonding technique employed for the cementation of the PLV, the teeth samples were randomly divided into the four groups of ten each. The Group I and Group II samples were conditioned with etch and wash; the polymerization of resin was accomplished with the dual cure for Group I and light cure for Group II. The Group III and Group IV samples were conditioned with self-etch and self-adhesive technique correspondingly. The teeth shade was recorded in similar locations with a spectrophotometer before and after subjecting them to the accelerated ageing process. The ageing process included the thermocycling process in water between 5°C and 55°C for 5000 cycles followed by 100 hours xenon light exposure. The data were analysed with SPSS 19.0 by ANOVA and LSD post-hoc comparison. Results: The higher mean colour change was observed in Group I sample (etch washdual cure) with a ?E value of 2.491. The ?E value for Group II (etch wash-light cure) and Group III (selfetch) was 1.110 and 2.357 respectively. The lowest mean colour change was observed in Group IV (self-adhesive) with ?E at 0.614. Statistical analysis showed significant differences between Group IV and Group I; Group IV and Group III with p<0.05. Conclusion: The self-adhesive and etch-wash light cure luting cements were found to be less susceptible for colour changes due to accelerated ageing.

Clinical and Laboratory Profile of Urinary Tract Infections in Type 2 Diabetics Aged over 60 Years
Introduction: Urinary tract infections are frequently encountered among diabetic patients and the incidence rate increases with age. There have been growing research to identify the clinical profile of urinary tract infections in diabetic patients. However, such studies on elderly patients are rare. Aim: To determine the risk factors, clinical/laboratory profiles, causative organisms and antimicrobial susceptibilities in type 2 diabetics aged over 60 years. Materials and Methods: This prospective single centre study was conducted at NRI Medical College and General Hospital, Guntur, India, between November 2012 and November 2014. A total of 100 consecutive patients with type 2 diabetes mellitus, aged over 60 years, with symptoms suggestive of urinary tract infection were examined. Subsequently, the demographic characteristics, detailed medical history, signs/symptoms of urinary tract infections, laboratory investigations for blood and urine samples, ultrasound abdomen findings were compared between bacteriuric and non bacteriuric patients. In addition, the organisms in urine cultures and antibiotic sensitivity patterns were investigated for bacteriuric patients. Two groups were compared using the Mann-Whitney test for continuous variables and the Chi-square or the Fisher’s exact test for categorical respectively. Results: Bacteriuria was found in 43% of type 2 diabetic patients aged over 60 years. Comparative analysis revealed that bacteriuria was more common among patients with female gender (p=0.028), diabetes duration of >15 years (p=0.011) and diabetes complications such as neuropathy (p=0.027) and diabetic foot (p=0.003). Age and uncontrolled fasting blood sugar or HbA1c levels did show an increased propensity for developing urinary tract infections. Increased frequency (76.7%), and urgency (67.4%), dysuria (65.1%) were significantly more common among bacteriuric patients than that in nonbacteriuric patients (p<0.05). Urine culture analysis revealed that E. coli (69.8%) was the most common causative organism, followed by Klebsiella (16.3%). Majority of isolated organisms were sensitive to antimicrobial agents like nitrofurantoin and imipenem. Conclusion: Bacteriuria was very common in elderly patients with diabetes. The observed trends in risk factors, clinical profile, laboratory profile, causative organism patterns, and antimicrobial susceptibilities will help to add the growing literature on this topic.

Immediate Versus Delayed Loading of Implant for Replacement of Missing Mandibular First Molar: A Randomized Prospective Six Years Clinical Study
Introduction: Emergence of dental implants made the replacement of missing tooth easy. During the early days of introduction, implants were loaded three to six months after implant insertion, but understanding of healing cascade and improved production technology has changed the phase of restoration from delayed to immediate loading. Aim: To evaluate and compare the clinical outcome of immediate and delayed loaded implant supported prosthesis for missing mandibular first molar. The objectives were bleeding on probing, probing depth, implant mobility, marginal bone level and peri-implant radiolucency were evaluated during follow up period. Materials and Methods: Twenty patients were included in this study who were in the need of fixed implant supported prosthesis for missing mandibular first molar. Single tooth implant with immediate loading done within two days of implant insertion in one group and another group were loaded after three months of implant insertion. These groups were evaluated clinically and radiographically over a period of 72 months after loading using Wilcoxon matched pairs test and Mann-Whitney U test. Results: The study consists of 14 male and six female patients with the age range of 19 to 31 years. There was no bleeding on probing and probing depth remained well within the normal range even after 72 months of loading among both the groups. Minimal marginal bone loss observed with no mobility and peri-implant radiolucency. Conclusion: Implant supported prosthesis for missing mandibular first molar with immediate loading can be used as a successful treatment modality. It reduces treatment time, provides early function and prevents undue migration of adjacent tooth. Immediate loading showed similar clinical and radiographic results as that of delayed loading, indicating it as an equally efficient technique for implant supported prosthesis.

Comparative Evaluation of Two Bis-GMA Based Orthodontic Bonding Adhesives - A Randomized Clinical Trial
Introduction: Of the various orthodontic bonding materials, orthofix is a fairly new entrant into this field. This material was exclusively introduced for orthodontic bonding purposes; however, the application of this material for orthodontic purpose has not been scientifically evaluated so far. Aim: The aim of the present study was to evaluate by an in-vivo double blinded split mouth rando mized clinical trial, the overall bond failure rates of two Bis-GMA based composite materials namely Transbond XT and Orthofix. Materials and Methods: Thirty three participants who fulfilled the inclusion criteria were randomly allocated by lottery method into two groups. Group A participants had maxillary right and the mandibular left quadrants bonded using Orthofix and the remaining quadrants were bonded using Transbond XT. In Group B, the quadrants were reversed. Both groups were followed for a period of six months and were reviewed every 3-4 weeks. If a bond failed, the details were recorded and the duration of treatment before each breakage was calculated. Data were analyzed using Independent t-test and chi-square test. (p< 0.05) at 90% power. Results: The overall bond failure rate for 263 brackets was 2.7% for Orthofix and 3.6% for Transbond XT. The mean esitmated survival time was 221.58 days for Transbond XT and for Orthofix was 220.07 days. The difference between these mean values were statistically insignificant (p>0.05). Similarly, failure rates of the anterior and posterior segment were compared and no difference was observed between the groups (p>0.05). The maxillary and mandibular teeth were compared and more failures were found in the mandibular teeth among both the groups but they were not statistically significant (p>0.05). Conclusion: The overall bond failure rate and mean survival time for Transbond XT was similar to Orthofix with no statistically significant difference.

Functional Results of Communited Intra-articular Distal Humerus Fractures Treated with Bicolumnar Plating
Introduction: Communited intra-articular distal humerus fractures are commonly encountered in orthopaedic practice and they are present with unique difficulties for internal fixation. This problem is especially worse in the elderly due to osteoporotic bone. Aim: To evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population. Materials and Methods: Sixty three consecutive patients operated with bicolumnar plating for communited intra-articular distal humerus fractures at the tertiary care centre were identified in the time period between 2009 and 2013. All patients had an age more than 60 years at the time of surgery. A minimum follow up of two years post surgery was a mandatory criteria. The Disabilities of Arm and Shoulder and Hand (DASH) score and the Mayo Elbow Performance (MEP) score calculated along with complete range of motion. Results: The mean follow-up was 38 months. All patients achieved fracture union with mean MEP and DASH scores being 85 ± 15.5 and 21.4 ± 4.9 respectively. These scores although poor were comparable to the opposite side (90 and 12.2 respectively). Also the mean supination-pronation arc and flexion-extension arc was 156 degrees and 105 degrees respectively. This is well within the functional range of elbow. The mean block to extension was at 15 degrees with a mean maximal flexion of 120 degrees. Conclusion: Our study conclusively establishes that excellent functional outcome can be achieved with open reduction and internal fixation in Type C distal humerus fractures in elderly including the ones that are communited. Total elbow arthroplasty although a viable option, gives similar results to a well done internal fixation with added cost.

Anxiety Levels among Five-Year-Old Children Undergoing ART Restoration - A Cross-Sectional Study
Introduction: Atraumatic Restorative Treatment (ART) involves manually excavating the carious part of the tooth and restoring the prepared cavity with chemically adhesive restorative material [Glass Ionomer Cement (GIC)] and it may induce and/or impact the dental anxiety in children. It is well established that ART procedure is less anxiety producing when compared with other restorative procedures using dental drill. Aim: The aim of this study was to evaluate the anxiety levels among five-year-old children undergoing ART restoration in I.T.S. Dental College, Greater Noida, India. Materials and Methods: A sample of 50, five-year-old children visiting the Outpatient Department (OPD) of ITS Dental College, Greater Noida was selected for ART treatment using Fuji IX GIC. Modified Venham Anxiety Scale based on their behaviour and heart rate of the children were measured and recorded before, during and after the ART procedure. Heart rate was measured using Radial Pulse examination method. Chi-square test was used and tests were conducted using IBM SPSS software (ver.20.0; IBM, Chicago, IL, USA). Results: Before the ART treatment, heart rates and Modified Venham Anxiety Scores of majority of children were higher than that after the treatment. A p-value was statistically significant (0.028 and 0.048 respectively) for association of gender with heart rate and Modified Venham’s score before the ART treatment. No statistically significant relation was found between the variables during and after the ART treatment. Conclusion: The level of anxiety for ART treatment in children was higher before the treatment than that during and after the treatment. There is a correlation between the gender of children and their level of anxiety for ART treatment.

Comparative Diagnostic Utility of IS6110 PCR Assay in CSF and Peripheral Blood Samples of Tuberculous Meningitis Patients: A Pilot Study from Central India
Introduction: Tuberculous Meningitis (TBM) is the most severe form of Central Nervous System Tuberculosis (CNS-TB) and constitutes about 6% of all Extrapulmonary TB (EPTB) cases. Most guidelines for the diagnosis and management of TBM agree on the use of simple Cerebrospinal Fluid (CSF) analysis using molecular tools like Polymerase Chain Reaction (PCR). However, the sensitivity of PCR varies while using a CSF sample. In the present study, we have compared the diagnostic utility of PCR assay in both peripheral blood and CSF sample collected from TBM cases. Aim: To evaluate the application of the peripheral blood PCR assay as an alternate tool for TBM diagnosis compared to conventional CSF-PCR based system. Materials and Methods: A total of 50 TBM patients were prospectively recruited from in patient department wards of Central India Institute of Medical Sciences (CIIMS) between January 2014 - Feburary 2015. Mycobacterium tuberculosis (MTB) specific IS6110 PCR and BactT liquid culture were performed in 20 of recruited cases classified as Stage 1, 2 and 3 based on British Medical Research Council (BMRC) contemporary clinical criteria for the severity of TBM. Clinical characteristics were summarised in terms of percentages for categorical variables, i.e., age groups, gender, signs and symptoms. All statistical analysis was carried out using MedCalc software version 11.6. Results: Overall IS6110 PCR positivity in CSF was around 80% (16/20), which was higher than culture (29.3%) and peripheral blood (39%). Out of 8 positive cases, stage wise positivity of peripheral blood PCR assay in three TBM stages was 0% (stage1) 50% (stage 2) and 67% (Stage 3) respectively. Positivity of peripheral blood PCR was significantly more (86%) in patients with CSF culture/ IS6110 PCR positive for MTB infection with sensitivity and specificity of 50 and 100% respectively. Increased positivity rates of peripheral blood PCR was observed with decreased CSF/Blood sugar ratio in stage 3 cases, suggesting enhanced probability of mycobacterial blood dissemination in cases of TBM severity. Conclusion: Our results suggest that although the molecular diagnosis of TBM infection in CSF remains the method of choice, peripheral blood based PCR can be used as a good alternative to CSF in case of TBM severity where the repeated CSF collection may be needed. However, study demands further validation in large cohorts to justify the present hypothesis..

Analgesic Effect of Intra-articular Morphine or Dexmedetomidine Added with Levobupivacaine in Arthroscopic Knee Surgeries - A Comparative Evaluation

Rajat Kumar Agarwal, Yashwant Singh Payal, Gaurav Chopra, Atul Agrawal
Introduction: Knee arthroscopy is associated with variable amount of postoperative pain. In an attempt to improve postoperative analgesia, intra-articular injection of local anaesthetic in combination with other agent have been studied. However, the best combination is not known. Aim: To compare the analgesic efficacy of intra-articular injection of morphine and dexmedetomidine when added with levobupivacaine in arthroscopic knee surgeries. Materials and Methods: Seventy eight patients, scheduled to undergo elective arthroscopic procedure under spinal anaesthesia were recruited for the study. All the patients received 18 ml of 0.25% levobupivacaine however in addition to this Group M patients received 8 mg (2 ml) morphine, Group D patients received 100µg (2 ml) of dexmedetomidine while Group C patients received 2 ml of isotonic saline intraarticularly. Postoperatively the intensity of pain was assessed using Numerical Rating Scale (NRS). Rescue analgesia was given at NRS = 4. The duration of analgesia and total diclofenac consumption was noted. Results: The mean duration of analgesia was longest in Group M (576.20±67.09 minutes) followed by Group D (460.93±38.95 minutes) and Group C (370.27±58.80 minutes) statistically this difference was found to be highly significant (p-value < 0.001). Total consumption of diclofenac in 24 hours was found lowest in group M (86.25±27.48 mg) followed by group D (110.87±44.48 mg) and group C (141.35±44.13 mg) this difference was found to be highly significant (p-value < 0.001). Conclusion: Morphine when added with levobupivacaine in patients undergoing arthroscopic knee surgery improves the quality and prolongs the duration of postoperative analgesia.

Gastroesophageal Reflux Disease and its Association with Body Mass Index: Clinical and Endoscopic Study
Introduction: Obesity is rapidly becoming a pandemic and poses a serious health risk to the individuals. Abdominal obesity is quite common in India and is a prime risk factor for diseases like diabetes, coronary artery disease, Gastroesophageal Reflux Disease (GERD), osteoarthritis etc. A complex and multifactorial aetiopathogenesis of GERD exists in presence of obesity. The current study focuses on high Body Mass Index (BMI), a marker of obesity, as a risk factor for GERD and aims for a better understanding of their complex association. Aim: To study the association between the BMI and symptoms as well as gross endoscopic appearance of GERD. Materials and Methods: A prospective cross-sectional study was carried out at a tertiary care hospital in Maharashtra, India, between January 2016 and June 2016. A total of 176 patients referred for upper Gastrointestinal (GI) endoscopy due to dyspeptic symptoms of more than two months duration were selected. BMI (weight in kilograms/square of height in metres) was calculated for all patients and they were classified as normal weight (BMI 18.5 -24.9), overweight (BMI 25-29.9) and obese (BMI=30). The frequency and severity of GERD symptoms was assessed by a self-administered questionnaire. Data on typical and atypical symptoms of GERD was collected. Upper GI endoscopy was done on all patients. Based on gross endoscopic appearance, the disease was divided as Endoscopy Negative Reflux Disease (ENRD) and true GERD (as per Los Angeles staging system). Association between BMI and frequency, severity and type of symptoms of GERD and also between BMI and gross endoscopic oesophagitis was studied using various statistical tests. All tests were two-tailed with a confidence level of 95%. A p-value < 0.05 was considered to be statistically significant. Results: Typical symptoms of heartburn and acidic regurgitation were present in 71.6% subjects. The frequency and the severity of the dyspeptic symptoms increased significantly with increasing BMI (p<0.05). Based on the endoscopic gross appearance of the oesophageal mucosa, 48.3% participants had ENRD and 51.7% had erosive disease (GERD). High BMI had a statistically significant relationship with occurrence of both ENRD and GERD (p<0.05) but a statistically insignificant relationship with LA classification system for endoscopic oesophagitis. Conclusion: The prevalence, frequency and severity of symptoms of GERD increases with increase in the BMI. Erosive oesophagitis has significant correlation with increasing BMI, but the staging and classification of endoscopic erosive oesophagitis is independent of the BMI of the patients.

