Journal of clinical and diagnostic research

Increased Serum Alkaline Phosphatase and Serum Phosphate as Predictors of Mortality after Stroke

Pratibha S, Praveen-kumar S, Agadi JB

Context: Serum Alkaline phosphatase (ALP) & phosphate are considered to be indicators of vascular calcification. Link between bone metabolism, vascular calcification, cardiovascular events have been well studied in chronic kidney disease and ischemic heart disease. Aims: To determine that increased serum phosphate and alkaline phosphatase are predictors of mortality rates and recurrent vascular events in stroke. Materials and Methods: Sixty patients admitted with acute stroke (ischemic & haemorrhagic) were included in the study. Their baseline clinical characteristics and biochemical parameters including serum ALP and phosphate were noted. All patients were followed up for a period of one year. The all- cause mortality, the mortality due to cardiovascular events and recurrent vascular events without death were noted during the follow up. Statistical analyses were done to look for any correlation between mortality and baseline levels of serum ALP and phosphate. Results:Of the 60 patients, 8 (13.3%) patients were lost for follow up. Fourteen (26.9%) patients died; of which 12 deaths were due to vascular causes and 2 deaths were due to non vascular causes. Increasing levels of serum ALP and phosphate correlated with all cause mortality and recurrent vascular events without death. Conclusion:Serum ALP and phosphate prove to be cost effective prognostic indicator of mortality and recurrent vascular events in stroke. This finding has to be confirmed with studies including larger population. Further research on ALP inhibitors, Vitamin D analogues and phosphate binders to improve mortality in stroke population can be encouraged.

Mean Platelet Volume in Patients with Acute Coronary Syndromes: A Supportive Diagnostic Predictor

Randheer Pal, Rajeev Bagarhatta, Sandhya Gulati, Monika Rathore, Nidhi Sharma

Background: Platelets and their activity have a crucial role in acute coronary events. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets. Objectives: The aim of this study is to investigate whether there is an association between mean platelet volume (MPV) measurement and cardiac Troponin I( cTn I ) in patients admitted with a suspected diagnosis of ACS and to assess the potential diagnostic efficiency of MPV in the diagnostic workup for ACS. Materials and Methods: After thorough evaluation of 215 eligible patients, 3 ml. Venous blood collected using Becton, Dickinson and company vacutainer and MPV measured within 1-2 hr of sample collection. Sample for cTn I collected at 6 hr and at 12 hrs, if required and level measured using Biosite analyzer. Results: Mean platelet volume (MPV) was found to be higher among ACS patients as compared to non ACS, 11.44±1.23 vs 9.91±1.27 fl (p-value<0.001). The NPV of MPV in the diagnostic workup of chest pain suggestive of ACS within 6 hours of presentation were found to be 82.53%. Conclusion: In this study the MPV is significantly higher in patients with ACS than in those with chest pain of non-cardiac origin and its negative predictive value of 82.53%, it might be useful as an assisting rule-out test in conjunction with other markers in the early prediction of the risk of ACS.

Oral Leukoplakia – Is Biopsy at the Initial Appointment a Must?

Background:Oral leukoplakia is a potentially malignant disorder of the oral cavity. Leukoplakias with chances of undergoing malignant transformation owing to the presence of dysplastic changes may not be clinically distinguishable from leukoplakias without dysplasia. The study was carried out to evaluate the usefulness of biopsy in assessing the clinico-pathologic correlations of oral leukoplakia at the patient’s initial visit. Materials and Methods: Hospital records with clinical diagnosis of oral leukoplakia were retrospectively analysed. All these patients had undergone biopsy in their initial visit. Histopathological slides were reviewed and reported by a single pathologist. Diagnosis agreement was considered to be present if the clinical diagnosis matched the histopathological diagnosis. Misdiagnosis was considered if the clinical diagnosis did not match the histopathological diagnosis and underdiagnosis when malignancy was detected on histopathological examination. Results: A total of 115 patients were clinically diagnosed with oral leukoplakia. According to clinical appearance of the leukoplakia patch was categorized in to three types viz homogeneous leukoplakia (n= 24 i.e. 20.87%), speckled leukoplakia (n=76 i.e. 66.08%) and verrucous leukoplakia (n=15 i.e. 13.04%). Histopathological examination confirmed clinical diagnosis in 88 cases (a diagnosis agreement of 76.52%). Histopathological examination of 19 cases revealed a different diagnosis, thus categorized as misdiagnosis (16.52%) and 8 cases had unexpected malignancy which accounted for underdiagnosis in 6.96% cases. There was dysplasia in 45 (51.13%) of the histopathologically confirmed cases of leukoplakia. Conclusion: The clinical appearance of suspicious white lesions does not provide a true nature of its disease status and malignant changes may be missed.

Fournier’s Gangrene in a Two Year Old Child: A Case Report

Satinder Pal Singh Bains, Vikram Singh, Manmeet Kaur Gill, Amit Jain, Vivek Arry

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any age but it is relatively uncommon in children. Here, we report a case of Fournier’s gangrene in a two year old male child who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gave good results.

Expression of VEGF in Periodontal Tissues of Type II Diabetes Mellitus Patients with Chronic Periodontitis -an Immunohistochemical Study

Ramya, Senthil Kumar

Background:Vascular endothelial growth factor (VEGF) induces proliferation of endothelial cells, stimulates angiogenesis, and increases vascular permeability, but information about its role in periodontal diseases is limited. The aim of this study is to determine the association between VEGF expression in healthy and periodontally diseased tissues of healthy and diabetic patients. Materials and Methods:Seventeen systemically healthy and 17 Type 2 diabetic patients (DM), all diagnosed with periodontitis were enrolled into the study. Gingival samples were collected from both periodontal and healthy sites in all patients. Each patient served as his/her own control samples were subjected to immunohistochemical analysis. Results:The diseased sites of diabetic subjects expressed higher level of VEGF when compared to diseased sites of non diabetic subjects with chronic periodontitis, VEGF was observed in healthy periodontal tissues of both diabetic and systemically healthy people with periodontitis and VEGF was intensely present in monocytes and macrophages. Conclusion:The increased expression of VEGF in diseased sites of diabetic patients suggests that diabetes mellitus might have direct influence over VEGF expression.

Ratio Of Serum Asymmetric Dimethyl Arginine (ADMA)/ Nitric Oxide in Coronary Artery Disease patients

Rajni Rajendra Shivkar, Subodhini Anant Abhang

Background: Coronary artery disease (CAD) is the leadingcause of mortality and morbidity in the world. Current predictions estimate that by the year 2020 cardiovascular diseases, notably atherosclerosis will become the leading global cause of the total disease burden. Atherosclerosis of the Coronary artery causes myocardial infarction and angina pectoris. Endothelial Nitric oxide (NO), released by the intact and healthy endothelium plays a very important role in the maintenance of vascular tone and structure. Decreased NO level leads to endothelial dysfunction is an initial event in the atherosclerosis. Endogenous Asymmetric dimethylarginine (ADMA) is a structural analog of L-arginine, competitively inhibits the enzyme NO synthase and thus decreases the NO level. Aim: To study the ratio of serum ADMA / NO as a marker of severity of CAD. Materials and Methods: The study comprises of 60 patients of CAD diagnosed by coronary angiography. We divided them into two Groups according to percentage of atherosclerotic block, Group A (71% and more block, n=30) and Group B (40% - 70% block, n=30). We measured serum ADMA, serum NO and calculated ADMA/ NO ratio. Results were compared with 30 healthy age and sex matched controls. Serum ADMA was determined by reverse phase high performance liquid chromatography. Serum NO was measured by cadmium reduction method. Statistical analysis of data analysis was done using the SPSS (Statistical Package for the Social Science) Version 11 for window. Results: Serum ADMA was correlated positively with the presence and severity of CAD and inversely related with the serum NO levels. Serum ADMA / NO ratio was statistically significant in CAD patients with atherosclerotic block 71% and above (Group A) but ratio was not significant in Group B (block 40% - 70%). Conclusion: Serum ADMA/ NO ratio can be the better predictive marker for the severity of the CAD where patient is at the risk of angina pectoris or myocardial infarction due to the extent of coronary atherosclerotic block than individual serum ADMA levels .

Role of Appropriate Therapy in Combating Mortality among the Ventilated Patients

Context: Ventilator associated pneumonia (VAP) is a nosocomial infection prevalent among the intensive care unit (ICU) patients despite proper infection control practices. The diagnosis of VAP still remains controversial and hence the mortality rate is higher among this group of patients. Aim: The aim of our study was to identify the antibiotic pattern and the appropriateness of treatment followed in the ICU in relation with the clinical pulmonary infection score (CPIS) as a tool to diagnose VAP. This was compared with patients who had an inappropriate treatment in comparison to the CPIS and the clinical outcome. Results:Out of the 18 VAP patients, 12 (66.7%) received appro priate therapy based on the antibiotic susceptibility pattern of the causative organism, while 1 (5.5%) received partially inappropriate therapy and 5 (27.8%) received totally inappropriate therapy. Nine of the 18 (50%) VAP patients died, while only 5 of the 58 (8.6%) patients without VAP died. 72.2% patients with VAP received appropriate treatment based on the sensitivity of the isolates. The mortality rate in VAP patients receiving inappropriate therapy was 80%, while in those receiving appropriate therapy the mortality rate was 38.5%. The mortality rate among VAP patients with blood culture positivity was 100%, while it was 43.75% among those with negative blood culture. Conclusion: The mortality rate among the patients receiving inappropriate therapy is high compared to other group of patients. Hence, a proper evaluation and administration of appropriate antibiotics can curb mortality among the ventilated patients.

Using VARK Approach for Assessing Preferred Learning Styles of First Year Medical Sciences Students: A Survey from Iran

Background:Preferred learning styles of learners are different, which depend on tastes, mentality preparedness, as well as physical condition, in terms of sensory modalities. Identifying and employing appropriate learning styles could play an important role in selecting teaching styles, which can improve education ultimately. Aim:The present study aimed to assess the diversity of learning styles amongst medical students of a medical sciences university which was located west of Iran, in 2010. Methods: A cross-sectional study which employed VARK learning style’s questionnaire was done on 141 first year medical sciences students at Ilam University of Medical Sciences in 2010. Data was collected with use of VARK questionnaire. The validity of the questionnaire was assessed on basis of experts’ views and its reliability was calculated by using Cronbach’s alpha coefficients ( a =0.86). Data were analysed by using SPSS software and Chi-square test. Results: Overall, 41.6% of the samples preferred to use a single learning style (Uni-modal). Of these, 17.7% preferred the Aural style, 17% preferred Reading and Writing, 6.4% preferred Kinesthetic style and 0.7% preferred Visual styles. Among the rest of the 82 students who preferred more than one style (multimodal), 17% chose two modes (bimodal), 13.5% chose three modes (tri-modal), and 27.6% chose four modes (quad-modal). There was a significant difference between educational levels and majors on one hand and choice of quad modal of VARK styles on the other hand (p=0.008). A significant association was also found between participants’ genders and selection of visual and reading/writing styles (p=0.03). Conclusion: The preferred learning styles of medical students in the present study were aural and reading/writing. It is suggested that all medical students must be tested to determine their desired learning styles by using VARK questionnaire, also to choose appropriate teaching methods and to improve educational goals.

Hyperhomocysteinemia, Insulin Resistance and High HS- CRP Levels in Prehypertension

Prashanth Talikoti, Zachariah Bobby, Abdoul Hamide

Background: Pre-hypertension refers to blood pressure in the range of 120 to 139 mm of Hg / 80 to 89 mm of Hg and its prevalence is increasing in India. Previous studies have documented the increase in homocysteine, C-reactive protein and insulin resistance and their role in the development of hypertension. In recent years much attention has been focused on subjects with prehypertension, as the risk for development of cardiovascular disease is higher in these subjects compared to those with normal blood pressure. Objectives: To evaluate the serum homocysteine, hs-CRP level and insulin resistance in subjects with prehypertension. Materials and Methods: Sixty prehypertensives and 32 normotensives were recruited according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of blood pressure (JNC 7) guidelines. Serum homocysteine, vitamin B 12 , folate, insulin, hs-CRP and lipid profile were analysed. Independent t-test was carried out to compare two groups and pearson correlation analyses were carried out between various parameters with systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Cardiovascular risk factors like serum homocysteine, insulin resistance and inflammatory marker hs-CRP were significantly increased in prehypertensives. Total cholesterol, TG, LDL-C and VLDL-C were significantly increased when compared to normotensives. Serum homocysteine correlated positively and vitamin B 12 and folate negatively with Systolic Blood Pressure. Conclusion: The present study concludes that the established cardiovascular risk factors, homocysteine, insulin resistance, and hs-CRP which have roles in the etiopathogenesis of hypertension, were elevated in subjects with prehypertension. Thus, early detection and life style modification may reduce the risk or delay the onset of hypertension and other cardiovascular complications.

Analysis of Salivary Antioxidant Levels in Different Clinical Staging and Histological Grading of Oral Squamous Cell Carcinoma: Noninvasive Technique in Dentistry

Hanspal Singh, Pushparaja Shetty, Sreelatha S.V., Madhvika Patidar

Objective: To estimate and Compare of salivary antioxidant level {Uric acid (UA), Glutathione S Transferase (GST) and Superoxide dismutase (SOD)} between healthy control and study group (oral squamous cell carcinoma patients).Further comparison of sub division of study group on the basis of clinical staging and histological grading. Materials and Methods: The study group consists of 50 cases of squamous cell carcinoma and 50 healthy patients. These parameters were estimated by spectrophotometer. The biochemical values of this study were subjected to statistical analysis i.e. Independent t-test, ANOVA and Tukey test. Result: UA suggested statistically significant changes in saliva of clinical staging and histological grading of oral squamous cell carcinoma (SCC) patients. Salivary SOD level between well to poorly differentiated SCC showed a progressive increase although it is not statistically significant. Conclusion: Salivary analysis of antioxidant is simple, non-invasive technique which may be useful as diagnostic, prognostic and therapeutic marker.

