Journal of clinical and diagnostic research

Postpartum Haemolytic Uremic Syndrome (PHUS) with Posterior Reversible Encephalopathy Syndrome (PRES) Complicating Pregnancy: A Rare Case Report

Avni Bhatia, Aditya Bhagwat, Sourya Acharya, Amol Bhawane, Neema Acharya

Haemolytic Uremic Syndrome (HUS) and Posterior Reversible Encephalopathy Syndrome (PRES) are two diverse conditions that may have common triggering pathways. Postpartum HUS is a known phenomenon that complicates pregnancy with eclampsia and haemolysis, elevated liver enzymes and low platelet count (HELLP syndrome). Treatment is usually by plasmapheresis and heamodialysis. PRES, though rare may complicate pregnancy with eclampsia. We present a case of a 24-year-old primigravida who developed postpartum HUS and PRES simultaneously making it a rarest combination.

IgG4- Related TIN: Masquerading as Malignant Infiltrative Disorder

S Vijaya Devi, Deepika Hemrajani, Pankaj Beniwal, Ranjana Solanki

Immunoglobulin G4 Related Disease (IgG4-RD) is an autoimmune disease first described in pancreas. IgG4 RD has been reported in various organs and its renal involvement is known as IgG4-Related Kidney Disease (IgG4-RKD). Here, authors report a case of a 37-year-old male who presented with chronic kidney disease. He had generalized lymphadenopathy and hepatomegaly. Investigations revealed proteinuria, raised serum creatinine and high serum protein with marked hypergammaglobulinemia. Radiology revealed bilateral nephromegaly. Renal biopsy was done to rule the infiltrative disorder. Histopathological examination showed extensive periglomerular fibrosis, tubular atrophy and plasma cell-rich inflammatory infiltrate. Foci of storiform fibrosis were also seen. Serum IgG4 levels were found to be 49.3 g/L (reference range 0.03 to 2 g/L). Hence, a diagnosis of IgG4-TIN was rendered. In a background of multiple organ involvement with characteristic histomorphological features a possibility of IgG4 RKD must always be considered.

Rare Presentation of Primary GI Lymphoma with Synchronous Lesions in a Retropositive Patient

Gursimran Singh, P Ganesh, S Shanmuganathan

Non Hodgkin’s Lymphoma (NHL) with primary Gastrointestinal (GI) involvement occurs in 27-74% of all HIV infected persons. Most common site of involvement is stomach, small intestine and ileocaecal region. Synchronous GI lesions are quite rare presentations in lymphoma. There are very few case reports of synchronous lesions in lymphoma, but no reports of the same in primary GI lymphoma. These tumours behave aggressively and need early diagnosis and treatment. Here, we present the case of a 48-year-old retropositive male patient, presenting with jaundice and significant weight loss. On CT whole abdomen, he was found to have gastric and colonic lesions with perigastric nodes and nodes at porta hepatis. Presence of B-cell type of lymphoma was diagnosed by histopathological examination and confirmed with immunohistochemistry. Chemotherapy was initiated and he responded to the same. This case is presented for its rarity, whereby synchronous gastric and colonic lymphomas are seen in retropositive patient.

Immunoglobulin Light-Chain Isotype Switch (IS) during Lenalidomide Therapy in Multiple Myeloma and its Association with Increased M Protein Production and Miliary TB

Ashok Kumar Kapoor, Supriya Mehrotra, Rajesh Kumar Srivastava

Multiple Myeloma (MM) is a malignant neoplasm arising from a single plasma cell clone. It mainly affects older people. It forms localised osteolytic lesions. It secretes a single monoclonal immunoglobulin of constant isotype with light-chain restriction (paraprotein). MM cells may express, an adhesion molecule. This molecule is not present on normal plasma cell. In addition, immunoglobulin light-chain may be detected in urine (Bence jones proteins). Rarely, one of the isotypes may switch to another type during high-dose chemotherapy. In addition, Isotype Switch (IS) may occur spontaneously without any treatment. The present case relates about an 87-year-old man who complained of pain in dorsal thoracic region. X-ray examination showed fractures of thoracic vertebra eighth to tenth. Sternal puncture was done. Bone marrow examination showed large number of plasmacytoid cells. Moreover, serum protein electrophoresis revealed moderately raised M band proteins in gamma globulin region (M band protein concentration was 2.03 gm/dL). The patient was diagnosed as a case of MM. Initially, he was treated with Thalidomide 100 mg daily for one month. Later, he was treated with Lenalidomide 10 mg daily for 30 days followed by a drug-free period of 15 days. After eight cycles of Lenalidomide therapy light-chain IS was detected. Initially, tumour produced lambda (?) light-chain for one year as seen in first, second and third serum specimens. Later, light-chain switch was detected in fourth serum specimen from lambda (λ) to kappa (k) light-chain. IS was accompanied with high level of M band proteins (5.4 gm/dL). In addition, the patient developed Miliary Tuberculosis. Subsequently, the patient was treated with Phaglomide (Pomalidomide) instead of Lenalidomide.

A Rare Presentation of Gall Bladder (GB) Mass in the Form of Mixed Adenoneuroendocrine Carcinoma (MANEC): A Case Report

Rishikant Sinha, Pranav Kumar Santhalia, Prem Kumar, Punam Prasad Bhadani

Primary Neuroendocrine Carcinoma (NEC) of gall bladder is extremely rare. The diagnosis is incidental in most cases. Here, we present a case of Mixed Adenoneuroendocrine tumour (MANEC) in a 48-year-old female who presented with pain in abdomen, nausea and loss of appetite and diffuse non-tender lump in right hypochondrium. CECT abdomen showed distended Gall Bladder (GB) with intraluminal polypoidal mass, with multiple liver and retroperitoneal metastasis. Histopathological and immunohistochemistry study revealed MANEC in GB with NEC metastasis in liver. This case highlights the rarity of the disorder and role of immunohistochemical studies and therefore MANEC should be considered as a differential to GB carcinoma.

Robot Assisted Nephron-sparing Surgery for Renal Leiomyoma

Vinit Kumar Singh, Altaf Khan, Muhammed AP Manzoor, M Mujeeburahiman

Leiomyomas are benign mesenchymal tumour originating from muscle cell. Renal leiomyomas an unusual primary renal tumour of the kidneys originating from smooth muscle cell. Here, authors describe a rare case of renal leiomyoma in a 46-year-old female patient who presented with recurrent haematuria and flank pain. Authors report their first experience in robot-assisted nephron-sparing surgery for renal leiomyoma. Easier resection and suturing was a potential advantage of this approach. The patient improved after tumour removal and the prognosis is excellent without recurrence after six months postsurgically. Authors also discuss the summary of clinical features of renal leiomyomas.

Post Partum Seizures Associated with Reversible Posterior Leukoencephalopathy Syndrome (RPLS): A Case Report

Manali S Dhage, Sarumathy S, Fatema J Haji, Ahalya SP, Muthuraj K

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is a condition characterised by severe headache, confusion, seizures and visual loss. It can occur secondary to electrolyte disturbances, eclampsia and preeclampsia, ultimately leading to vasogenic oedema in the cerebral parieto-occipital region. It is a rare condition and the prevalence is unknown. Inconsequential literature studies have been found related to RPLS associated with delayed onset of post partum eclampsia. Here we present a case of young female patient aged 25-year-old with complaints of post partum seizures preceded by severe headache and blurring of vision. She was treated with anti-hypertensive and anti-seizure medications. Imaging studies are vital for the prompt and accurate diagnosis of RPLS. Precise and immediate management has led to reversal of this syndrome in the patients.

Unilateral Breast Abscess by an Extremely Drug Resistant Salmonella enteric serovar Typhi: First Case Report from Pakistan

Nadia Midhat Zehra, Luqman Satti, Faisal Hanif, Saman Nadeem

Invasive salmonellosis caused by Salmonella typhi and Salmonella paratyphi is a serious life-threatening complication in immunocompromised patients. Since blood cultures have only 40-80% sensitivity, very limited diagnostic modalities are left. Here, authors present a case of a 24-year-old pregnant lady who develops a unilateral breast abscess harbouring Salmonella typhi. The isolate was Extremely Drug Resistant (XDR), that is resistant to first line drugs, ciprofloxacin and ceftriaxone. She was successfully treated with combination of injection meropenem and tablet azithromycin and continued for 14 days. To the best of authors knowledge, this was the first reported case of Salmonella enterica serovar Typhi in a pregnant lady from Pakistan.

Pyrexia of Unknown Origin: A Perplexing Case

Pyrexia of Unknown Origin (PUO) is a common diagnostic dilemma in the medical wards. We present the case of a 64-year-old man who had presented with fever, fatigue, dry cough and bloody diarrhea. Over the next few days, he developed severe testicular pain and renal failure. Blood results revealed anaemia, raised ESR, negative ANA and negative ANCA. Renal biopsy showed crescentic glomerulonephritis. Repeat value of c-ANCA was positive which clinched the diagnosis of Granulomatosis with Polyangiitis (GPA). We present this case in order to illustrate the masquerading nature of the vasculitic syndromes and to emphasise the need to integrate clinical and laboratory clues to reach a diagnosis.

Ultrasound Guided Superficial Cervical Plexus and Superior Trunk Interscalene Block as Sole Anaesthetic Technique for Acromioclavicular Joint Fixation Surgery

Anju Annie Paul, RV Ranjan, Sagiev Koshy George, Shishir Murugharaj Suranigi

Treating pain that patient experiences from repair of distal clavicle fracture can be a challenge for the anaesthesiolgists. The primary technique employed in the management of distal clavicular surgeries is by incorporating the use of interscalene block. One important factor that reduces the overall effectiveness of the interscalene block is the inability to cover area incised for the surgery due to the dual innervation in this region. While in contrast the use of cervical plexus block for clavicular pain is relatively new, studies have shown that the combination of superficial cervical plexus and selective C5 nerve root blockade under USG is a novel approach to alleviate the pain associated with distal clavicular fracture repair. In this case report, authors describe the use of combination of Ultrasound guided superficial cervical plexus plus superior trunk interscalene block as sole anaesthetic technique in management of right Acromial-clavicular disruption.

Unilateral and Atypical Presentation of Vogt-Koyanagi-Harada Syndrome: A Case Report

Abhinav Dhami, GS Dhami

Vogt-Koyanagi-Harada (VKH) disease is a multisystem disorder with ocular manifestations including severe bilateral panuveitis with iridocyclitis, serous retinal detachment, diffuse choroidal swelling and optic disc hyperemia. We report a case of 41-year-old male who presented with diminution of vision in left eye with the presence of yellowish subretinal lesions throughout the posterior pole. There was no evidence of anterior or vitreous inflammation. The fundus fluoresce in angiography revealed early hypofluoroscent lesions with late phase showing multiple areas of pooling with no significant pin point hyperfluorescent lesions. The optical coherence tomography showed undulation of the outer retinal layers. Blood work up was within normal limits, Mantoux test showing 10×8 mm of induration. A differential diagnosis of atypical VKH disease versus central serous retinopathy was established. Oral steroids were started in close monitoring and marked resolution of the retinal lesions was noted. The case presents a unique scenario in which atypical VKH disease mimicked a central serous retinopathy like retinal picture and a correct diagnosis was established with the aid of Optical Coherence Tomograpy (OCT).

MR Imaging Features of Non Convulsive Status Epilepticus: A Great Masquerader

Ayaz Jamil Ikbalhusen Dabivala, Chetan Muljibhai Mehta, Payal Manilal Damor

Variable clinical presentation and overlapping imaging findings make Non Convulsive Status Epilepticus (NCSE) a diagnostic challenge. NCSE is known to be a heterogeneous disorder with varied causes and several subtypes. Several disagreements exist as regards to its definition as well as the characteristic Electroencephalographic (EEG) features that are consistent with NCSE. We here present a case of nine-year-old female patient who presented with a recent onset history of regression of milestones since 5 to 6 months, and altered sensorium since 1-2 days. Contrast enhanced MRI brain was performed in this patient. This case highlights NCSE as a masquerader of inborn error of metabolism and attempts to address MR imaging findings of NCSE in acute intensive care setting.