Effect of Dexmedetomidine Versus Fentanyl on Haemodynamic Response to Patients Undergoing Elective Laparoscopic Surgery: A Double Blinded Randomized Controlled Study

Lovina Neil, Ashok Patel
Introduction: Dexmedetomidine, an a2 agonist, can be used as an adjuvant in general anaesthesia as it attenuates the stress response to various noxious stimuli and helps in maintaining the perioperative haemodynamic stability along with sedation and not causing any significant respiratory depression in the postoperative period. Aim: To study the difference in haemodynamic responses of dexmedetomidine and fentanyl in patients undergoing laparoscopic surgery. Materials and Methods: Sixty patients were divided into two groups of 30 each randomly. In Group F, fentanyl 0.5 µg/kg as loading dose over 10 minutes prior to induction followed by 0.2-0.7 µg/kg/hr as maintenance dose and in Group D, Dexmedetomidine 0.5 µg/kg as loading dose over 10 minutes prior to induction followed by 0.2 µg/kg/hr-0.7 µg/kg/hr as maintenance dose till surgery was over. Haemodynamic variables and Visual Analogue Scale (VAS) scores were recorded continuously. Postoperative sedation and recovery were assessed by modified Ramsay sedation score. Results: Systolic Blood Pressure (SBP) fell by 9% in Group-D as compared to no fall in Group F during intubation. After intubation, 9% increase is seen in Group D v/s 19% in Group F. During the period of pneumoperitoneum upto 5 minutes post extubation, the SBP in Group D was significantly lower as compared to Group F rest duration, the difference was not significant between both groups. Heart Rate (HR) remained stable throughout the study except at laryngoscopy when it rose. Heart rate was similar in both groups at intubation, decreased by 3.51% in Group D as compare to 11.11% rise in Group F. Post intubate on, heart rate fell by 2% in Group D vs 15% rise in Group F. Diastolic Blood Pressure (DBP) remained higher than baseline than throughout the study. After intubation, 3% higher in Group D where as 15% in Group F increase was seen. In intraoperative period the difference between both groups was not significant. There was significant difference between two groups at 10 minutes, 45 minutes of pneumoperitoneum. End Tidal CO2 (ETCO2) was similar in both groups. Conclusion: Dexmedetomidine is better drug as compared to fentanyl for maintaining the haemodynamic response during intubation and intraoperative period.

Evaluation of Masood’s and Modified Masood’s Scoring Systems in the Cytological Diagnosis of Palpable Breast Lump Aspirates

Smrithi Krishna Cherath, Savithri Moothiringode Chithrabhanu
Introduction: Fine Needle Aspiration Cytology (FNAC) has a leading role in the assessment of breast lesions. Masood’s Scoring Index (MSI) and its modification (Modified Masood’s scoring index; MMSI) has been proposed to aid in sub-grouping breast lesions and to help in subsequent management. Aim: To assess and compare the diagnostic accuracy of MSI and MMSI by subsequent correlation with histopathology. Materials and Methods: The study was cross-sectional in nature and was conducted in a tertiary care setting. The study included 207 cases presenting as palpable breast lump, which had undergone FNAC and subsequent excision biopsy for histopathology. Statistical Analysis: The cases were grouped into four categories as suggested by Masood et al., (MSI) and Nandini et al., (MMSI) and concordance analysis with reference to histopathological diagnosis was done. Results: In comparison to MSI, MMSI showed better concordance with histopathological diagnosis and superior diagnostic accuracy in non-proliferative breast disease category (p-value = 0.046) as well as in proliferative breast disease without atypia category. The overall diagnostic accuracy of the cytological scoring was 97.5%, with 94.5% sensitivity and 100% specificity. Conclusion: Though both MSI and MMSI were found effective in subcategorizing breast lesions, MMSI was found to have better concordance with histopathology. Inclusion of cellular pattern and background material may further help in increasing the accuracy.

AUDIT (Alcohol Use Disorders Identification Test) to Estimate the Pattern and Correlates of Alcohol Consumption among the Adult Population of West Bengal, India: A Community Based Cross-sectional Study

Arkaprabha Sau
Introduction: Pattern of alcohol consumption substantially changed in India with in last 20 to 25 years. Excessive alcohol consumption is a major risk factor for various morbidity and mortality. So, scientific study to identify alcohol consumption patterns and its correlates will be helpful to formulate preventive strategies. Aim: To estimate the pattern of alcohol consumption and to determine its correlates, among the adult population of the state of West Bengal in India. Materials and Methods: A community based cross-sectional study was conducted among the adult population of the state of West Bengal at Gram Panchayat (GP) level. Ninety-nine (n=99) adult (= 18 years) men and women of Guchati GP at Paschim Medinipur district, was selected using Lot Quality Assurance Sampling (LQAS) technique. The study participants were interviewed using a pre-designed and pre-tested schedule. Results: It was estimated that the prevalence of low risk drinking or abstinence (Zone I) was 65.5% (95% CI 55.5% to 75.5%) and the prevalence of alcohol use in excess of low-risk (Zone II) was 17.6% (95% CI 7.6% to 27.6%), and the prevalence of harmful and hazardous drinking (Zone III) was 8.5% (95% CI 0% to 18.5%) and the prevalence alcohol dependence (Zone-IV) was 8.4% (0% to 18.4%). Logistic regression model shows that “gender” (p = 0.00) and “employment status” (p = 0.01) added significantly to the model with adjusted odds ratio of 82.27 (95% CI 18.17-372.58) and 0.13 (0.03–0.66). Conclusion: There is a need for comprehensive screening and treatment programme to deal with the problems of Alcohol Use Disorders among adults to achieve good health and well being for sustainable development.

Disorders Affecting Quality of Life During Pregnancy: A Qualitative Study

Farideh Kazemi, Fatemeh Nahidi, Nourossadat Kariman
Introduction: Pregnancy is a special condition which results in unique physiological responses which is more than any other physiological event and it increase stress in women’s body. Information about the changes experienced by pregnant women in physical, psychological, and social areas is limited, indicating that the quality of life and changeable areas in pregnant women require more attention. Aim: This study was aimed to identify the disorders affecting the quality of life during pregnancy. Materials and Methods: A qualitative study was performed with the conventional content analysis approach. Participants included 16 pregnant women who were recruited using purposive sampling and performed with maximum variety. The semi-structured in depth interview started face to face with the general question and was followed with specific questions. The interviews were conducted in Fatemieh Hospital in Hamadan, Iran. Data analysis and data collection were conducted concurrently and the interviews were continued until achieving data saturation. Results: Five main categories emerged in this study including “psychological disorders of pregnancy”, “disorders of activities”, “body-image disorder”, “disorders in sexual intercourse” and “physical disorders” that were analyzed revolves common around of disorders affecting quality of life. Conclusion: Pregnancy can have undesirable effects on various aspects of women's lives in their point of view and lead to a decreased life quality. Therefore, it is essential in prenatal care. In addition to addressing the physical aspects of maternal health, other aspects are also evaluated, and in case of any disorder, the necessary consultation should be done.

A Comparative Analysis of Two Different Dose Fractionation Regimens of High Dose Rate Intracavitary Brachytherapy in Treatment of Carcinoma of Uterine Cervix: A Prospective Randomized Study
Introduction: High Dose Rate (HDR) intracavitary brachytherapy is an integral component in treatment of carcinoma uterine cervix. There is no consensus about optimal fractionation in HDR brachytherapy. Aim: To assess the feasibility, tolerability of HDR intracavitary brachytherapy schedule of 8 Gy per fraction per week for 3 fractions over 6Gy per fraction per week for 4 fractions with or without chemotherapy in the treatment of carcinoma of uterine cervix. Materials and Methods: From 2013 to 2014 total 80 patients with carcinoma of the uterine cervix (Stages IIB and IIIB) were treated with External Beam Radiotherapy (EBRT) and High Dose Rate Intracavitary Brachytherapy (HDR- ICBT). During course of EBRT, those patients fit for brachytherapy were randomized to arm A- 6 Gy per fraction per week for 4 fractions and arm B - 8 Gy per fraction per week for 3 fractions. Results: The median follow up was 30 months, local control was 90% in Arm A and 83.3% in Arm B (p= 0.21) and the diseasefree survival was 90% in Arm A and 83.3% in Arm B (p= 0.39). There is no significance difference for late rectal and bladder toxicities between two arms (p=0.43). Conclusion: Taking into account of increased hospital burden of locally advanced cancer cervix patients in Indian context, HDR intracavitary brachytherapy schedule of 8 Gy per fraction per week x 3 fractions is the preferable option over 6 Gy per fraction per week x 4 fractions with regard to comparable loco-regional control, acute and late toxicity, disease free survival and better patients compliance to lesser fractionation schedule.

Nature of Hard Tissues in Oral Pathological Lesions –Using Modified Gallego´s Stain
Introduction: Histological stains are dyes that bind to various tissues. Special stains form an integral part of routine histopathology as an adjunct to Haematoxylin and Eosin (H&E), and give meaningful diagnostic information of the tissues available. By using routine histological procedure like H&E alone, it is difficult to differentiate the various hard tissues present in the oral pathological lesions. Modified Gallego’s stain can be used as one of the differential stain for these hard tissues. Aim: To differentiate various hard tissues of teeth and to identify the presence of hard tissue components in different oral pathological lesions using Modified Gallego’s stain under light microscope. Materials and Methods: A total sample of 20 cases, amongst which 10 were human extracted teeth and 10 oral pathological lesions were included. From 10 human extracted teeth, five ground sections and five decalcified sections were prepared. From pathological lesions, two slides of each lesion were prepared. All the sections were stained with Modified Gallego’s stain and viewed under light microscopy. Results: In properly stained slides, cementum stained red, dentin and bone stained green and enamel stained pink in colour. Conclusion: Modified Gallego’s stain can be used as a differential stain for various hard tissues in oral pathological lesions and also for ground sections for which histochemical stains are very rare.

Comparison of Steroid and Itraconazole for Prevention of Recurrence in Allergic Fungal Rhinosinusitis: A Randomized Controlled Trial

Moirangthem Rojita, Swagatika Samal, Pradeep Pradhan, VP Venkatachalam
Introduction: Posterior paranasal sinuses consisting of posterior ethmoid and sphenoid sinuses show varying pneumatization and relationship to Optic Nerve Canal (ONC). Most commonly ONC is superolateral to sphenoid sinus, however varied protrusion of ONC into the sinuses may occur. Rarely it may pass completely through the sinus. Optic Nerve (ON) is covered by a thin bony layer or by periosteum and sinus mucosa without bone. Extensive pneumatization of sphenoid sinus and bony dehiscence predisposes to ON injury. The posterior ethmoid cell namely the Onodi cell is of great surgical importance when the ON is along its lateral wall and surrounds the nerve. These varied relations imply that a detailed knowledge of the intimate relationship of ONC with the posterior paranasal sinuses is necessary to avoid unintentional complications during the surgeries involving the ONC region. Aim: To assess relationship of ONC to the posterior paranasal sinuses in Indian Ethnic study group. Materials and Methods: Retrospective review of 100 paranasal sinus Computed Tomography (CT) scans were done using 64 row Multi Detector Computed Tomography (MDCT). Multiplanar reformation images were assessed for ONC relation to posterior ethmoid and sphenoid sinuses, wall dehiscence, and Pneumatization of Anterior Clinoid Process (PACP). Results: 200 optic nerve canals were assessed and grouped into four types based on the modification of Delano et al., classification. The most common OCN was Type-1 (60%), followed by Type-2 (15%), Type-3 (14%) and Type-4 (11%). Dehiscence was seen in 35(17.5%) mostly in Type-3 canals. PACP was seen in 30 (15%). Conclusion: Knowledge of ON relationship to posterior paranasal sinuses will reduce the devastating complications during sinus surgeries. Our modified ONC classification is based on the bony canal morphology and the degree of protrusion into sinuses. As with other reported studies worldwide, Type-1 ONC is the commonest among the Indians also. Type-2 and 3 ONC with sinus wall dehiscence and PACP are the most important anatomical variations which may potentially predispose to risk of surgical injury to the optic nerves.

The Study of Cognitive Change Process on Depression during Aerobic Exercises
Introduction: Several studies have shown that aerobic exercise is effective in treating the depression and improving the mental health. There are various theories which explains why aerobic exercise is effective in the treatment of depression and improve mental health, but there are limited studies to show how cognitive components and depression improve during aerobic exercises. Aim: The current study was carried out to investigate the cognitive change process during aerobic exercises in depressed students. Materials and Methods: This study was conducted through structural equation modeling; the study sample included 85 depressed students. Participants were selected through purposive sampling method. Beck Depression Inventory (BDI-II), Automatic Negative Thoughts (ATQ), and the Dysfunctional Attitude Scale (DAS) were used as the data collection instruments. The participants received eight sessions of aerobic exercise (three times a week). The obtained data was analysed by AMOS-18 & SPSS 18 software. Results: The results showed that depression (p=0.001), automatic thoughts (ferquency p=0.413, beliefs p=0.676) and dysfunctional assumptions (p=0.219) reduce during aerobic exercise; however, it was only meaningful for the depression. The casual and consequential models were not fit to the data and partially and fully interactive models provided an adequate fit to the data. Conclusion: Fully interactive model provided the best fit of the data. It seems that aerobic exercise reduced cognitive components separately leading to reduce depression.

Clinicopathological Evaluation of 223 Cases of Mature Cystic Teratoma, Ovary: 25-Year Experience in a Single Tertiary Care Centre in India

Ruchi Rathore, Sonal Sharma, Deepshikha Arora
Introduction: Mature Cystic Teratoma (MCT) is the most common benign neoplasm of the ovary constituting 10-20% of all the ovarian tumours. Although, much has been published about ovarian teratomas, in English literature, there are very few retrospective cross sectional studies from India to understand the epidemiology of the disease. Aim: To evaluate the prevalence, clinicopathological characteristics and complications of MCT of the ovary. Materials and Methods: This was a retrospective study of 223 cases of MCT of ovary received over a period of 25 years from 1990 to 2014. The data regarding age, size, laterality, gross, morphological features, complications and surgery performed was retrieved from the archives of pathology department. Descriptive statistics was performed using SPSS software version 22 and the results were expressed as percentages. Results: MCT constituted 20.2% of the total ovarian neoplasms and 78.5% of all the germ cell tumours. The mean age of the patients with MCT was 32.5±13.11 years and the mean size of tumour was 8.6±3.1 cm. Torsion was the most common complication of these tumours. Malignant transformation of this tumour though rare was seen in 3.5% of the cases. Conclusion: MCT are most common tumours of the ovary. Though predominantly seen in reproductive age group, they may also be seen in children and postmenopausal women. Torsion is the most common complication of this tumour. Age of the patient and the size of the tumour are important prognostic factors in terms of malignant transformation of teratomas. Since 8.9% of these tumours were bilateral it is essential to thoroughly examine the contralateral ovary to rule out bilaterality. Early diagnosis and early treatment is essential to preserve fertility in these patients.