Clinical Evaluation of Analgesic Activity of Guduchi (Tinospora Cordifolia) Using Animal Model

Introduction: Pain is a very well-known signal of ill health and analgesics are the drugs that are used to relieve pain. The main problem with these drugs remains that of side effects. Safer alternatives are natural herbs. Guduchi ( Tinospora cordifolia ) is one such plant with analgesic potential but few studies are there. Objective: To evaluate the analgesic activity of commercially available extract of Guduchi ( T. cordifolia ). Materials and Methods: For this purpose commercially available extract of Guduchi ( T. cordifolia ) by Himalaya Drug Company, Bangalore was used. Albino rats were divided randomly in three groups of six rats each. Group 1 (control) received distilled water orally, group 2 (test) received T. cordifolia extract in dose of 300 mg/kg orally and group 3(standard) received Pentazocine in dose 10mg/kg intraperitoneally. Analgesic activity was evaluated using hot plate and abdominal writhing method. All the observations were analysed statistically using student’s t-test. Observation and Results: T. cordifolia extract significantly (p<0.05) increased the response time and decreased the number of writhes in hot plate method and abdominal writhing method respectively, on comparison with the control group. Conclusions: The above findings suggest that this commercially available extract of Guduchi ( T. cordifolia ) possess analgesic activity. This analgesic activity probably involves peripheral as well as central mechanisms as the extract showed analgesic activity in both hot plate and abdominal writhing method.

Correlation Between Collagen Fibers and Radiographic Patterns of Keratocystic Odontogenic Tumour

Background: WHO has recently renamed odontogenic keratocyst as keratocystic odontogenic tumour (KCOT) depending on its tumour like behaviour. Aim: To quantitate and qualitate different types of collagen fibers in KCOT using picrosirius red stain under polarising microscopy and to correlate with different radiographic patterns of KCOT to elucidate its biological behaviour in order to determine whether all KCOTs behave like a tumour. Materials and Methods: Sixty histopathologically confirmed cases of KCOT were selected and stained histochemically using picrosirius red and examined under polarising microscope to evaluate colour of collagen fibers in the wall. Radiographic analysis of all the cases were also carried out and correlated with type of collagen of fibers. Results: Greenish yellow collagen fibers were present statistically significantly more in multilocular KCOT and KCOT with multiple radiolucencies (both syndromic and non-syndromic) as compare to unilocular whereas orange red were significantly more in unilocular variety. Syndromic variety showed significantly higher number of greenish yellow collagen fibers than non-syndromic variety. Conclusion: Quality, organization and packing of collagen fibers of unilocular type is different than other radiographic patterns which accounts for difference in biological behaviour of these lesion, so we conclude that aggressive treatment should be reserved for selected cases.

Effect of Isometric Exercise on QTc Interval

Arati Meher, Manasi Bhattacharjee, Parikha Rampal, Raj Kapoor, Renuka Sharma

Comparison between the Analgesic Effect of two Techniques on the Level of Pain Perception During venipuncture in Children up to 7 Years of Age: A Quasi-Experimental Study

Background: Distraction techniques are often provided by nurses, parents or child life specialists and help in pain alleviation during procedures. The use of non pharmacological procedures to cope with pain behaviour is less costly and most of these procedures can be administered by a nurse. Hence, the aim of the present study was to assess and compare the analgesic effect of holding the child by a family member versus holding the child by a family member along with an animation distraction intervention on the level of pain perception during venipuncture in children up to seven years of age. Materials and Methods: Purposive sampling technique was used to select 70 children admitted in paediatric ward of Guru Gobind Singh Medical Hospital, Faridkot, 35 children in each group viz. Group 1(child held by family member during venipuncture) and Group 2 (child held by family member along with an animation distraction during venipuncture) and video clippings were made for each subject in both groups. Standardized FLACC pain scale was used to assess the level of pain during venipuncture by seeing the video clips of procedure in both groups. Results: Findings revealed that the mean pain score of Group 1 was 3.86 and that of Group 2 was 2.43. Findings revealed that in Group 1 majority 31(88.57%) got severe pain and none remained relaxed during venipuncture whereas in Group 2 majority 10(28.58%) got moderate pain, 09(25.71%) remained relaxed and only 07(20%) got severe pain. The comparison of mean pain score of both groups was checked statistically by computing independent t-test and the value of t comes out to be 7.199 with p-value 0.000*** which was found to be highly significant. Conclusion: The study concluded that when during painful procedures like venipuncture if children are given any non-pharmacological intervention like animated distraction along with their family member it helps in managing the pain. In other words, it distracts/diverts the child’s attention from pain and results in better cooperation of child during procedure.

Knowledge, Attitude and Practice of School Teachers Towards Oral Health in Pondicherry

Background: School teachers by virtue of their training can influence a large number of children thereby play major role in the planning and implementation of oral health preventive programs. Hence, this study was undertaken with the objective of assessing the knowledge, attitude and practice of school teachers towards oral health. Materials and Methods: This was a cross-sectional survey conducted among school teachers of the city of Pondicherry. A structured questionnaire was used and 212 teachers were assessed on their knowledge on oral health, attitude and practice regarding their personal oral health, attitude regarding oral health of children and status of oral health education at the schools. All data collected was entered into SPSS version 21.0. Results: Around 47% of the participants felt that bacteria and sugar are the main causes of dental caries, while 42% felt that plaque and calculus are the main agents for periodontal disease. Around 82.5% teachers brushed twice daily. However, only 32% felt it is necessary to visit dentist regularly. While 86% of the teachers felt that children’s teeth should be checked by dentist, only 51% agreed that it is their duty to impart oral health education to the students. Conclusion: The knowledge regarding oral health among school teachers was fair. Oral Health education must be imparted to preschool and primary school teachers as a part of National Oral Health care Program on a regular basis and further studies must be done to assess their awareness levels and make the necessary changes in further education modules.

Prevalance of Obesity in Children with Cerebral Palsy

Ankita Bansal, Shraddha Diwan, Jasmin Diwan, Neeta Vyas, Prevalance of Obesity in Children with Cerebral Palsy (Published in Journal of Cilinical and Diagnostic Research. 2014 August: 8(8):). BC08–BC11 It was brought to the editorial notice, that this article has contents which are plagiarized. It was later confirmed that most of the Introduction and Discussion were taken from other sources verbatim. Authors were communicated; they acknowledged and agreed that it was an honest error by a junior researcher. Hence the article has been retracted. Date of Retraction: 7.02.15

Evaluation of Examination Stress and Its Effect on Cognitive Function among First Year Medical Students

Ganesh Pradhan, Nishitha Linet Mendinca, Manisha Kar

Background:Aim: The present study aimed to evaluate stress status among first year MBBS students by recording pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and using stress questionnaire; its effect on cognitive function by recording auditory reaction time (ART) and visual reaction time (VRT). Setting and Design: It is a cross-sectional study. Materials and Methods: A total of 100 (49 males and 51 females) first year healthy MBBS students participated. Stress questionnaire was given and assessed. Cardiovascular parameters were also assessed. The ART and VRT were recorded before (pre examination setting) and after 3 month of examination (post-examination setting). Statistical Analysis: The data were analysed by using SPSS 21.0 version. Results: All parameters namely PR, SBP, DBP, ART, VRT and stress scores were increased in preexamination setting irrespective of gender. Increased PR was observed in female learners where as stress score and SBP were increased in males in pre-examination setting. ART and VRT were more in females as compared to males in both setting. Conclusion: It is concluded that examination in the form of stressor hampers cognitive function of first year medical students. The cognitive functions of the female learners were more affected as compared to males. Therefore, proper counselling of the students should be initiated at the earliest to decrease their stress level.

Evaluation of Effect of Antiepileptic Drugs on Serum Lipid Profile Among Young Adults with Epilepsy in a Tertiary Care Hospital in Pondicherry

K. Manimekalai, B. Visakan, Kartik J. Salwe, S. Murugesan

Introduction: Several studies have reported that commonly used antiepileptic drugs like phenytoin, and carbamazepine increase serum High Density Lipoproteins Cholesterol (HDL-C) levels, while some others documented no such effect. Further, some researchers also observed that valproic acid and other newer antiepileptic drugs like lamotrigine and levetiracetam has no influence on serum lipid profile. The present study was planned to assess and compare serum lipid profile of young adult patients on commonly used antiepileptic drugs (phenytoin, oxcarbazepine and valproic acid) and newer antiepileptic drug (levetiracetam) attending Neurology OPD of a tertiary care hospital in Puducherry, India compared to normal subjects. Materials and Methods: A prospective hospital based cross-sectional study was conducted in Tertiary care hospital. Epileptic patients attending Department of Neurology and taking antiepileptic drugs for last six months or more and on regular follow up; approximately 60 patients on commonly used antiepileptic drugs (20 on phenytoin, 20 on oxcarbazepine, 20 on valproic Acid) and 20 patients on newer antiepileptic drug (levetiracetam) was included in the study. Age and sex matching 80 controls were taken. Statistical analysis: Descriptive statistics explained using mean ± SD. Inferential statistics was used depending on the nature of variables. We used one-way-ANOVA and followed by independent t-test for comparison with control group and statistically significant was considered at p-value <0.05. Results: We observed statistically significant high mean TC, HDL-C, LDL-C and TG levels in the group receiving phenytoin for more than six months when compared with control group. We observed statistically significant high mean TC, HDL-C and TG levels in the group receiving oxcarbazepine for more than six months when compared with control. However, no significant difference was observed in mean LDL-C levels when compared to control. We did not observe any statistically significant difference among mean TC, HDL-C, LDL-C and TG levels in the group receiving valproate. We did not observe any statistically significant difference among mean TC, HDL-C, LDL-C and TG levels in the group receiving levetiracetam. Conclusion: From the present study we can conclude that CYP enzyme inducer anti epileptic medicines like phenytoin and oxcarbazepine is strongly associated with increased levels of TC, LDL-C, HDL-C and TG where as valproate and levetiracetam showed no significant change. Therefore, the serum cholesterol level should be regularly monitored in patients undergoing therapy with inducer anti epileptic medicines.

Knowledge, Attitude and Practices Related to Dietary Supplements and Micronutrients in Health Sciences Students

Ajitha Sharma, Shalini Adiga, Ashok M.

Objectives: Little is known about supplement users and their dietary behavior in India. This study was conducted with the following objectives: 1. To determine the usage of dietary supplements in health sciences students. 2. To determine their knowledge, attitudes and beliefs regarding micronutrients. Materials and Methods: Cross-sectional, questionnaire based study conducted at a University in south India, which included second year students pursuing medical, dental and nursing courses. Data was analysed using SPSS version 19. Results: The commonest reasons for consuming supplements were to maintain good health (136, 40.1%) and ensure adequate nutrition (125, 36.9%). The respondents’ opinions about dietary supplements were generally between ‘unsure’ and ‘agree’. Medical students scored the highest percentage (44.84%) in their knowledge about micronutrients as compared to nursing (43.17%) and dental (37.8%). There was a significant difference between the scores of medical and dental students (p=0.005) while the scoring of students of medical and nursing did not vary significantly. There was no significant difference between the scoring percentage of males and females in medical and dental groups while in the nursing group female students scored a better percentage as compared to males (p=0.036). Conclusion: Although, the usage of dietary supplements in health sciences students is high, there is a dearth of knowledge, especially regarding role of micronutrients in health and disease. Hence, it is crucial this information must be highlighted in the health sciences curriculum with the objective of producing well-informed professionals who can later on have a positive impact on the health of society.

A Knowledge, Attitudes and Practices Survey regarding Sex, Contraception and Sexually Transmitted Diseases among Commerce College Students in Mumbai

Introduction: One in four Indians is a juvenile. Sexual crimes, pre marital sex, sexually transmitted diseases and unwanted pregnancies are on the rise. It has been shown that lack of sexuality education can significantly contribute to the above. Aim: We conducted this study to determine the knowledge and awareness of college students regarding sex and related matters and the factors affecting the prevalent outlook and practices of youth towards the same. Methodology: A prospective cross-sectional survey was conducted amongst 500 students of the K.P.B. Hinduja College of Commerce from December 2012 to March 2013 as per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Main Outcome Measures: 1. Sex knowledge scores of males and females regarding contraception, sexually transmitted diseases and HIV/AIDS. 2. Percentage response of males and females to questions depicting attitudes and perceptions regarding premarital sex and promiscuity, sexual fantasy and masturbation, unwanted pregnancies and contraception. 3. Responses depicting participant’s premarital and high risk sexual activities. Results: The mean age was 18.6 ±1.6 years, 46% of participants were female. The total sex related knowledge scores of males and females were 8.2±1.2 and 6.2±2.4 (p<0.0001), respectively. 84% males and 72% females disagree that virginity should be preserved till marriage. Premarital sex was reported by 48% males and 18% females. Out of those who had premarital sex, 68% males and none of the females had more than one sex partner and 21% males and 12% females had used a contraceptive during their sexual encounter. 87% males and 82% females disagree that sex education in secondary schools will cause a rise in premarital intercourse. 40% males and 13% females are of the view that birth control is primarily a female’s responsibility. 14% of males and 21% of females (p = 0.2) reported being forced to have sex. Conclusion: Participants, especially females, lacked basic information about sexuality and related concepts. Male participants had a very casual attitude towards having sex with multiple partners. Premarital sex is more common than once believed. In the light of our finds and the current scenario, sexuality education is indispensable in order to guide the youth to develop and adopt healthy and appropriate sexual practices.

Relationship of High Sensitivity C-Reactive Protein Levels to Anthropometric and other Metabolic Parameters in Indian Children with Simple Overweight and Obesity

Devi Dayal, Hemant Jain, Savita Verma Attri, Bhavneet Bharti, Anil Kumar Bhalla

Context: High senstivity C-reactive protein (hsCRP) levels correlate well other parameters of obesity related metabolic syndrome (MS) and can be used as predictors of future cardiovascular disease risk. There is limited data on hsCRP levels in Indian children with simple obesity. Aim: To study the relationship of hsCRP levels with various anthropometric as well as metabolic parameters in children with simple overweight and obesity. Materials and Methods: This case control study was conducted in Paediatric Endocrinology clinic of a tertiary care hospital in Northern India. Levels of hsCRP were estimated in 100 overweight and obese children (BMI between 85th and 95th percentiles according to age & gender specific CDC 2000 growth charts) aged between 6 and 16 years and in 100 nearly age and sex matched healthy controls. These levels were then correlated to various anthropometric (body mass index, BMI; waist circumference, WC; hip circumference, HC; waist hip ratio, WHR; blood pressure) and biochemical (fasting blood glucose, FBG; total cholesterol, TC; high-density lipoprotein-cholesterol, HDL-C; low-density lipoprotein cholesterol, LDL-C; very low-density lipoprotein-cholesterol, VLDL-C; triglycerides, TG) parameters. Results: Mean levels of hsCRP were significantly higher in the study group (3.92±2.20 versus 2.15±1.05 mg/L) as compared to controls. Significantly more (58% versus 10%) subjects in the study group had hsCRP (>3 mg/L). Of all the parameters studied, only BMI showed a positive correlation with hsCRP levels in the study group. Multiple logistic regression analysis for predicting outcome of high hsCRP showed positive correlation with BMI; with every 1 kg/m2 increase in BMI, odds of high hsCRP level were increased by 37% (OR=1.37; 95% CI 1.23-1.53, p-value <0.0001). Mean values of all the biochemical parameters except HDL-C were significantly higher in the study group. Conclusion: Levels of hsCRP were significantly elevated in overweight and obese children as compared to non-obese children. In addition, these patients also showed abnormalities of lipid and glucose metabolism.