A Case of Limb Girdle Muscular Dystrophy Type 2A from India: Copy Number Variation Analysis using Targeted Amplicon Sequencing

Arpan D Bhatt, Krati Shah, Apurva Puvar, Chaitanya G Joshi, Madhvi Joshi

Limb Girdle Muscular Dystrophy-Type 2A (LGMD-2A) is an autosomal recessive disease caused due to mutation in the Calpain-3 (CAPN3) gene, leading to partial or total loss of protein. In India, LGMD-2A is the most prevalence form of the disease accounting for 47% of cases amongst the heterogeneous group. Here, we report a case of 26-year-old female, having difficulty in walking due to proximal muscle weakness since the age of 13 years and had elevated Creatine Phosphokinase (CPK) with abnormal muscle biopsy findings. She was considered for the targeted gene panel based diagnosis with the query of muscular dystrophy. A homozygous exon 17 to 24 deletion was detected in the CAPN3 gene located in the long arm of chromosome 15, which was consistent with the patient’s clinical reports of calpinopathy.

Glans Cyst- A Rare Anomaly

Rama Kishan Saran, Kiran Mirdha, Sanya Saran, Rajendra Prasad Takhar

The glans cyst of the penis is an uncommon occurrence and was first described by Lantin and Thompson in 1956. These cysts are generally asymptomatic; however, may present with varied symptoms including dysuria, acute urinary retention, and difficulty in micturition. Cyst may also impact normal anatomy of the penis. Here, we report three cases of glans cyst presenting as slow growing, non-tender, soft cystic swelling measuring 1×1.5 to 2.5×2.5 cm size. The diagnosis of this cyst was made primarily based on physical examination and the management included complete surgical excision. Histopathological examination showed monolocular cystic cavity lined by a pseudo stratified columnar epithelium in two cases and stratified squamous epithelium in the third case.

Donovanosis in Central India: A Series of Six Cases and Review of Literature

Donovanosis is a chronic, sexually transmitted bacterial infection caused by Klebsiella granulomatis, previously known as Calymmatobacterium granulomatis characterised by granulomatous ulceration affecting primarily genitalia and inguinal region. It is endemic in tropical regions of the world including the east coast of India. We hereby report six cases of Donovanosis in Central India registered in two years, diagnosed by presence of beefy red granulomatous ulcers and microscopic visualisation of Donovan bodies on tissue smear. Five out of six cases were associated with HIV infection and required longer duration of treatment and often a combination of antibiotics.

Role of Primary Diaphragmatic Repair in Traumatic Diaphragmatic Herniation: Case Series and Review of Literature

JMV Amarjothi, OLN Babu, Villalan Ramasamy, Jeyasudhahar Jesudason

Diaphragmatic rupture due to blunt trauma (especially small ruptures) can be effectively treated by primary closure by either laparotomy or laparoscopy with minimal morbidity and mortality. Here, we present a series of cases where the diaphragmatic rupture was managed by primary repair emphasising the role of primary diaphragmatic repair in traumatic rupture. It places a premium on effective early diagnosis of such cases, which is difficult. Though, these injuries may be associated with other organ injuries, early diagnosis and effective treatment are the key to the management of diaphragmatic injuries due to blunt trauma.

Medical Therapy, A Better Alternative to Micro Lymphatic-Venous Anastomosis in Advanced Lymphoedema of the Leg: Review of Some Cases

Dwijesh Kumar Panda

Advanced lymphoedema of leg is frequently encountered in clinical practice. Chronic inflammation and fibrosis are the histological hallmarks of lymphoedema. This article presents three case reports. Two patients were suffering from advanced lymphoedema who underwent micro lymphatic-venous anastomosis. And the third patient suffering from advanced lymphoedema was treated with medical therapy. Surgery was a failure whereas medicine treatment helped the patients to lead a normal life.

Effect of Falcaria vulgaris against Toxic Effect of Ethanol to the Rat’s Liver

Introduction: Alcoholic liver disease is the most important side effect of alcohol consumption. Falcaria vulgaris (F. vulgaris) plant or long leaf contains antioxidant and antimicrobial ingredients. This plant is consumed in western Iran as a vegetable in the spring. Aim: To evaluate the effects of F. vulgaris against toxic effects of ethanol on the liver of rats. Materials and Methods: In this study, hydroalcoholic extract of F. vulgaris was prepared. Sixty four Wistar rats (male rats) were randomly assigned to eight groups: control normal and ethanol control groups; F. vulgaris groups (50, 100, 150 mg/kg) and ethanol + F. vulgaris treated groups (50, 100, 150 mg/kg). Treatments were administered by gavage daily for 28 days. Griess technique was assessed for determined Serum nitric oxide level. Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Alkaline Phosphatase (ALP) concentrations were determined for liver functional disturbances. In addition, liver weight, total antioxidant capacity, the diameter of hepatocytes and the Central Hepatic Vein (CHV) were investigated. Results: Ethanol enhanced significantly total antioxidant capacity, nitric oxide level, the mean diameter of CHV, and hepatocyte and liver enzymes and significantly decreased liver weight compared to the normal control group (p<0.05). The F. vulgaris and F. vulgaris+ethanol at all doses reduced significantly the mean diameter of hepatocyte and CHV, liver enzymes and nitric oxide levels and increased liver weight compared to the ethanol control group (p<0.05). Conclusion: The present study concluded that F. vulgaris provides protection against oxidative stress resulting from ethanol in the liver and such an ability of the F. vulgaris might be due to its strong potential antioxidant attributes. F. vulgaris administration moderates the detoxification enzymes and the antioxidant agents in the extract bring about hepatic tissue recovery and prevention of ethanol adverse-effects on nitric oxide, ALT, AST and ALP as evidenced in the above mentioned examination of the male rats.

The Role of Withania somnifera (Ashwagandha) and Omega-3 Fatty Acids on TNF-α and Joint Inflammation in an Animal Model of Rheumatoid Arthritis

Introduction: Rheumatoid Arthritis (RA) is an autoimmune disorder characterised by progressive joint destruction leading to severe disability. The existing management of RA includes Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Disease-Modifying Antirheumatic Drugs (DMARDs) and biological such as Tumour Necrosis Factor (TNF) inhibitors but search for alternative and safer therapy is still going on. Aim: To evaluate the efficacy of the combination of Withania somnifera (WS) and omega-3 fatty acids on TNF alpha level and joint histopathology in the treatment of Complete Freund’s Adjuvant (CFA) induced rheumatoid arthritis in a rat model. Materials and Methods: Healthy adult male Wistar albino rats were divided into six groups containing six rats in each group (n=36). Group I served as arthritis control, Group II and III received WS in dose of 500 mg/kg and 1000 mg/kg respectively. Group IV received Omega-3 polyunsaturated fatty acids in dose of 100 mg/kg. The combination of WS (1000 mg/kg) and Omega-3 polyunsaturated fatty acids (100 mg/kg) was given to rats of group V. Group VI served as standard treatment group and received Indomethacin 3 mg/kg. Arthritis was induced in groups II to VI by CFA. TNF-α was determined on day 0, 10 and 21. On day 21 all rats were sacrificed and inflamed limbs were excised above the ankle joints and examined for a pathological finding of RA. The data was analysed by one-way analysis of variance (ANOVA) followed by Dunnett’s test and Tukey test. The Dunnett’s test compares each mean to a control mean and simultaneous comparison between all other pairs was done by Tukey test. Results: WS in both doses showed significant reduction in TNF-α (p<0.001). Among all the treated groups, maximum mean percent TNF-α reduction in group VI (-65.65%) and minimum in group II (-37.35%) was found. Group V containing combination of WS and Omega-3 fatty acid showed a higher percent reduction in TNF-α and minimal cell infiltration as compared with groups II, III and IV. Conclusion: WS and omega-3 fatty acids suppress the changes produced due to adjuvant induced arthritis and combination of WS and omega-3 fatty acids was more effective than individual drugs alone.

Mott Cells: The Herculean Plasma cell

SV Sreelatha, Vimal Kumar Karnaker, Sanjana Nair

Family Physician - Oral Physician Interplay in Diagnosing Coronary Heart Disease among Adults with the Help of Tooth Loss: The Malaysian Perspective

Ramasamy Chidambaram

Correspondence: Age, Sex and Seasonal Variations of Vitamin D Level in Children of Jammu Region

Jogender Kumar, Arushi Yadav

Correspondence: Overweight/Obesity: An Emerging Epidemic in India

Jogender Kumar, Arushi Yadav

Does Zinc Really Improve the Outcome of Severe Pneumonia in Children?

Prawin Kumar, Jagdish Prasad Goyal

Correlation of Echocardiography Findings with Intraoperative Findings in Infective Endocarditis Patients: A Prospective Cohort Study

Musawenkosi Henema, Jamila Khatoon Adam, Suresh Babu Naidu Krishna

Introduction: Echocardiography plays an important role in the management of Infective Endocarditis (IE) but may be limited in some clinical situations. Lately, with arrival of novel hybrid imaging modalities, offers examination of IE at molecular level and better prospect for monitoring the disease. Aim: To compare the transthoracic echocardiographic findings with intraoperative findings (histology and visual) in patients with infective endocarditis. Materials and Methods: The study was a prospective, quantitative and observational, involving 40 patients diagnosed with IE and admitted under Cardiology department of Dr George Mukhari Hospital in Pretoria, South Africa. Echocardiography and Intraoperative findings (visual and histology) were performed to evaluate endocarditis. Blood culture was done to demonstrate the presence of microorganisms. In patients demanding a heart operation, the cardiac surgeon did the valve replacement, and the intraoperative findings were evaluated visually to consent the presence of vegetation or abscess and leaflets destruction. Clinical data were compared between the intervention and control groups using Mann-Whitney tests for non-parametrically distributed dependent variables, t-tests for those which were normally distributed, and Pearson’s chi-square tests for categorical variables. A p-value of <0.05 was considered as statistically significant. Results: In all, the intraoperative and echocardiography findings showed 32 of 40 (80%) vegetation, 2 of 40 (5%) perforation, 4 of 40 (10%) pseudoaneurysm and 2 of 40 (5%) abscesses. The prognosis of patients with poor ejection fraction (40-50% EF) was poorer than those with good ejection fraction (60-75%). The clinical findings of all patients confirmed infective endocarditis and 32 of 40 (80%) blood cultures were positive and 8 of 40 (20%) were negative. There were 7 of 40 (17.5%) patients who showed poor correlation 40-50% between echocardiographical findings and post-operative findings. The results of 33 of 40 (82%) patients showed moderate correlation 69% between the echocardiographical findings and post-operative findings. Conclusion: The study suggested that 8 of 40 (20%) had stenosis and 32 of 40 (80%) had regurgitation in patients who had IE. In addition, echocardiography and intraoperative findings in patients for Left Ventricular Ensystolic Diameter (LVES) was moderate (r=0.68).

Social Media for Teaching Infection Prevention and Control in Dentistry: Survey of Students Perception and Comparative Study of Academic Performance

Introduction: Promoting student engagement for safe practice in dentistry has been a challenge. Social media, so strongly present in the lives of young people, can become a support for better engagement, motivation and learning. Aim: To evaluate dental student perception (adherence and applicability) about the inclusion of social media (Facebook-F, WhatsApp-W, and Instagram-I) as learning tools for teaching infection prevention and control. The performance (scores) of the students was compared to the results obtained by students who did not have access to social media for educational purposes. Materials and Methods: This research sample was formed by the students enrolled in the discipline of Biosafety and Ergonomics 2, at Federal University of Pernambuco-Brazil, between 2014 and 2017 (n=371). They answered a questionnaire survey in which the adherence, applicability and use of social media were evaluated as educational platforms. The academic performance (scores) of the interviewees on the discipline was compared to the results obtained by students who did not have access to social media for educational purposes in previous semesters (2011 to 2014). Results: The adherence of the use of social media apps was 98.3% (F), 100% (W), and 90% (I). Students considered that social media were advantageous teaching platforms (F-99%, W-100% e I-94%) because of: easy access to obtain didactic material (F); obtaining information quickly (W); images making the student assimilate the studied subject more effectively (I). There was no difference when comparing the students’ scores before and after inclusion of the social media in the subject (p=0.141; Student’s t-test). Conclusion: The majority of students adhered to social media and considered them to be advantageous infection prevention and control study platforms. This inclusion did not have negative impact on students’ academic performance.