Accuracy and Precision of Measured Blood Sugar Values by Three Glucometers Compared to the Standard Technique
Introduction: The prevalence of diabetes mellitus has magnified, globally. Being cost effective and user friendly, using the glucometer systems has become more widespread. However, despite their advantages, there are controversies regarding their accuracy and precision. Aim: To determine the accuracy and precision of the common glucometers of Bionime, Accu-check, and Beurer compared with the laboratory technique. Materials and Methods: In a cross-sectional study, 257 patients of a general internal unit of Imam Reza hospital of Kermanshah were recruited. The blood sample of the subjects was transferred to the laboratory, then, two samples of capillary blood were tested by the three glucometers. The data was entered into a checklist, then entered to SPSS-16.0 software, and analyzed by descriptive and inferential statistics. Results: In this study, there was a positive correlation between the three blood glucose measurement methods with the standard approach, significantly, which indicates acceptable accuracy. However, this correlation was higher in the Beurer Glucometer (r=0.976, p<0.001). There were no significant differences in repeated measurements of blood glucose in the glucometers of Beurer (t=0.96, p=0.92), and Bionime (t=0.50, p=0.61) by paired t-test, but this test was significant for Accu-chek system (t=2.7, p=0.006). Conclusion: With respect to the acceptable accuracy and precision of Beurer and Bionime glucometers, it is suggested to use these methods for diabetic patients at homes as well as in the hospital units.

Prevalence of Autonomic Neuropathy in Patients of Rheumatoid Arthritis and Its Correlation with Disease Severity

Devika Aggarwal, Sumeet Singla
Introduction: Autonomic Neuropathy (AN), found to be a strong predictor of sudden cardiac death, has been reported variably in patients with Rheumatoid Arthritis (RA). Manifesting as sweating disturbances, gastrointestinal irregularities, bladder or erectile dysfunction, AN can significantly affect a patient’s quality of life and alter the course of the disease. Aim: This study was undertaken to find out the prevalence and severity of AN in RA patients attending the Rheumatology Clinic at a Tertiary Care Hospital in New Delhi, India and also to investigate its correlation with patient and disease factors such as age, gender, disease severity, duration and serological status. Materials and Methods: In this cross-sectional study, AN was assessed subjectively by a survey of autonomic symptoms. Cardiac autonomic involvement was assessed by five cardiovascular reflex tests as described by Ewing: Heart Rate (HR) response to deep breathing, standing, and Valsalva and Blood Pressure (BP) response to standing and sustained handgrip. Results: A total of 31 RA patients and 31 age and sex matched healthy volunteers were recruited. Upon analysis it was found that the prevalence of cardiac AN was significantly higher in patients (80.65%) as compared to controls (51.61%) (p=0.016). Positive correlation with disease severity was observed with the patient reported questionnaire but not with the objective cardiovascular reflex tests. No significant correlation between grade of AN and patient’s age, gender, disease duration or serological status was established. Conclusion: At the end of the study, it was concluded that the pathological mechanisms responsible for autonomic dysfunction are more active in RA as compared to others.

Pentazocine Alone Versus Pentazocine Plus Diclofenac for Pain Relief in the First 24 Hours after Caesarean Section: A Randomized Controlled Study
Introduction: Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. Aim: To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. Materials and Methods: This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05. Results: The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value =0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value=0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value=0.05). Conclusion: The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.

Evaluation of Interdental Spaces of the Mandibular Posterior Area for Orthodontic Mini-Implants with Cone-Beam Computed Tomography
Introduction: The use of mini-implants has increased in recent years because of their role in absolute anchorage, but the placement sites may affect the success or failure of the procedure, so it is very important to determine the appropriate and safe location for orthodontic mini-implants. On the other hand, the Cone Beam Computed Tomography (CBCT), which offers clear 3-Dimentional (3D) images, has been widely used in orthodontics and implant dentistry for surgical guidance of mini-implant placement. Aim: The aim of this retrospective study was to evaluate inter-radicular spaces between mandibular canines to second molars using cone beam 3D images. Materials and Methods: In this retrospective cross-sectional descriptive study, maxillofacial CBCT scan data were obtained from 40 adults. The 3D images were evaluated in five axial sections at 2, 4, 6, 8 and 10 mm from the cementoenamel Junction (CEJ). To determine inter-radicular spaces, tangent lines were drawn buccolingually to the roots in axial section and the minimum distance between these two lines was measured. The data was analysed using Friedman test with SPSS(ver.13). Results: Interradicular spaces of canine to second molar increased from cervical to apical direction. The maximum distance was recorded at 4 mm from the CEJ between first and second molars. Conclusion: According to our findings there is a distinct pattern of inter-radicular space changes in mandible. Attention to this pattern during placement of mini-implants can ensure the safety of the procedure.

HER2/neu Testing In 432 Consecutive Breast Cancer Cases using FISH and IHC - A Comparative Study
Introduction: The development of trastuzumab, a HER-2/neu targeted monoclonal antibody resulted in significant improvements in clinical response and survival in HER-2/neu gene amplified group of patients. Thus, accurate assessment of HER-2/neu status becomes critical. Fluorescence In Situ Hybridization (FISH) and Immunohistochemistry (IHC) are the most commonly used methods for this purpose and specific recommendations exist with regard to the concordance to be observed between the two tests. Aim: Here, we report and evaluate the concordance rate between FISH and IHC for HER-2/neu status in breast cancer specimens. Materials and Methods: Archival paraffin blocks of tumour tissue from 450 patients of breast cancer were analyzed for Her-2/neu status using FISH and IHC. Results: There was a highly significant concordance between the results of FISH and IHC assays in HER-2/neu status assessment in invasive breast cancer cases. There were inverse associations between the expression of Oestrogen Receptors/Progesterone Receptors (ER/PR) and HER-2/neu amplification. Conclusion: Although, IHC gave significant concordant results with FISH in determining HER-2/neu status, its subjective grading system precludes its use as a gold standard. FISH should always be used to determine true gene amplification when the IHC results are equivocal.

Ultrasound Guided Percutaneous Injection of Thrombin: Effective Technique for Treatment of Iatrogenic Femoral Pseudoaneurysms

Atul Mishra, Akhilesh Rao, Yayati Pimpamlwar
Introduction: Arterial pseudoaneurysms are well known iatrogenic complication of percutaneous angiographic or interventional vascular procedures. In the past, the definitive treatment option was open surgical repair which is a relatively invasive procedure. In the last few years, Ultrasound (US) guided percutaneous thrombin injection has been gaining popularity as definitive treatment of pseudoaneurysms. Aim: To evaluate efficacy and safety of US guided percutaneous injection of thrombin for treatment of iatrogenic femoral pseudoanurysms at a tertiary care interventional radiological and cardiology centre. Materials and Methods: A retrospective analysis was conducted on 38 consecutive patients, diagnosed to have iatrogenic femoral artery pseudoaneurysms by Doppler study, in the period from Jan 2013 to Jun 2016. All these patients were treated by US guided percutaneous injection of thrombin solution inside the pseudoaneurysm sac till contents became echogenic and flow inside the pseudoaneurysm stopped completely. One month further follow up in all these patients was done. Results: The dose of thrombin injected varied from 200-1000 IU (mean 300 IU). Immediate thrombosis was seen in all the pseusdoaneurysms. Follow up at 24-48 hours showed complete thrombosis and regression of pseudoaneurysm in all the patients except one in whom a small residual sac was seen which thrombosed completely on second thrombin injection. Further follow up at one month showed regression of aneurysms in all the cases. No significant post procedural clinically significant complications were seen in any of the patients. Conclusion: US guided percutaneous thrombin injection is a highly successful and safe procedure for the treatment of iatrogenic femoral pseudoaneurysms.

The Efficacy of Mindfulness-Based Cognitive Therapy on Resilience among the Wives of Patients with Schizophrenia

Kamal Solati
Introduction: The wives of patients with schizophrenia experience high levels of stress due to their spouses' disease, which leads to certain problems and decreased adaptability and efficiency in them. Aim: This study investigated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) on resilience in schizophrenia patients. Materials and Methods: In this quasi-experimental study, 40 wives of patients with schizophrenia (20 assigned to experimental group and 20 to control group) whose husbands were kept in rehabilitation centers for mental disorders were enrolled according to convenience sampling. In the experimental group, the therapeutic protocol of MBCT was conducted. Accordingly, the patients were encouraged to process the experiences in a non-judgmental manner as they have been formed, and to change their relationship with and embrace challenging thoughts and feelings. Meanwhile, the control group underwent no intervention. The research instrument was Connor-Davidson Resilience Scale. Data were analysed by ANCOVA in SPSS 16. Results: At post-test, mean resilience score of the experimental group (77.95±4.71) was much higher than that of the control group (71.75±5.81). There was a significant difference in the mean resilience score at post-test between the experimental and control groups (p<0.05). Conclusion: Training MBCT strategies was effective on resilience in the wives of schizophrenia patients. Therefore, this approach can be incorporated into mental health-related interventions for the families of patients with psychiatric disorders such as schizophrenia.

Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents
Introduction: Self esteem is more of a psychological concept therefore, even the common dental disorders like dental trauma, tooth loss and untreated carious lesions may affect the self esteem thus influencing the quality of life. Aim: Thus, this study aims to assess the impact of dental disorders among the adolescents on their self esteem level. Materials and Methods: The present cross-sectional study was conducted among 10 to 17 years adolescents. In order to obtain a representative sample, multistage sampling technique was used and sample was selected based on Probability Proportional to Enrolment size (PPE). Oral health assessment was carried out using WHO type III examination and self esteem was estimated using the Rosenberg Self Esteem Scale score (RSES). The descriptive and inferential analysis of the data was done by using IBM SPSS software. Logistic and linear regression analysis was executed to test the individual association of different independent clinical variables with self esteem. Results: Total sample of 1140 adolescents with mean age of 14.95 ±2.08 and RSES of 27.09 ±3.12 were considered. Stepwise multiple linear regression analysis was applied and best predictors in relation to RSES in the descending order were Dental Health Component (DHC), Aesthetic Component (AC), dental decay {(aesthetic zone), (masticatory zone)}, tooth loss {(aesthetic zone), (masticatory zone)} and anterior fracture of tooth. Conclusion: It was found that various dental disorders like malocclusion, anterior traumatic tooth, tooth loss and untreated decay causes a profound impact on aesthetics and psychosocial behaviour of adolescents, thus affecting their self esteem.

Estimation of DMFT, Salivary Streptococcus Mutans Count, Flow Rate, Ph, and Salivary Total Calcium Content in Pregnant and Non-Pregnant Women: A Prospective Study

Wasim Ismail Kamate, Nupura Aniket Vibhute, Rajendra Krishna Baad
Introduction: Pregnancy, a period from conception till birth, causes changes in the functioning of the human body as a whole and specifically in the oral cavity that may favour the emergence of dental caries. Many studies have shown pregnant women at increased risk for dental caries, however, specific salivary caries risk factors and the particular period of pregnancy at heightened risk for dental caries are yet to be explored and give a scope of further research in this area. Aim: The aim of the present study was to assess the severity of dental caries in pregnant women compared to non-pregnant women by evaluating parameters like Decayed, Missing, Filled Teeth (DMFT) index, salivary Streptococcus mutans count, flow rate, pH and total calcium content. Materials and Methods: A total of 50 first time pregnant women in the first trimester were followed during their second trimester, third trimester and postpartum period for the evaluation of DMFT by World Health Organization (WHO) scoring criteria, salivary flow rate by drooling method, salivary pH by pH meter, salivary total calcium content by bioassay test kit and salivary Streptococcus mutans count by semiautomatic counting of colonies grown on Mitis Salivarius (MS) agar supplemented by 0.2U/ml of bacitracin and 10% sucrose. The observations of pregnant women were then compared with same parameters evaluated in the 50 non-pregnant women. Paired t-test and Wilcoxon sign rank test were performed to assess the association between the study parameters. Results: Evaluation of different caries risk factors between pregnant and non-pregnant women clearly showed that pregnant women were at a higher risk for dental caries. Comparison of caries risk parameters during the three trimesters and postpartum period showed that the salivary Streptococcus mutans count had significantly increased in the second trimester, third trimester and postpartum period while the mean pH and mean salivary total calcium content decreased in the third trimester and postpartum period. These changes reflected on the DMFT score which increased in the third trimester and postpartum period. Conclusion: The results of this study suggest that there is a definite correlation between pregnancy and dental caries. We conclude that the third trimester and postpartum period of pregnancy are the periods during which the pregnant women are at a higher risk for development of dental caries

Optic Nerve Canal Relation to Posterior Paranasal Sinuses in Indian Ethnics: Review and Objective Classification
Introduction: Posterior paranasal sinuses consisting of posterior ethmoid and sphenoid sinuses show varying pneumatization and relationship to Optic Nerve Canal (ONC). Most commonly ONC is superolateral to sphenoid sinus, however varied protrusion of ONC into the sinuses may occur. Rarely it may pass completely through the sinus. Optic Nerve (ON) is covered by a thin bony layer or by periosteum and sinus mucosa without bone. Extensive pneumatization of sphenoid sinus and bony dehiscence predisposes to ON injury. The posterior ethmoid cell namely the Onodi cell is of great surgical importance when the ON is along its lateral wall and surrounds the nerve. These varied relations imply that a detailed knowledge of the intimate relationship of ONC with the posterior paranasal sinuses is necessary to avoid unintentional complications during the surgeries involving the ONC region. Aim: To assess relationship of ONC to the posterior paranasal sinuses in Indian Ethnic study group. Materials and Methods: Retrospective review of 100 paranasal sinus Computed Tomography (CT) scans were done using 64 row Multi Detector Computed Tomography (MDCT). Multiplanar reformation images were assessed for ONC relation to posterior ethmoid and sphenoid sinuses, wall dehiscence, and Pneumatization of Anterior Clinoid Process (PACP). Results: 200 optic nerve canals were assessed and grouped into four types based on the modification of Delano et al., classification. The most common OCN was Type-1 (60%), followed by Type-2 (15%), Type-3 (14%) and Type-4 (11%). Dehiscence was seen in 35(17.5%) mostly in Type-3 canals. PACP was seen in 30 (15%). Conclusion: Knowledge of ON relationship to posterior paranasal sinuses will reduce the devastating complications during sinus surgeries. Our modified ONC classification is based on the bony canal morphology and the degree of protrusion into sinuses. As with other reported studies worldwide, Type-1 ONC is the commonest among the Indians also. Type-2 and 3 ONC with sinus wall dehiscence and PACP are the most important anatomical variations which may potentially predispose to risk of surgical injury to the optic nerves.