Acute Febrile Encephalopathy in Children and Predictors of Mortality

CM Bokade, RR Gulhane, AS Bagul, SB Thakre

Background: Incidence of acute febrile encephalopathy (AFE) is high in children and associated with high mortality and sequela. Limited data is available about predictors of mortality in children of AFE from central India. Aim: To study the predictors of mortality in children of AFE. Methods: This is observational, prospective study, carried out in a tertiary care hospital of central India. Duration of the study was two years (2010 to 2012). One hundred and seventy six children in the age group of one month to 12 years, presented with fever = 2wks duration and altered mental status lasting for more than 4h were enrolled in the study. Outcome was evaluated in the study subjects. Data was analysed by use of Chi-square test, Fisher’s exact test and multivariate regression. P-value = 0.05 was considered statistically significant. Results: Maximum enrolled children were of viral encephalitis (46.59%) and rest, were of pyogenic meningitis, tuberculosis meningitis and cerebral malaria. Among independently significant variables, shock, severe anaemia, bradycardia, Glasgow coma scale (GCS) of less than eight and refractory seizures were found to be significant and other variables like respiratory failure, multiorgan dysfunction syndrome and abnormal coagulation profile were found insignificant on full model of multivariate regression analysis. Conclusion: Refractory seizures, GCS <8, bradycardia, shock and severe anaemia were independent predictors for mortality in children of AFE.

Dexamethasone as An Additive to Bupivacaine in Fascia Lliaca Compartment Block: A Prospective, Randomized and Double Blind Study

Suresh Kumar N, Kiran N, Ravi M, Don Sebastian, Punith Gowda RM

Background: Patients with fracture femur experience severe pain on movement during positioning for spinal anaesthesia. Fascia Iliaca Compartment Block (FICB) has been used effectively for providing analgesia during positioning of the patient for spinal anaesthesia. Aim: To test the hypothesis that, adding dexamethasone would significantly prolong the duration of Bupivacaine in FICB. Materials and Methods: Sixty patients aged 18 to 80 years posted for ORIF (Open Reduction and Internal Fixation) of fracture femur were included to receive FICB. This was a prospective, randomized, double blind study done at tertiary medical college hospital. Thirty patients received 38ml of 0.25 % bupivacaine with 2ml saline and another 30 patients received 38ml of 0.25 % bupivacaine with 2ml dexamethasone (8mg). Thirty minutes after FICB, patient satisfaction during positioning for spinal anesthesia was recorded. In the post-operative period, duration of analgesia and the total doses of rescue analgesics were recorded in both the groups. Results: Patients who received Bupivacaine with dexamethasone had significant prolongation of analgesia and required fewer doses of rescue analgesics as compared to patients who received Bupivacaine alone for FICB. However the onset of analgesia, VAS scores and patient satisfaction during positioning for spinal anaesthesia were similar in both groups. Conclusion: Our study shows that adding Dexamethasone (8mg) to Bupivacaine for FICB significantly prolonged the duration of block and decreased the requirement of rescue analgesics as compared to patients who received Bupivacaine alone. FICB is relatively easy and safe to perform. In our study we did not encounter any complication while doing the procedures and also by adding dexamethasone.

Comparision of Shear Bond Strength of Stainless Steel and Ceramic Brackets at 24 Hours after Etching Enamel with Different Proportions of Acidulated Phosphate Fluoride

Ramachandhra prabhakar, Karthikeyan, Sarvanan, Raj vikram, Abinaya

Aims and Objectives: To evaluate and compare the shear bond strength of stainless steel brackets and ceramic brackets at 24h after etching the enamel with acidulated phosphate fluoride gel (1.23% APF) at different proportions (40%,30%,20%) incorporated in conventional etchant (37% phosphoric acid). Materials and Methods: Eighty premolars (maxillary and mandibular first and second premolars) extracted for orthodontic purpose has been selected for the study and samples were divided into 4 groups containing 10 teeth each. Comprised of teeth etched Group 1 with 40% of APF gel etchant is Group 2 teeth etched with 30% of APF gel in Group 3 teeth etched with 20% of APF gel etchant and Group 4 teeth were etched with conventional etchant (37% phosphoric acid). Results: The experimental group of Acidulated Phosphate Fluoride (APF) at different proportion (40%, 30%, 20%) incorporated with etchant application for 40s on the enamel surface at 24h indicated that group 4 showed the higher bond strength of all other remaining groups and the groups 1, 2 and 3 showed satisfactory bond strength. The statistical evaluation also revealed that the bond strength of control group (37% phosphoric acid) was greater than those of experimental groups. Conclusion: The present study results shows that the ceramic brackets have higher bond strength than stainless steel brackets (material wise).

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City

Background: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. Objectives: To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. Materials and Methods: A cross-sectional study. Result: A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Conclusion: Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.

NS1 Antigen Capture ELISA an Effective Method for Diagnosis of Early Dengue Infection - Report of an Outbreak at Angul District, Odisha, India

Background: An outbreak of dengue infection occurred in Angul district of Odisha in the month of August & September, 2011. The study was undertaken to detect NS1 antigen positivity among the study population, to compare IgM capture ELISA with NS1 antigen detection for diagnosis of dengue and to identify the predominant genotype of Dengue virus responsible for the outbreak. Materials and Methods: Total 1020 serum samples were collected from clinically suspected cases of dengue from the outbreak. All were subjected for NS1 antigen detection, 92 were selected based on their clinical severity of illness (fever, rash, bleeding manifestation, arthralgia) for further study of IgM ELISA and platelet count and 148 NS1 positive samples were selected from different Blocks of Anugul district for RT-PCR at NIV, Pune, India. Results: Five hundred and thirteen (50.2%) samples were positive for NS1 antigen (highly significant p-value <0.0001, C.I - 95%) with 88% positivity during 1-5 days. The NS1 Ag positivity was peaked to 86.9% on days 3 to 5 (Sensitivity & NPV - 100% each) & declined to 6.2% during 6-10 days with a low sensitivity of 7.14% but 100% specificity & PPV. However, the IgM antibody positivity was 81.2% on days 6 to 10 and 87.5% after 10 days (Sensitivity- 100%, Specificity-13.33%,PPV-7.14% & NPV - 100%). RT-PCR resulted 32.4% positivity (6- DEN1, 39 - DEN 2 & 3- DEN 3) among which 20% were in IgM +ve & 68% in IgM -ve cases. Conclusion: Therefore, early diagnosis of dengue could be mainly by NS1 antigen detection whereas Ig M ELISA is a better tool during the later stage of infection &RT-PCR is more effective in IgM -ve cases.The predominant genotype responsible for the outbreak was found to be DEN-2.

Morphological Traits Around Patellofemoral Joint in Indian Femora and their Implications

Madhu Sethi, Suchismita Ghosh, Neelam Vasudeva

Introduction: Knowledge of structural variations around patellofemoral joint has helped to understand postural behavior patterns of various population groups. The biomechanical impact of postures may lead to certain skeletal modifications which may contribute to knee pathologies like patellofemoral arthritis, patellar subluxation and trochlear dysplasia. This study was conducted to report the incidence of skeletal non-metric markers on femur in Indian population and to understand their correlation with some pathologies of patellofemoral joint. The traits studied were Martin’s facet, Peritrochlear groove and Supratrochlear facet. Materials and Methods: The study material was a collection of 152 adult femora from osteology museum in Department of Anatomy, Maulana Azad Medical College, New Delhi, India, with equal percentage of bones from each side and gender. All bones were evaluated for the above mentioned traits and results were obtained as percentage of incidence and Chi-Square test using SPSS version 17. Results: The data showed that Martin’s facet and Peritrochlear groove showed a higher occurrence in male femora. However, Supratrochlear facet was more commonly found in female bones. Martin’s facet had an equal incidence on femora of each side while peritrochlear groove and supratrochlear facet had higher percentage of occurrence on right side. Supratrochlear facet revealed significant side variation. Conclusion: These data suggest that casual or occupational postures may impose structural adaptations around patell- ofemoral joint. The stress of these postures may have causal,consequential or co-incidental relationship with joint pathologies. The gender, special occupations like sports and genetic predisposition may possibly have a role to play.

Laparoscopic Cholecystectomy Under Spinal Anaesthesia vs. General Anaesthesia: A Prospective Randomised Study

Introduction: Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in our institution. There are multiple studies which have found spinal anaesthesia as a safe alternative. We have conducted this study of LC, performed under spinal anesthesia to assess its safety and feasibility in comparison with GA. Materials and Methods: Fifty patients with symptomatic gallstone disease and American Society of Anesthesiologists status I or II were randomised to have LC under spinal (n = 25) or general (n = 25) anesthesia. Intraoperative vitals, postoperative pain, complications, recovery, and surgeon satisfaction were compared between the 2 groups. Results: In the SA group six patients (24%) complained of shoulder pain, two patients required conversion to GA (8%) as the pain did not subside with Fentanyl. None of the patients in the SA group had immediate postoperative pain at operated site. Only two (8%) patients had pain score of 4 at the operative site within eight hours requiring rescue analgesic. One patient had nausea but no vomiting (4%). All the patients (100%) in the GA group had pain at operated site immediately after surgery and their pain score ranged from 4-7, all patients received rescue analgesic before shifting to the ward. In the first 24h tramadol required as rescue in the GA group was 82±24 mg which was significantly higher than the SA group requiring only 30±33.16 mg. Although, the GA group had more patients experiencing postoperative nausea & vomiting it was not statistically significant. Conclusion: SA as the sole anaesthesia technique is feasible, safe and cost effective for elective LC.

Prevalence of Insulin Resistance in Siblings of Type 2 Diabetics of North West Punjabi Population

Sukhraj Kaur, Mridula Mahajan, B.S.Bal

Context: Insulin resistance a physiological condition is marked by hyperglycemia and failure of cells to respond to normal action thus hyperinsulinemia. It is prevalent in individuals having genetic predisposition and family history of type 2 diabetes mellitus. Physically inactive individuals having sedentary life style are also at a risk of developing insulin resistance. Aim: The present study was planned to observe the prevalence of insulin resistance or pre diabetes in various age groups of North West Punjabi population. Materials and Methods: A total of 400 families comprising of 1159 offsprings of diabetic patients and siblings amongst each were included in the present study. All these 400 families had history of type 2 diabetes mellitus in the present or past generation. Written consent was taken from the head of the family for inclusion in the study. Fasting samples were collected and analysed for Glucose, Glycosylated Hb, complete lipid profile, Insulin and c-peptide. Body mass index, waist hip ratio and HOMA-IR were calculated. Comparison of mean of various parameters was done using student t-test. Analysis of variance (ANOVA) was applied for comparison between groups followed by Bonferroni post hoc analysis. Pearson’s correlation method was used for quantitative variables. Statistical significance was defined as p<0.05 (two tailed). Results: Prevalence of impaired fasting glucose both in males and females increased with advancing age. Hyperglycemia along with hyperinsulinemia, hypercholesterolemia and hypertriglyceridemia was observed in individuals having impaired fasting glucose. Individuals belonging to age group of >18-35 years were more prone to insulin resistance as compared to other age groups. Conclusion: Insulin resistance at a young age of 18-35 years predisposes these individuals to coronary events. Females in reproductive years are more prone to insulin resistance or pre diabetes as compared to males of the same age group.

Ossified Ligamentum Longitudinale Anterius in Adult Human Dry Vertebrae

Kalyan Chakravarthi Kosuri, Nelluri Venumadhav, Siddaraju KS

Background: The ligamentum longitudinale anterius is a broad and strong band of fibrous tissue that runs along the anterior surfaces of the bodies of the vertebrae. Aim: The study was undertaken to evaluate the incidence of ossified ligamentum longitudinale anterius in adult dry human vertebra. Materials and Methods: This study was carried out on 95 sets of dry human vertebral columns irrespective of age and sex at Mayo Institute of Medical Sciences- Barabanki,-UP, Melaka Manipal Medical College-Manipal University and Department of Anatomy, KMCT Medical College, Manassery- Calicut, India. All the sets of vertebral columns were macroscopically inspected for the ossified ligamentum longitudinale anterius. Results: It was observed that out of 95 sets of vertebral columns, 27 (28.42%) vertebral columns showed ossification. Out of 27 vertebral columns, 17 (17.89%) vertebral columns showed segmental type of ossification, 2 (2.11%) vertebral columns showed continuous type of ossification and 8 (8.42%) vertebral columns showed mixed type of ossification at different vertebral level. Conclusion: Such type of ossification will affect the biomechanics of the spine and may results in stiff neck, low back pain, dysphagia, odynophagia, compression of the brachial plexus, aphonia, immobility or mucosal thickening of larynx. Hence, knowledge of such abnormalities should be kept in mind to minimise serious complications in any surgical intervention or investigative procedures in the region.

Role of Absolute Reticulocyte Count in Evaluation of Pancytopenia- A Hospital Based Study

Poorana Priya.P, Subhashree.A.R

Background: Pancytopenia is a common hematological entity encountered in our laboratory practice. Evaluating the causes of pancytopenia is essential for the diagnostic as well as therapeutic management of the patients. Absolute Reticulocyte count (ARC) plays a pivotal role in identifying the cause of pancytopenia in most of the cases but it has grossly been overlooked. Hence, we attempted to identify the significance of ARC as a deciding parameter in evaluating the causes of pancytopenia. Materials and Methods: The study was conducted in a tertiary health care hospital, Chennai, India. A cross-sectional descriptive study was conducted over a period of two years (2011-2013). Patients who satisfied the criteria for pancytopenia were evaluated with clinical details. Pancytopenia work-up including Peripheral blood picture, Complete blood counts, Reticulocyte count, Serum Ferritin, B12, Folate and Bone marrow aspirate was carried out. ARC was calculated and an algorithm to approach the cases of pancytopenia was derived considering ARC as the key factor. Results: A total of 429 cases of pancytopenia were evaluated and based on our algorithm results were tabulated. ARC was found to be <25x10^9/L for cases of Aplastic anaemia; 25-50x10^9/L for Nutritional anaemia; and, >100x10^9/L in Marrow infiltrative disorders and in cases of sepsis and malaria. Conclusion: We found that ARC plays an important role in differentiating various causes of pancytopenia and hence should be routinely included in pancytopenia work up in order to avoid unnecessary bone marrow aspirations in pancytopenic patients.