Interruption Regions in the White Line: A Novel Panoramic Finding in the Risk Assessment of Mandibular Canal Exposure by Third Molar

Introduction: Panoramic markers are the indicators which can be demonstrated in panoramic radiograph to aid in dental diagnosis. Several panoramic markers were developed as diagnostic approach to predict Mandibular Canal (MC) exposure by Impacted Mandibular Third Molar (IMTM). Aim: To evaluate the type and number of panoramic markers in panoramic radiographs. To evaluate presence or abscence of mandibular canal exposure by impacted mandibular third molar from cone beam computed tomography images. To relate the type and number of panoramic marker with the risk of mandibular canal exposure by impacted mandibular third molar. Materials and Methods: The design of this study was a retrospective cross-sectional. A total of 188 panoramic radiographs of IMTMs were analysed initially to determine the type and number of panoramic radiological markers. A panoramic radiological marker would suggest an increased risk of MC exposure by IMTM when there was presence of MC exposure sign from the associated Cone Beam Computed Tomography (CBCT) image. The presence of MC exposure sign in the CBCT image was characterised by a disruption in the radiopaque cortex of MC by IMTM. A modification of the original classification of panoramic markers by Rood and Shehab (1990) was performed and used to determine the type of markers present. Chi-square test was used to analyse the association between the panoramic radiological markers and the MC exposure. Results: Markers such as interruption of the white line posterior to the third molar tooth (OR 2.74, p=0.02) and interruption of the white line anterior to the third molar tooth (OR 2.65, p=0.01) showed increased involvement with the risk of MC exposure. Presentation of more than two markers on the panoramic radiograph was also found to be significantly associated with high risk of the MC exposure, with the odds of 2.14 (p=0.04). Conclusion: Presence of panoramic markers involving the interruption of white line both anterior and posterior to the IMTM poses high involvement of the MC exposure.

Psychiatric Comorbidity, Severity of Dependence and Liver Enzymes Dysfunction among Alcohol Dependent Individuals: A Cross-sectional Study from Central Rural India

Introduction: Alcohol Dependence Syndrome (ADS) is a serious health issue all over the world and prominently associated with alcoholic liver disease. Alcohol dependent individuals have high prevalence of psychiatric comorbidities and liver damage among them may further influence associated diagnoses. Aim: To estimate the prevalence of psychiatric comorbidities among alcohol dependent individuals; to determine association of liver enzymes with psychiatric comorbidities and severity of ADS. Materials and Methods: A cross-sectional study was conducted on 100 patients of ADS from Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe) Wardha, Maharashtra. They were assessed through semi-structured sociodemographic proforma, Severity of Alcohol Dependence Questionnaire (SADQ), laboratory investigations for hepatic enzymes and Mini International Neuropsychiatric Interview (MINI PLUS). Data were analysed using SPSS 22.0 and considering p-value significant at <0.05. Results: The prevalence of psychiatric comorbidities among ADS was found to be 49% with Mood disorders (21%) being the most common diagnosis. Prevalence of ADS severity was found to be 10% (mild), 38% (moderate) and 52% (severe) respectively. GGTP (gamma-glutamyl transpeptidase) was significantly associated with psychiatric comorbidities (0.025) while, ALT (0.02), AST (0.023) and GGTP (0.0001) were significantly associated with dependence severity, considering p-value significant at <0.05. Conclusion: This study suggests that liver enzyme dysfunctions correlated with psychiatric comorbidities and severity of dependence. The liver function profile may alter the mood status of individuals and hence these factors need to be addressed during the management.

Profile of Neonatal Seizures and its Correlation with Serum Sodium Levels: A Prospective Cross-sectional Study

Rachna Pasi, Banashree Roy, Kumar Satish Ravi, Swathi Chacham

Introduction: Neonatal seizures have detrimental effect on the immature developing, neonatal brain despite aetiological factors. Also, they can denote systemic diseases or altered biochemical milieu. Maintaining electrolyte balance is vital to the functioning of central nervous system and has either direct or indirect impact on neuronal stability. Aim: To estimate the serum sodium levels in neonates presenting with seizures and to correlate the serum levels with clinical manifestations and to delineate its aetiological factors. Materials and Methods: It was a prospective cross-sectional study conducted on 76 neonates admitted in tertiary level care NICU with seizures and evaluated with detailed history and clinical examination. They were subjected to serum sodium level estimation coupled with other relevant investigations to delineate the definitive aetiology. These parameters were recorded in a predesigned, pretested structured questionnaire and the obtained data was analysed statistically by Chi-square test using SPSS version 20. Results: Of the 76 neonates enrolled, 59.2% (n-45) neonates had hyponatremia, of them 17.7% (n-8) had severe hyponatremia. Drowsiness was significantly more frequent in hyponatremic neonates (p<0.001). Hyponatremia manifested more often among preterm neonates with statistical significance (p=0.020). Also, mortality was significantly high in neonates with hyponatremia (p=0.003). Similarly, hyponatremia was found to be significantly more frequent in neonates with Hypoxic Ischemic Encephalopathy (HIE) (p<0.001). Conclusion: Hyponatremia was manifested in 59.2% of the neonates with seizures. Severity and duration of hyponatremia is an important prognostic marker of neonatal seizures, so should be managed immediately.

Histopathological Pattern of Prostate Carcinoma using New Grading System in a Tertiary Centre of Saudi Arabia

Nazima Haider, Bala Krishnamoorthy Adiga, Sohaila Fatima, Nihal Mirza

Introduction: Gleason grading of prostate carcinoma has undergone significant revisions and the new grading system has been accepted by the World Health Organisation (WHO) 2016, which is known to avoid confusion among treating urologists and the patients. Aim: To analyse the pattern of prostate carcinoma and to compare with new grading system. Materials and Methods: The present retrospective study consists of specimen obtained from transrectal ultrasound-guided core needle biopsies and transurethral resection of prostate within the duration of three years. Biopsy specimens were reviewed by histopathologists and grading of prostatic carcinoma was done according to modified Gleason grading system. Results: There were 47 cases of prostatic carcinoma in three years. The basic statistical analysis of cases and findings were applied manually. The 44 cases (94%) were adenocarcinoma and its variants. Only three cases (6%) were of small cell carcinoma, which was not assigned any grade. Conclusion: Determination of patterns especially Pattern 4 and their percentages becomes important which changes the Grade Group. The old system of Gleason Scoringisless sensitive (90.9%) and specific (95.45% ) as compared to new Grade Grouping.

Gender Variation in the Prevalence of Internet Addiction and Impact of Internet Addiction on Reaction Time and Heart Rate Variability in Medical College Students

Bhaskar Kannan, S Karthik, Gopal Krushna Pal, Vikas Menon

Introduction: In the present era, the internet is widely used by college students for academic, entertainment and communication purposes. College students are vulnerable to internet addiction due to various psychological and social factors. The prevalence and pattern of internet addiction vary between males and females. Internet addiction can significantly affect the physical and mental health of adolescents and college students resulting in poor academic performance and impaired functioning at work. Aim: To assess the prevalence of internet addiction and its impact on the auditory and visual reaction times and short-term heart rate variability in medical college students. Materials and Methods: In this cross-sectional study, 201 undergraduate medical students between 18 and 25 years of age participated. Young’s ‘Internet Addiction Test (IAT) questionnaire’ was used to classify the subjects on the basis of their level of internet addiction and prevalence was calculated. In a smaller subset of 93 students who scored 50 or greater in the IAT questionnaire were taken as internet addicts. Auditory reaction time (Tone, Click), visual reaction time (Green, Red) measured using Audio-Visual Reaction Time Apparatus and short-term heart rate variability estimated using Polygraph was analysed between the internet addicts and non-addicts. Shapiro-Wilk normality test was used to assess type of data distribution and Mann-Whitney U-test used for comparison. Results: Among 201 study subjects, 127 (63.2%) were males and 74 (36.8%) were females. Internet addiction was more prevalent in males (22.8%) than in females (8.1%). Auditory reaction time was significantly prolonged in the internet addicts compared to the non-addicts. Differences in the visual reaction time and short term-heart rate variability parameters were not statistically significant between the two groups with high and low IAT scores. Conclusion: This study shows the prevalence of internet addiction as 17.4% in undergraduate medical students, based on Young’s IAT score (50 or above). The internet addiction amongst males is significantly higher than in females. An understanding of the gender differences may be helpful for the clinicians to develop cognitive behavioural therapy, taking into account these findings. Auditory reaction time is prolonged, even in the early stages with a moderate level of internet addiction.

Efficacy of Intradialytic Stretching Exercise on Health-related Quality of Life among Patients Undergoing Haemodialysis

A Swapna Mary, V Chiranjeevi

Introduction: Patients suffering from End Stage Renal Disease (ESRD) are physically less active typically when compared to healthy individuals. Performing regular exercise could improve many attributes indicating the physical functioning of such patients and thus improving their quality of life. Haemodialysis patients can be safely guided to participate in a range of exercise programs to improve their health-related quality of life while restricting adverse effects to a minimum. Aim: To evaluate the efficacy of intradialytic stretching exercise on quality of life among patients undergoing haemodialysis and to find the association between quality of life with selected variables in the experimental and control group. Materials and Methods: A quasi-experimental pre-test and post-test design with a control group was used to assess the effectiveness of intradialytic stretching exercise on Health-Related Quality of Life (HRQOL) among haemodialysis patients. Two hundred patients were selected through purposive sampling technique. The inclusion criteria considered were chronic kidney patients undergoing haemodialysis for a period of one year, whose vital signs were within safe limits for exercise therapy. Patients with femoral catheter and lower limb pathology were excluded from the study. Results: There was no significant difference between experimental and control groups before the intervention in terms of HRQOL. Six months after the intervention, the post-test findings revealed that out of 100 participants in experimental group, 65 (65%) were having good HRQOL, 35 (35%) were having average HRQOL and no one had poor HRQOL. Whereas, in control group, out of 100 participants, pre-test scores were very similar to those of post-test. The pre-test scores showed 83 (83%) were having poor HRQOL, 17 (17%) were having average HRQOL and no one had good HRQOL. Post-test scores showed 84 (84%) were having poor HRQOL, 16 (16%) were having average HRQOL and none had good HRQOL. Conclusion: The study concluded that regular intradialytic stretching exercises among haemodialysis patients help in improving HRQOL.

Narratives as Active Learning Strategy to Emphasise the Clinical Relevance of Enzymology in Medicine

Maya Roche, K Indira Adiga, Akshatha Ganesh Nayak, Ronald Aloysius Roche

Introduction: Student learning is dictated by the learning environment rather than the inherent qualities of the learner. Mode of curriculum delivery heavily influences the learning environment and pushes the learner towards rote learning or meaningful learning. In every curriculum, there are areas which are perceived by students as unappetising and demanding. In biochemistry, enzymology is not a favourite among students since it entails learning kinetics and related equations and graphs. However, enzymology is important in the medical curriculum because of its clinical relevance in the diagnosis, prognosis and treatment of diseases. The present study employs an active learning strategy using a themed narrative and case scenarios to make the learning experience more interesting and meaningful. Aim: The objective of this study was to revise and integrate the core concepts in ‘enzymology’ and to bring home the clinical relevance of enzymology in medicine. In addition, the study would also facilitate active learning, thus promoting knowledge retention. Materials and Methods: A narrative on enzymology with specific numbered blanks, to be filled in by students was designed. Five case scenarios containing pictures and text, highlighting the clinical aspects of enzymology were constructed and validated. MBBS students (n=82) of the first year were asked to fill in the gaps in the narrative. Case scenarios were narrated to the students using PowerPoint slides containing pictures and text. Students responded to specific questions relating to the case scenarios. The marks obtained in both the activities were tabulated and students’ opinion on the activity based on predefined indicators was assessed using a questionnaire. Results: Students (43%) scored distinction marks (>75%) in the narrative on enzymology. They opined that it helped them to recall and integrate (81%) and retain knowledge (88%). They also felt that case scenarios were clinically relevant (82%) and helped to bridge the gap between theory and actual practice of enzymology in medicine (85%). Conclusion: Narratives and case scenarios can be used effectively to improve learning by medical students, especially when the subject matter is not easy to comprehend and is perceived as challenging.

Potential Advantages of Bone Marrow Sparing IMRT in Cancer Cervix: A Dosimetric Evaluation

Introduction: Concurrent Chemoradiation (CRT) is the standard of care for locally advanced cervical cancer patients. Addition of chemotherapy to pelvic radiotherapy augments Haematological Toxicity (HT). Whether reducing the radiation dose to Bone Marrow (BM) will diminish HT is yet not clear. Aim: The purpose of the present study was to analyse the feasibility of Bone Marrow Sparing (BMS) in cervical cancer patients using Intensity Modulated Radiotherapy (IMRT). Materials and Methods: Computed Tomography (CT) images of 10 consecutive biopsy-proven invasive cervical cancer patients were used. All patients were treated using Intensity Modulated Radiotherapy (IMRT) without bone marrow sparing (normal-IMRT). BMS-IMRT plans were generated for this study and Dose-Volume Histogram (DVH) parameters were then compared with normal-IMRT plans. Results: The mean values of the Planning Target Volume (PTV) V95 and V97 were lower and were statistically significant (p=0.016 and 0.019 respectively) in BMS-IMRT when compared to normal-IMRT, however, PTV coverage was not compromised in any BMS-IMRT plan. There was no statistically significant difference in the mean values of rectum V30, V40, bowel V35, V40, V45, and femoral head V35. However, the mean values of rectum V50, bladder V40, V45, and V50 were statistically lower in the case of BMS-IMRT. When compared to normal-IMRT the mean values of Pelvic Bone Marrow (PBM) V10, V20, V30, V40 were lower and found to be statistically significant in BMS-IMRT. Conclusion: The BMS-IMRT spares the PBM without compromising the target volume and at the same time spares bladder and rectum more effectively.