Effectiveness of Various Endodontic Irrigants on the Micro-Hardness of the Root Canal Dentin: An in vitro Study
Introduction: Irrigating solutions used for the elimination of micro-organisms during root canal preparation may affect the chemical and the physical properties of dentin thereby rendering the tooth more susceptible to fracture. Therefore careful and judicious selection of irrigant is required which have maximum benefits with minimum undesirable properties. Aim: The aim of the present study was to evaluate the effect of various endodontic irrigants on the micro-hardness of the root canal dentin. Materials and Methods: This in vitro study was carried out on eighty freshly extracted mandibular premolars with single canals. They were decoronated at the cemento-enamel junction. Roots were sectioned longitudinally into two halves. They were then polished and placed in autopolymerised resin moulds with the polished surface facing outside. The samples were divided into four groups based on the irrigants in which they were immersed i.e., 3% Sodium Hypochlorite (3% NaOCl), 17% Ethylene Dioxide Tetra Acetic Acid (17% EDTA), 0.2% Chitosan and 6% Morindacitrifolia Juice (MCJ) for 15 minutes each. All the specimens were then subjected to micro-hardness testing using a Vickers micro-hardness tester. Statistical analysis was done using one way Analysis of Variance (ANOVA), Post-Hoc Tukey test and Paired t-test to compare the pre and post immersion micro-hardness values of the selected samples. Results: The results of the present study indicated that 17% EDTA and 0.2% Chitosan, significantly decreased the micro-hardness of root dentin whereas 6% MCJ and 3% NaOCl had no significant effect on the microhardness before and after immersing in the irrigants. Conclusion: A 6% MCJ and 3% NaOCl which have significant antibacterial, antifungal, anti-inflammatory and smear layer removing properties showed negligible effect on the micro-hardness of root canal dentin making them suitable endodontic irrigating solution.

Study of Glycated Haemoglobin (HbA1c) In Non-Diabetic Subjects with Subclinical Hypothyroidism
Introduction: India has the higher prevalence of prediabetes, diabetes and hypothyroidism. Subclinical Hypothyroidism (SH) is more prevalent in the females than in the males. Studies have shown the elevated HbA1c in the non-diabetic hypothyroid patients. SH is defined by normal serum triiodothyronine (T3), thyroxine (T4) levels and serum Thyroid Stimulating Hormone (TSH) level falling between 4.2 to 10 mU/L. Aim: To study the HbA1c level in the non-diabetic SH patients and to compare the HbA1c level with the controls. Materials and Methods: This case-control study was conducted on 200 subjects. A total of 100 subjects of the SH without diabetes were selected on the basis of the serum TSH (> 4.2 to < 10 mU/L), Fasting Blood Sugar (FBS) (< 110 mg/dl) level and another 100 age and sex matched normal healthy individuals were selected as the control. The HbA1c levels were measured using Immunoturbidimetry method in the Cobas Integra 400 plus. An independent t-test is applied to find out the statistically significant difference in the level of HbA1c in the case and the control groups. Results: Subjects with the non-diabetic SH had a significant higher level (5.70±0.35 %) of the HbA1c than the controls (5.26±0.17 %) (p<0.0001). There was no significant difference between the cases and the controls for the age, sex, FBS, vitamin D3, Haemoglobin (Hb), serum T3 and serum T4 levels. Conclusion: Our data suggest that the non-diabetic subjects with SH show misleadingly high levels of the HbA1c. Therefore, the effect of altered levels of the serum TSH on the HbA1c must be considered when interpreting the HbA1c for the diagnosis of diabetes in the SH patients.

Imaging Evaluation of Enhancement Patterns of Flat Gall Bladder Wall Thickening and Its Correlation with Clinical and Histopathological Findings
Introduction: Gall bladder Wall Thickening (GWT) is caused by wide spectrum of diseases. Initially Ultrasound (USG) was used as imaging modality for screening of acute abdomen because of its high sensitivity and real time character. Now, Computed Tomography (CT) is used because of its high temporal and spatial resolution. Aim: Evaluation of GWT and its enhancement patterns on contrast enhanced CT scan in a bid to differentiate benign from malignant causes and to correlate the imaging features with clinical and histopathological findings. Materials and Methods: It was a hospital based prospective study in which USG was done as an initial modality for screening and Multi Detector Computed Tomography (MDCT) scan was done later on for detailed evaluation of enhancement patterns of GWT. The study cases were then divided into five CT patterns according to enhancement patterns. The diagnostic performance of MDCT was compared with histopathological and serological findings. Relevant history, clinical examination and routine investigations were done. Results: The one layered pattern with a heterogeneously enhancing thick layered pattern (Type 1) was significantly associated with gall bladder cancer (p<0.001). The sensitivity and specificity of Type 1 enhancement pattern on CT for predicting the Gall Bladder (GB) malignancy were 90.476% and 97.43% respectively. The positive and negative predictive values were 95% and 95%, respectively. Focal wall thickening, irregular margin character and hepatic infiltration by GWT and lymphadenopathy were other findings that predict malignancy (p-value<0.05). Conclusion: MDCT enhancement patterns of a thickened GB wall and associated findings were helpful in differentiating malignant GWT from benign GWT

Determination and Validation of a Lower Cut Off Value of Cerebrospinal Fluid Adenosine Deaminase (CSF-ADA) Activity in Diagnosis of Tuberculous Meningitis

Raviraj, Renoy A Henry, G. Ganapathi Rao
Introduction: Tuberculous meningitis is an infection of the meninges caused by Mycobacterium tuberculosis. It is one of the most common infectious diseases of the Central Nervous System (CNS) and a major health problem in developing countries like India. If there is delay in diagnosis and initiation of specific treatment, it causes significant morbidity and mortality. CSF-ADA 10 U/l is the standard cut off value that is used for differentiation between Tuberculous (TBM) and Non-Tuberculous Meningitis (non-TBM). Aim: To determine and validate a lower cut off value for CSF-ADA for diagnosing TBM in an Indian setting. Materials and Methods: This was a prospective study involving 85 cases of meningitis whose CSF were analysed and ADA estimated using an enzymatic deamination assay kit. Diagnosis of various types of meningitis was made based on specified diagnostic criteria. The comparison of mean value of CSF- ADA activity of the two types of meningitis was done using two Sample t-test. A p-value of <0.05 was considered as significant. Cut off value to differentiate between TBM and non-TBM meningitis was determined using ROC curve analysis. Results: The CSF-ADA activity of TBM and non-TBM cases was compared. The mean CSF-ADA activity was found to be significantly higher in TBM patients (10.97±4.43; Mean±SD) than in non-TBM patients (5.09±1.53) which was statistically significant with a p-value of <0.001. A cut off value of 6.65 was calculated using ROC curve for the diagnosis of TBM which gave a sensitivity of 85.3% and a specificity of 84.3% for differentiating TBM from non-TBM. The positive predictive value was 78.3% and negative predictive value of 89.5% using the above cut off. The positive likelihood ratio was 5.44 and negative likelihood ratio of 0.17 when this lower cut off value was applied. Conclusion: This study has demonstrated that CSF-ADA can be used as an important diagnostic tool in early diagnosis of TBM using a cut off value of 6.65. This cut off value gave a good sensitivity and specificity in differentiating it from non-TBM.

Antibacterial Effects of Garlic Extracts and Ziziphora Essential Oil on Bacteria Associated with Peri-Implantitis
Introduction: Peri-implantitis is an inflammatory process, characterized by loss of bone around implants and bleeding on probing. Colonization of bacteria in the pocket created around the implant is one of the most important aetiologic factors involved. Although antibiotics are routinely used and are effective agents against this bacterial infection, due to the side effects and drug resistance of these medications, researchers are more interested in using herbal derivatives. There are relatively limited number of studies in this respect. Aim: To evaluate and compare the antibacterial effects of the extracts of Allium sativum and Ziziphora clinopodioides essential oil on S. aureus and P. aeruginosa. Materials and Methods: In this in vitro study conducted at Tabriz University of Medical Sciences between March 2016 and July 2016, aqueous and methanolic extracts of garlic and ziziphora essential oil were prepared and then their effects on one standard strain of P. aeruginosa and two standard strains of S. aureus and 18 clinical strains, (nine strains of P. aeruginosa and nine strains of S. aureus) which had been isolated from wound and blood cultures, were evaluated using the reference broth macro dilution method and disk diffusion technique. Data were evaluated with descriptive statistical techniques and t-test for independent groups, using SPSS 17. Results: Aqueous and methanolic extracts of garlic did not exhibit inhibitory effects on S. aureus and P. aeruginosa. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) for ziziphora essential oil against S. aureus were 0.25 and 0.5 µg/mL, respectively. The mean diameter of growth inhibition zone for S. aureus in the ziziphora essential oil group (0.25µg/mL) and Vancomycin group (10 µg/mL) were 26.09±5.8 and 14.63±1.20 mm respectively (p<0.001). Growth inhibition zone for P. aeruginosa were observed in only one (35 mm) and three cases (12.5±3.4 mm) in the ziziphora essential oil group (0.5 µg/mL) and Nalidixic acid group (10 µg/mL) respectively. Conclusion: The essential oil of ziziphora exhibited a favourable antibacterial effect on S. aureus; therefore, its extract can be used as an effective antimicrobial agent alone or in association with other antibiotics in the treatment of infections due to S. aureus.

The Importance of Liver-Fatty Acid Binding Protein in Diagnosis of Liver Damage in Patients with Acute Hepatitis

Ozlem Ozer Cakir, Aysun Toker, Huseyin Ataseven, Ali Demir, Hakki Polat
Introduction: Acute hepatitis is acute inflammation of liver elicited by a large number of causes. It sometimes spontaneously recovers, sometimes may progress to chronic hepatitis. LiverFatty Acid Binding Protein (L-FABP) is a small protein that is abundant in hepatocytes, and which binds most of the longchain fatty acids present in the cytosol. Aim: The present study was aimed to investigate the levels of serum and urine L-FABP in acute hepatitis and diagnostic value of serum and urine L-FABP levels in patients with acute hepatitis. Materials and Methods: The present study included a total of 85 patients. Total number of patients with acute hepatitis were 17 (five of acute hepatitis B, one of acute hepatitis A, two of acute hepatitis C, five of autoimmune hepatitis and four of toxic hepatitis), 19 of hepatic encephalopathy, 29 of liver cirrhosis, and 20 controls were included. Serum and urinary L-FABP levels were analyzed by the Enzyme-Linked Immunosorbent Assay (ELISA). Results: Serum L-FABP levels were 9110±3352.5, 9410±1355, 9715±2462 and 3672±982.5 ng/l in patients with acute hepatitis, hepatic encephalopathy and cirrhosis and control subjects, respectively. There were statistically significant positive correlations between serum levels of L-FABP and Aspartate Aminotransferases (AST), Alanine Aminotransferases (ALT), Creatinine (Cre) and Gamma Glutamyl Transferases (GGT) (p<0.001, p<0.001, p<0.001 and p<0.001, respectively). While the cut-off value of serum L-FABP for all of the patients was 5183 ng/l {p<0.001 and Area Under Curve (AUC) 0.985}, the sensitivity and specificity were 95.4% and 100%, respectively. Positive and negative predictive values for serum L-FABP were 100% and 87%, respectively. Conclusion: Serum and urine L-FABP may be a new diagnostic marker for liver damage in patients with acute hepatitis. However, our study showed that except of aminotransferases, L-FABP should be used for diagnosis of liver damage in patients with acute hepatitis, chronic hepatitis and also cirrhosis.

Significance of Platelet Volume Indices in STEMI Patients: A Case-Control Study
Introduction: Platelets have been well known contributors in the pathogenesis of cardiovascular disorders such as atherosclerosis and its complications such as acute Myocardial Infarction (MI). Aim: To study the changes in platelet volume indices and platelet count in ST-Elevated Myocardial Infarction (STEMI) and assess their usefulness in predicting coronary events. Materials and Methods: A case-control observational study was carried out on 173 cases diagnosed with STEMI and 191 controls from January 2015 to December 2015, considering the inclusion and exclusion criteria. In total, 364 patients were included, 173 patients with STEMI, from those patients admitted to the intensive care unit and the emergency ward. In addition, 191 healthy non diabetic non hypertensive age-matched controls were enrolled. Results: The mean age of cases was 59.4±11.9 years and of controls were 55.25±8.5 years. Males (74.6%) had higher incidence of STEMI then females (25.4%). The Mean Platelet Volume (MPV) was significantly higher in patients with STEMI (10.2±2.8) as compared to controls (8.5±6.9). The Platelet Distribution Width (PDW) was also significantly higher in cases compared to controls (p<0.05). According to Pearson correlation analysis, the positive relationship determined between MPV and Gensini score was statistically significant (p < 0.001, r = 0.132). Conclusion: High MPV and PDW seem to be an independent risk factor for STEMI and correlated with the severity of the STEMI. They can be used as a simple, reliable, and economical method for predicting an impending acute coronary event.

Relationship between Maternal General and Specific-Pregnancy Stress, Anxiety, and Depression Symptoms and Pregnancy Outcome

Parvin Hasanjanzadeh, Mahbobeh faramarzi
Introduction: Despite scientific advances in the field of physical problems during pregnancy, the effect of mental problems on the health of pregnant women is still an important issue that needs further research. Aim: To determine the association of symptoms of stress, anxiety and depression during pregnancy and there effect on the pregnancy outcome. Materials and Methods: This was a descriptive correlational. The population included 200 pregnant women of the urban and rural health centers affiliated with Babol University of Medical Sciences. There were hundred each in second and third trimester. Convenience multi stage cluster sampling was performed. Data collection was received through the Hospital Anxiety Depression Scale (HADS), Pregnancy Distress Questionnaire (PDQ), and Perceived Stress Scale (PSS-14) questionnaires. Results: The correlation results showed a significant difference between variables of depression, stress, and anxiety with birth weight, birth height and head circumference and infants’ Apgar score (p<0.05). Multiple regression analysis showed that interpersonal relationships on prediction of infant weight (B=-0.324), anxiety on prediction of infant height (B=-0.197), stress on prediction of head circumference (B=-0.350) and depression on prediction of Apgar score (B=0.323) are effective (p<0.001). Conclusion: The findings emphasize the need to identify women with depression, anxiety and stress in pregnancy, and scheduling to avoid adverse consequences of the pregnancy outcome.

Effect of Ranolazine in Patients with Chest Pain and Normal Coronaries- A Hospital Based Study
Introduction: There is an important role of coronary microcirculation in the clinical presentation and prognosis of patients who have typical chest pain despite normal epicardial coronary arteries (microvascular angina). Treatment of these patients is empirical because of the incomplete knowledge of its cause. Limited data has shown that ranolazine reduces angina and improves exercise performance in such patients with frequent angina. Aim: To evaluate the effect of ranolazine in patients with chest pain and normal epicardial coronaries (micro-vascular angina). Materials and Methods: Sixty-five patients with anginal symptoms with abnormal exercise stress test and normal epicardial coronaries were enrolled for the study. All participants had baseline demographic and health history questionnaires, including Seattle Angina Questionnaire (SAQ) and Duke Activity Status Index (DASI). After enrolment, patients were randomly divided into two groups. One group (group 1) was assigned to ranolazine for six weeks along with other indicated anti-anginal drugs. The other group (group 2) was assigned to anti-anginal drugs other than ranolazine. Patients were reassessed for symptomatic and functional improvement (SAQ, DASI) at six weeks. Results: Mean age of patients examined were 49.03 years in group 1 and 49.77 years in group 2. Approximately 42.9% of patients in group 1 and 40% in group 2 were male. Despite current anti-anginal therapy, patients in both the groups were symptomatic. At six weeks, 60% of patients in group 1 had angina as compared to 88.6% at baseline (p<0.05). Similarly, scores of domains of SAQ were higher at six weeks as compared to baseline (p<0.05) except for treatment satisfaction. No improvement of DASI score and functional capacity were seen in either group at six weeks as compared to baseline (p>0.05). At six weeks, angina was significantly lower in group 1 as compared to group 2 (60 % vs 86.7%; p<0.05). Four out of five SAQ subscale score were higher in ranolazine group as compared to the other group (p<0.05). Treatment satisfaction trended lower on ranolazine group (p<0.05). There was no significant differences in DASI in the two groups (DASI score 30.59 vs 29.85, p>0.05). Conclusion: Ranolazine is safe and improves symptoms significantly in patients with micro-vascular angina.