Evaluation of Efficacy of Curcumin as an Add-on therapy in Patients of Bronchial Asthma

Afroz Abidi, Surabhi Gupta, Manu Agarwal, H.L. Bhalla, Mahip Saluja

Background: Bronchial asthma being a chronic inflammatory disease of airways has numerous treatment options none of which have disease modifying properties. Curcumin, a yellow dietary pigment has varied pharmacological activities, prominent among which is an anti-inflammatory activity which may be crucial in bronchial asthma as has been proved by various in vitro and in vivo animal studies. Aims: To determine the efficacy and safety of curcumin as an ‘add-on’ therapy in patients of bronchial asthma. Settings and Design: This study was conducted on 77 patients of mild to moderate Bronchial asthma who had a documented positive bronchodilator reversibility test with = 15% improvement in forced expiratory volume one second (FEV1). Material and Methods: Seventy seven patients were recruited for the study and randomized into either of the two groups, but 17 patients were lost to follow up. Thus Group A – Receiving standard therapy for bronchial asthma for 30d (n=30) and Group B – Receiving standard therapy for bronchial asthma + Cap Curcumin 500mg BD daily for 30d (n=30). The predefined primary endpoints were clinical assessments of dyspnoea, wheezing, cough, chest tightness and nocturnal symptoms, change in the pre-bronchodilator FEV1 during the treatment and hematological improvement. The secondary end points were assessed by the change in the post-bronchodilator FEV1, C-reactive protein (CRP) concentration and incidence of adverse events. Statistical Analysis used: The data was analysed by SPSS 17.0 software using one-way ANOVA or Paired t-test. Results and Conclusion: The results showed that curcumin capsules help in improving the airway obstruction which was evident by significant improvement in the mean FEV1 values. There was also significant improvement in the hematological parameters and absence of any clinically significant adverse events indicates dependable safety profile of curcumin capsules, though there was no apparent clinical efficacy. Therefore, it is concluded that curcumin is effective and safe as an add-on therapy for the treatment of bronchial asthma.

A Study on Morbidity Profile and Associated Risk Factors in a Rural Area of Dehradun

Shaili vyas, SD Kandpal, Jayanti semwal, Deepshikha

Background: First few years of life is the most crucial period of life as this age is known for accelerated growth and development, warranting regular monitoring. During this period about 40% of physical growth and 80% of mental development occurs. Any adverse influences during this period may result in severe limitations in their development. Methods: A cross-sectional study was conducted in the field practice area of Rural Health Training Centre. Mothers of children between 0-3 years of age were enquired about the morbidity in the past two months. Results: Diarrhea (47.9%) followed by ARI (22.21%), Pica (13%) and Worm Infestation (9.21%) were the commonest morbidities found in the study population. Morbidities were found to be common in males as compared to females. Amongst the nutritional deficiencies anaemia & Vitamin B deficiencies were the commonest. Conclusion: There was considerable sickness load amongst the toddlers. Morbidity can be reduced by improvement in the health care system at peripheral level.

A Three-Dimensional Study of Variations in Root Canal Morphology Using Cone-Beam Computed Tomography of Mandibular Premolars in a South Indian Population

Background: Conventional radiographic techniques being two dimensional, has its restrictions and is confined to limited diagnostic value. However, the incorporation of Cone Beam Computed Tomography (CBCT) gives a three dimensional insight to the tooth morphology and leads to better evaluation and treatment management. Aim: The aim of this study was to evaluate and assess the root canal morphology of mandibular pre-molars in South Indian Population using CBCT radiographic technique. Materials and Methods: One thousand and eighty six and 814 fully erupted mandibular first and second premolars respectively were scanned using CBCT to evaluate the canal morphology according to Vertucci and Gulabiwala’s classification. Results: The most common configuration in mandibular first and second premolars was Vertucci’s Type I(83.81% and 93.48% respectively) followed by Type V (11.97% and 3.5% respectively). Conclusion: South Indian population presented Type IV ertucci’s canal morphology as the most common in mandibular first and second pre-molars followed by Type V. CBCT scanning poses a greater advantage in assessing the complexity of root canal morphology and planning an appropriate endodontic treatment for the same.

Relationship of Lipid Profile and Serum Ferritin levels with Acute Myocardial Infarction

Introduction: National Health and Nutrition Examination Survey (NHANES III), 1988-1994, first time reported a significant, positive association in iron storage and heart disease risk. Thereafter several researchers have found an association between iron overload, serum ferritin (SF) and MI. No such Indian study was available in the literature and so we decided to find out the relation of lipid profile and Serum Ferritin with myocardial infarction (MI). Materials and Methods: Fifty indian patients of AMI (study group) and fifty indian healthy volunteers (control group) were included for the present study. Lipid profile including TC, HDL-c, LDL-c, VLDL-c & TG and SF levels were estimated in all subjects. Observations and Results: Mean ± SD of TC level was 250.64 ± 25.61, of HDL-c was 36.52 ± 2.86, of LDL-c was 165.69 ± 26.80, of VLDL-c was 42.35 ± 8.53 and of TG was 211.83 ± 42.65 in study group while these values were 174.46±47.68, 43.2±12.52, 98.37±41.13, 32.88±21.45 and 164.42±107.29 respectively in control group. All the parameters were found not only raised in patients of acute myocardial infarction (AMI) but were also statistically significant when compared with control group (p=<0.01). Mean ± SD of SF levels was 268.43±30.17 ng/ml in study group and 110.96±56.5 ng/ml in control group; this level was found not only raised in patients of AMI but were also statistically significant when compared with control group (p=<0.01). Conclusion: TC, LDL-c, VLDL-c, TG and SF levels were raised in patients of AMI and found to be statistically significant; while HDL-c levels were reduced in such patients and is also statistically significant. It can be concluded that there exists an association in lipid profile and SF with AMI therefore dyslipidemia and raised SF levels are the features of AMI.

Clinico-Histopathological Analysis of Neoplastic and Non-Neoplastic Lesions of the Ovary: A 3-Year Prospective Study in Dhule, North Maharashtra, India

Kanthikar S.N., Dravid N.V., Deore P.N., Nikumbh D.B., Suryawanshi K.H.

Background: Ovary is the commonest site of neoplastic and non-neoplastic lesion, can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions. Aim: This study was done to analyse the frequency of ovarian lesions their clinico-histological features in a rural set up. Materials and Methods: This is a prospective study of 145 ovarian lesions at tertiary care hospital over a period of 3yr. All the relevant clinical data of patients analysed from hospital record file. Results: The total number of ovarian lesions studied during study period was 145 cases, amongst them 75 were non-neoplastic and remaining 70 were neoplastic. The most common non-neoplastic lesion seen was solitary follicular cysts i.e. 56 cases (74.66%), followed by corpus luteal cysts 15 cases (20%). Among the 70 neoplastic ovarian lesions 55(78.57%) cases were benign, 1(1.42%) case was at borderline and 14 (20%) cases were malignant. In benign ovarian neoplasm, most commonly seen lesion were serous cystadenoma followed by benign cystic teratoma. In malignant cases, maximum were of serous cystadenocarcinoma, followed by mucinous cystadenocarcinoma and metastatic tumours. Conclusion: Ovarian lesion possess wide gamut of histology. Specific diagnoses are made on routine gross and histological examination or in certain difficult cases require immunohistochemistry.

Role of Sublingual Misoprostol for Cervical Priming in First Trimester Medical Termination of Pregnancy

Megha Mathur, Jyotsna Rani, Vijayshree

Objective: To evaluate the efficacy and safety of sublingual misoprostol as facilitator in first trimester medical termination of pregnancy (MTP) by surgical method. Materials and Methods: This was a prospective open label study conducted at a tertiary center. A total 150 patients at 6-12 wks gestation requesting for MTP were randomized into two groups. Patients in study group (n=75) received sublingual misoprostol three hours before surgical abortion and in control group (n=75) directly underwent surgical abortion without prior cervical priming with misoprostol. The outcomes of both groups were recorded in terms of baseline cervical dilatation, need of additional cervical dilatation, intraoperative blood loss, operative time and procedure related complications. The results were statistically analyzed using student-t test and chi-square test. p-value of <0.05 and <0.001 were considered significant and highly significant respectively. Results: The mean baseline cervical dilatation was significantly more in study group compared to control group (8.6±1.3mm versus 5±2.3mm; p <0.001) and the operative time and intraoperative blood loss were also less (p<0.001). Higher incidence of side effects like nausea, vomiting and pyrexia were recorded in sublingual misoprostol group but were well tolerable to the patients. Conclusion: Sublingual misoprostol is an effective and safe drug for cervical priming prior to surgical evacuation and has good patient acceptability.

Correlates of Intention to Use Condom among Male Migrant Factory Workers in Northern India

S A Rizwan, Shas hi Kant, Kira n Goswami, Sanjay K. Rai, Puneet Misra

Objective:Consistent condom use among high-risk groups, which in turn are dependant on favourable condom use intention is important for the success of HIV/AIDS prevention programmes. We aimed to determine intention to use condom and delineate their correlates in a sample of male migrant workers in northern India. Materials and Methods: This was a cross-sectional facility based survey conducted in 2011. Inclusion criteria were: male migrant workers aged = 18 years, who were born outside Haryana, who had moved to current location after 15 years of age, who had worked in the current factory for at least one year and who were able to give valid consent. Face-to-face interviews were conducted with semi-structured questionnaire. Since this analysis was a secondary objective of a larger migrant study, sample size was not calculated separately. Intention to use condom was measured on a five point Likert scale and expressed as a linear score (higher the score more unfavourable the intention). A linear regression analysis was performed to identify factors independently associated with unfavourable intention. Results: Mean (SD) score for intention to use condom was 10.4 (3.4). Unfavourable intention was associated with men who had migrated to greater number of places, who had lesser HIV/ AIDS knowledge, who had never used condom and who had not used condom at last non-spousal sex. The model had an adjusted R-square value of 0.63 and was statistically significant (F = 41.9, p <0.001). Conclusion: Male migrant workers had unfavourable intention to use condom. This intention could be favourably modified by behaviour change communication through already existing targeted intervention platforms, focussing attention on groups with higher mobility, lower education, lower HIV/AIDS knowledge and inconsistent condom use.

Predictors of Success of Medical Management of Ectopic Pregnancy in a Tertiary Care Hospital in United Arab Emirates

Pooja Rajesh Vaswani

Introduction: Ectopic pregnancy is the most common cause of pregnancy related deaths in the first trimester of pregnancy. Advances in laboratory and imaging technologies in last few decades allow an early diagnosis of ectopic pregnancy, many times even before the patient develops any symptoms. Consequently in many such patients surgery is not always necessary. Expectant and medical management are feasible options in properly selected cases. In the present study, efficacy of medical management of selected cases of ectopic pregnancy with injection methotrexate and the factors influencing the success of medical management were evaluated. Materials and Methods: Retrospective study involving 40 women with ectopic pregnancy who met inclusion criteria and were managed medically with Methotrexate (MTX) in a tertiary hospital in United Arab Emirates (UAE). Various factors which could possibly influence the success of medical management were evaluated. Results: ROC analyses for day 1(pretreatment) Beta HCG levels revealed that the optimum cut off for Beta HCG level of 6000 mIU/ml on day 1 can be considered a good predictor of success of medical management with MTX. Falling serum Beta HCG between day 1-4 very well predicted success of MTX therapy (irrespective of number of doses of MTX) with a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 31.25%. Similarly adnexal mass size = 3 cms and duration of amenorrhoea < 6 weeks were found to be good predictors of success of medical management (PPV 96.66% and NPV 90% for both factors).In the present study, irrespective of number of doses received, medical management with MTX was successful in 75% cases (30 out of 40). Conclusion: Results of this study indicate that pretreatment Beta HCG level of < 6000 mIU/ml, adnexal mass size <3 cms, amenorrhoea < 6 weeks and absence of free fluid in the pelvis are predictors of a successful treatment with MTX. In properly selected cases medical management of ectopic pregnancy with MTX is highly effective and can be considered a forward step taken towards conservation of fallopian tubes especially in countries like UAE where there is inclination towards large family size based on religious and cultural background.

A Comparative Evaluation of Scoring Systems for Assessing Necro-Inflammatory Activity and Fibrosis in Liver Biopsies of Patients with Chronic Viral Hepatitis

Rahul Mannan, Vatsala Misra, S.P Misra, Pramela A Si ngh, Manisha Dwiv edi

Introduction: To compare the five scoring systems in assessing grading and staging of liver biopsies from patients with chronic viral hepatitis and their problems and pitfalls. Materials and Methods: Liver biopsies from 25 patients with chronic viral hepatitis were studied. Sections were stained with Haematoxylin and Eosin, Reticulin and Masson’s Trichrome stains. Van Gieson, Perl’s and Shikata’s Orcein stains were used as and when required. Coded histological sections were scored independently by three histopathologists using the Knodell Histology Activity Index (HAI), the Scheuer scoring system, Ishak’s system, Metavir system and Ishak modified HAI. Results: There were 15 males and 10 females. Their mean age was 51.24 years. On histological examination, hepatocytes showed degenerative changes with varying grades of necrosis (spotty and confluent). Widening of portal tracts with varying severity of mononuclear inflammatory infiltrate and interface hepatitis was observed. Fibrosis appeared as periportal, portal-portal and portal-central septa. A significant agreement was found by kappa statistics for both grading (p< 0.001) as well as staging (p < 0.001) among all the five scoring systems. Lobular activity was the only parameter that showed some discrepancy. No significant intra observer difference was observed. Conclusion: It is concluded that all the scoring systems are equally good for grading and staging in the hands of an experienced hepatopathologists.