Motor Control Training in Chronic Low Back Pain

P Delicia Roshini, P Antony Leo Aseer

Introduction: Chronic Low Back Pain (CLBP) is the most disabling musculoskeletal disorder with altered functioning of the lumbar core muscles. Movement impairment and control impairment syndromes are present in CLBP. Control impairment is the loss of the ability of the core muscles to prevent excessive movement that happens at the lumbar spine. The concept of motor control training is very limited. Many protocols of motor control exercises have used stabilisation exercises. Motor control training has specific exercises for the type of impairment present. Aim: This study intends to design a motor control training program for CLBP and to measure its effectiveness using pressure biofeedback. Materials and Methods: Quasi Experimental (pre-post-test design) study design was conducted on 30 subjects fulfilling the inclusion criteria. They were divided into 2 groups-controls and experimental. Motor control tests were performed to find out the type of control impairments-flexion control, extension control and rotation control. The control group received conventional therapy with the basic core stabilisation exercises and flexibility exercises. The experimental group received specific control impairment exercises (flexion/extension/rotation) with specific dosages. The outcome measures used were lumbar core muscle strength (Chattanooga’s pressure biofeedback), pain severity and Roland Morris Disability Questionnaire. The outcomes were measured at baseline and after two weeks of treatment sessions. Independent t-test was used to compare between the groups. Results: The results showed statistically significant pain reduction (p=0.01), improvement in the lumbar core muscle strength (p=0.01) and functional outcome (p=0.03) was noted in the experimental group. The level of significance was set at p-value <0.05. There was a positive correlation of Fear Avoidance Beliefs Questionnaire (FABQ) physical activity subscale with baseline pain and transversus abdominis activation. Conclusion: The motor control training was found to improve the strength of lumbar core muscles, reduction in pain severity and enhanced functional outcome.

Maternal Anaemia is a Risk Factor for Anaemia in Infants at 14-16 Weeks-Need for Early Initiation of Iron Supplementation

Indrani Misra, Padmasani Venkat Ramanan, Rajesh Balan

Introduction: Exclusive Breast Feeding (EBF) is recommended uniformly for all infants till six months. It is believed that since bioavailability of iron in breastmilk is high this along with the fetal iron stores will be adequate till six months. Current recommendation for iron supplementation in term infants is only from six months. However, maternal iron deficiency may reduce fetal iron stores and the infant may develop deficiency earlier. Aim: To study the prevalence of anaemia in term appropriate for gestation age exclusively breastfed infants at 14-16 weeks of age and its relationship to mothers’ haemoglobin at delivery. Materials and Methods: This observational study was done from March 2017 to July 2018. We recruited 350 Term Appropriate for Gestational Age (TAGA) infants on EBF aged 14-16 weeks. Chi-square test was used to test the association between the categorical variables. A binary logistic regression was used to calculate the odds ratio and 95% confidence interval. Results: Among the 350 infants studied 129 (36.8%) had anaemia. In the anaemia group, 34 (26.4%) out of 129 infants were significantly underweight compared to 36 (16.3%) out of 221 non-anaemic infants. There were significantly more anaemic children among the lower Socio-economic class with 10/17 (58.8%). Among the 350 mothers, 137 (39%) had anaemia at the time of delivery. The prevalence of anaemia in the infants born to anaemic mothers was 64% and among non-anaemic mothers it was 19%. There was a moderate positive correlation (0.52) between maternal Haemoglobin (Hb) at delivery and anaemia in infants at 14-16 weeks. Conclusion: The prevalence of anaemia in the infants born to anaemic mothers was significantly higher than non-anaemic mothers. Maternal anaemia should be taken as a risk factor for anaemia in EBF infants and these children should be routinely started on iron supplements in early infancy.

Evaluation of Intra Ocular Pressure after Leg Press Test in Young Males- A Comparative Study

D Gajenthiran, Lalitha Shanmugam

Introduction: Intra Ocular Pressure (IOP) is fluid pressure within the eye, which ranges normally from 10-21 mmHg. Elevated IOP is the most important risk factor for the optic nerve damage. Leg press test is an exercise which lowers IOP. Aim: To evaluate the effect of IOP after leg press test in young males in Melmaruvathur, Tamil Nadu, India. Materials and Methods: The present cross-sectional study was conducted on 102 young male volunteers from Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS) in the age group of 18-27 years. The systolic blood pressure of subjects ranged from 110-124 mmHg and diastolic blood pressure ranging from 70-82 mmHg without having the habit of smoking, taking alcohol and without any eye infection were included in this study. We measured the height, weight and IOP before and after leg press test for the participants by using Schiotz tonometer. IOP measurements was analysed by mean and standard deviation, paired t-test was used to compare the two measurements. Results: Mean IOP of Right eye before leg press test was 16.17±3.08, after leg press test was 11.84±3.11 showing highly significant p<0.001. Mean IOP of Left eye before leg press test was 16.92±2.64, after leg press test was 12.65±3.45 showing highly significant p<0.001. Conclusion: Hence our study suggests that IOP of both eyes was decreased after leg press test.

Significance of Morphometric Evaluation of Pre-Malignant and Malignant Lesions of Uterine Cervix: A Cross-sectional Analytical Study

Hajra K Mehdi, Kalyani Raju, SR Sheela

Introduction: Morphometric analysis of various parameters of the cells is done to classify the lesion as benign or malignant. It is an objective assessment which reduces the variability due to subjective visual assessment. Authors have done the nuclear morphometric analysis in ectocervix and endocervix tissue sections. Aim: To evaluate the significance and utility of nuclear morphometry in pre-malignant and malignant lesions of uterine cervix. Materials and Methods: This was a retrospective cross-sectional study done on 120 cases of cervix which were categorised histomorphologically into normal ectocervix, chronic cervicitis, Low-Grade Squamous Intraepithelial Lesion (LSIL), High-Grade Squamous Intraepithelial Lesion (HSIL), Squamous Cell Carcinoma (SCC), normal endocervix, chronic endocervicitis, Low-Grade Cervical Glandular Intraepithelial Neoplasia (LCGIN), Adenocarcinoma In Situ (AIS) and adenocarcinoma. The quantitative nuclear morphometry analysis was done and entered in Microsoft Excel sheet. Statistical analysis was done by using SPSS software 22.0 version. The p-value <0.05 was considered as statistically significant. Results: In ectocervical cases, all the nuclear parameters as Mean Nuclear area (MNA), Mean Nuclear Perimeter (MNP), Minimum Nuclear Diameter (mND), Maximum Nuclear Diameter (MND), Mean Nuclear Compactness (MNC) and Mean Nuclear size (MNS) were statistically significant (p-value <0.05) except Mean Shape Factor (MSHF) where the p-value was 0.415. In the endocervical cases, only mND and MSHF were statistically significant. Conclusion: Nuclear morphometry can be used as a tool in distinguishing the premalignant and malignant lesions in both ectocervical and endocervical tissue samples.

Standardisation and Evaluation of Direct MTT Rifampicin Tube Assay for Sputum against Smear Grading, Volume and Turnaround Time

Introduction: WHO has rolled out rapid molecular methods for detection of rifampicin resistance. However, the same are not yet accessible at all the laboratories which are still dependent on alternative methods. Direct colorimetric dye 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide tube assay (DMTT) for rifampicin susceptibility on sputum, has been shown to be fairly rapid, sensitive and specific but its evaluation has not been reported based on volume of sputum or Acid Fast Bacilli (AFB) grading which is still the routine method for quantifying the bacilli on smear microscopy. Aim: To standardise the DMTT test against volume, grading and Turnaround Time (TAT), and to evaluate the results on clinical samples. Materials and Methods: The present cross-sectional study, duly approved by Institutional Ethics Committee and with written consent from all the patients, was conducted on the sputum samples received in the Department of Microbiology of the Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India, between January 2010 to September 2011. Taking Indirect Agar Proportion Method (IAPM) as reference standard, the test was first standardised with 36 sputum samples of different grades of AFB positivity. The samples were concentrated by Modified Petroff’s method and directly processed for DMTT rifampicin susceptibility test as per protocol. Subsequently 153 clinical samples were similarly evaluated. Results: The test was sensitive even for scanty positive sputum and all results were available by 21^st day. For 3+ grade 96% results were ready by 14^th day. Increase in volume of sputum decreased the TAT in all grades. DMTT showed good concordance with IAPM in all grades of sputum (91.4% to 100%), overall 95.48%, and could be easily read by naked eye. Conclusion: The DMTT rifampicin test can be performed in all grades of positive sputum and the TAT in scanty and low positive samples can be enhanced by increasing the volume to at least three mL.

Effectiveness of Cervical Stabilisation Exercises on Respiratory Strength in Chronic Neck Pain Patients with Forward Head Posture- A Pilot Study

Sonia Pawaria, Dharmpal Singh Sudhan, Sheetal Kalra

Introduction: Forward Head Posture (FHP) is one of the most common abnormalities associated with chronic neck pain. In FHP the altered rib cage mechanics leads to decrease in thoraco-abdominal mobility, impaired diaphragm muscle mobility and reduced the ventilator efficacy of diaphragm, reduced the effectiveness of abdominals and intercostals muscles. Aim: To examine the efficacy of Cervical Stabilisation Exercises on neck pain, neck disability, craniovertebral angle and respiratory muscles strength. Materials and Methods: This pilot study was conducted on a total number of 20 subjects, which were further divided into study and control groups. Study group received Cervical Stabilisation Exercise with the conventional Physiotherapy. Control group received only Conventional Physiotherapy for six weeks. The baseline measurement was taken on day one of the study for Numeric Pain Rating Scale (NRPS) and Neck Disability Index (NDI). The Forward head posture which was assessed by the digital camera, measured the Cranio Vertebral Angle (CVA). Respiratory muscle strengths (MIP and MEP) were assessed by respiratory pressure meter. All measurements were repeated at the end of sixth week. The baseline measurement and measurement at the end of sixth week were compared by using the analysis of variance. Results: Significant increase in CVA (from mean value of 37.90 to 59.21) and respiratory strength (PImax from mean value of 65.33 to 75.01, PEmax from mean value of 77.78 to 87.89) with decrease in NPRS (from mean value of 7.6 to 0.90) and NDI (from mean value of 12.11 to 0.60) scores were found in the group that received cervical stabilisation exercises as compared to control group (p<0.05). Conclusion: Cervical stabilisation exercise is an effective approach to reduce the forward head posture and thus helps to regain the respiratory muscle strength by improving the biomechanics of respiratory muscles.

Injury Severity Score as a Predictor for Requirement of Surgical Exploration in High Grade Renal Trauma

Introduction: With the current advances in intensive care protocols, conservative management is successful in a large proportion of renal trauma patients who are haemodynamically stable. In spite of the current trend towards conservative management of renal trauma, there still remains a dilemma regarding need for surgery in patients with grade IV renal trauma. Various predictors of failure of conservative management for high grade renal trauma have been studied. Aim: To assess the utility of the Injury Severity Score (ISS) in predicting the need for surgical exploration in patients with high grade renal trauma. Materials and Methods: We retrospectively studied 38 patients with renal injury over a period of 4 years. The Injury Severity Score (ISS) was calculated for all patients on admission. Renal injury grading on contrast enhanced computed tomography followed the American Association for the Surgery of Trauma (AAST) system. Patients were divided into three management groups: Group A- conservative management; Group B- double J ureteric stenting; and Group C- surgical exploration. The ISS in different management groups were compared using the Mann-Whitney U test. Results: Fifteen (39.47%) patients required intervention and 23 (60.5%) were managed conservatively. In the conserved Group A, 39.1%, 47.8% and 13% had injury grades 1, 2 and 3 respectively. Seven patients (18.4%) required ureteric stenting or pigtailing of perinephric collection (Group B) for urinary extravasation. All 7 had grade 4 injury. Eight patients (21.8%) were explored (Group C), out of which five had grade 4 injuries while three had grade 5 injuries. Average ISS in the 3 groups were 12.3, 11 and 19 respectively. Group C had significantly higher ISS than A (p=0.005) and B (p=0.0002). Of the grade 4 injuries, those who required surgical exploration had a higher ISS (17.80) compared to those who could be managed with minimal intervention (9.85); and this difference was statistically significant (p=0.007). ROC curve analysis showed an AUC of 0.863 for the predictive value of ISS for surgical exploration in renal trauma. Conclusion: Grade 4 renal injuries with a lower ISS can be managed with minimally invasive management in the form of double J stenting. The ISS can guide clinical decision making when faced with a dilemma of conservative vs surgical management of patients with high grade renal trauma.