Physicochemical Characteristics of Rat Muscle Glycogen Fractions

Zahra Ghafouri, Mehdi Rasouli
Introduction: Homogenization of animal tissues with cold Perchloric Acid (PCA) produces two fractions of glycogen, Acid Soluble Glycogen (ASG) and Acid Insoluble Glycogen (AIG). Aim: To determine some physicochemical characteristics of muscle glycogen fractions in two groups of rat. Materials and Methods: An experimental study was conducted on two groups of five male rats. Rats in control group were kept at rest and in case group on 30 minutes physical activity. The content of carbohydrate, protein, phosphate, index and relative Molecular Weights (MWs) were determined for glycogen fractions. Results: Total glycogen decreased following muscular activity (1.40±0.08, mg/g wet muscle vs. 0.97±0.11, p<0.05) and the change occurred totally in ASG (1.02±0.07 vs. 0.57±0.07, p=0.017), whereas, AIG changed insignificantly (0.39±0.05 vs. 0.36±0.02, p=0.5). The protein content of AIG was about 5.5 times of ASG fraction. The ratio of carbohydrate to protein was 0.33±0.01 (mg/mg) in ASG and decreased to 0.19±0.02, p=0.01 after 30 minute activity. This ratio in AIG was about 6% of ASG fraction and did not change significantly during physical activity. The ratio of phosphate to protein was three times in ASG relative to AIG at rest and did not change following activity. The index of molecular weight was calculated for each fraction of glycogen as the ratio of concentration per osmolality (mg/mmol). The index was 1.82±0.02 for ASG at rest and decreased significantly to 1.07±0.12, p<0.05 following 30 minutes activity. The index did not change significantly for AIG fraction (0.56±0.05 vs. 0.48±0.10, p=0.4). The relative MW of the fractions of ASG to AIG was 3.3±0.3 at rest and decreased significantly to 2.2±0.6, p<0.05 following 30 minutes activity. Conclusion: Two fractions of muscle glycogen, ASG and AIG, differ in the relative carbohydrate: protein content and ASG have a higher mean of MW and is more metabolic active form.

Gap between the Expectations and Perceptions of Students regarding the Educational Services Offered in a School of Nursing and Midwifery

Fariba Asefi, Masoumeh Delaram, Fatemeh Deris
Introduction: Awareness of students’ opinions about the various aspects of training provided is an essential factor to evaluate the quality of education. Aim: The aim of this study was to determine the gap between the students’ expectations and perceptions from the educational services provided to them in the School of Nursing and Midwifery in Shahrekord University of Medical Sciences. Materials and Methods: In this cross-sectional study, 320 students were selected by stratified random sampling method and data were collected by SERVQUAL questionnaire to examine the areas of assurance, responsiveness, empathy, tangibles and confidence. Data analysis was conducted by descriptive (frequency, percentage, mean±SD) and analytical (paired t-test, independent t-test and One-Way ANOVA) statistics in SPSS 20. Results: The mean scores of the students’ expectations and perceptions of the educational services delivered to them were 4.34±0.63 and 3.56±0.68, respectively, with a significant, negative gap (–0.77±0.77, P<0.0001). The lowest gap of quality was derived for assurance (-0.65) followed by reliability (-0.69), accountability (-0.74), and empathy (-0.81), and the greatest gap observed in tangibles (-0.96). Conclusion: A negative gap was observed between the students’ expectations and perceptions of the quality of educational services delivered to them. This means that the quality of services delivered to students was less than what they expected. The highest gap was related to the tangibles. In order to improve the educational services, paying attention to different areas of quality of educational services, especially, the tangibles, is necessary.

Auxanographic Carbohydrate Assimilation Method for Large Scale Yeast Identification
Introduction: The auxanographic carbohydrate assimilation had been an important method for differentiation of yeasts. Prevailing methods described in the literature for carbohydrate assimilation has limited scope for use in large scale yeast identification. Aim: To optimize the large scale auxanographic carbohydrate assimilation method for yeast identification. Materials and Methods: A modified auxanographic carbohydrate assimilation method was developed and a total of 35 isolates of Candida species comprising of four ATCC (American Type Culture Collection) Candida strains (Candida albicans ATCC 90028, Candida tropicalis ATCC 90018, Candida parapsilosis ATCC 750, Candida krusei ATCC 6258) and 31 clinical isolates of Candida tropicalis (n=13), Candida krusei (n=7), Candida glabrata (n=3), Candida kefyr (n=3), Candida albicans (n=5) were validated. The carbohydrates tested were Glucose, Sucrose, Maltose, Lactose, Cellubiose, Raffinose, Trehalose, Xylose, Galactose and Dulcitol. Results: A total of 35 Candida species were tested for their carbohydrate assimilative property and the results were consistent with the existing standard protocols. A well circumscribed opaque yeast growth indicated assimilation of the test carbohydrate and translucent to opalescent growth with the outline of initial inoculum alone indicated lack of assimilation. The control plate indicated no growth of the Candida species. Conclusion: The carbohydrate assimilation tests finds utility for yeast diversity studies exploring novel ecological niches. The technique described here facilitates testing of an extended range of carbohydrates and yeasts in a cost effective manner.

Dexmedetomidine as an Additive to Spinal Anaesthesia in Orthopaedic Patients Undergoing Lower Limb Surgeries: A Randomized Clinical Trial Comparing Two Different Doses of Dexmedetomidine

Arati Rai, Meyong Pincho Bhutia
Introduction: Use of dexmedetomidine as an additive to spinal anaesthesia is gaining popularity; but there seems to be no clear consensus on the ideal dose to be used. Because of dose related prolongation of duration of motor blockade along with increase in the incidence of side effects of dexmedetomidine namely hypotension and bradycardia, use of higher doses is not recommended. Aim: To evaluate the efficacy of two different doses of dexmedetomidine (3 µg and 5 µg) given in combination with 0.5% hyperbaric bupivacaine via intrathecal route with regard to the quality of anaesthesia namely the time to attain highest sensory and motor blockade, side effects of dexmedetomidine and time to first rescue analgesia. Materials and Methods: Sixty American Society of Anaesthesiologist (ASA) Grade I and II orthopaedic patients undergoing lower limb surgeries between the ages of 20-60 years and height >150 cm were randomly divided into two groups of 30 patients each: Group D3 to receive 3 µg of Inj. Dexmedetomidine (0.5 ml, reconstituted using normal saline) along with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and Group D5 to receive 5 µg of inj. Dexmedetomidine (0.5 ml, reconstituted using normal saline) along with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine keeping the total volume of study drug constant in all 60 patients (3 ml). Data recordings were done for time to reach best sensory and motor block, intraoperative haemodynamic changes and time to first postoperative rescue analgesia. Statistical analysis was done using students t-test and Chi-square test with p-value of <0.05 considered to be significant. Results: The two groups analysed were similar in terms of demographic profile, time to reach highest sensory block (T10) dermatome, time to reach Bromage scale 4, time to surgical incision after spinal and the total duration of surgery (p>0.05). The change in haemodynamics was similar (p>0.05). A statistically significant difference (p<0.001) was observed in time to first rescue analgesia after skin closure with Group D3 having 206.47 minutes while in Group D5 the time was 271.33 minutes. Conclusion: Used in a dose of 5 µg (in 0.5 ml volume) as an additive in spinal anaesthesia maximal beneficial effect of dexmedetomidine can be obtained without any side effects.

Association Between Serum Cystatin C and Creatinine in Chronic Kidney Disease Subjects Attending a Tertiary Health Care Centre

Janice DSa, Sukanya Shetty, Roopa Rani Bhandary, Ashalatha V Rao
Introduction: Chronic Kidney Disease (CKD) is an emerging health problem due to the increasing prevalence of conditions like diabetes mellitus and hypertension. Most patients are diagnosed during the later stages of CKD when the clinical symptoms become apparent. There is a need for early diagnosis to prevent disease progression and associated morbidities. Serum Creatinine (SCr) is commonly used among clinicians to determine renal function. However, SCr is affected by several factors and cannot be entirely relied upon. In pursuit of an alternative indicator of renal function, several biomarkers have been discovered and their utility in prompt diagnosis has been evaluated. Among such biomarkers, serum cystatin C (SCysC) has been extensively studied. Aim: To determine and compare the levels of SCr and SCysC in CKD subjects across various severity groups based on estimated Glomerular Filtration Rate (eGFR). Materials and Methods: The study comprised of 120 CKD subjects. SCr was estimated by modified Jaffe’s method and SCysC was estimated by particle enhanced immunoturbidimetric method. Estimated GFR (eGFR) was determined using Chronic Kidney Disease Epidemiology collaboration (CKD EPI) 2009 creatinine based formula. Based on eGFR, CKD subjects were further categorized into four groups. Statistical analysis was done using SPSS. Data were represented as median and interquartile range. Kruskal Wallis test was used for comparison between more than two groups. Correlation was done using Pearson’s test. Statistical significance was considered as p <0.05. Results: Both SCr and SCysC levels increased significantly across CKD groups (p<0.001). In CKD subjects with eGFR = 60 ml/min/1.732 m2, the median value of SCr (1.01 mg/dl) was well within the normal range while median value of SCysC (1.34 mg/l) was found to be more than the upper reference limit. A positive correlation was present between SCysC and SCr (r=0.875, p<0.001). Both SCysC (r=-0.736) and SCr (r=-0.719) had a negative correlation with eGFR (p<0.001). Conclusion: SCysC is useful in detecting individuals with CKD having mild decrease in GFR compared to SCr. Both SCr and SCysC levels increase with decrease in eGFR. SCysC may be used to screen patients with poorly controlled diabetes mellitus or hypertension when SCr level is inconclusive.

A Goal Unrealized: Patient Empowerment on Hand Hygiene- A Web-Based Survey from India

S. Vijayalakshmi, S. Ramkumar, K.A. Narayan, P. Vaithiyanathan
Introduction: Each year, millions of patients around the world are affected by Health Care Associated Infections (HCAIs). Understanding and assessing the global burden of HCAI is one of the key areas of work to improve the hand hygiene. Aim: To assess the patient empowerment and awareness on hand hygiene among online users. Materials and Methods: A web-based cross-sectional survey was conducted during September 2013 to December 2013 among adults. A predesigned questionnaire to assess the awareness on hand hygiene was sent to volunteers through emails and social networking sites. The data were transferred to excel sheet and analyzed in Epi info and represented in proportions and percentages. Results: Total 94 (57%) participants responded to the survey among which 51.1% were males and 48.9% were females. Majority of them belongs to the age group of 20 to 35 years. Only 28.7% of them said they will ever ask health care worker to wash their hands before they examine. A 27.7% of the participants reported that their country/community have a program that educates/communicates with patients about the importance of hand hygiene. Conclusion: Adherence and compliance to hand hygiene practices is suboptimal among people. There seems to be a lack of knowledge regarding hand hygiene

The Effect of Metoclopramide Addition to Lidocaine on Pain of Patients with Grades II and III Post-Episiotomy Repair
Introduction: Episiotomy is the most common procedure used for dilatation of the vaginal opening for giving birth. Although episiotomy is associated with benefits for the mother, it may lead to short term and long term disabilities, including postpartum perineal pain that is secondary to perineal tearing. Aim: The aim of this study was to investigate the effect of subcutaneous lidocaine compared with lidocaine and metoclopramide on pain after episiotomy. Materials and Methods: In this clinical trial study, the patients (83 for control group and 83 for case group) with episiotomy Grades II and III were enrolled and were asked to express their postpartum episiotomy pain as a number, from zero (no pain) to 10 (severest pain) Visual Analogue Scale (VAS score) at 0, 30 minute, 1 hour, 2 hour, 4 hour, 6 hour and 12 hour postpartum. Patients at the second stage of labour (crowning) were assigned to two groups: In the control group, 5 cc lidocaine 2% and in the case group, 5 cc lidocaine + 10 mg metoclopramide was injected for episiotomy. Then, the pain score was compared between the two groups. The data were analyzed by t-test and chi-square test with software SPSS version 20.0. Results: Mean age of the women was 23.19±0.46 years in the control group and 23.96±0.58 years in the case group with no significant difference between the two groups (p<0.05). The mean pain score in the control group was 3.54±0.71 and in the case group 2.93±0.91 at 30 minutes after the injection, with a statistically significant difference. At other intervals, postnatal pain scores in the case group was lower than those of the control group (p<0.05). Conclusion: Injection of metoclopramide with lidocaine is more effective than lidocaine alone for relieving the pain after episiotomy.

Effect of Diclofenac Mouthwash on Postoperative Pain after Periodontal Surgery

Ashank Mishra, Jyotsna Amalakara, Haritha Avula, Krishnajaneya Reddy
Introduction: Non-Steroidal Antiinflammatory Drugs (NSAIDs) are widely used drugs for the management of pain. Oral administration of NSAIDs has various adverse events like gastrointestinal alterations - nausea, dyspepsia and gastrointestinal bleeding, hepatotoxicity and blood dyscrasias. As orally given NSAIDs are associated with systemic side effects, it is preferred to alleviate pain and inflammation using topical medication. Thus, recently the focus has been on the development of topical administration of NSAIDs in the form of gels, toothpastes and rinses. Aim: To determine if diclofenac mouthwash, would be a better alternative to its systemic administration post surgery, in terms of patient acceptance and to minimize the adverse effects of orally administered drug. Materials and Methods: The study was designed as a single blinded, randomized, controlled clinical trial. Thirty chronic periodontitis patients scheduled for full mouth flap surgeries were randomized to receive either Diclofenac Mouthwash (MW) or Diclofenac Tablets (TB), post surgery. The MW group patients (15) were advised to rinse undiluted 15 ml solution for 30 secs, twice daily for three days. TB group (15) was advised to take 50 mg tablet twice daily for three days. A 10 point Visual Analog Scale (VAS) and Wong Baker Facial Rating Scale (FRS) was recorded to measure the pain perception by the patients. Gingival status was assessed by the Modified Gingival Index (MGI) at Baseline and seventh day. Data pertaining to pain perception were analysed using repeated measures of ANOVA (Analysis of Variance) with post-hoc LSD test. Results: Intra group comparisons showed a significant reduction in pain, post surgery. Inter group comparisons showed a significant reduction only in the MGI scores of MW group, when compared to TB group. Intergroup comparisons showed no significant reduction in pain scores between both the groups, stating that diclofenac mouthwash is as effective as oral administration. Conclusion: Diclofenac mouthwash is a better alternative to the systemic administration post surgery, in terms of patient acceptance and to minimize the adverse effects of orally administrated drug.

Keeping up with Dental Literature: A Study on Continuing Professional Development among Dental Practitioners in Hubli-Dharwad, India
Introduction: Continuing Professional Development (CPD) refers to skills and knowledge attained for both personal development and career advancement. In India, very few studies have been documented to discover the patterns of information update by dental practitioners. Aim: To discover the educational tools that dentists of Hubli - Dharwad, Karnataka, India, prefer for updating their knowledge on new therapeutic methods and to assess the perceived usefulness of these CPD activities. Materials and Methods: Face to face interview was carried out using questionnaire comprising questions on various CPD activities among all the practicing dentists. Pearson’s chi-square test was used to evaluate any association between the frequency of information update and perceived usefulness with gender, qualification, practice types and academic attachments. Results: Out of 112 practicing dentists in Hubli-Dharwad, 104 consented for the study. Mean age group of the study population was 32.3±7.56 (SD) years. Discussion with colleagues and discussion with medical sales representatives were the most frequently utilized information sources. On the other hand, attending dental fairs was found to be the most rarely utilized method of information access. Discussion with colleagues, reading textbooks and accessing internet were rated as most useful CPD activities and discussion with sales representatives and attending dental fairs were rated as least useful CPD activities. Conclusion: Both conventional methods of information sources like discussions with colleagues and textbook reading as well as contemporary information sources like accessing internet were the preferred methods of information update by dental practitioners of Hubli-Dharwad.