Comparative Efficacy and Safety of Triple Therapy (Ramipril, Telmisartan, Hydrochlorothiazide) Vs Dual Anti Hypertensive Therapy (Ramipril or Telmisartan, Hydrochlorothiazide) in Stage 2 Hypertensive Patients

Aim: To evaluate the comparative efficacy and safety of ramipril 5mg plus hydrochlorothiazide 12.5mg (R + HCTZ), telmisartan 40mg plus hydrochlorothiazide12.5mg (T + HCTZ) and ramipril 2.5mg plus telmisartan 20mg plus hydrochlorothiazide12.5mg (R + T + HCTZ) in patients with stage 2 hypertension. Material and Methods: A prospective, open label, randomized comparative study was conducted to study the comparative efficacy and safety of R+HCTZ (group 1), T+HCTZ ( group 2) and R+T+TCTZ (group3) in eighty eight patients with stage 2 hypertension without co morbid conditions. Echocardiography was done to assess left ventricular function. Patients were followed up to 24 weeks and any ADR occurring in this period was recorded. Results: All the three treatment groups showed significant fall in both systolic and diastolic blood pressure compared to the baseline scores (p<0.0001).Intergroup comparison did not reveal any significant difference .Total number of adverse drug events reported were fifteen . Group III had higher percentage ADRs . Dry cough (8) was most common ADR . The echocardiography parameters did not change from baseline values with all three treatment regimens . Conclusion: All three medications were of equal efficacy in patients with stage 2 hypertension without co morbid conditions, failing to prove superiority over each other.

Comparison of Directly Observed Treatment Short Course (DOTS) with Self-Administered Therapy in Pulmonary Tuberculosis in Udupi District of Southern India

Amrita Parida, K.L. Bairy, Bharti Chogtu, Rahul Magazine, Sudha Vidyasa gar

Background: Directly observed treatment short course (DOTS) and self-administered therapy (SAT) are the treatment options available for tuberculosis (TB). Studies conducted worldwide have shown difference in treatment outcome with these two treatment modalities. Aim: The study was undertaken to compare treatment outcome of DOTS and SAT in patients of pulmonary TB taking SAT from a tertiary care hospital and DOTS from the DOTS centre of a government hospital. Materials and Methods: It was a retrospective comparative study. The case record files of patients with pulmonary TB diagnosed from March 2011 to February 2012 were analysed as per the proforma. The sample size of patients was 150 (75 each from DOTS and SAT). Results: The treatment outcome in DOTS group was cured 70.7%, treatment completed 1.3%, failure 5.3%, deaths 10.7%, defaulters 8% and transferred out 4% whereas in SAT group, cure was seen in 68% and 4% completed the treatment, 1.3% had treatment failure, and 26.7% were lost to follow up which included deaths, defaulters and those patients who switched over to other hospitals. The treatment success rate was similar (72%) in both groups. There was no statistically significant difference observed in the average weight gain at the end of treatment between the two groups. A total of 11 adverse drug reactions (4 DOTS, 7 SAT) were recorded in the study. Conclusion: The study shows no statistically significant difference between success rate in patients taking DOTS and SAT.

Study on Variant Anatomy of Sciatic Nerve

Mallikarjun Adibatti, Sangeetha V

Introduction: Sciatic Nerve (SN) is the nerve of the posterior compartment of thigh formed in the pelvis from the ventral rami of the L4 to S3 spinal nerves. It leaves the pelvis via the greater sciatic foramen below piriformis and divides into Common Peroneal Nerve (CPN) and Tibial Nerve (TN) at the level of the upper angle of the popliteal fossa. Higher division of the sciatic nerve is the most common variation where the TN and CPN may leave the pelvis through different routes. Such variation may lead to compression of the nerve and lead to Non-discogenic sciatica. Materials and Methods: Fifty lower limbs were used for the study from Department of Anatomy, J.J.M.M.C Davangere, Karnataka, India. Observation and Results: In our study on 25 cadavers (50 lower limbs), we have observed 4 (8 %) lower limbs high division of sciatic nerve was noted. High division of sciatic nerve in the back of thigh was noted in one specimen (2%), while high division within the pelvis was noted in 3 specimens (6%), while in 46 (92%) it occurred outside the pelvis. Conclusion: Knowledge regarding such variation and differences in the course of SN is important for the surgeons to plan for various surgical interventions pertaining to the gluteal region. The variant anatomy of SN may cause piriformis syndrome and failure of SN block. Hence present study is undertaken to know the level of division, exit, course, relationship to piriformis and variations in the branching pattern of SN.

Medical Symbols in Practice: Myths vs Reality

Anil Shetty, Shraddha Shetty, Oliver Dsouza

Background: The caduceus is the popular symbol of medicine. However, premier health organizations and regulatory bodies such as the World Health Organization and the Medical Council of India use a different symbol- the rod of Asclepius in their logo. There is an increasing awareness and recognition that the caduceus is a false symbol and has no historical substantiation as an emblem of medicine. Many academic and health institutions in the western hemisphere have changed their logo as a consequence. There are other symbols of medicine which are similarly misunderstood. Objectives: The purpose of the study is to assess the knowledge of common medical symbols among doctors and medical students. Materials and Methods: Three hundred doctors and medical students were assessed on their knowledge about the Rx symbol, the Red Cross emblem and the true representative emblem of medicine. Logos and emblems of elite medical colleges and medical associations were also studied. Results: Only 6% of doctors were aware that the Rod of Asclepius is the true symbol of healing. Knowledge of the significance of the Rx symbol and the origin of the Red Cross emblem was 55% and 39 %. Conclusion: There is very little awareness about the rod of Asclepius and most institutions have adopted a logo based on the caduceus. Awareness of the true origins and the symbolism of the emblems is lacking in the medical fraternity.

Iodine Status and Prevalence of Goitre in School Going Children in Rural Area

Sridhar P.V, Kamala C.S

Introduction: Iodine deficiency disorder (IDD) is one of the preventable major public health problems in India. It has been always thought that goitre was only found in the Himalayan goitre belt. Recent surveys outside the conventional goitre belt have identified foci of iodine deficiency in other parts of India. Aim: 1) To assess the prevalence of goitre among school- going children in the age group of 6-15 years. 2) To find out the relationship of goitre prevalence with the salt intake and urinary iodine excretion. 3) To unfold the iodine nutritional status of the study population. Materials and Methods: The study was conducted from January 2005 to July 2006 in school children of 6-15 years of age, attending the 55 schools of Bellur hobli in the southern part of India. The clinical examination of all the 1600 children of the selected schools was done to detect and grade goitre. Urine and salt samples were collected from sub-samples (n = 400) to estimate the urinary iodine excretion level and iodine content in the salt respectively. Results: The goitre prevalence in the study population was found to be 0.125%. Urinary iodine excretion (UIE) level of = 100 mcg / l was found in 361 children (90.25%) and < 100 mcg/ l in 39 children (9.75%). Estimation of iodine content of the salt samples revealed that 363 (90.75%) consumed adequately iodised salt (> 15ppm) and 37 (9.25%) consumed inadequately iodised salt (< 15ppm). Conclusion: Bellur Hobli is not an endemic area for goitre and there is no biochemical iodine deficiency in this population due to effective implementation of Universal iodization programme (UIP). It is reasonable to conclude that by achieving the universal iodisation of salt, IDD can be successfully eliminated from the community.

Preoperative Preparation with Lugol’s Iodine in Thyroidectomy of Euthyroid Patients-Is it Really Mandatory?-An Otorhinolaryngologist’s View

Santosh.U.P, Prashanth K.B, Lavanya Karanam

Objective: To elucidate the necessity of Lugol’s iodine in preoperative preparation of patients undergoing thyroidectomy. Materials and Methods: Hundred and five euthyroid patients who underwent surgery without preoperative preparation of patients with Lugol’s iodine were enrolled in this retrospective study conducted during the period May 2009 to August 2013 in Teaching Hospital. Indication of surgery was ranging from suspected malignancy to cosmetic reasons and compressive features like dysphagia , dyspnoea and hoarseness of voice. Results: All patients were operated by the same surgeon where in hemi, total and subtotal thyroidectomies were performed without any usage of Lugol’s iodine preoperatively. During the postoperative period the following events occurred, five patients (4.7%) had incurred recurrent laryngeal nerve palsy (RLNP) which was confirmed with postoperative Indirect laryngoscopic examination and two patients (1.9%) with hypocalcemia (serum calcium less than 8mg/dl) which was managed conservatively and effectively. Among these five patients, three patients had (Right RLNP) and two patients had (Left RLNP) palsies. Of these four RLNP (3.8%) were temporary which improved with conservative management within 3weeks-6months duration and one (0.9%) was a permanent Rt RLNP with no improvement even after six months. Conclusion: Hence, we conclude that it is not of much importance to use Lugol’s iodine preoperatively in patients undergoing thyroidectomy. There does not appear any convincing evidence of advantages of preoperative preparation of patients with lugol’s iodine in euthyroid state undergoing surgery.

Facial Pain Followed by Unilateral Facial Nerve Palsy: A Case Report with Literature Review

Sowmya GV, Manjunatha BS, Saurabh Goel, Mohit Pal Singh, Madhusudan Astekar

Peripheral facial nerve palsy is the commonest cranial nerve motor neuropathy. The causes range from cerebrovascular accident to iatrogenic damage, but there are few reports of facial nerve paralysis attributable to odontogenic infections. In majority of the cases, recovery of facial muscle function begins within first three weeks after onset. This article reports a unique case of 32-year-old male patient who developed facial pain followed by unilateral facial nerve paralysis due to odontogenic infection. The treatment included extraction of the associated tooth followed by endodontic treatment of the neighboring tooth which resulted in recovery of facial nerve plasy. A thorough medical history and physical examination are the first steps in making any diagnosis. It is essential to rule out other causes of facial paralysis before making the definitive diagnosis, which implies the intervention. The authors hereby, report a case of 32-year-old male patient who developed unilateral facial nerve paralysis due to odontogenic infection with a good prognosis after appropriate treatment.

Morphometric Analysis of Upper End of Tibia

Introduction: The present study aims to assess different morphometric parameters of condylar and intercondylar surface of tibia and to compile the results, analyze and formulate a baseline data for future studies with relevance to Indian population and also to compare the current data with accessible literature for pertinent surgical utilities. Morphometric parameters of upper end of tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Information regarding morphometry of upper end of the tibia is vital as it provides reliable method of assessing knee deformity. Materials and Methods: The study group comprised of 50 male and 50 female adult human tibiae. Morphometric measurements of medial condyle, lateral condyle and intercondylar area of tibiae were meticulously recorded with digital Vernier calipers with a least count of 0.01 mm. Student’s t-test was used with significant level of p-value < 0.05 and 95% confidence interval. Results: All measurements were found to be statistically significant when compared between the two sexes on both sides (p-value<0.05). Anteroposterior measurements were found to be greater than transverse measurements for both medial and lateral condyles. Furthermore, both anteroposterior and transverse measurements were greater in medial condyle than in lateral condyle on both sides and sexes. Conclusion: The present study is an endeavor to provide a base line data pertaining to morphometric details of upper end of tibia with reference to unicompartmental and total knee arthroplasty in Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

Characterization of Cervicofacial Lymphnodes - A Clinical and Ultrasonographic Study

Reshma Vj, Shihab Anwar A, Abdulla Mufeed, Vadivazhagan, Johnson K. Issac

Background: Lymph nodes undergo reactive changes in response to a wide variety of stimuli, the most common cause being inflammatory and immune reactions, apart from primary malignant neoplasms and metastatic tumours. It is well accepted that a clinical examination alone cannot be considered diagnostic to justify the involvement of cervicofacial lymph nodes especially deep and small nodes. Ultrasonography is an easy, reproducible, non invasive, non-ionizing imaging modality to evaluate cervicofacial lymph nodes. Aims: The present study was devised with an aim of comparing the clinical and ultrasonographic features of cervicofacial lymphadenopathy. Materials and Methods: The subjects for the study were selected from the patients who visited the outpatient department with clinically palpable lymph nodes. 52 patients were included in the study and they were divided into 4 groups; group I (subjects with odontogenic infections), group II (subjects with non odontogenic oral conditions), group III (subjects with tuberculosis) and group IV (subjects with head and neck carcinomas). A detailed case history was recorded and a thorough clinical examination was carried out for all subjects. The cervicofacial lymph nodes were palpated and examined. Ultrasonographic examination of cervicofacial lymph nodes was carried out and recorded. The statistical analysis was done using chi square test. Result and Conclusion: Most of the subjects considered for the study showed cervicofacial lymphadenopathy associated with odontogenic causes, specific infections like tuberculosis and head and neck malignancies. The lymph nodes showed varied clinical features. The ultrasonographic features such as number, size ,shape, short axis/long axis ratio , border sharpness, hilum , echogenicity, distribution of the internal echoes, intranodal necrosis, matting or soft tissue edema were evaluated. The results were tabulated and statistical analysis was done.

Comparison of the Antibacterial Efficacy of Manuka Honey Against E.faecalis and E.coli – An In vitro Study

Aim: To compare the antibacterial efficacy of Manuka honey against E.faecalis and E.coli. Materials and Methods: Escherichia coli (ATCC-25922) and Enterococcus faecalis (ATCC-29212) were separately inoculated in the nutrient broth and incubated at 37oC for 24-48hrs. Bacterial samples were kept in contact with each disinfectant solution for varying intervals of time. Once the test time had elapsed 10?L of the bacterial dilutions were plated on Mueller?Hinton agar and incubated for 24-48hrs at 37?C to estimate the density. Study of the disinfection process with respect to time and Modeling was done. Results: The mean value of the antimicrobial activity of Manuka honey against E.coli and E.faecalis are 1.55 and 0.36 respectively and are relatively higher. It shows that there is a significant difference among the various root canal disinfectant groups against E. coli and E. feacalis. (p<0.001) Conclusion: Manuka honey is shown to be a potential root canal disinfectant against gram positive and gram negative bacterial pathogens.