Seroprevalence of Mycoplasma pneumoniae and Clinical Profile of Affected Patients in a Tertiary Care Hospital

PB Pooja, A Tejashree, D Narayanappa

Introduction: Mycoplasma pneumoniae is the most common causative agent of community acquired pneumonia. Rapid and reliable method for the diagnosis of Mycoplasma pneumoniae infection is important for the appropriate treatment. Aim: To determine the rapid diagnosis of Mycoplasma pneumoniae pneumonia in a clinically suspected Community-Acquired Pneumonia (CAP) cases. Materials and Methods: A cross-sectional study was carried out in the Department of Microbiology, JSS Hospital, Mysuru, Karnataka, India, for a period of two years from January 2016-January 2018. All the suspected cases of CAP from inpatients and outpatients attending JSS Hospital were enrolled in the study. The samples were subjected to Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Immunofluorescence Assay (IFA) for the detection of IgM antibodies against Mycoplasma pneumoniae. Results: A total of 200 patients were enrolled in this study. Among which 123 (61.5%) were paediatric population and 77 (38.5%) were adults respectively. A total of 60 samples were positive for IgM antimycoplasma antibody. Out of 60 samples 11 samples were positive by ELISA and 60 samples were positive by IFA. Sensitivity and specificity was found to be 100% and 74.1% of the tests. The prevalence of Mycoplasma pneumonia in the present study was found to be 30%. The most common symptom was cough followed by fever. Conclusion: Mycoplasma pneumoniae pneumonia constituted to about 30% of CAP in our study. Combination of tests must be carried out along with significant suggestive clinical signs in the clinically suspected cases for the CAP for the better management and early diagnosis of the disease.

Knowledge, Attitude and Practices of Dentists about Oral Health Care during Pregnancy: A Cross-sectional Study from Turkey

Muhittin Ugurlu, Hikmet Orhan

Introduction: Oral hygiene care during pregnancy is critically substantial. Nevertheless, previous studies indicated that pregnant women uptake less oral health care during pregnancy. There are some reasons that hinder pregnant women receive oral health care. Additionally, dentists are hesitant to treat pregnant women for fear of causing harm to the mother and foetus. Studies have not reported the perception of dentists about oral health care during pregnancy in Turkey. Aim: The aim of the study was to evaluate the knowledge, attitude and practices of dentists about oral health care during pregnancy. Materials and Methods: A questionnaire was prepared by reviewing the literature regarding dental care during pregnancy. A total of 210 questionnaire were distributed to dentists in Isparta and Burdur, Turkey and 200 (95.2%) completed surveys were returned. Statistical analyses were performed by chi-square test. Results: Most of the dentists were knowledgeable about oral health care during pregnancy but had limited knowledge about the safety of radiographs during this period and early childhood caries. Only 27.5% of the dentists were sure about radiographs could be securely taken during this period. Around 48% of the dentists believed that poor maternal oral health can contribute to early childhood decay. The majority of the dentists in this study knew that basic dental treatment is safe during pregnancy (84%) and were aware of the dental procedures that are safe to undertake during this period. The dentists were knowledgeable about the safety of using medications (51.5-100%). The dentists had rather positive attitude towards perinatal oral health (59.5-99.5%). Higher proportions of the dentists stated that they wanted further information about dental care during pregnancy (77%). Conclusion: The findings from this survey suggest a large consensus among dentists in the management of pregnant women. Nevertheless, further research with more national sample is recommended to confirm these findings. Education programs and practice guidelines on perinatal oral health can be beneficial for dentists to provide dental care during pregnancy.

Hereditary Multiple Exostoses and Orthopaedist- Till the Plausible Management Evolves

Pankaj Kumar Mishra, Amol Dubepuria, Sanjiv Gaur

Introduction: Hereditary Multiple Exostoses (HME) is an inherited genetic skeletal disorder of enchondral bone. It is an autosomal dominant disorder affecting juxtaepiphyseal region of the long bones and includes multiple exostoses. The treatment of HME is mainly surgical, while the medical approach is still in evolving phase. Surgery is needed only in symptomatic cases to avoid eventual intricacy. Limb length equalization, deformity correction by osteotomy and epiphysiodesis are frequently entertained procedures. Aim: To carry out the descriptive study over HME patients with clinical profile and surgical execution. Materials and Methods: It was a prospective study involving 17 cases. The present institute provides tertiary care as well; caters to the major number of cases, even from long distance. So it is assumed that most of the HME patients would have been referred to or visited the hospital only after moderate to severe functional deficit in their lifestyle. All the patients were dealt with according to their complaint and the Short Assessment of Patient Satisfaction (SAPS) score was obtained. Results: Three patients (17.6%) were very satisfied, 11 patients were satisfied (64.7%), 3 (17.64%) patients were dissatisfied and one patient was very dissatisfied with the treatment executed. Conclusion: The orthopaedic surgeon is the first treating doctor who faces diagnosis and treats HME patients. Orthopaedists should be cognizant to clinical display of it, along with its differential and aftermath. Surgical mediation often needed to excise the clinically obliged exostoses only.

Comparison of Propofol Alone and Propofol-Ketamine Mixture for Sedation during Endoscopic Retrograde Cholangiopancreatography (ERCP): A Randomised Study

Introduction: Propofol is frequently used for deep sedation for Endoscopic Retrograde Cholangiopancreatography (ERCP). Sedation-Related Adverse Events (SRAEs), associated with propofol administration, include hypotension, arrhythmia, oxygen desaturation, unplanned intubation and procedure termination whereas, ketamine propofol combination has favourable haemodynamic effects. Aim: To evaluate the efficacy of the synergistic effect of small dose of ketamine (25 mg) and propofol in comparison with propofol alone on propofol consumption for deep sedation in patients undergoing ERCP. Materials and Methods: A total of 60 patients undergoing ERCP were randomly assigned to one of the two medication regimens through chit and box method. Patients in Group 1 (n=30) received only intravenous propofol, while patients in Group 2 (n=30) received 25 mg of i.v. ketamine along with intravenous propofol and both groups of patients were titrated to achieve deep sedation. Total propofol consumption was recorded in both groups. Results: Patients in both groups were comparable in terms of BMI, ASA status and duration of ERCP. Group 1 patients required significantly higher doses of propofol (370±123.4 mg) as compared with Group 2 (342.65±116.4 mg). The mean percentage decline in oxygen saturation during the procedure was greater in Group 1 than it was in Group 2. Conclusion: Authors concluded that during ERCP addition of ketamine to propofol resulted in decrease in propofol consumption without disturbing intra and post-procedure haemodynamic stability.

Structured Reflection with Self-assessment Rubrics: A Study Report on Dental Students Expression, Experience, and Perceptions about Reflective Practice

Introduction: The clinical competence is supported by reflective practice by assisting the beginners to analyse their progress and update their capabilities. Aim: To introduce Structured Reflection with Self-assessment Rubrics (SRSR) for dental undergraduates and to determine its effectiveness in enhancing the participant’s clinical competence and students’ perspectives about reflective practice. Materials and Methods: A non-randomised experimental study was carried out consecutively for four academic years. Using purposive homogeneous sampling methods, 247 internship students were included in the study. A structured reflective worksheet was designed by focusing on seven essential domains of dental practice and each participant was asked to reflect on 12 clinical procedures during their internship period. The self-completion survey was conducted using a close-ended questionnaire to predict the participants’ experience and a 5-point Likert’s scale feedback questionnaire to analyse their perceptions and attitudes toward reflective practice. Results: Statistical analyses of the survey results revealed that 72% of the total participants accepted that structured reflective practice enhanced their self-directed learning and made them provide high-quality patient care. About, 75% of the participants expressed their interest in adopting the reflective practice in their upcoming learning activities. Interestingly, 57% of the participants stated that they experienced a mismatch between idealism and reality when practising structured reflection in a clinical environment. However, 64% of the present total participants strongly agreed on the importance of reflective practice in clinical training. Conclusion: Based on the study results, authors ensure the effectiveness of structured reflection in enhancing dental student’s clinical competence and their positive attitude towards the reflective practice.

Effectiveness of a One-day Diabetes Group Education Session for Glycaemic Control in Type 2 Diabetes Patients: A Randomised Controlled Trial

Introduction: A strategy of a diabetes group education session as a diabetes camp without staying overnight is commonly practiced in Thailand for type 2 diabetes patients. Aim: To compare the effectiveness of diabetes control between a group education session and non-intervention in type 2 diabetes. Materials and Methods: A randomised controlled trial was conducted between May 2015 and January 2016 at the Diabetes Clinic, Naresuan University Hospital, and 6 Health Promotion Hospitals. Type 2 diabetes patients with Glycosylated Haemoglobin Level (A1C) levels of more than 8% who received insulin with or without oral hypoglycaemic treatment were randomly assigned to join or not to join a 1-day diabetes group education session or a so-called Diabetes Day Camp. The primary outcomes were glycaemic control determined by fructosamine value and A1C level, 2 weeks and 3 months after finishing the intervention, respectively. Chi-square test and independent t-test were used for comparison of demographic data and final outcomes between the experimental group and the control. Before and after outcome analysis within group was determined by paired t-test. The p-value <0.05 was considered statistically significant. Results: After exclusion, there were 68 patients left for analysis, 33 in the interventional group and 35 in the control group. The 33 patients assigned to the interventional group attended one of the two consecutive sessions of a 1-day group education intervention conducted on August 8 and October 31, 2015. There were no significant differences in fructosamine values (mg/dL) and A1C levels (%) after finishing the intervention between the interventional group and control group (281.03±49.20 versus 287.94±74.08; p=0.654 and 8.99±1.37 versus 9.16±2.03; p=0.695, respectively). Conclusion: Author’s program of behavioural modification through a 1-day diabetes group education session in type 2 diabetes patients has not shown any improvement in glycaemic control as compared with non-intervention. Adding a booster or extending duration should be considered for further studies.

Newer v/s Classical Anthropometric Indices as a Screening Tool for Dyslipidemia in Healthy Young Adults

Nikhil Mathur, Srinidhi Rai, Neveditha Sujith, Orru Gayatri

Introduction: The association of obesity with higher rates of dyslipidemia and cardiovascular diseases has been well documented. The most commonly used classical anthropometric indices do not provide an accurate distinction between adipose tissue and lean body mass and therefore are an unreliable indicator of obesity. Therefore, newer Anthropometric indices such A Body Shape Index (ABSI) and Body Roundness Index (BRI) were assessed and their co-relation with plasma lipid levels was determined to predict future at-risk population for dyslipidemia. Aim: To compare classical and newer anthropometric indices in their ability in predicting dyslipidemia. Materials and Methods: The cross-sectional study was conducted on 100 subjects (aged 18-35 years). The lipid profile (total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein) was measured by enzymatic colorimetric assay. Classical anthropometric indices: Body Mass Index (BMI), Waist Circumference (WC), Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHt.R) and newer anthropometric indices: ABSI and BRI were measured. Normality of the data was assessed using Kolmogorov-smirnov test. Correlation of lipid parameters with various anthropometric indices was assessed using Pearson’s correlation test. Receiver Operating Characteristics (ROC) curve analysis was done to analyse the predictive capability of various anthropometric indices for distinguishing between dyslipidemic and non-dyslipidemic individuals. Results: In the study population, 44 (44%) participants had dyslipidemia and 56 (56%) had normal lipid levels. TC showed a statistically significant (p<0.05) positive correlation with BMI (r=0.207), WC (r=0.214) and BRI (r=0.237). TG showed a statistically significant (p<0.05) positive correlation with Wt. (r=0.209), BRI (r=0.242) and a highly significant (p<0.001) (p<0.05) positive correlation with BMI (r=0.311) and WHt.R (r=0.263). HDL-c showed a statistically significant (p<0.05) negative correlation with Wt. (r=-0.232) WC (r=-0.233), WHR (r=-0.199) and highly significant (p<0.001) negative correlation with BMI (r=-0.271) and WHt.R (r=-0.257). LDL-c showed a statistically significant (p<0.05) positive correlation with WC (r=0.249), ABSI (r=0.210) and BRI (r=0.247). BRI showed the highest prediction accuracy with the area under the ROC curve (AUC=0.637). Conclusion: BRI is closely associated with dyslipidemia. BRI is a powerful index that outperforms the classical anthropometric indices in identifying dyslipidemia and thus shows a potential to be used as an alternative obesity measurement in healthy young adults.