Comparative Assessment of Canal Transportation and Centering Ability of Reciproc and One Shape File Systems Using CBCT-An In Vitro Study
Introduction: Root canal preparation leads to deviation of the canal anatomy causing canal transportation which affects the success of the treatment. Cone Beam Computed Tomography (CBCT) is a non invasive imaging technique to analyse the shape of the root canal before and after the preparation. Aim: The purpose of this study was to investigate and evaluate the canal transportation in curved mandibular molar root canals and centering ability of Reciproc and One Shape file systems after instrumentation using CBCT. Materials and Methods: Twenty mandibular molars were taken and allocated into two groups (n=10): Group 1-One Shape and Group 2-Reciproc. The canals were then scanned using CS 3D CBCT scanner (Carestream) before and after preparation, to assess the transportation and centering values at different levels respectively from the apex. The data gathered were then assessed statistically with Mann-Whitney test. Results: Analysis revealed that Reciproc and One Shape showed statistically no significant difference in terms of canal transportation and centering ability (p>0.05). Conclusion: One shape and Reciproc performed similar in terms of canal transportation & centering ability.

Financial Burden of Out-of-Pocket Expenditures for Primary Health Care in Hilly Areas of Garhwal Region, Uttarakhand, North India

Arti Gupta , B Venkatashiva Reddy , Vandana Semwal , Amit Kumar Singh
Introduction: High total health expenditures via Out-of-Pocket (OOP) as formal user fees and informal payments put India in challenging situation to achieve towards universal health coverage. Aim: To assess the (OOP) expenditure and its determinants among outpatient in primary care settings of Uttarakhand, North India. Materials and Methods: A hospital based cross-sectional study was conducted in a Outpatient Department of Urban Health Training Centre, Srinagar, Uttarakhand, India and Rural Health Training Centre, Kritinagar, Uttarakhand in 2015. A total of 200 patients were enrolled in the study using random sampling. Questionnaire covering costs like: travel cost, drug cost, investigation cost, and others was used for measuring OOP expenditure incurred toward health care by patients. Results: Of the total 200 patients, 43.5% were males and 56.5% were females with mean age 40.36 (SD 19.45) in years. Average annual family income was 11718.5 INR+13457.3 INR. Of the total study subjects, 42.5% were unskilled or had no occupation (unemployed, student, and homemaker). The majority (68.5%) had travelled less than or equal to 10 km to reach the health facility. About 50% of the study subjects presented with communicable diseases and 20% with non-communicable diseases. The health expenditure of the outpatient revealed that major part of the expenditure is the direct cost of the treatment, including registration fee, drugs, and investigation. Mean OOP expenditure for drugs and investigations was 509 INR and 673.1 INR, respectively. Mean total out-of-patient expenditure was 303.1 INR. The proportion of monthly family income spent on out-of-patient expenditure was 2.58%. Conclusion: The implementation of primary health care needs to be further strengthened in order to improve access of public sector hospitals for curative care.

A Qualitative Study of Knowledge, Attitude and Practice towards Pharmacovigilance among Doctors and Nursing Staff in a Tertiary Care Hospital in India

Bharat Gajjar, Nazima Mirza, Alpa Gor, Malkesh Mistry, Nishal Shah
Introduction: Pharmacovigilance is the branch of science that deals with the detection, assessment, understanding and prevention of adverse reactions to medicines (i.e., adverse drug reactions or ADRs). The purpose of pharmacovigilance is to implement the safe and rational use of medicines, which ultimately helps in improving patient care. Aim: To investigate the Knowledge, Attitude And Practice (KAP) of clinicians, residents and nursing staff towards pharmacovigilance and Adverse Drug Events (ADE) reporting and to identify possible reasons for underreporting and to receive suggestions to improve the ADE reporting. Materials and Methods: This was a qualitative study, conducted at Shree Krishna Hospital, attached to Pramukhswami Medical Collage, Karamsad, Gujarat, India. ‘Focused Group Discussions’ were organized which consisted of 5-10 clinicians and residents of the same departments and 10-15 nursing staff members. Their KAP regarding ADE reporting were assessed by using a structured open ended questionnaire. Data were analysed with qualitative methods. Results: Total six sessions of Focused group discussion were conducted consisting of 42 clinicians and residents (16 were faculty members and 26 were residents) and seven sessions of Focused group discussion were conducted, consisting of 89 nursing staff members. Most of the participants knew the meaning of ADR and importance of ADR reporting. They all agreed that it’s their responsibility also to report ADE. Some of the participants admitted, forgetfulness and workload as major constraints. There was a suggestion of display phone number of department of Pharmacology for coordination and maintaining a separate register for ADEs in each ward. Conclusion: In spite of awareness and willingness for reporting of ADEs amongst the clinicians and residents, the practice is lacking because they do not consider this work as their priority.

Quantitative Analysis of Remineralization of Artificial Carious Lesions with Commercially Available Newer Remineralizing Agents Using SEM-EDX- In Vitro Study”
Introduction: The basic principle of remineralization is by advocating a biological or non-invasive approach rather than the surgical approach for early enamel lesions. There are relatively newer products available for remineralization, latest being the resin-infiltration technique, commercially available as Icon. Aim: The aim of the study was to evaluate the remineralizing potential of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP), Vantej and Icon by the quantitative evaluation of mineral gain. Materials and Methods: Seventy eight maxillary premolars were decoronated at Cemento-Enamel Junction (CEJ) and then sectioned mesio-distally using diamond disc into two halves. Mineral content of the sound specimens were recorded using Energy Dispersive X-ray (EDAX) micro-analyser. The samples were then subjected to demineralization by using demineralizing solution. The samples were grouped (n=26) based on the remineralizing agent used, Group 1: Vantej, Group 2: CPP-ACP, Group 3: Icon. After the application of remineralizing agent, the mineral content was measured using EDAX. Results: After remineralization, there was a significant difference between the groups when calcium and phosphorous ratios (Ca:P) were compared, showing greater potential of remineralization for CPP-ACP followed by Vantej and Icon group. Conclusion: CPP-ACP performed better than Vantej and Icon in remineralizing the demineralized enamel.

The Effect of Sevoflurane Plus Propofol on Pain and Complications after Laminectomy: A Randomized Double Blind Clinical Trial
Introduction: Pain is one of the most important reasons for the patients concern after surgery. The perfect sedative should have properties like rapid onset, least pain and adverse effects. Aim: To assess the effect of sevoflurane plus propofol on postoperative pain, haemodynamic stability and complication after lumbar disc surgery. Materials and Methods: This was a randomized double- blind clinical trial. A total of 75 patients scheduled for elective lumbar disc surgery with simple random sampling design received sevoflurane (n=25, induced with Thiopentone and maintained with sevoflurane), propofol (n=25, induced and maintained with propofol) and sevoflurane plus propofol (n=25, induced with propofol and maintained with sevoflurane). Visual Analog Scale (VAS) was used to determine the intensity of postoperative pain. Complications after surgery and haemodynamic changes during surgery were recorded. Results: The mean pain intensity and morphine consumption in the sevoflurane plus propofol group was lower compared to the propofol and sevoflurane groups at different intervals (p<0.001). The prevalence of shivering, nausea and vomiting in the sevoflurane plus propofol group was 24%, 28%, 28% respectively vs sevoflurane group 32%, 60%, 48% respectively and propofol group 32%, 16%, 12% respectively with p-value > 0.05, <0.001, <0.05 respectively. The mean blood pressure and heart rate were significantly lower in the sevoflurane plus propofol group compared to the propofol and sevoflurane groups (p<0.001). Conclusion: According to the effect on pain and complications after lumbar disc surgery sevoflurane plus propofol can be regarded as safe and alternative drug in general anaesthesia for these patients.

Histopathological Study of Central Nervous System Lesions: Emphasizing Association of Neoplasms with ABO Blood Groups

B.N. Kumarguru, P. Pallavi, Sunila, G.V. Manjunath, T.S. Vasan, B.R. Rajalakshmi
Introduction: The Central Nervous System (CNS) lesions show considerable geographic and racial variations with respect to the incidence and the pattern of distribution of lesions. The ABO blood status is a readily accessible factor in genetic constitution of the patients. It has been shown to be associated with many diseases. But the influence of blood group status on the pathogenesis of brain tumours is still unclear. Aim: To study various histopathological patterns of CNS lesions and to evaluate the association of CNS tumours with the distribution of ABO blood groups in documented cases. Materials and Methods: In the present study, 147 cases were analyzed. It was an analytical type of study, done at JSS Medical College, Mysore, over a period of 2 years and 8 months from January 2009 to August 2011. Histopathology slides were routinely stained by Haematoxylin and Eosin (H&E) stain. Special stains were performed in selected cases. Blood group of the patients and the control group were documented. Blood group distribution pattern was assessed in relation to histopathological diagnosis of various CNS tumours. Results: Histopathological diagnosis of 147 cases included neoplastic lesions (84.35%) and non-neoplastic lesions (15.64%). Neoplastic lesions (84.35%) constituted the majority, which included neuroepithelial tumours (29.25%) as predominant pattern. Non--neoplastic lesions constituted only 15.64%, which included inflammatory lesion (8.16%) as the predominant pattern. ABO blood group data was available in 92 cases (84.4%) of neoplastic lesions, which included 71 cases (48.29%) of primary CNS neoplasms categorized according to WHO grades. The control group constituted 21,067 healthy voluntary donors. Blood group O was the most frequent blood group in neoplastic lesions (40.21%) and primary CNS neoplasms categorized according to WHO grades (45.07%). The association between the CNS neoplasms and ABO blood groups was not statistically significant (p = 0.055). But a definite change in the pattern of distribution of ABO blood groups observed between neoplastic lesions and control groups. Conclusion: The influence of blood group types on the development of brain tumours appears intriguing and needs to be well established. Though statistically insignificant, a definite change in the pattern of distribution of ABO blood groups was observed between neoplastic lesions and control groups. This necessitates attention and stratification of patients for effective management.

Interlocking Nailing Versus Plating in Tibial Shaft Fractures in Adults: A Comparative Study
Introduction: Tibial diaphyseal fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures following plating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: A hospital based non randomized clinical trial was performed from September 2013 to August 2016 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Forty patients with forty one involved limbs completed follow up for one year. The duration of surgery and average blood loss during surgery was 75.45±3.03 minutes and 165.00±5.31 ml respectively in case of nailing and 85.05±2.54 minutes and184.29±5.33 ml respectively in case of plating and their difference was statistically significant. In our study union was achieved in less than 20 weeks in 29 (70.8%) of the patients and 25-30 weeks in nine (22%) cases. The average time of union in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. However, there is statistically significant difference in the functional score in between the two groups in terms of Lower Extremity Functional Score (LEFS). Delayed union in one case of nailing and two cases of plating, valgus malunion in one case of nailing and joint stiffness in two cases each of nailing and plating were the major complications observed. Conclusion: There was no difference between the two modalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating.

Periodontal and Dentition Status among Orphans and Children with Parents in Mysore City, India: A Comparative Study
Introduction: Oral health symbolises the general health and quality of life of an individual. The socioeconomic status of the parents shows direct impact on oral health status of children. Thus, it can be hypothesised that the pattern of oral diseases would be different among children living with parents and orphans. Aim: To explore periodontal and dentition status among orphans and children with parents in Mysore city, India. Materials and Methods: A cross-sectional study was conducted among six to 15-year-old children residing in eight orphanages. Equal number of age and gender matched children living with parents were selected from government schools (non orphans) located in the same geographical areas for comparison. Clinical examination was conducted by a single trained, calibrated examiner and oral findings were recorded according to World Health Organization (WHO) diagnostic criteria 2013. The data collected was analysed using Mann–Whitney U test and Chi-square test. Results: A total of 957 children (478 from orphanages and 479 from government schools) were examined in the study. The mean defs and DMFS were significantly higher among government school children (non orphans) (defs: 3.20±4.0; DMFS: 2.43±2.8) compared to children from orphanages (defs: 2.72±4.4; DMFS: 1.72±2.3). Prevalence of gingival bleeding among orphans (79.49%) was higher compared to non orphans (71.4%). Conclusion: The present study concluded that prevalence of caries was lower among orphans but periodontal status was poor among them as compared to non orphans.

Demystifying the Mysteries: Sexual Dimorphism in Primary Teeth

Akshara Singh, Hind Pal Bhatia, Shveta Sood, Naresh Sharma
Introduction: One of the critical steps in the process of identification is the sex determination of an unknown individual. Many studies have shown that sex can be determined using the human skeleton, especially by examining the pelvis and skull. Odontometric analysis of the human sexual variation has been less investigated, especially of primary dentition. Aim: To verify the presence of sexual dimorphism in primary teeth of local population of Faridabad, Haryana, India. Materials and Methods: The research was performed on dental casts of 500 children (250 boys and 250 girls, age range 3-5 years). Mesiodistal and buccolingual crown dimensions of maxillary and mandibular primary teeth were measured with a digital Vernier's caliper and were analysed for sexual dimorphism. Mann-Whitney-U test was used to check the statistical significance of difference in tooth dimensions among boys and girls. Results: Differences were found in the mean values of mesiodistal and buccolingual diameters of primary teeth, in which boys generally had larger crown diameters than girls. Conclusion: Primary teeth may be used as an additional tool for sex identification of juvenile skeletons where other dimorphic features are not much developed.

Reinforcement of Aluminum Oxide Filler on the Flexural Strength of Different Types of Denture Base Resins: An In vitro Study
Introduction:Acrylic resins have been used extensively for the fabrication of denture bases because of their aesthetic qualities, ease of manipulation and repairability. Flexural fatigue of the denture base has been shown to be a factor in the clinical failure of polymethyl methacrylate resin dentures. Also, the fracture can result from impact, fatigue or degradation of the base material. Hence, there is a need to increase the strength of denture base resins. Aim: To evaluate the effect of reinforcing alumina oxide filler on the flexural strength of different acrylic resins. Materials and Methods: A total of 180 acrylic specimens were fabricated, which were divided into three groups self cure acrylic resin (SC), conventional heat cure resin (HC) and high strength heat cure resin (HI). Each group was divided into four subgroups i.e., control group and the specimens of the remaining three groups were reinforced with aluminum oxide (Al2O3) powder by 5%, 10% and 15% by weight. Specimens were stored in distilled water for one week; flexural strength was tested by universal testing machine. Results were analysed by one-way analysis of variance and post-hoc Tukey paired group comparison tests. Results: Flexural strength of SC increased by 9%, 13% and 19%, Flexural strength of HC increased by 8%, 15% and 19% and that of HI increased by 21%, 26% and 29% compared to control group by adding 5%,10% and 15% of alumina filler (p-value <0.001). Addition of 15% of alumina powder to SC showed high flexure strength compared to control group of HC (p-value <0.001). Addition of 10% and 15% of alumina powder to HC showed high flexural strength compared to control group of HI (p-value <0.001). Conclusion: Addition of alumina to self cure acrylic resin, conventional heat cure acrylic resin and high strength heat cure acrylic resin increased the flexural strength. Increasing the flexural strength of the acrylic resin base material could lead to more clinical success.