Awareness and Approach towards Hypertension Management among General Practitioners of Western Vadodara

Background: Hypertension (HTN) is a major risk factor contributing to premature mortality from cardiovascular and cerebrovascular disease.To decrease morbidity and mortality from HTN, timely diagnosis of the disease and its complications, urgent treatment and referrals are required. General Practioners (GPs) are the first tier of the health care system in India and have a wide scope of practice. It is important to know the awareness and approach of primary care physicians to hypertension in their daily practice as compared to standard practice recommendations and guidelines, to identify targets for improvements. With this objective we decided to interview them personally and analyse their approach. Materials and Methods: We conducted a cross-sectional survey in 80 general practitioners (GPs) of the western part of Vadodara city with the use of a questionnaire prepared from JNC-7 guidelines and standard medical books. Seventy seven [97.55%] GPs completed the questionnaire and their responses were statistically analysed. Results: Twenty percent of GPs were not applying BP cuff properly for BP measurement. Only 18% and 16.6 % could diagnose isolated diastolic hypertension (IDH) and isolated systolic hypertension respectively (ISH) and 21% and 29% would have considered treatment of IDH and ISH respectively.48% consider treating pre-hypertension using non-pharmacological measures. Only 21% use thiazide diuretics for uncomplicated HTN and 50% use beta-blockers in coronary artery disease patients. Conclusion: In our study, most of the GPs in western Vadodara are well aware and updated about the initial lab investigations,non-pharmacological measures and complications of HTN but lack an effective approach towards history taking for HTN,technique for measurement of blood pressure, diagnosis and treatment of IDH and ISH. Pre-hypertension and systolic and diastolic hypertension is under-treated and thiazide diuretics are underutilized. This study can be used to identify targets and approaches to improve hypertension management at the primary care level.

Impact of Low Level Magnification on Incipient Occlusal Caries Diagnosis and Treatment Decision Making

Neha Sisodia, M.K.Manjunath

Introduction: This in-vitro study aimed to test the accuracy and reproducibility in detection of incipient occlusal caries and treatment decision making using unenhanced visual–tactile technique and low level magnification by the use of loupes and surgical operating microscope (SOM). Methodology: Sixty extracted human posterior teeth were assessed by two examiners using ICDAS- II index and CPI- TN probe, with and without magnification. Histopathology was used as gold standard for diagnosis of caries and treatment decision making. Inter and intra examiner reproducibility was determined using Kappa statistics. Results: Intraobserver reproducibility for caries detection using surgical operating microscope ranged from average to good (0.4-0.63). Inter-examiner reproducibility values for treatment decision making using experimental techniques such as unaided (0.40), Loupes (0.51) & SOM (0.63) were similar.

Ossifying Fibroma in the Sinonasal Tract: A Rare Case Report

Shekhar Charavarty, Debashish Datta, Esha Boro, Bijita Dutta

Ossifying fibroma involving the sinonasal tract is an extremely rare occurrence. We are reporting a case of ossifying fibroma in the left maxillary sinus in a 19-year-old female who presented with a mass in the left cheek and nasal obstruction. On examination, the swelling in the left cheek seemed to originate from the left maxilla and was smooth and bony hard. Patient underwent detailed radiological and image guided cytopathological investigations. Depending on the results of these tests complete surgical excision of the mass was done. Histopathological evaluation of the excised mass revealed it to be an Ossifying Fibroma.

Relationship Between Femur Bone Mineral Density, Body Mass Index and Dental Panoramic Mandibular Cortical Width in Diagnosis of Elderly Postmenopausal Women With Osteoporosis

Objectives: To measure and determine mandibular cortical width (MCW) on the panoramic radiographs, to evaluate the usefulness of the method in identifying postmenopausal women with low femoral bone mineral densities (f- BMD) and to correlate the radiographic findings on panoramic radiographs with the f-BMD assessed by dual X-ray absorptiometry ( DXA) to predict the efficacy of the radiographic method in diagnosing osteoporosis. Materials and Methods: One hundred and twenty postmenopausal women (60 normal and 60 osteoporotic) in the age group of 50-75 y with f-BMD assessed by DXA had undergone panoramic radiographic examination. The patients were classified as normal (T-score = -1.0) and osteoporotic (T-score = -2.5). MCW on panoramic radiographs was measured bilaterally at the mental foramen region with a caliper and their mean was used as the exposure measure in the analysis. Results: Student t-test showed that mean f-BMD, BMI and MCW was found be less in osteoporotic patients as compared to normal group with a statistically significant p-value < 0.001. Pearson correlation coefficient test revealed that MCW correlated positively with f-BMD and showed a significant decrease with age of the patient. Conclusion: Postmenopausal women with low f-BMD had thinner mandibular cortex at the mental foramen region when compared to normal subjects and are more susceptible to femoral neck fractures. Mandibular inferior cortical width at the mental foramen region could be used to identify postmenopausal women with low f- BMD. Hence, dental panoramic radiographs serve as a useful screening tool for early diagnosis of osteoporotic fractures.

Post- Thyroidectomy Haematoma Causing Severe Supraglottic Oedema and Pulmonary Oedema - A Case Report

Leena Harshad Parate, Vinayak Seenappa Pujari, Tejesh C Anandaswamy, Saurabh Vig

Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy haematoma is a rare but life threatening complication of thyroid surgery leading to airway obstruction. We report a case of huge goiter that underwent near total thyroidectomy and developed post thyroidectomy haematoma. Within no time it resulted in near fatal airway obstruction, pulmonary oedema and cardiac arrest. The haematoma was evacuated immediately and patient was resuscitated successfully. Pulmonary oedema was further worsened by subsequent aggressive fluid resuscitation. She was electively ventilated with PEEP and was extubated after five days. Except for right vocal cord palsy her postoperative stay was uneventful. This is unique case where a post thyoidectomy haematoma has resulted in fatal supraglottic oedema and pulmonary oedema. Early recognition, immediate intubation and evacuation of haematoma are the key to manage this complication. We highlight on the pathophysiology of haematoma and discuss the strategies to prevent similar events in future.

Quality of Life and Marital Adjustment after Cognitive Behavioural Therapy and Behavioural Marital Therapy in Couples with Anxiety Disorders

Chirumamilla Kavitha, Uma Rangan, Praveen Kumar Nirmalan

Background: Anxiety disorders may affect nearly one in four persons and may cause significant impairment of interpersonal relationships including marital relationships. The effect of the disorder on the spouse and the impact of including the spouse in therapy are not well studied. Aim: To determine if Cognitive Behavioural Therapy (CBT) improves the quality of life of participants with anxiety disorders and if marital adjustment of couples with anxiety disorders can be improved with Behavioural Marital Therapy (BMT), relative to standard care of pharmacotherapy and psychoeducation. Methods: An open label randomised controlled trial. Participants were randomly assigned to CBT+BMT or standard of care. Final assessments were carried out at 3.5 months after baseline. Quality of life was assessed using the WHOQOL-Bref instrument and Marital adjustment was measured using a marital quality scale. Chi-square test, student’s t-test and Analysis of Variance (ANOVA) and Effect sizes with Cohen’s d were used to compare differences between groups. Results: Clinically meaningful effect sizes for the CBT+ BMT intervention were evident for the marital adjustment scores among participants (d=0.63) and their spouses (d=1.29), and for the psychological (d=0.84), social (d=0.72) and environmental (d=0.52) domains of the WHOQOL of participants and psychological (d=0.86), social (d=0.32) and environmental domains (d=1.01) of the WHOQOL of spouses of participants. Conclusion: CBT for the partner with anxiety disorder and BMT for couples with anxiety disorders and marital discord and involvement of the spouse in the therapy will be a useful addition to the management of a couple where one partner has an anxiety disorder.

Comparison Between Efficacy of Four Different Types of Orthodontic Separators

Aim: To evaluate the rapidity and amount of separation of four different types of separators (i.e. Elastomeric separators, Dumbbell separators, Kesling springs and NEET springs) and also the percentage of loss of these separators. Materials and Methods: The separating effect of 4 different types of separators (i.e. Elastomeric separators, Dumbbell separators, Kesling springs and NEET springs) were assessed for 3 days, and the separated space between molars and premolars were noted separately for three consecutive days. The number and types of lost separators were recorded at the same time. The amount of separation between molars and 2nd premolar in each quadrant was measured separately with a leaf gauge (sensitivity 5/100mm) and noted on each day. Results: Dumbbell separators proved to be the fastest in producing separation and they produced consistently greater amount of separation on all three days. Conclusions: The Dumbbell separator would be ideal for situations where in rapid separation is needed, and also in cases where in the patient comes with the loss of separators.

Intramuscular Hemangioma of the Oral Cavity - A Case Report

Sushruth K. Nayak, Prachi Nayak

Haemangiomas are the most common benign soft tissue tumor of the oral cavity. It often presents at birth or soon after, and appears as a soft and vascular swelling in lip, tongue, or buccal mucosa. This article reports a rare case of intra muscular haemangioma of the buccal mucosa in a 27-year-old female patient.

Onychomycosis in Qassim Region of Saudi Arabia: A Clinicoaetiologic Correlation

Background: Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The aetiological agents of the disease may show geographic variation. Aim: The aim of the present study was to isolate the causative pathogens and to correlate the various clinical patterns of onychomycosis with causative pathogens. Materials and Methods: The study population comprised 170 patients with clinical suspicion of onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens. Results: Out of total 170 cases included in the study, 140 (82.4%) were positive by microscopy and 77 (45.3%) showed positive mycological findings by both microscopy and culture. The male:female ratio was 1:2.5 and the mean age was 35.29 ± 16.47 years. Fingernails were involved in 51.9%, toenails in 28.6% and both fingernails and toenails in 19.5% of the 77 patients. The clinical types noted were distal lateral subungual onychomycosis (71.4%), proximal subungual onychomycosis (10.4%), total dystrophic onychomycosis (10.4%), superficial white onychomycosis (3.9%) and mixed pattern onychomycosis (3.9%). Yeasts were the most common pathogens isolated, being found in 36 patients (46.8%) followed by nondermatophyte molds which were isolated from 28 patients (36.4%) followed by dermatophytes which were isolated from 13 patients (16.9%). Conclusion: Distal lateral subungual onychomycosis was the most common clinical presentation. Candida albicans, Aspergillus species and Tricophyton rubrum were the major pathogens. A single pathogen can give rise to more than one clinical type.

Sexuality in Adolescents: have we Explored Enough! A Cross-sectional Study to Explore Adolescent Health in a City Slum in Northern India

Timsi Jain, Yogesh Mohan

Context: Adolescent health is a relatively new focus area of India’s National health program. However, little evidence is available for the existing problems especially in adolescent slum population. A study was planned to explore the problems of adolescent pertaining to sexuality, physical health, tobacco and alcohol use in slums of Urban Meerut, and create evidence base for informed planning and decision making by the local health authorities. Aims: To study the adolescent health in the slums of Meerut City, India. Settings and Design: Entire slums of Urban Meerut, cross-sectional study. Materials and Methods: Study was done in the slums of Meerut city, in Northern India. WHO 30 cluster sampling technique was used. Thirty slums were selected from the list of all the slums of Meerut, 210 adolescents were selected with 7 adolescents from each slum. Statistical Analysis: Proportions and Chi-square test. Results: More than one third of the (36.7%) adolescents reported to have a current health problem, however only half of these sought medical help for treatment. Tweleve percent of adolescents reported history of alcohol or tobacoo use. Nine percent adolescents complained of stressful atmosphere at home. About 10% adolescents in the surveyed population gave history of sexual activity, but only one third of them had used condom during their last sexual intercourse. Conclusion: This study reflects the high morbidity and poor treatment seeking behaviour among adolescents in urban slums. A significant proportion of adolescents indulge in high risk sexual behavior, tobacco and alcohol use. There were significant gender differences with regards to treatment seeking behaviour, sexual behaviour, tobacco and alcohol use. The gender nuances must be taken into account while planning interventions for this section of population.

Diagnostic Value of Bone Marrow Aspiration and Biopsy in Routine Hematology Practice

Manjit Kaur, Amrit Pal Singh Rana, Shivali Kapoor, Arun Puri

Background: The bone marrow is frequently involved in variety of cases presenting with hematological and non-hematological disorders, which are diagnosed by two separate but interrelated techniques such as bone marrow aspiration (BMA) and bone marrow biopsy (BMB). Aim: This study was aimed to assess the diagnostic value of the BMA and BMB and role of both the procedures to reach final diagnosis when done simultaneously. Settings and Design: It was a prospective study. The findings of BMA smears were correlated with BMB sections and data obtained was analysed. Materials and Methods: BMA and BMB were performed on 50 patients. Criteria of inclusion included the main indications for performing this procedure, the availability of full medical records and patient consent. The patients had a male to female sex ratio of 1.6:1 and a wide age range from 4 years to 74 years. Results: In the present study, the main indications for bone marrow examination were categorized. Out of 50 cases studied, in 23 cases, a strong positive correlation between BMA and BMB was noted. However, it was found that in the cases of aplastic anaemia, different phases of myeloproliferative neoplasm (MPN), multiple myeloma, tubercular granulomas and hemato-lymphoid neoplasm, involvement of the marrow was detected better in bone marrow biopsies. Conclusion: The study concludes that preparations of aspirate and trephine biopsy are easy, rapid and complementary to each other in majority of the lesions. The advantage of both the procedures done together enabled us to study the cytomorphology of the cells along with the pattern of distribution of the cells depending on the cases, hence help in making the diagnosis accurately.

Concordance among Measurements Obtained by Three Pulse Oximeters Currently Used by Health Professionals

Introduction: Oxygen saturation is considered as the 5th vital sign. Presently, there exist fixed and wireless pulse oximeters, being the latter most widely used in the last years. Some of them have no possibility of calibration. This situation leads the health staff to adopt therapeutic attitudes which can be wrong. Therefore, it is extremely important to know if these wireless oximeters show a right concordance as regards measurements, since it is of great interest in daily clinical practice. Objective: To evaluate concordance among measurements obtained by three different pulse oximeters currently used by health professionals. Materials and Methods: This is an observational, descriptive and cross-sectional study related to the concordance of the results obtained in measurements collected by three different pulse oximeters (one monitor and two wireless oximeters) which are available and in use in this hospital unit. The sample size calculation was performed for a concordance above 0.81 and an estimation error which did not exceed 0.20. The intraclass correlation index (ICI) was used to establish the concordance whereas the Landis-Koch criteria were used to interpret the results. Systematic errors were analyzed using the Bland-Altman plot. Results: The overall concordance among the three pulse oximeters analyzed resulted in 0.88, a value considered as “good” according to the Landis-Koch criteria. Conclusion: The results obtained show that in daily clinical practice both wireless pulse oximeters analyzed can be used with a certain reliability, taking into account the limitations of this research.