Does Normalised Apparent Diffusion Coefficient Further Improve the Diagnostic Accuracy of Diffusion-Weighted MRI at 3T in Characterising Breast Masses?

Varsha S Hardas, Aparna H Chandorkar, Aparna A Atre

Introduction: In recent times, a significant rise has been observed in the incidence of breast cancer among Indian women. Breast Magnetic Resonance Imaging (MRI) plays an adjuvant role in the high risk screening, diagnosis, staging and follow-up of breast cancer. It is used as a complementary tool to mammography and ultrasound for the diagnostic work-up of breast masses. An advanced MRI technique such as Diffusion-Weighted Imaging (DWI) with quantitative absolute and normalised Apparent Diffusion Coefficient (ADC) measurements is employed to improve the diagnostic performance of Contrast-Enhanced Breast MRI (CE-MRI). Aim: To assess whether glandular tissue-normalised Apparent Diffusion Coefficient (nADC) could further improve the diagnostic accuracy of MRI, in characterising benign versus malignant breast masses. Materials and Methods: This cross-sectional study included 39 patients with 51 focal breast masses. These patients underwent CE-MRI and DWI, on a 3T MR system. Absolute ADC values and glandular tissue-normalised ADC values were measured in the breast masses satisfying the inclusion criteria. The diagnostic accuracy and kappa measure of agreement between the diagnoses obtained from various imaging techniques (independently and in combination) and the final histopathology/follow-up results were calculated. Results: Twenty six (51%) of the 51 breast masses were benign and 25 (49%) were malignant. The mean nADC value (0.619+0.21×10^-3 mm²/sec) obtained from malignant breast masses was significantly lower than the mean nADC value (0.98+0.26×10^-3 mm²/sec) measured from benign breast masses (p<0.05). Adding, normalised ADC to CE-MRI, increased the specificity of breast MRI in differentiating benign from malignant breast masses, from 88.5% to 92.3% and improved its kappa score of agreement with histopathology or follow-up results, from 0.883 to 0.960. Receiver Operating Characteristic (ROC) curve analysis indicated that the Area Under Curve (AUC) for nADC (0.870) was higher than the AUC for absolute ADC (0.809). Conclusion: Quantitative DWI with glandular tissue-normalised ADC mapping at 3T, improves the diagnostic performance of breast MRI in characterising breast masses; especially in a subset of masses with borderline CE-MRI findings and absolute ADC values.

A Comparative Study of Body Composition and Sleep Habits Between Male and Female Students

Qassim I Muaidi, Mohammad Ahsan, Mariam I Albaker

Introduction: Elevated body composition is associated with many health hazards and it is also strongly associated with sleep habits of individuals. Aim: To compare body composition and sleep habits between male and female students. Materials and Methods: A total of 500 subjects (N=500) were chosen using a convenience sampling technique, Male students (N=250) and female students (N=250). Body composition was measured using Bioelectric Impedance Analyser, Sleep habits were measure with Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Independent sample t-test was used to compare body composition and sleep habit for male and female students. Results: The result showed that there is a significant difference between male and female students for the Body Mass Index (BMI), body fat, total body water, except PSQI and ESS. Whereas, no significant difference existed between male and female students to PSQI and ESS for sleep habits. Conclusion: Sleep habits also need further commitment towards the factors that may obstruct with good quality of sleep. Authors may develop evidence-based strategies according to the individual need for prevention of obesity and abnormal sleep habits.

Left Atrial Volume Index: As a Predictor of Early In-Hospital Major Adverse Cardiovascular Events in Acute Coronary Syndrome

Sharan Badiger

Introduction: Raised Left Atrial Volume Index (LAVI) is considered as an important predictor of poor outcome in patients having acute coronary syndrome. Aim: To study LAVI as a predictor of early in-hospital major cardiovascular events in acute coronary syndrome. Materials and Methods: Prospective observational study was carried out in 84 patients admitted in ICU of tertiary care hospital with a diagnosis of acute coronary syndrome. Clinical, electrocardiogram, 2D echocardiographic, laboratory tests and outcome of patients having acute coronary syndrome during hospital stay were assessed. Biplane method of discs was used to measure Left Atrial Volume (LAV). LAVI was calculated by dividing LAV and body surface area. Out of 84 patients, 26 patients having LAVI >32 mL/m2 were grouped into group A and 58 patients having LAVI <32 mL/m2 were grouped into group B. Data were analysed using SPSS software v.23.0. Data was compared between groups using diagrams and significance of data was found by chi-square test. Chi-square (?2)/Freeman-Halton Fisher-exact test were employed to determine the significance of differences between groups for categorical data. Results: In group A (26 patients), mean LAVI was 43.2 mL/m2±11.2, major adverse cardiovascular events were cardiogenic shock and pulmonary oedema in nine patients (34.6%) each followed by death in five patients (19.2%), heart failure in three patients (11.5%). In group B (58 patients), mean LAVI was 22.9 mL/m2±10.9, major adverse cardiovascular events were cardiogenic shock in four patients (6.8%) followed by pulmonary oedema in three patients (5.2%), heart failure in two patients (3.4%) and death in one patient (1.7%). Out of 84 patients, the common wall motion abnormality was anterior wall occurring in 28 patients. There was no significant association between LAVI and wall motion abnormality as p-value was >0.05. Mean ejection fraction was 46.7% in patients with LAVI <32 mL/m2 (group B) and 37.9% in patients with LAVI >32 mL/m2 (group A) which was significant, p-value <0.001. Conclusion: Routine measurement of LAV and calculation of LAVI in patients with acute coronary syndrome is necessary to prevent major adverse cardiovascular events.

Safety Attitudes among Doctors and Nurses in an Emergency Department of an Australian Hospital

Naif Alzahrani, Russell Jones, Mohamed E Abdel-Latif

Introduction: Safety attitudes have been investigated in a number of countries across different hospital departments, however there are few studies including Emergency Departments. Aim: To investigate doctors’ and nurses’ attitudes towards patient safety in Emergency Department in an Australian hospital. Materials and Methods: A cross-sectional research design was used. The participants included 51 doctors and nurses who completed a Safety Attitudes Questionnaire (SAQ) and reported the number of errors they had witnessed over the last year. Multivariate and univariate analysis was used to compare mean subscale scores of safety attitudes between doctors vs. nurses. Results: The findings showed doctors had comparatively positive safety attitudes compared to nurses, who rated teamwork climate, safety climate, unit management and work conditions particularly low. Both doctors and nurses had low opinions of hospital management and working conditions. Doctors and nurses with longer tenures and those who reported a higher number of medical errors had good safety attitudes. Conclusion: This study provides an insight into the safety attitudes of doctors and nurses employed in an Emergency Department in an Australian hospital. Further investigation into the relationship between safety attitudes, error rates and reporting should be performed in future studies.

Evaluation of Impedance and Reactance in the Intensive Treatment of Lymphoedema

Introduction: Lymphoedema is a progressive, chronic, clinical sign of an abnormal accumulation of macromolecules in the interstitial space that causes a buildup of fluids. Aim: To evaluate specific data of bioimpedance such as impedance and reactance in the evolution of lymphoedema treatment. Materials and Methods: A prospective quantitative study was enrolled in the Clinica Godoy-Brazil in May 2013, on 24 patients with bilateral lower limb lymphoedema (48 legs). Bioimpedance variables (impedance and reactance) were evaluated before and after five days of intensive treatment (mechanical lymphatic therapy, cervical stimulation, manual lymphatic therapy and grosgrain compression stockings) of the legs with the results being compared with a control group. The patients of the control group had arm lymphoedema without clinical evidence of swelling of the legs. All patients were weighed and underwent volumetry by the water displacement technique or perimetry (elephantiasis), and multi-frequency bioelectrical impedance before treatment and at the beginning and at the end of each day of treatment. The results are reported as descriptive statistics and Kruskal-Wallis test (Conover-Inman). Results: Statistically significant differences were found between the study and control groups for impedance (p-value <0.0001). The ages of the 17 female and seven male patients ranged from 22 to 75-year-old (mean: 43.7 years) and ages of control group ranged from 42 to 71-year-old (mean: 51.8 years). Conclusion: Impedance and reactance evaluations contribute to the diagnostic evaluation in the follow-up of lymphoedema treatment.

Effect of Heavy Metal Ions on Candida Isolated from HIV Positive Patients

Monal M Kukde, Silpi Basak, Deepak S Selokar

Introduction: Over 90% of AIDS patients and 1/3^rd of HIV seropositive patients are affected by Oral candidiasis. Moreover, the frequency of HIV related oral candidiasis is increased when CD4 count falls <400/mm³ of blood. The widespread use of antifungal drugs in People Living with HIV/AIDS (PLHA) has led to emergence of drug-resistant strains of Candida species. Aim: To detect the effect of heavy metal ions on Candida species and also to find the relationship between CD4 count and oral candidiasis in PLHA. Materials and Methods: A total number of 25 HIV positive patients were studied after taking written informed consent. From each patient oral swabs from tongue and hard palate were collected and thus a total of 50 specimens were processed for isolation of Candida as per conventional methods. Effects of heavy metal ions like Lead, Zinc, Silver, Mercury and Cadmium on 26 Candida strains isolated were studied by agar dilution method. Percentages and proportions were used using frequency tables. Results: All 26 (100%) Candida strains were resistant to Zinc ions with 100 mM concentration whereas all of these 26 (100%) Candida strains were sensitive to Cadmium ions even with 1 mM concentration. Maximum 8 (32%) PLHA from whom Candida species was isolated had CD4 count 300-399/mm³ of blood. Conclusion: Though heavy metal salts can be used for therapeutic use at very high dilutions heavy metals toxicity can result in long-term exposure. Heavy metal contacts with the skin also cause toxicity to different organ and damage to Central Nervous System (CNS), erythematous area over the skin, hyperpigmentation and argyria. Further study with animal experiment and human volunteers is required.

Tobacco Menace and Challenges in Quitting Tobacco in an Indigenous Population of Tamil Nadu: A Cross-sectional Survey

D Prabu, S Nirmala, Nesa Aurlene

Introduction: Tobacco usage is one of the leading causes of preventable death and morbidity all over the world. Many indigenous cultures are known to use tobacco as part of their religious or traditional rites. Such practices are usually initiated at a very young age and maintained lifelong in addition to being transmitted from generation to generation. Aim: The aim of the present study was to evaluate tobacco use practices, awareness on health hazards of tobacco use, practice, success of quit attempts, and knowledge on tobacco cessation aids among a tribal population of Narikuravars in Chennai, Tamil Nadu. Materials and Methods: A cross-sectional survey using a self-styled 14-item questionnaire was conducted from November 2018-December 2018 in two clusters of Narikuravar population in Chennai, Tamil Nadu. The questionnaire consisted of four parts. The first part consisted of three items to assess the awareness of health hazards of tobacco use, the second part consisted of two items to assess current tobacco use practices, the third part consisted of six items to assess quitting practices and factors that were challenging or led to relapse, the last item in this part of the questionnaire was partly open ended and assessed whether participants had motivated any other person to quit using tobacco and what were the reasons they cited in asking others to quit. The fourth part of the questionnaire consisted of three items to assess the awareness on the availability of professional help to aid in quitting tobacco, awareness on cessation aids and awareness on tobacco control laws in India. In addition to this the questionnaire also included assessment of demographic details such as gender, age, education status and occupation. A total of 130 participants over 15 years of age were included in the study following a cluster sampling technique. The principal investigator administered the questionnaire using face-to-face interviews. All the data were entered into Micro Soft Excel and frequency distributions for all the variables was tabulated. Results: In this study, 56.2% of tribal people aged over 15 years were users of tobacco in smoking or smokeless form. Natural tobacco preparation with tobacco leaf, betel leaf, areca nut and slaked lime was the most common form of tobacco used by 57.5% of Narikuravars. Nearly half (49.3%) of Narikuravars had thought of quitting tobacco use but only 14.4% were able to successfully quit tobacco for at least six months without relapsing back to using. A majority of 97.6% of participants were unaware that professional assistance can be sought to help them quit tobacco use, likewise a majority of 91.5% of participants were unaware of the existence of pharmacological or non-pharmacological aids to assist them in quitting tobacco. Conclusion: The present study demonstrated a relatively high awareness on health hazards of tobacco use among a tribal population of Narikuravars in Tamil Nadu. Nearly half of the users of tobacco wanted to quit the habit but a majority were unable to quit tobacco successfully. Knowledge and awareness regarding seeking professional assistance to quit tobacco and tobacco cessation aids was very poor among tribal people indicating the need for health education efforts in these areas, so as to enable tribal people to quit tobacco use more successfully.