Role of Echocardiography in Prenatal Screening of Congenital Heart Diseases and its Correlation with Postnatal Outcome

Shivani Sharma, Navkiran Kaur, Khushpreet Kaur, Naveen Chandrashekhar Pawar
Introduction: Congenital Heart Defects (CHDs) are one of the most common forms of congenital anomalies. Fetal echocardiography performed during second trimester aims at early diagnosis of congenital heart disease which is instrumental in proper planning of delivery, perinatal care and counselling of parents. Aim: To evaluate the role of fetal echocardiography in prenatal screening of CHDs and to study the role of associated extracardiac anomalies. Materials and Methods: This was a hospital based prospective and correlative type of study, done over a period of one year. Antenatal screening of fetal heart was done in mid-trimester high and low risk pregnancies. The prenatal echo findings were co-related with postnatal findings in case of any abnormality detected. The extra-cardiac anomalies associated with positive cases were evaluated and studied for their impact on postnatal outcome. Results: A total of 1200 pregnancies were screened out of which 672 were low risk and 528 were high risk. The cases with abnormal echo findings were followed postnatally. The overall incidence of CHD in study population was 15 per 1000. The incidence in high and low risk pregnancies were 16.3 and 13.25 per thousand respectively. Complete agreement of 68.17% was found between prenatal and postnatal findings. The most frequent Extra-Cardiac Anomalies (ECA) in cases with CHD was of musculoskeletal system. The CHD cases with ECA were significantly of low birth weight, born preterm and delivered by Lower Segment Caesarean Section (LSCS). Conclusion: Fetal heart is the most overlooked part in every routine anomaly scan. We conclude that fetal echocardiography should be an integral part of every second trimester anomaly scan for all pregnant females irrespective of their risk factors. The associated ECAs are another factor that causes increased mortality both in antenatal and neonatal life, again warranting an early fetal echo.

Assessment of Enamel Remineralisation After Treatment with Four Different Remineralising Agents: A Scanning Electron Microscopy (SEM) Study

Renita Soares, Ida de Noronha de Ataide, Marina Fernandes, Rajan Lambor
Introduction: Decades of research has helped to increase our knowledge of dental caries and reduce its prevalence. However, according to World Oral Health report, dental caries still remains a major dental disease. Fluoride therapy has been utilised in a big way to halt caries progression, but has been met with limitations. This has paved the way for the development of newer preventive agents that can function as an adjunct to fluoride or independent of it. Aim: The purpose of the present study was to evaluate the ability of Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP ACPF), Bioactive Glass (BAG), fluoride enhanced Hydroxyapatite (HA) gel and self-assembling peptide P11-4 to remineralise artificial carious lesions in enamel in vitro using a 30 day pH cycling model through surface microhardness analysis and SEM. Materials and Methods: Sixty enamel samples were divided into five groups of 12 samples each. The control Group A consisted of intact enamel samples, Group B: CPP-ACPF (Tooth Mousse Plus), Group C: BAG (SHY- NM), Group D: fluoride enhanced HA gel (ReminPro) and Group E: Self-assembling peptide P11-4 (Curodont Protect). All groups excluding the control group were subjected to demineralisation following which four of these groups were remineralised using the four remineralising agents. The treated groups were subjected to pH cycling over a period of 30 days. This was followed by assessment of surface microhardness and SEM for qualitative evaluation of surface changes. The results were analysed by One-Way Analysis Of Variance (ANOVA). Multiple comparisons between groups were performed by paired t-test and post-hoc Tukey test. Results: The results of the study revealed that remineralisation of enamel was the highest in samples of Group E (Self assembling peptide P11-4) followed by Group B (CPP-ACPF), Group C (BAG) and Group D (fluoride enhanced HA gel). There was a significant difference (p<0.05) in the remineralising ability between the self assembling peptide P11-4 group and BAG and fluoride enhanced HA gel group. Although no significant difference was observed between the self assembling peptide P11-4 and CPP-ACPF group, the self assembling peptide P11-4 remineralised the enamel lesions more effectively. SEM photomicrographs of the test groups demonstrated either amorphous crystals or particles scattered on the surface or lines of remineralisation along the prismatic borders. Conclusion: Self assembling peptide P11-4 demonstrated promising results by effectively and significantly remineralising the enamel lesions as compared to other test agents.

Effect of DOTS Treatment on Vitamin D Levels in Pulmonary Tuberculosis
Introduction: Vitamin D (Vit D) modulates a variety of processes and regulatory systems including host defense, inflammation, immunity, and repair. Vit D Deficiency (VDD) is been implicated as a cause in diabetes, immune dysfunction and Tuberculosis (TB). Impaired metabolism of Vit D and an adverse outcome is associated with Pulmonary Tuberculosis (PTB). Directly Observed Treatment Short Course (DOTS) consist of drugs like rifampicin and isoniazid, which respectively cause accelerated loss of Vit D due to increased clearance and impairment of 25- hydroxylation causing diminished Vit D action. Aim: The aim of the present study was to estimate and compare serum Vit D status in newly diagnosed PTB patients before and after DOTS to validate the supplementation of Vit D in PTB patients. Materials and Methods: Forty four newly diagnosed PTB patients of both the sexes in the age group of 18 to 60 years before starting DOTS were recruited to participate in this nonrandomized controlled trial with their voluntary consent. Vit D status in these patients and the effect of DOTS on Vit D were evaluated. Results: Mean Vit D levels of the study population aged 43±13 years was 20.74 ng/ml (normal >30 ng/ml) at the time of diagnosis. After completion of six months of therapy mean Vit D reduced to 17.49 ng/ml (p-value=0.041). On individual observations, 70% of the participants showed a decrease in Vit D levels from their baseline, whereas 30% showed an increase. Comparison between the two groups indicated the possible role of younger age in the improved status. Conclusion: VDD was seen in PTB patients, which worsened in majority of the study population after treatment; hence it would be advisable to recommend Vit D supplementation in PTB patients for a better outcome.

The Study of Different Clinical Pattern of Diabetic Ketoacidosis and Common Precipitating Events and Independent Mortality Factors

MG Mahesh, Rajendra Prasad Shivaswamy, BJ Subhash Chandra, Sajid Syed
Introduction: Diabetic Ketoacidosis (DKA) is an important cause of morbidity and mortality among diabetic patients in spite of major advances in the pathogenesis and more standardized diagnosis and treatment. Aim: To find out the different patterns of clinical presentations, common precipitating factors and independent mortality factors in DKA. Materials and Methods: This study was conducted in a tertiary care hospital, Mysuru on 110 patients from November 2007 to October 2009. Clinical presentation and precipitating factors of DKA were monitored. Univariate analysis was done to identify statistically significant risk factors contributing to DKA mortality and was used for multiple logistic regressions to identify independent mortality predictors. A scoring methodology was used to identify the risk of having multiple risk factors in an individual. Results: In this study, the mean age was 42.33 years, with a male to female ratio of 1.2:1. The most common complaints were vomiting and generalized weakness seen in 55 (50%) and 49 (44.5%) cases respectively. The most common precipitating factors were infections and poor compliance to antidiabetic treatment seen in 57 (52%) and 23 (21%) cases respectively. The predictors of mortality included age equal to or more than 65 years, Depressed Mental State (DMS) in the first 24 hour, insulin requirement equal to or more than 50 units in the 12 hours to bring blood glucose to less than 300 mg%, fever in the first 24 hours, shock in the first 24 hours, RBS persistently equal to or more than 300 mg% even after 12 hours with standard treatment protocol, fluid requirement equal to or more than 6 L in the first 24 hours, pH less than 7.2 and bicarbonate less than 15 mmol/l at presentation were statistically significant predictors of mortality. Multivariate analysis failed to identify an independent mortality factor; but, adverse parameters of more than 5 was significantly associated with death. Conclusion: Risk stratification of patients with DKA is possible from simple clinical and laboratory variables available during the first day of hospitalization and further channeling the patients to ICU at the correct time to prevent mortalities.

A Retrospective Study to Assess the Effect of Proton Pump Inhibitors on Renal Profile in a South Indian Hospital
Introduction: Proton Pump Inhibitors (PPIs) are arguably among the most commonly prescribed drugs in clinical practice, either as part of treatment or prophylaxis. Many clinicians prescribe these drugs as part of any prescription, without a proper rationale. Recent studies done outside India have shown that these drugs are not entirely safe, and they can result in the development of acute renal injury. Aim: To assess the effect of PPIs on blood urea and serum creatinine, when administered for at least seven consecutive days. Materials and Methods: The study was conducted in a retrospective manner, using data from the medical records department. Values of blood urea and serum creatinine were taken twice, first before start of therapy and then after at least one week of therapy. Results: A total of 175 subjects were selected for the study. When their case files were analysed, acute kidney injury was identified in 19 (10.86%) of them. Pantoprazole was the most common drug involved (84.21%). Renal injury was more common in the age group of over 50 years of age. Conclusion: PPIs are not entirely free of adverse effects, as assumed by several practitioners. A vigilant eye has to be maintained on the patient’s renal profile so as to avoid any untoward decline in renal function, as evidenced in the current study.

A Comparative study of the Dynamic Hip Screw, the Cemented Bipolar Hemiarthroplasty and the Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures
Introduction: Fractures of the Intertrochanteric (IT) region are some of the most common fractures encountered by an orthopedic surgeon in his lifetime. With increase in life expectancy, the incidence of these fractures is also increasing. By 2040, the incidence of these fractures is expected to double. Unstable IT fractures are a major cause of concern in the elderly due to the associated increase in morbidity and mortality. Aim: The purpose of this study was to compare the intraoperative and postoperative parameters using the Dynamic Hip Screw (DHS), the Cemented Bipolar Hemiarthroplasty (BH) and the Proximal Femoral Nail (PFN) for the management of unstable IT fractures. Materials and Methods: Fifty patients, having unstable IT fractures with age more than 60 years were randomly selected and were followed up averagely for 19 months (12– 30 months). The type of implant for a particular patient and a particular type of fracture was randomly selected and the same surgical team treated all patients. Total number of 19 patients were operated using the DHS (Group-1), 13 using the BH (Group-2) and 18 using the PFN (Group-3). All patients in the three groups were compared in terms of preoperative, intraoperative and postoperative parameters and functionally assessed using the Harris hip score and the mobility score of Parker and Palmer. Results: Patients operated using the PFN had significantly lower mean blood loss as compared to the other two groups. The mean days to unaided Full Weight Bearing (FWB) was significantly higher in patients treated by the DHS as compared to the other two groups. All three groups were comparable in terms of functional assessment. Conclusion: Treatment of unstable IT fracture of femur is a matter open to debate. IT fractures of elderly must be treated with considering the age of the patient, mental status, bone quality, and the type of fracture. Level of Evidence according to OCEBM Levels of Evidence Working Group - Level 2.

Applicability of the CIELAB and CIEDE2000 Formulae for Detection of Colour Changes in Colour-Changeable Chewing Gum for Evaluating Masticatory Function

Yesiboli Yeerken, Takafumi Otomaru, Mohamed Said, NaLi, Hisashi Taniguchi
Introduction: Mastication is one of the essential stomatognathic functions and is impaired when mandibulectomy is performed for removal of head and neck lesions. Aim: The purpose of this study was to investigate the correlation between perceived chewing ability {Masticatory Score (MS)} and objective mixing ability (?E) in patients who had undergone marginal mandibulectomy. Materials and Methods: Twenty normal dentate subjects as control group and twenty mandibulectomy patients who had undergone marginal mandibulectomy and wearing a dentomaxillary prosthesis were enrolled. Perceived chewing ability MS and objective ?E were evaluated using a food intake questionnaire and the colour-changeable chewing gum, respectively. They were instructed to chew the gum continuously for 100 strokes on their usual side. The chewed gum was measured using the CIELAB colour space defined by a colourimeter and L, a* and b* were obtained. The change in colour of the gum after chewing was calculated using CIELAB (?Eab) and the CIEDE2000 (?E00) formula. The relationships of a*, ?Eab, and ?E00 with MS score were analyzed using the Spearman’s rank correlation coefficient. Results: A correlation was found between perceived chewing ability (MS) and objective mixing ability (index of the masticatory function {?E}) in marginal mandibulectomy patients. (?E00 = 0.481, a* = 0.587, ?Eab = 0.668). Conclusion: Within the limitations of this study, it can be concluded that the CIEDE2000 formula for calculation of colour difference can be used to evaluate masticatory function in patients who have undergone marginal mandibulectomy

Comparative Evaluation of Different Modes of Laser Assisted Endodontics in Primary Teeth: An In vitro Study
Introduction: The presence of bacteria in root canals has been considered to be responsible for endodontic treatment failure, even in case of primary teeth. The use of lasers can be a valuable addition in removing bacterial load in areas where traditional methods may fail to succeed. Methods like direct laser irradiation of canals, Laser Activated Irrigation (LAI) with sodium hypochlorite (NaOCl) and Photodynamic Therapy (PDT) seem to be a promising alternative for disinfection. Aim: This study was designed to compare the efficacy of latest advancements in disinfection techniques using diode laser namely direct laser irradiation, photodynamic therapy and laser activated irrigation using sodium hypochlorite. Materials and Methods: Sixty freshly extracted primary teeth either single or multi-rooted teeth with two third of their root length intact were collected. Instrumentation was completed to size 30 H-file. Teeth were randomly divided into Group 1- Direct Laser- irradiation, Group 2 - Photodynamic therapy; Group 3- Laser activated irrigation with 2.5% NaOCl. The tooth specimens were inoculated with Enterococcus faecalis. The bacterial colonies were counted preoperatively. Laser irradiation was performed for all groups in accordance to the groups each tooth belonged to. Postoperatively the bacterial colonies were counted. One-way Analysis was applied to compare bacterial count at baseline and post-test between three groups. Tukey’s post-hoc test was applied for pairwise comparison between groups. Paired t-test was applied to compare the mean baseline bacterial count with post-test mean bacterial count. Results: The results obtained with all the three groups postoperatively were highly significant (p-value<0.001). Statistically significant difference between results of Group 1 and Group 2 and also between Group 1 and Group 3 was found (p-value= 0.001). However, no statistical difference between Group 2 and Group 3 was found (p-value- 0.96). Conclusion: Disinfection strategies using diode laser by techniques gives promising results. Techniques like laser activated irrigation and photoactivated disinfection are better than direct laser irradiation in eliminating Enterococcus feacalis.