Comparison of Stresses Around Dental Implants Placed in Normal and Fibula Reconstructed Mandibular Models using Finite Element Analysis

Thiyaneswaran Nesappan, Padma Ariga

Purpose: This study was formulated to evaluate and compare stresses around endosseous implants in various normal and fibula reconstructed mandibular models using finite element analysis method. Materials and Methods: CT scan data of a completely edentulous patient and a fibula reconstructed patient was made and the Dicom images were used to design 3-D mandibular models using software. Based on the information from the scan data, various types of reconstructed FEA models were made. Implants (fixtures) and superstructures were then embedded in each model and Von Mises stress around the neck of each implant under a vertical loading of 200 N and Horizontal load of 50 N was calculated using finite element structural analysis software. The results were compared between the reconstructed mandible and their respective normal mandible. Results: Higher stress values were obtained for all the reconstructed types under horizontal loading and in reconstructed models involving larger area of reconstruction the stress were more. In the models involving smaller area of reconstruction like symphysis alone or body alone there is no significant change in the stress values on vertical loading. Conclusion: Stresses were comparatively smaller in mandibles involving a smaller area of reconstruction. Hence, fixed prosthesis could be advised and a bar retained over denture for reconstruction for larger area of reconstruction.

Anti Cariogenic Effect of Terminalia Chebula

Background: Terminalia chebula is one of the traditional medicines used in the treatment of many diseases and possesses a wide variety of therapeutic activities. The aim of this study was to determine the antimicrobial properties of Terminalia chebula against oral pathogens related to caries. Materials and Methods: In this study, Antimicrobial activity was tested using Kirby bouer method by streaking. Total phenol and total flavonoid content were analysed. Twenty high caries risk patients were subjected to rinse aqueous extract of Terminalia chebula. Salivary samples were collected for pH and microbial screening. Oral pathogens were identified by qualitative biochemical analysis. Results: The total phenol content of extract was found to be 21.33 ±1.633 (mean ± SD) and total flavonoids was found to be 23.17 ± 2.317 (mean ± SD). There was a gradual increase in pH till 45mts post-rinse when compared to pre-rinse was observed. Antimicrobial effect of Terminalia Chebula aganist microbes showed that there was a significant reduction between the pre-rinse and post-rinse samples. Conclusion: These promising findings suggested the presence of antimicrobial activity of Terminalia Chebula against oral pathogens and proven to be an effective alternate antimicrobial agent.

Assessment of Lipid Peroxides in Multiple Biofluids of Leukoplakia and Oral Squamous Cell Carcinoma Patients- A Clinico- Biochemical Study

Anuradha Ganesan, Gautham Kumar N

Background: Oral pre cancer and oral cancer results in lipid peroxidation, and assessment of lipid peroxides in body fluids may give insights into the role of anti oxidants in its management. Aim: The study was conducted to discern the varying levels of lipid peroxides in saliva, serum and tissue in oral pre cancer and oral cancer and also various forms of tobacco usage with sex as an added parameter. Materials and Methods: The levels of lipid peroxides were measured in saliva, serum and tissue in a total of 50 patients, 20 belonging to control, and 30 study group in which 10 with oral leukoplakia and 20 with histologically proven oral squamous cell carcinoma (OSCC). The mean value of malondialdehyde (MDA) were also recorded in males and females among the patients with oral leukoplakia and OSCC. Among the study group patients, the levels of MDA were also recorded in habits of smoking and chewing tobacco. Statistical analysis used: Student’s independent t-test, one way ANOVA, Tukey HSD procedure. Results: Significantly elevated levels of lipid peroxides were seen in saliva, serum and tissue in oral leukoplakia and OSCC when compared to control patients. Among the study group, there were statistically significant increased levels of MDA in OSCC when compared to oral leukoplakia. There was also increase in MDA level in patients with smoking and chewing, but the variations seen in males and females were not very significant. Conclusion: The results clearly indicate the increase in lipid peroxidation in oral pre cancer and oral cancer with no significant difference between gender groups. The role of saliva as a relatively risk free and reliable, easy to obtain biofuid for diagnostic purposes has been highlighted. Also, since the levels of antioxidants are drastically decreased in carcinogenesis, the importance of anti oxidant supplements in the early stages of the disease has also been elucidated.

Clindamycin 1% Nano-emulsion Gel Formulation for the Treatment of Acne Vulgaris: Results of a Randomized, Active Controlled, Multicentre, Phase IV Clinical Trial

Background: Acne vulgaris of the face is a common dermatological disease with a significant impact on the quality of life, psychosocial development as well as self-esteem of the patients. Nano emulsion gel formulations are said to have various advantages over the conventional formulations. Aim: The present study was conducted to assess the comparative efficacy and safety of a nano-emulsion gel formulation of clindamycin with its conventional formulation in the treatment of acne vulgaris of the face. Materials and Methods: This prospective, active controlled, multicentric, phase IV clinical trial evaluated the treatment of patients with acne vulgaris of the face by a nano emulsion gel formulation or conventional gel formulation of clindamycin (as phosphate) 1% locally applied twice daily for 12 weeks as per random allocation. Acne lesion counts (inflammatory, non-inflammatory and total) and severity grading were carried out on the monthly scheduled visits along with tolerability assessments. Results: A total of 200 patients (97 males) were included for Intention to Treat analysis in the trial with 100 patients in each group. Reductions in total (69.3 vs. 51.9%; p<0.001), inflammatory (73.4 vs. 60.6%; p<0.005) and non inflammatory (65.1 vs. 43.7%; p<0.001) acne lesions were reported to be significantly greater with the nano-emulsion gel formulation as compared to the conventional gel formulation. Significantly more reduction in the mean acne severity score was noticeable with the nano-emulsion gel formulation (-1.6 ± 0.9 vs. -1.0 ± 0.8; p<0.001) than the comparator. A trend towards better safety profile of the nano emulsion gel formulation was reported. Conclusion: In the treatment of acne vulgaris of the face, clindamycin nano emulsion gel formulation appears to be more effective than the conventional gel formulation and is also well tolerated.

Nevus of Ota”- A Rare Pigmentation Disorder with Intraoral Findings

Jitender Solanki, Sarika Gupta, Nisha Sharma, Meenakshi Singh, Sumit Bhateja

Nevus of Ota is a dermal melanocytosis seen along the distribution of ophthalmic and maxillary divisions of the trigeminal nerve. Only 12 cases so far have been reported in English literature and it is rare in Indian subcontinent. Most of the cases reported are in females and oral cavity is infrequently involved. Here, we report a rare case of unilateral Nevus of Ota in a 56-year-old male with oral manifestations.

Intraosseous Myoepithelial Carcinoma of Mandible- A Case Report with Clinical, Radiological, Histopathologic and Immuno-Histochemical Features

The primary central salivary gland neoplasms of the mandible are rare. They look clinically and radiographically similar to the odontogenic tumours or cysts which are common in the mandible. Myoepithelial carcinoma is a malignant counter part of myoepithelioma. Their diagnosis mainly depends only on thorough histopathological examination. This paper is to report a case of extra salivary tumour, intraosseous myoepithelial carcinoma of right ramus of the mandible. This case report serves to increase awareness and improve the index of diagnosis.

Spontaneous Expulsion of Foreign Body (Seewing Machine Needle) From Right Middle Lobe Bronchus - A Rare Case Report

Ashwin Ashok Jaiswal, Amrish Kumar Garg

Aspirated foreign bodies continue to present challenges to the Otorhinolaryngologists. The major issues involve the accurate diagnosis at the earliest and speedy, safe removal of the foreign body. Endoscopic removal is the mainstay of management of foreign body in tracheobronchial tree. Spontaneous expulsion of foreign body bronchus is a rare entity with few cases reported in literature. We report a rare and interesting case of 18-year-old male patient presented with sharp and pointed metallic foreign body in Right Middle lobe Bronchus i.e., sewing machine needle. Patient was admitted and planned for bronchoscopy. But prior to it, foreign body was spontaneously expelled out. The patient was discharged next day without any complication. Spontaneous expulsion saves the patient from the dangers of endoscopic removal of foreign body, but impose a great danger of subglottic lodgement of foreign body.

Primary Mucinous Eccrine Adenocarcinoma – A Rare Malignant Cutaneous Adnexal Neoplasm at an Unconventional Site

Hemalatha A. L, Kausalya S. K, Amita. K, Sanjay M, Lavanya. M. S

Primary mucinous eccrine adenocarcinoma, a rare malignant neoplasm of the skin adnexa usually occurs in the head and neck region. The most common sites for its occurrence are the eyelid, the peri-orbital region and the scalp. We report the rare occurrence of primary mucinous eccrine adenocarcinoma of the inguinal region which has been reported in only 1% of cases according to literature search. Since the differentiation from metastatic mucinous carcinomas is difficult, a careful search for primary in the breast, gastrointestinal tract and prostate is mandatory. This case report highlights the importance of precise diagnosis and accurate histological typing of mucinous carcinomas with an emphasis on their role in appropriate patient management along with a brief review of literature.

Modified Distal Shoe Appliance for Premature Loss of Multiple Deciduous Molars: A Case Report

Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry. The premature loss of second primary molar before the eruption of permanent first molar can create a significant arch space/tooth size discrepancy. Distal shoe space maintainer is a valuable part of the Paediatric Dentist’s armamentarium in those cases where the second primary molar is prematurely lost and it helps to guide the first permanent molar into place. Conventional design poses various limitations in cases of premature loss of multiple deciduous molars. Thus, it is required to modify the conventional designs according to the needs of the patient. This case report describes an innovative modification of distal shoe appliance in cases of premature loss of multiple deciduous molars. In the present case, modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars. Bilateral design of distal shoe was planned for unilateral loss of deciduous molars.

A Blue Tooth – Auricular Prosthesis: A Case Report

The absence of an ear is a considerable aesthetic problem which affects the patient’s psychology and social behaviour. We are describing a case of 25-year-old male reporting to the Department of Prosthodontics, with a chief complaint of deficient left auricular tissue. This can be corrected surgically, prosthetically or through a combination of these approaches; but the choice of treatment depends on patient. The patient chose prosthetic rehabilitation over surgical procedures & retention becomes a critical issue in this approach. Out of many types of retentive methods, we selectively incorporated new materials and used the latest technology to ensure the highest quality prosthesis. Creative approach for each patient with a focus on their individual needs was considered as it gives more satisfaction to the patient. This article describes a new, simple and cost effective technique by embedding Bluetooth-headset device into the silicone elastomer of a mechanically-retained auricular prosthesis.

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. Aims: To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Settings and Design: Prospective, double blind, randomized, comparative study. Materials and Methods: Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 µg/ml in Group II and with clonidine 1µg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded. Results: At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III. Conclusion: Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1µg/kg was superior to fentanyl 2µg/ml as an adjuvant in PCEA for labour without any significant feto-maternal adverse effects.

Recurrent Meningitis with Upper Airway Obstruction in A Child: Frontonasal Encephalocele- A Case Report

Soumya Sachdeva, Rohit Kapoor, Premila Paul, Rakesh Yadav

Nasal encephalocele are rare congenital anomalies; these benign masses may be confused with nasal dermoids, hemangiomas, nasal gliomas and anterior skull base masses. These lesions have concomitant defects in the anterior cranial fossa thus this potential communication can cause recurrent episodes of meningitis and/or difficulty in breathing and cosmetic anomalies. We bring a case of a 6-year-old child who presented to the clinic with multiple episodes of meningitis which was associated with nasal discharge. The imaging studies and nasal fluid analysis confirmed it as cerebrospinal fluid; subsequently imaging findings concluded it as frontonasal encephalocele which was later resected and patient showed improvement.

Circular Enamel Hypoplasia: A Rare Enamel Developmental Disturbance in Permanent Teeth

Meera Sandhu, Shweta Gulia, Mehak Nagpal, Vinod Sachdev

Circular enamel hypoplasia, a type of enamel hypoplasia is an extensive enamel disturbance that results in a demarcating line surrounding the crown of the injured teeth visible both clinically and radiographically that most frequently occurs as a result of trauma in children around the age of two years. Clinical features include poor aesthetics, dentin sensitivity, increased susceptibility to dental caries and malocclusion. Early radiographic diagnosis of such teeth is important for timely intervention and subsequent treatment.

Methicillin Resistant Staphylococcus Epidermidis Induced Endogenous Endophthalmitis

Fulminant endogenous endophthalmits, a relatively rare intraocular infection, caused by haematogenous spread of bacteria or fungi is usually seen in immune-deficient patients. We report a case of methicillin resistant Staphylococcus epidermidis causing endogenous endophthalmitis following platelet transfusion and intravenous antibiotic therapy for a suspected dengue fever.

Primary Subcutaneous Inguinal Hydatid Cyst: Diagnosis by Fine Needle Aspiration Cytology

Permeet Kaur Bagga, Satish Kumar Bhargava, Neema Aggarwal, Yogesh Chander

Hydatid disease or human cystic echinococcosis, recognized by ancient scholars such as Hippocrates, Galen and Rhazes, is one of the oldest diseases known to man. Though hydatid cyst may develop in almost any part of the body, a solitary primary subcutaneous localization is an extremely rare entity. We herein report a case of primary subcutaneous inguinal hydatid cyst which was diagnosed by fine needle aspiration cytology. Radiological examination done subsequently corroborated with the cytodiagnosis of Hydatid cyst and did not show involvement of any other organ or site. Histopathological examination of surgically removed cyst confirmed the diagnosis of Hydatid cyst. Hydatid disease should be considered in the differential diagnosis of all unusual swellings in soft tissues, especially in regions where the disease is endemic.

A Case of Intermittently Discharging Skin Lesion: Orodentocutaneous Fistula Demonstrated on CT Fistulography

Upasana Ranga, Senthil Kumar Aiyappan, Saveetha Veeraiyan

Orodentocutaneous fistula is a rare entity where periapical dental abscess communicates with both oral cavity and external skin. In few cases, patients presents initially with only cutaneous manifestation with no recollectable history of dental problem. Delay in diagnosis of odontogenic cause of skin lesion makes the disease more chronic and extensive. We hereby present a case of orodentocutaneous fistula that presented with intermittently discharging skin lesion and was evaluated by using CT fistulography.

Non-Hodgkin’s Lymphoma in Buccal Vestibule -Case Report

Indira Reddy, Sreenath G, Raghavendra Readdy Y, Ravi Prakash .A, Swathi T R

Lymphomas are malignant neoplasms arising from lymphocytes B cell or T cell that affects mainly lymph nodes, spleen and other non hematopoietic tissues. They are classified as Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). Diffuse large B-cell lymphoma (DLBL) is the most common variant of non-Hodgkin’s lymphomas and frequently involves extranodal sites. In the oral soft tissues lesions can occur as hard and diffuse tumors involving oral vestibule, gums and posterior region of the hard palate. Most lymphomas, including DLBL arise from B cells are characterized by diffuse population of large cells with cleaved or non cleaved oval nuclei. Both histopathlogical and immunohistochemical (IHC) analysis were strongly advisable for proper management and prognosis. We hereby report a rare case of Diffuse large B-cell variant of non-Hodgkin’s lymphoma in a male patient of age 50yrs in left upper buccal vestibule.