The Importance of Vascular Endothelial Growth Factor (VEGF) in Aggressiveness of Odontogenic Lesions

Reham Alsafadi, Mamdouh Almohareb

Introduction: Angiogenesis is a major part of a variety of physiological and pathological processes, including tumour growth. Vascular Endothelial Growth Factor (VEGF) is a highly potent and specific angiogenic factor. Many studies have indicated the importance of VEGF in growth and expansion of lesions which contributes to the local invasion of odontogenic lesions. Aim: To investigate the expression of VEGF in Ameloblastoma and Dentigerous Cyst, using a monoclonal antibody, then compare between them to investigate the role in diagnosis and determination of biological behaviour of some odontogenic lesions. Materials and Methods: The sample consisted of 15 formalin-fixed, paraffin-embedded specimens of Ameloblastoma (Follicular-plexiform pattern) and 15 cases of Dentigerous Cyst that were conventionally stained with H and E and immunohistochemically stained with a monoclonal anti-VEGF antibody. VEGF expression in this specimen was qualitatively evaluated, calculating the percentage of VEGF positive cells in the epithelial and stromal cells. Results: The expression of VEGF in Ameloblastoma (Follicular-plexiform subtype) was varied between high and medial while its expression in Dentigerous Cyst was low, the statistical analysis indicated significant differences between these lesions (p<0.05). Conclusion: VEGF contributes to the invasion of aggressive odontogenic lesions, thus we concluded its role as diagnostic and prognostic markers in the prediction of the biological behaviour of odontogenic lesions.

Aeroallergen Sensitivity Pattern in Poorly Controlled Asthmatics and its Relation to Asthma Control in a Tertiary Care Setting of Central Kerala, India

Introduction: Nasobronchial allergy is an exceedingly common problem in clinical practice. Estimates reveal that the prevalence of nasobronchial allergy is increasing worldwide, including in India. Sensitivity to individual aeroallergens varies depending on geography, genetic and environmental factors. Aim: To identify the sensitivity pattern to common aeroallergens in poorly controlled asthma patients and to correlate asthma severity with sensitivity to specific aeroallergens. Materials and Methods: A prospective cross-sectional study was conducted on out-patients attending the Department of Pulmonary Medicine with a diagnosis of asthma as per GINA guidelines. Patients above seven years with features of asthma were included in the study. The Asthma severity was assessed using the Asthma Control Test (ACT) questionnaire and lung function studies. SPT was performed as per clinical indication. The skin allergy sensitivity patterns were compared in groups as per their disease severity and level of control using Chi-square and Spearman rank correlation. Results: Patients with features of inadequately controlled asthma (ACT score less than 20 and FEV1 less than 80% predicted) showed a higher occurrence of positive reaction in the SPT to multiple aero and food allergens as compared with those having good ACT score and FEV1 >80%. Conclusion: Allergen sensitivity is very common in asthma. House dust mite, fungal allergens and grass pollens were the common allergen sensitisation identified in subjects with poorly controlled asthma. A correlation was seen between inadequately controlled asthma and sensitisation to multiple aeroallergens. So, vigorous allergen screening and allergen immunotherapy must be included in the management protocol of asthma.

Association of Arterial Stiffness and Lipid Profile in Coronary Artery Disease

Introduction: Coronary Artery Disease (CAD) is one of the leading causes of death in India. The prevalence of the CAD related mortality in non-diabetic patients is 11%. Increased arterial stiffness may be independently contributing to increased mortality and morbidity in CAD. However, arterial stiffness and hyperlipidaemia are known to coexist in CAD. Aim: To measure lipid profile and arterial stiffness and to explore the possible association between the two. Materials and Methods: It was a cross-sectional study, 150 angiographically proven CAD patients and 150 apparently healthy subjects with no history of CAD were recruited. The study was initiated after written consent informed was obtained. Augmentation Index (AIx) and Sub Endocardial Viability Ratio (SEVR) were measured out in all the participants using Pulse wave analysis (SphygmoCor device). Lipid profile parameters (Total cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, very low density lipoproteins, and total cholesterol/high density lipoproteins ratio) were measured using Humastar automated analyser. All the measured parameters were analysed by student t-test using SPSS version 22.0. Results: The present study found that significant increase in AIx in CAD patients (29.66±12.85) than controls (23.28±7.96%) (p<0.0001) and decrease in SEVR (p<0.0001) in CAD cases (139.56±31.77) when compared to controls (161.99±37.33). There was no significant difference in lipid profile between the two groups. Conclusion: The results suggest that arterial stiffness has independently increased in patients with CAD. However, we did not find significant association between lipid profile and arterial stiffening.

Evaluation of Treatment Responses and Failures of Intensive Care Unit Acquired Blood Stream Infections

Ümmügülsüm Gaygisiz, Dilek Arman

Introduction: Blood Stream Infections (BSI) are the second or the third most common infections acquired in Intensive Care Units (ICU) following pulmonary infections. Risk factors likely to affect response to treatment in BSI’s have been investigated in several studies. However, there have not been any studies in which the predictors of treatment failures have been evaluated to this extent. Aim: To investigate the treatment response of patients admitted to the ICU with acquired BSI cases and the predictors of treatment failures. Materials and Methods: The study was based on a cohort study design in which data were collected from all patients with admission to ICU >48 hours during one year. According to the resolution of signs and symptoms of infection, treatment outcomes (n=70) were stratified into two cohorts: 1) successful (n=20); and 2) failure (n=50) treatment. Following risk factors affecting the responses were recorded: source and severity of bacteraemia; Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores; isolated pathogens and resistance profile; appropriate antibiotic initiation; and catheter removal time. Fisher exact tests, contingency coefficients, t-tests, Mann-Whitney-U-test and logistic regression analysis was used to examine risk factors associated with treatment failure predictors. Results: The high levels of APACHE II detected on the third day of the treatment (OR=1.151) and delayed appropriate treatment with respect to the onset of bacteraemia (OR=1.532) were independent risk factors for treatment failure. The subgroup analyses revealed that other concomitant infections (78%) and superinfection (40%) were the most frequent reasons in the treatment failures. Conclusion: Delayed appropriate treatment was found to be the most crucial independent reason for treatment failure. Besides, other concomitant infections and superinfection are mostly observed other significant reasons for treatment failure.

FNAC is a Boon for Salivary Gland Lesions: A Routine Diagnostic Experience among Rural Population

Introduction: Salivary gland comprises of major and minor salivary glands. FNAC is a diagnostic method based on morphologic findings of individuals and group of cells. FNAC is accepted as an excellent investigation for evaluating space occupying lesions of the salivary gland. Aim: FNAC diagnosis was compared with the histological impression and concordance, discordance evaluated. Materials and Methods: This study was conducted in the Department of Pathology, UPUMS, Saifai, Etawah, (UP), India. Data was collected retrospectively from January 2012 to July 2018. Cases of Salivary gland swelling diagnosed on FNAC and its correlation with histopathology during that period were included. All the cytology and histology slides were reviewed and analysed. Results: FNAC was done in 202 patients. Male to female ratio was 1.1:1. A 97 (48.01%) were non-neoplastic, among neoplastic lesions, 71 (35.14%) were benign and 34 (16.83%) were malignant. Submandibular gland was a common location 104 (51.48%) and sialoadenitis 71 (35.14%) was frequent. Among benign tumours pleomorphic adenoma was common 61 (30.19%) and mucoepidermoid carcinoma 9 (4.45%) in malignancy. Histopathology was done in 93 (46.03%) cyto-histo concordance and discordance was achieved in 80 (39.6%) and 13 (6.43%) respectively. FNAC revealed sensitivity of 72.41% and specificity of 96%. Conclusion: FNAC is a reliable diagnostic technique. It provides preoperative diagnosis for therapeutic management, so that unnecessary surgeries are prevented. However, FNAC remains less efficient in a few cases which are inaccurately diagnosed due to overlapping features and for those cases, histopathology is the only modality for final diagnosis.

Facial Anthropometry in Adult Jaunsari Tribe Population of Dehradun District of Uttarakhand

Mohd Salahuddin Ansari, Mukesh Singla, Kumar Satish Ravi

Introduction: Observations say that there are specific changes in facial features with the change in the geographical location and ethnicity of the communities. There is lack of such type of study on Jaunsari population. Facial anthropometric indices are of much importance in plastic and cosmetic surgery, forensic medicine and other allied clinical sciences. So, the project was planed. Aim: To study facial anthropometric parameters in adult Jaunsari Tribe of District Dehradun, Uttarakhand. With objectives: 1) To study the facial anthropometric parameters of adult male and female population of Jaunsari Tribe of Dehradun district in Uttarakhand; 2) To analyse the sex difference in the facial anthropometric parameters of Jaunsari Tribe if any; 3) and statistical significance of the difference. Materials and Methods: The study was carried on 100 adult males and 100 adult females of more than 18 years of age, belonging to Jaunsari Tribe, after due approval from Institutional Ethical Committee and informed consent. The methodology adopted for the anthropometric measurements was of Singh and Bhasin (1968) and concerned measurements were done. Results: Important data were obtained, observed and analysed. It provided valuable data for the community for future use. It was found that according to Morphological Facial Index, 4%, 11%, 28%, 37%, 20% males and 5%, 14%, 27%, 32%, 22% females were Hypereuryprosopic, Euryprosopic, Mesoprosopic, Leptoprosopic and Hyperleptoprosopic whereas according to Morphological-upper facial Index, 0%, 0%, 3%, 81%, 16% males and 0%, 0%, 2%, 85%, 13% females were Hypereuryen, Euryen, Mesen, Lepten and Hyperlepten respectively. There were significant variations in all the measured facial parameters between male and female population of Jaunsari Tribe. Conclusion: So, we conclude that majority of male (57%) and female (54%) population of Jaunsari Tribe are having Leptoprosopic and Hyperleptoprosopic type of face. Mesoprosopic is second dominant face type whereas least dominant face type is Euryprosopic and Hypereuryprosopic. Lepten is the most common face type in both male and female. There are significant variations in all measured facial parameters and morphological-upper facial Index between male and female population of Jaunsari Tribe.

Histopathological Panorama of Leprosy in a Tertiary Care Hospital of Bihar

Ruchi Sinha, Mamta Kumari, Punam Prasad Bhadani

Introduction: Leprosy also known as Hansen’s disease is one of the oldest disease known to mankind. It is a chronic infectious disease caused by Mycobacterium leprae. It still remains as a major public health problem facing India. Nearly, 60% of all world leprosy cases are reported from India. The spectrum of presentation of leprosy is very wide. Histopathology is an important tool in making a definitive diagnosis. The objective of the study is to describe the histopathological profile of leprosy in the state of Bihar. Aim: To study the histopathological spectrum of leprosy at a tertiary care centre of Bihar. Materials and Methods: A retrospective hospital-based study of clinically diagnosed leprosy cases was conducted over a period of 28 months (January 2015 to April 2017). Lesional skin biopsies obtained were fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Ziehl-Neelsen (ZN) staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: A total of 200 cases were studied. Highest incidence was in the 11 to 30 years age group for both males and females. Males were more affected (M:F=2.4:1). Most common clinical feature was loss of sensation. The commonest reported histopathological type was borderline lepromatous (43%) followed by borderline (17%). Overall ZN staining was positive in 56 (28%) cases. Conclusion: The spectrum of presentation of leprosy is very wide and there is clinical overlap between different types of leprosy. Histopathology still remains the gold standard for early diagnosis and classification of the disease. Accurate diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance.