A Comparative Evaluation of Accuracy of the Dies Affected by Tray Type, Material Viscosity, and Pouring Sequence of Dual and Single Arch Impressions- An In vitro Study
Introduction: The clinician’s skill, impression techniques, and materials play a very important role in recording fine details in an impression for accuracy of fixed partial denture prosthesis. Impression of prepared teeth and of the opposing arch can be recorded simultaneously by dual-arch trays, while the full arch metal trays are used for impressions of prepared teeth in one arch. Aim: To measure and compare the accuracy of working dies made from impressions with metal and plastic dual arch trays and metal full arch trays, for two viscosities of impression material and by changing the sequence of pour of working and non-working sides. Materials and Methods: A balanced design with independent samples was used to study the three variables (tray type, impression material viscosity, and pouring sequence). An impression made by dual arch trays and single arch trays were divided in to three groups (Group A-plastic dual arch tray, Group B-metal dual arch tray, Group C-full arch metal stock tray). Out of these three groups, two groups (Group A and B) were subdivided in to four subgroups each and one group (Group C) was subdivided in to two subgroups. A sample size of 30 was used in each subgroup yielding a total 300 impressions in three groups or ten subgroups. Impressions were made of a machined circular stainless steel die. All three dimensions (Occlusogingival, Mesiodistal, and Buccolingual) of the working dies as well as stainless steel standard die were measured three times, and the mean was used for the three standard sample values to which all working dies means were compared. Statistical analysis used for this study was a 3-factor analysis of variance with hypothesis testing at a =0.05. Results: With respect to the selection of impression material viscosity statistically significant differences were found in the dies for the buccolingual and mesiodistal dimensions. Metal dual arch trays were slightly more accurate in the mesiodistal dimension in comparison to the plastic trays in reference of tray selection and in view of pouring sequence no differences were observed in occlusogingival dimension but in buccolingual and mesiodistal dimensions nonworking side was more accurate. Conclusion: The gypsum dies produced from the dual arch impressions were generally smaller in all three dimensions than the stainless steel standard die. Plastic dual-arch trays were more accurate with rigid impression material and there was not statistically significant difference for sequence of pouring. Metal dual-arch trays were more accurate with monophase impression material and working side was more accurate. Stock metal full arch trays were more accurate for monophase impression material.

An In-vivo Comparison of Vertical and Horizontal Distance between Incisive Papilla and Incisal Edge of Maxillary Central Incisors in Dentates with Different Arch Forms

Nivedita Pachore, Vikas Bhakhar, Jayanti Patel, Avani Patel, Kaushik Adeshra
Introduction: The incisive papilla is one of the most stable landmarks for assessing the original position of certain key teeth. To place anterior artificial teeth back in its original position such as in denture construction and full mouth rehabilitation cases vertical and horizontal distance from incisive papilla in different arch forms, imparts a significant role. The average distance will be helpful for arrangement of teeth in its original position which not only provides a pleasing appearance and normal function but also will save the dentists’ chair side effort. Aim: To determine the average vertical and horizontal distance of the maxillary central incisors from the incisive papilla in dentate individuals with different arch forms. Materials and Methods: Primary impressions and casts were made for 72 dentate patients, sorted into different arch forms and mid point of the incisive papilla was established. The vertical and horizontal distances were measured with the digital vernier caliper. The mean and standard deviation were subjected to Students t-test. Results: The range of horizontal distance was 4-7 mm, 6-8 mm, 5-8 mm and vertical distance was 4-6 mm in ovoid, square and tapered arch forms respectively. Conclusion: Horizontal distance of the maxillary central incisors from the incisive papilla varies in different arch forms whereas, vertical distance is almost same in all the arch forms.

Patient Centered Outcomes in Periodontal Treatment-An Evidenced Based Approach
Transformation of research into clinical practice is the most challenging step in evidence based dental practice. Designing the most reliable research with applicable endpoint evaluation is very important as it can lead to successful research outcomes that can be accepted in clinical practice. In the periodontal research few accepted endpoints are used frequently as they are believed to be the gold standard in measuring the periodontal disease and the treatment outcomes. However, a wide range of endpoints used are surrogate endpoints and these endpoints have no direct correlation with the patient centered outcomes. Hence, a direct relationship of surrogate endpoints with true endpoints needs to be established. This review highlights the importance of true endpoints and challenges in implementing these in clinical research. Importance of patient’s centered outcomes are also reviewed and duly discussed here. Need for conducting research which includes the true endpoints or the surrogate endpoints with clinical applicability and tangible outcomes, was also suggested in this review.

Are we Training Enough of Communication Skills and Patient Psychology Required in Dental Practice

Varsha Murthy, Shakila Rajaram, Sunayana Choudhury, K.R. Sethuraman
The aim of this review is to discuss about lacunae in the areas of Communication skills and Patient psychology teaching in the dental set up in India. A literature search was performed using various databases and other resources. Data obtained was reviewed to obtain the work done in this field. It was found that there is currently no clear data in literature as to how much and how well students are taught about communication and behavioural skills and patient personality in dental curriculum in India. Pinpointing such lacunae can help dental colleges and universities to focus on the emphasis of their approaches to teaching about communication skills and psychology of the patient. Identification of future research area in this field is the need of the time for future discovery and progress in this overlooked field.

Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management

Sreelatha Diviti, Nishant Gupta, Kusum Hooda, Komal Sharma, Lawrence Lo
Morel-Lavallee lesion is a post-traumatic soft tissue degloving injury. This is commonly associated with sports injury caused by a shearing force resulting in separation of the hypodermis from the deeper fascia. Most common at the greater trochanter, these injuries also occur at flank, buttock, lumbar spine, scapula and the knee. Separation of the tissue planes result in a complex serosanguinous fluid collection with areas of fat within it. The imaging appearance is variable and non specific, potentially mimicking simple soft tissue haematoma, superficial bursitis or necrotic soft tissue neoplasms. If not treated in the acute or early sub acute settings, these collections are at risk for superinfection, overlying tissue necrosis and continued expansion. In this review article, we discuss the clinical presentation, pathophysiology, imaging features and differential diagnostic considerations of Morel-Lavallee lesions. Role of imaging in guiding prompt and appropriate treatment has also been discussed.

Inhaled Insulin - Current Direction of Insulin Research

Rashmi Ranjan Mohanty, Smita Das
Diabetes Mellitus (DM) is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. Subcutaneous insulin and Oral Hypoglycaemic Agents (OHA) constitute the main treatment option for DM. Insulin is administered by injection or continuous infusion to control glucose levels mainly in Type I diabetes. Newer routes both oral and non oral, for insulin administration are current direction of insulin research as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is an attractive alternative for systemic administration of insulin given its accessibility and large alveolar-capillary network of lungs for drug absorption. Afrezza, inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a new, quicker acting inhalable insulin with a different and safer pharmacokinetic profile in comparison to previously failed inhaled form of insulin.

Mucous Cell Prosoplasia in Oral Pathologies: A Brief Review
One of the enigmas in cell differentiation process is prosoplasia, which is contemplated as forward differentiation. A well-known example of prosoplastic switch is mucous cell prosoplasia, which is the transformation of a simple squamous epithelial cell into mucous secreting cell. Numerous theories have been proposed for histogenesis of this phenomenon, which are comprehensively discussed in the present paper. Oral pathologies like odontogenic cysts and salivary gland tumours show mucous prosoplasia quite often; sometimes leading to diagnostic difficulties. In the present paper, efforts have been made to comprehensively discuss diverse aspects of mucous prosoplasia like histogenesis, theories and diagnostic importance in various oral pathologies.

Surgical Management of a Rare Case of Massive Compound Odontome Associated with Missing Primary Tooth

Elengkumaran Sankaran, Sangeetha Narasimhan, KS Sabitha, Punit Chitlangia
Odontomes are considered to be the most common odontogenic tumours of the jaws. They are benign, mixed tumours arising from the remnants of both odontogenic epithelium and the ectomesenchyme resulting in the deposition of varied propotions of enamel, dentin, cementum and pulp tissues. As these lesions show deficiency only in structural arrangement, some authors consider odontomes as hamartomas or tumour like malformations. Though these lesions are more common in children, very few cases have been reported in less than five years age group. Blood loss is a major issue in paediatric surgery. Careful and safe surgery is the primary goal of the surgeon. The external carorid artery which is the only feeder of blood to the face and oral cavity can be ligated to control bleeding in extensive maxillofacial injuries and orofacial malignancies. Herewith, we report a massive odontome in a three and half-year-old child which was treated by surgical excision along with carotid control to prevent excess bleeding.

Solitary Myofibroma of the Mandible in a Six-Year Old-Child: Diagnosis of a Rare Lesion
Myofibroma is a benign uncommon fibroblastic tumour originating from the soft tissue, bone and may affect both children and adults. Radiographically myofibroma presents as unilocular radiolucency. Histologically, typical biphasic cellular arrangement is noted. Immunohistochemical markers are useful for definitive diagnosis of this uncommon neoplasm. Here, a case of six-year-old male child with a localized swelling in the left body of mandible is presented. The clinical, radiological, histological and immunohistochemical findings were corroborative of Infantile Myofibroma.

Blastoid Variant of Mantle Cell Lymphoma with Leukemic Presentation - A Rare Case Report

Ruchee Khanna, Sushma Belurkar, P. Lavanya, Chethan Manohar, Manna Valiathan
Mantle Cell Lymphoma (MCL) is a type of Non-Hodgkins lymphoma and has a wide spectrum of histopathological subtypes of which the blastoid or the blastic variant constitutes 10-15% of all cases. It is difficult to diagnose blastoid variant of MCL on the basis of morphology alone as it mimics lymphoblastic lymphoma and centroblastic large cell lymphoma, hence additional analysis like immunophenotyping and molecular studies aid in its diagnosis. We present a case of 45-year-old male who presented to medicine OPD with chief complaints of fever, fatigability and inguinal swelling. Complete blood count, peripheral smear and bone marrow examination was performed. Peripheral smear showed thrombocytopenia along with 53% abnormal cells. On bone marrow examination 43% abnormal lymphoid cells were seen. This case was diagnosed as blastoid variant of MCL on the basis of routine morphology and immunohistochemistry on bone marrow biopsy and flow cytometric immunophenotyping on peripheral blood.

Acute Respiratory Distress Syndrome Complicated by Amiodarone Induced Pulmonary Fibrosis: Don’t Let Your Guard Down

Vipin Kumar Singh, Vijeta Maheshwari
Amiodarone is an antiarrhythmic agent which is commonly used to treat both supraventricular and ventricular arrhythmias. This iodine containing compound has been associated with several adverse events like it tends to accumulate in several organs. Among those, the most serious is Amiodarone Pulmonary Toxicity (APT). While the incidence of this complication has decreased with the use of lower doses of amiodarone but it can occur with any dose. Pulmonary complications usually present as an acute or subacute pneumonitis. On chest X-ray and high-resolution Computed Tomography (CT), diffuse infiltrates were found. Here, we present a case in which acute respiratory distress syndrome like features were detected which got subsided after stopping tablet amiodarone. The patient was a known case of atrial fibrillation for which she was taking tablet amiodarone for the last six months.

Invasive Mucormycosis in a Case of Aluminium Phosphide Poisoning

Nitin Gupta, Gagandeep Singh, Karan Aggarwal, Alok Thakar, Immaculata Xess
Mucormycosis is a rapidly progressive disease with high mortality reported mostly in immunocompromised individuals. We report a case of Rhino-orbital mucormycosis (Lichtheimia corymbifera) in an immunocompetent individual with history of consumption of Aluminium Phosphide (ALP) tablets. We postulated the following effects of ALP poisoning that would have increased the chances of mucormycosis in this patient: 1) Metabolic acidosis; 2) Acute Kidney Injury (AKI); and 3) Liberation of free oxygen radicals.

Unilateral Absence of Ethmoid Sinus and Nasal Turbinates: A Rare Case Report

Vinod Felix, Narendrakumar Veerasigamani
A variety of anatomical variation of paranasal sinus and nasal turbinates exist, as its development is a complex and long standing process. Computerized Tomography (CT) of the paranasal sinuses is a very valuable tool in diagnosing these variations. Preoperatively defining the anatomical variations of the intranasal structures is essential in performing the safe functional endoscopic sinus surgery and to avoid unnecessary complications. Several degrees and combinations of aplasias and hypoplasias have been reported. We report a case of 37-year-old male who presented with bilateral nasal block and rhinorrhea and his CT paranasal sinuses showed gross septal spur in left side, absence of right middle, inferior and superior turbinates, absent right ethmoid air cells, aplastic right frontal sinus, left concha bullosa with bilateral maxillary sinusitis.

Isolated Skull Metastasis of Follicular Carcinoma Thyroid in an Elderly Female: A Rare Case

Archana Shetty, Vijaya Chowdappa, Padma Priya Kasukurti
Isolated skull metastasis from a well differentiated follicular thyroid carcinoma, as the presenting feature is a rare manifestation. We report a case of a 79-year-old female who presented to us with only a painful, gradually increasing scalp swelling with associated pain and blurring of vision over the past few days. Neuroimaging findings strongly favoured a diagnosis of meningioma. A bifrontal craniotomy was performed and the tumour was excised. Histopathological examination of the same showed, it to be a case of metastatic thyroid carcinoma. We present this case not only because of the diagnostic challenge it posed, but also because the patient in our case is one of the oldest case of skull metastasis from follicular thyroid carcinoma till date.

Youngest Case of Allergic Broncho Pulmonary Aspergillosis in India: A Case Report from Arid Zone of India

Navgeet Mathur, Medha Mathur, Virendra Singh
Allergic Broncho Pulmonary Aspergillosis (ABPA) is an immunological allergic disorder and asthmatic patients are predisposed to ABPA. Although, ABPA commonly develops in the third and fourth decades but no age group is unaffected from the disease. Youngest case of ABPA in India so far reported was four years of age. This case report is about a young child of bronchial asthma with ABPA aged four years and nine days only, from arid zone of country. Her diagnosis of ABPA was supported by clinical, serological and radiological findings. This case report concludes the importance of early diagnosis and treatment of ABPA along with general awareness for the disease.

Moringa oleifera Leaf Extract: Beneficial Effects on Cadmium Induced Toxicities - A Review
Environment has been contaminated by heavy metals ever since the original magma of earth has solidified. One such toxin is cadmium. Cadmium that has been around since the industrial age, is considered hazardous both to us and to the environment. From time immemorial man is dependent on plants available in nature for several health benefits. Moringa oleifera, has nutritional, pharmacological and antioxidant properties, thus having several medicinal applications. In the present article, we discuss the dose and time dependent damage due to exposure to cadmium on kidneys, liver, testis, lipid profile and haematological parameters in adult Wistar rats and the protective effects of Moringa oleifera (pre-treatment) on cadmium induced damage.

Missing IUCD Strings: Role of Imaging in Locating the Misplaced Device

Deepti Goswami, Anoosha K. Ravi, Akanksha Sharma

Correspondence: Skeletal Maturation and Mineralization of Children with Moderate to Severe Spastic Quadriplegia

Anirban Mandal, Amitabh Singh, Puneet Kaur Sahi, Bhavika Rishi

Health Issues among Radiologists: Toll they Pay to their Profession

SWAPNDEEP SINGH ATWAL, AKHILA PRASAD, DESH DEEPAK, KSHITIJ AGARWAL
In modern era, with tremendous competition, long working hours and more demanding workstyle, nearly every profession is associated with some or the other health hazards. These may develop and progress rapidly or in a gradual way but ultimately add up unwanted morbidities and in long run affects the production and work output. Unfortunately, doctors and other health professionals who look after the health of society, are not the exceptions to this rule and depending upon their specialty, they have to face some or the other health issues. This article highlights some important though underestimated health issues among radiologists and some remedies. It aims to sensitize radiologists about such health issues so that they can take timely remedial measures before it is really late.

Correction: 2015 Aug:9(8): ZC11-ZC14

Correction: 2015 Jan:9(1): EL01-EL02
Gayathri Priyadarshini.R.S, Srinivasa Kannan.S.R, Parijatham.B.O, Hemalatha Ganapathy, Subhashree.A.R, A Rare Case of Disseminated Cutaneous Rhinosporidiosis. (Published in Journal of Cilinical and Diagnostic Research. 2015 Jan : 9(1)): EL01-EL02. In this article, Email ID of corresponding author has been corrected. Correct Email id is gaya3_rsgp@yahoo.co.in.