Association of Metabolic Obesity and BMI Status with Severity of Angiographic Coronary Artery Disease in Stable Angina Patients

Introduction: Obesity and metabolic syndrome frequently co-exist and are one of the major health problems around the globe and its prevalence is 25-30%. In India prevalence of metabolic obesity is =30%, among females who have higher levels as compared to males. There is a significant proportion of the population who are obese (BMI >25 kg/m²) but metabolically healthy, likewise some people with normal BMI status, but metabolically obese. In this study, we have evaluated the association between metabolic obesity and severity of Coronary Artery Disease (CAD) in stable angina patients. Aim: To assess the association of severity of angiographic CAD based on the Metabolically Obese (MO) status and Body Mass Index (BMI). Materials and Methods: Total 408 subjects with stable angina and with positive stress test were included in the study and severity of CAD was measured by SYNTAX score. Obesity was defined as BMI =25 kg/m², and normal weight was defined as BMI <25 kg/m². The metabolic obesity was determined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEPATP-III) classification in which Asian-specific cut-offs for abdominal obesity is used. Therefore, study subjects were categorised as follows: 1) Metabolically Healthy and Normal Weight (MHNW); 2) Metabolically Obese but Normal Weight (MONW); 3) Metabolically Healthy but Obese (MHO); and 4) Metabolically Abnormally Obese (MAO). Statistical analysis was carried out using statistical package for social sciences (SPSS) version 20. Baseline clinical, demographic, anthropometric and laboratory data are presented as mean±Standard Deviation (SD), median (range), or number (%) unless specified. Comparison among groups was calculated with an analysis of variance (ANOVA) test and Kruskal-Walis test for continuous variables and the Pearson chi-square test for categorical variables. Association between groups and severity of CAD was done by Kruskal-Wallis test. The p-value <0.05 was considered statistically significant. Results: Out of 408, 70.3% (n=287) subjects were male, 52.7% (n=215) subjects were hypertensive, and 42.9% (n=175) subjects had high BMI. Metabolic obesity showed higher prevalence of CAD (MO, OR=0.25, 95% (1): 0.31-1.03) than patients with higher BMI status (BMI, OR=1.39, 95% (1): 0.79-2.4). Syntax score which measures the severity of CAD is marginally high in MONW group (p-value-0.003) when compared to MHNW group. Conclusion: MO group was associated with a high prevalence and severity for CAD than metabolically healthy group irrespective of their weight status.

Comparison of Vitamin D Levels in Pre-eclamptic and Normotensive Pregnant Women in a Tertiary Care Centre

Misha Singla, Priyanka Garg, Sadhna Sharma

Introduction: Pre-eclampsia is a multi-system disorder of pregnancy that is significantly contributes to maternal and fetal morbidity and mortality rates. The aetiology of pre-eclampsia remains unknown. Besides other risk factors, attention has been drawn towards vitamin D deficiency as a causative factor for pre-eclampsia. Aim: To compare vitamin D levels in pre-eclampsia and normotensive pregnant women. Materials and Methods: A prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, Adesh Institute of Medical Sciences and Research (AIMSR), Bathinda, Punjab, India from January 2017 to October 2018. Thirty pregnant women with pre-eclampsia were compared with equal number of normotensive pregnant women for serum vitamin D levels. MS Excel 2010 software was used to analyse the data. Quantitative data were expressed as a mean±standard deviation. Results: It was observed that vitamin D deficiency was invariably present in all pregnant women but the mean vitamin D level was significantly lower in Pre-eclampsia group as compared to Control group (8.7±5.32 and 14.2±7.88 ng/mL respectively) with p<0.05 which was statistically significant. Conclusion: The present study revealed significant association between maternal serum vitamin D deficiency and occurrence of pre-eclampsia. Vitamin D supplements should be added to all the antenatal patients as routine screening to prevent the risk of pre-eclampsia.

Comparison of Paediatric Patient Flow Following Presentations of Fever in the Community Versus Hospital Setting

Introduction: Fever is a common paediatric presentation in both the hospital and community setting. However, there is a widespread perception that febrile children who present to community or hospital settings receive different investigations and follow-up, potentially impacting on patient outcomes. Aim: To compare paediatric presentations of fever in hospital vs community settings in regard to patient flow investigations, follow-up arrangements and advice given. Materials and Methods: Retrospective analysis of Clinical Audit Project database, containing demographic and clinical parameters relating to patients surveyed from a period inclusive of 2007-2012 and additionally 2014, was performed. From this data set, records relating to 319 paediatric patients were included in the final analysis with inclusion criteria of age =16 years and fever. Data were compared between community and hospital locations by chi-square test with continuity correction where appropriate. Results: Of the 319 patients analysed, 265 (83.1%) were surveyed in the hospital and 54 (16.9%) were surveyed in the community. Within the hospital setting, 133 (50.2%) patients had at least one investigation, while in the community group only 7 (13%) patients did (p<0.001). Almost all patients received follow-up (n=305, 95.6%). The largest number of no follow-up patients was found in the subgroup of community patients who received no investigations. Conclusion: Significant differences in patient flow exist in paediatric patients presenting with fever, in hospital versus community settings in this dataset. Further research is required to delineate these differences. This data may provide direction for future studies of resource distribution and patient outcomes in hospital and community settings.

The Status of Organisational Culture and Job Satisfaction in Hamadan Specialty Hospitals

Introduction: Job satisfaction is one of the factors that can affect the health of staff in hospitals. Organisations often cause job dissatisfaction among employees in three mechanisms which include formal structure of organisation, command-and-control leadership. Aim: To investigate organisational culture and job satisfaction of specialty hospitals in Hamadan. Materials and Methods: This descriptive analytical study was conducted in two Hamadan specialised hospitals in the west of Iran. The organisational culture and job satisfaction were evaluated using Robins’ Organisational Culture and Minnesota Job Satisfaction Questionnaires. Based on inclusion criteria (lack of significant physical and psychological disorders, at least one year of work experience), 600 staff were entered in this study. Results: The results showed that the organisational culture score was average in both hospitals (131-206) and the mean score of organisational culture in the hospital 1 (175.89±12.35) was higher than that of the hospital 2 (171.86±11.35), but this difference was not statistically significant (p=0.216). In term of job satisfaction, the average score of internal (30.69±7.22), external (29.60±6.80) and overall job satisfaction (60.29±13.61), in hospital 1 was better than the hospital 2 (29.29±7.45, 29.07±7.15, 58.27±14.17 respectively), but for external and overall satisfaction the difference was not statistically significant (p>0.05). Also, job satisfaction was average in two hospitals (48-76). The results showed that, organisational culture has a significant relationship with internal, external and overall job satisfaction (p<0.001). Conclusion: The findings indicated that organisational culture and job satisfaction have an average score in the studied hospitals. The treatment-oriented policy and vertical management in hospitals are the important reasons that affect organisational culture and job satisfaction.

Application of Distraction Techniques in Obstetrics and Gynaecology: A Systematic Review

Paria Amiri, Maryam Najjarzadeh, Mojgan Mirghafourvand

Introduction: International institutions have emphasised the role of midwives in ensuring women health, which guarantees family health and its physical, psychological, social, and spiritual aspects. The integration of midwifery knowledge with psychology is a good opportunity for the patients and healthcare providers. Distraction technique is a psychological approach, which has interested the field of medicine. Aim: To review the effectiveness of Distraction techniques in Obstetrics and Gynaecology. Materials and Methods: This systematic review study was conducted on articles indexed in Cochrane Library, Web of Sciences, PubMed, Scopus, Google Scholar, CINHAL and Persian databases including SID, Magiran, and Barakat Knowledge Network System in October 2018 without time restriction. Search was conducted according to MeSH-based keywords, including distraction or distraction technique Distraction OR Distraction techniques and use + or AND with keywords Midwife, Birth Attendants, Traditional Midwives, Traditional Birth Attendant, Genital Diseases, Female, Gynaecologic Surgical Procedures, Reproductive Medicine, Obstetrics, Pregnancy Complications, Obstetric Surgical Procedures, Gynaecology and Gynaecological diseases. To ensure, the search process was conducted once again by using keywords of dysmenorrhea, vomiting, nausea, pregnancy, delivery and cesarean section. The inclusion criteria, based on PICOS were: Clients of obstetrics-gynaecology centres; receiving a distraction technique; clinical trials with a parallel design; psychosomatic outcomes; full-text articles in Persian and English. Evaluation of the quality of articles was done using Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. Results: Five out of 595 articles were included in this systematic review. Outcomes of these studies were intensity of pain, and stress and anxiety in patients visiting obstetrics-gynaecology centres. Results showed that the distraction techniques could reduce the intensity of pain in patients under obstetrics-gynaecology procedures, and also the stress of prepubescent girls caused by genital examination. Moreover, the meta-analysis results showed that the mean score of anxiety in pregnant women and women at labour, who received distraction interventions, was significantly lower than the control (mean difference: -7.0; 95% Confidence Interval: -13.7 to -0.4; p=0.04). Conclusion: According to the results, distraction is a simple, low-cost, and accessible technique for reducing pain, anxiety, and stress in the field of obstetrics and gynaecology. Moreover, given that there are scant studies into this field and their high risk of bias, it is recommended to use distraction techniques in different areas of clinical trials with higher quality.

Basilar Artery Tip Aneurysm: A Review

Fahd Al Qahtani

Patients with arterial aneurysms in the basilar tip location represent a therapeutic challenge. Various studies have shown the cause of Basilar Tip Aneurysm (BTA) as a multifactorial process which involves factors like genetic, anatomic, and environmental risk factors. The present review aims to discuss the risk factors, epidemiology, familial aneurysm, prevalence of basilar tip aneurysm and author’s opinion on the importance of the role of radiology in the diagnosis and treatment of BTA.

Digital Versus Conventional Impressions in Dentistry: A Systematic Review

Sachin K Chandran, JL Jaini, Anna Serene Babu, Anil Mathew, Arun Keepanasseril

Introduction: Accuracy of definitive impressions determines the quality of final prosthesis to a great extent. In conventional impression, elastic impression materials are used to replicate the anatomy and prosthesis is fabricated indirectly. Digital impression on the other hand gains popularity due to the advantages like 3D previsualisation, cost effectiveness and decreased time consumption. Aim: To review the existing reports, to bring forth the comprehensive overview on the comparative superiority of digital impression technique based on accuracy, patient acceptance, operators preference and time effectiveness when compared to conventional technique. Materials and Methods: Search strategy for this review was based on Population, Intervention, Comparison, and Outcome(PICO) framework. An electronic search of articles published from 1980 to 2017 in PubMed, Medline and Cochrane via Ovid, along with additional hand searches were done. Data screening and extraction was performed in covidence systematic reviews of tware. Clinical and preclinical studies and randomised controlled trials which compared optical impression with conventional impressions based on accuracy, patient outcome and operator outcome were included in the study. Results: A total of 36 articles that complied fully with the inclusion criteria were evaluated. Among the 24 studies which compared digital and conventional impressions based on accuracy, 16 articles reported that digital impressions are superior to conventional impressions; however no statistical significance was mentioned. Based on patient preference, four articles concluded digital impression as the preferred choice. Eight articles assessed the operator preference and the outcome was in favour of digital impressions. Conclusion: This review has concisely summarised that digital impressions are superior to conventional impressions, without any statistically significant difference, based on assessment of accuracy, patient preference and operator preference.

Approach to Lung Neoplasm-Primary vs Metastasis: Short Review

Neema Tiwari

Lung cancer is a very serious problem of the Indian subcontinent, especially in the lower socioeconomic subgroups. As per the ICMR registry of 2002, in Indian population lung cancer is the 5th most common tumour and 2nd most common tumour in the males. It accounts for 6.9% of new cancer cases detected each year. Since lung is a metastatic site for almost all the cancers in the body there is a great confusion in diagnosing a primary from metastasis or pleural tumour. Hence, this short review aims to throw some light on the salient features and the approach. All pubmed indexed articles present online and in English were read and then summarised in this paper. There were many overlaps morphologically in pleural tumours, lung primary and metastasis and morphology apart IHC and molecular factors play a great role in its diagnosis as is discussed in the article.

An Innovative Technique to Evaluate Quantitative Pupillary Light Reflex by Dynamic Pupillometry using Infrared Videography

AV Siva Kumar, R Padmavathi, KN Maruthy, B Sowjanya, K Mahesh Kumar

Introduction: An innovative approach was designed to quantify the pupillary light reflex using infrared and white light illumination. This method is convenient to detect pupil edges, area and the diameter of pupil contour recorded in different ambient light conditions. Aim: To establish newer methodology, to quantify pupillary light reflex using image analysis. Materials and Methods: A standard web camera was modified as an Infrared camera to capture the real time pupil response to various intensities of illuminations. Pupillary response to a flash of light was video graphed and split into video frames. These images of the pupil thus obtained were subjected to an image analysing software. This methodology also provides a solution to exclude infra-red LED reflection within the pupil circle. The orientation of pupil within iris can be appreciated with this protocol. Results: The steps were tailored to measure various parameters of pupillary light reflex like minimum, maximum and mean pupil diameters. It also facilitates to calculate constriction and dilation velocities. The capture, cleavage and offline analysis of these video frames were done using all open source softwares. Conclusion: This simple, user-friendly, innovative technology can be used for quantifying the pupil response which can be used as an indicator for autonomic dysfunction.