Transitional Cell Carcinoma of the Ovary: Case Series and Review of Literature

Rajashree J. Ingin, Sainath K. Andola, As hraf Ahmed Zubair

Transitional cell carcinoma (TCC) of the ovary is a recently recognized, subtype of ovarian surface epithelial cancer; the pure form accounting for only 1% of surface epithelial tumors. It has been described as a primary ovarian carcinoma with definite urothelial features but no benign, metaplastic and/or proliferating Brenner tumor (BT) identified. Recognition of such tumours is important because of its rarity, favorable response to chemotherapy and an improved patient survival. A case series of primary TCC of the ovary (3 cases) with brief review of literature is being presented.

Vulvar Syringoma: A Rare Case Report

Sarita Nibhoria, Kanwardeep Kaur Tiwana, Ashish Yadav

Syringoma is a benign eccrine sweat gland tumour affecting mostly females at puberty as multiple soft papules usually 1-2 mm in diameter. The sites of predilection are lower eyelids, cheeks. Syringoma of the vulva is a rare disorder. Only few cases have been reported in the literature. We report here a case of 46-year-old female who presented to gynecology department with vulvar papules associated with vulvar itching and burning since two years. Microscopic examination of the punch biopsy revealed numerous small ducts lined by two layers of epithelial cells embedded in a fibrous stroma. Some of the ducts showed small comma like tails of epithelial cells imparting them a tadpole shape. Despite being a rare diagnosis, vulvar syringoma should be kept in differential diagnosis with vulvar pruritus

Brown Tumour of Posterior Maxilla Associated with Polydactyly, Syndactyly and Cardiac Anomalies: A Unique Case Report

Suresh K V1, Kumar Nilesh2, Mounesh kumar C D3, Manisha R Patil4, Pramod R C5

Brown tumour [BT] is an uncommon, non neoplastic complication of Hyperparathyroidism [HPT]. Skeletal changes are the main consequences of this endocrine condition. HPT manifest in three categories. Primary HPT is due to hyperfunction of one or more parathyroid gland, causing an increase of parathyroid hormone secretion resulting in hypercalcemia. Secondary HPT occurs due to chronic renal failure, decreased vitamin D production or with hypocalcemia. Tertiary HPT occurs when the parathyroid activity turns autonomous and excessive, leading to hypercalcemia. BT occurs frequently in the mandible than the maxilla. They are more common in women aged over 50y and majority of BT are asymptomatic. Radiographically, it appears as well defined radioluceny. The gross specimen usually shows a brown or reddish-brown colour. We report a relatively rare combination of maxillary posterior BT as a clinical manifestation of secondary HPT due to vitamin D deficiency with polydactyly, syndactyly and cardiac anomalies.

Twisting Lipoma Presenting as Appendicitis-A Rare Presentation

Right iliac fossa (RIF) pain is the most common presenting complaint in the general surgical ward. Though there are several causes for the RIF pain, acute appendicitis is the first and common diagnosis. Here we present one of the rare differential diagnoses of RIF pain in a young female patient with one month history of intermittent right lower abdominal pain. Patient’s symptoms and clinical findings indicated acute appendicitis, though ultrasonography didn’t show any significant abnormality. Through diagnostic laparoscopy we found that there was torsion of anterior abdominal wall parietal peritoneal pedunculated lipoma located in RIF region. The clinical presentation, examination, investigation, laparoscopic findings and further management is presented in this case report.

Azithromycin–Induced Rash in a Patient of Infectious Mononucleosis – A Case Report with Review of Literature

Antibiotic induced skin rash in setting of infectious mononucleosis is often encountered in clinical practice. However, macrolides like azithromycin are considered relatively safe and till date only two cases of azithromycin induced rash in setting of infectious mononucleosis have been reported. The following report illustrates the case of a 23-year-old man suffering from infectious mononucleosis who exhibited a generalized cutaneous rash following treatment with azithromycin. Using the Naranjo ADR probability scale, this case of acute onset rash following azithromycin administration was found to be in ‘probable’ category. The mechanism of antibiotic-induced rash in patients suffering from infectious mononucleosis is incompletely understood. It has been suggested that the rash could result from virus mediated immuno - modulation or due to altered drug metabolism. The report calls for cautious use of antibiotics in the setting of suspected viral infections like infectious mononucleosis as injudicious use might increase the risk of deleterious skin reactions and increase the cost of healthcare.

Oral Manifestations in a Renal Osteodystrophy Patient - A Case Report with Review of Literature

Parthiban, Aarthi Nisha V, Asokan GS, Prakash CA, Varadharaja MM

Renal Osteodystrophy (ROD) is a common complication of chronic renal disease (CRD) and is the part of a broad spectrum of disorders of mineral metabolism that occurs in the clinical setting. It occurs early in the course of chronic renal failure and progresses as the kidney function deteriorates. It is an osseous alteration believed to arise from increased parathyroid function associated with inappropriate calcium, phosphorus and vitamin D metabolism. Involvement of the jaws is common and radiographic alterations are often one of the earliest signs of chronic renal failure. Herein, reporting a case of Chronic Renal Failure (Bilateral Grade I Neuropathy) with ROD presenting oral manifestations in an 11-year -old male child.

Jejunal Diverticulitis Ascending to the Duodenum as a Rare Cause of Acute Abdomen

Robert Fresow, Hendryk Vieweg, Peter Kamusella, Roland Talanow, Reimer Andresen

We present the case of a 73 year-old Caucasian male with acute abdominal pain, peritonism and vomiting. Due to the severity of symptoms a CT examination of the abdomen was performed. The scans revealed multiple jejunal diverticula, wall thickening of the duodenum and jejunum, and free peritoneal fluid. No clear signs of mesenteric infarction, free abdominal air or abscess formation were seen. An additional exploratory laparotomy was conducted to confirm the CT findings and rule out the need for resection of small bowel. Since the results were matching, conservative therapy was scheduled and the patient recovered well. Jejunal diverticulitis is a rare cause of acute abdomen, however has to be considered as a differential diagnosis to more common entities. It usually stays localized, while in our case the inflammation ascended to the duodenum. CT is the modality of choice to diagnose and rule out potentially life threatening complications.

Congenital Bilobed Gallbladder with Phrygian Cap Presenting as Calculus Cholecystitis

N.S.Kannan, Usha Kannan, C.P.Ganesh Babu

The incidence of congenital bilobed gall bladder is 1 in 3000 to 4000. A Phrygian cap is a congenital abnormality of the gallbladder with an incidence of 4%. Preferred mode of diagnosis for Phrygian cap is cholescintigraphy and multi phase MRI, as Ultrasonography and CT are not always conclusive. The estimated prevalence of gallstone disease in India has been reported as 2% to 29%. A case of bilobed gall bladder with Phrygian cap in both the lobes and pigment gallstone in one of the lobes presenting as calculus cholecystitis is reported for its rarity and difficulty in arriving at correct preoperaive diagnosis

Malignant Melanoma of the External Auditory Canal

Primary malignant melanoma of the external auditory canal is rarely reported. Malignant melanoma of the ear is estimated to occur in 1-4% of all skin melanomas and about 7-20% of melanomas of the head and neck region. The pathophysiology of these tumours is different from other skin lesions because of their anatomical and functional characteristics. The case presented is of a 11 year old female child with malignant melanoma of the external auditory canal confined to the right side, who initially presented with right ear pain, bleeding, post auricular swelling and also a mass in the external auditory canal which was thought to be an aural polyp in the right ear. Excision of the tumour was accomplished by a radical mastoidectomy. It was confirmed to be malignant melanoma after histopathological examination and Immunohistochemistry. Despite all efforts, the patient succumbed to the disease after receiving three cycles of chemotherapy. Even though this malignancy is rarely found in the external auditory canal, it should be expanded into the differential diagnosis of an aural polyp and a post aural abscess. The incidence, symptoms, investigations, treatment and prognosis of malignant melanoma of the external auditory canal is discussed in this article.

Primary Pulmonary Ewing’s Sarcoma: Rare Cause of Superior Vena Cava Syndrome in Children

Shibani Mehra, Swapndeep Singh Atwal, Umesh Chandra Garga

Ewing’s sarcoma is a common malignant bone tumour presenting in children and young adults. Rarely extra- skeletal soft tissues and visceral organs can also be the site of origin of Ewing’s sarcoma. Primary pulmonary Ewing’s sarcoma is an extremely rare malignancy which occurs in the paediatric population. We report an unusual case of primary pulmonary Ewing’s sarcoma in a nine year old girl who presented with features of superior vena cava syndrome in the emergency department. The diagnosis was confirmed pathologically both by light microscopy and immunohistochemistry. The patient was put on chemotherapy and surgery was planned but the patient expired within three days of starting chemotherapy.

Vanishing Testis Syndrome: Report of Two Cases

Vanishing testis syndrome or Testicular regression syndrome (TRS) is defined as the absence or an incomplete development of the testis of varying degrees in 46XY patients with normal external genitalia.TRS or vanishing testis syndrome may be seen in less than 5% of all patients of cryptorchidism. We report two cases of TRS who underwent surgical exploration with an initial diagnosis of cryptorchidism with impalpable testis. Grossly testicular tissue was not identified and the vas deferens was ending into a nubbin in both the cases. The presumed testicular remnants were sent for histological examination. The histological sections in both the cases showed vascularised fibrous nodule, structure of the spermatic cord and calcification, supporting the diagnosis of TRS.

Hirayama Disease: Imaging Profile of Three Cases Emphasizing the Role of Flexion MRI

We report three cases of Hirayama disease, cervical flexion myelopathy presenting as unilateral or bilateral asymmetric muscular atrophy of forearm and hand involving C7 - T1 myotomes in young males. MRI revealed asymmetric cord atrophy, altered signal intensity of cord, posterior dural detachment and enlarged posterior epidural space with multiple flow voids. This article emphasizes the role of Flexion MRI in diagnosing Hirayama disease.

Visual loss in Takayasu Arteritis – Look Beyond the Eye

Jayanthi Peter, George Joseph, Vivek Mathew, John Victor Peter

Patients with Takayasu arteritis often present with reduced vision related either to the disease per se or due to complications of therapy. We report a patient with Takayasu arteritis who developed acute onset bilateral visual loss 6wks following percutaneous revascularization of occluded aortic arch branches. No ocular cause for the visual loss was evident. The reason for visual loss in this patient was an extraocular cause. Ocular and extraocular causes of visual loss in Takayasu arteritis are discussed.

Recent Trends in the Management of Thornwaldts cyst: A Case Report

Tornwaldt’s cyst is a benign cyst located in the upper posterior nasopharynx. It is a relatively rare lesion and most are small and asymptomatic whereas some cause nasal obstruction, postnasal drip, occipital headache or eustachian tube dysfunction. In our case a 28- year-old man presented with nasal obstruction since 10-years whose diagnostic nasal endoscopy showed a large well-encapsulated lesion arising from the posterior wall of the nasopharynx. A magnetic resonance imaging (MRI) was performed which was suggestive of a fluid filled cystic lesion. The patient underwent successful marsupialisation using endonasal endoscopic approach using rigid endoscopes and powered instrumentation. Histopathology of the aspirate revealed a respiratory lined epithelial cyst. Based on the clinical, radiological and histopathological findings a diagnosis of Tornwaldt’s cyst was made. We report this case to highlight the role of MRI in diagnosis and use of endoscopic assisted powered instrumentation for treatment of Tornwaldt’s cyst.

Rehabilitation of Digital Defect with Silicone Finger Prosthesis: A Case Report

Deepesh Saxena, Sunit Jurel, Ajay Gupta, Manu Dhillon, Divya Tomar

Patients with acquired defects often had severe trauma which leads to psychological instability, functional loss and poor aesthetics. Digital defects threaten the integrity of one’s self esteem and also leads to a reduced and compromised function. A well fitted and colour matched finger prosthesis can make a patient feel a capable person and not a handicap. This article describes a technique for fabrication of custom made finger prosthesis with a silicone elastomer. The customization of the prosthesis leads to a better fit and retention. An excellent shade matching is achieved by the use of intrinsic colours. The other advantages of using silicone as a material of choice for prosthesis fabrication are also discussed.

Urinary Tract Infection By Chromobacterium Violaceum

Chromobacterium violaceum, a facultative anaerobic proteobacterium, is particularly isolated from water and soil in tropical areas and has been implicated in few infections like septicemia, visceral abscesses, skin and soft tissue infections, meningitis and diarrhea. But urinary tract infection caused by it is very rare. Limited awareness about this pathogen and inappropriate antibiotic therapy contribute to a high mortality rate. Here, we describe an unusual case of urinary tract infection by Chromobacterium violaceum in a young immuno-competent male which was managed aggressively with proper antibiotics as per the culture sensitivity report.

A Sequential Approach in Treatment of Endo-Perio Lesion A Case Report

Endo-perio lesions primarily occur by way of the intimate anatomic and vascular connections between the pulp and the periodontium. Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. An untreated primary endodontic lesion may become secondarily involved with periodontal breakdown, which clinically present unusual signs and symptoms. This may delay the diagnosis and hence the correct treatment. This case report describes diagnosis & treatment protocol for an endo-perio lesion of primary endodontic with secondary periodontal involvement.

Wilkie’s Syndrome and Left Adnexal Mass: Unusual Presentation of Duodenal Adenocarcinoma

Duodenal adenocarcinoma (DACa) is a rare malignancy, the presenting symptoms of which are vague and nonspecific. We report the case of a patient presenting with symptoms of subacute small bowel obstruction whose CT scan revealed i) left adnexal mass and ii) compression of 3rd portion of duodenum with reduced aortomesentric angle consistent with Wilkie’s syndrome (WS). Laparatomy in addition revealed a distal duodenal stricture, which showed a well differentiated DACa causing subtotal intestinal obstruction. The ovarian mass revealed adenocarcinoma with similar morphology. Immunophenotypic analysis revealed positive expression of CK 20 and CDX 2 and absence of CK 7 staining in the tumours consistent with Primary DACa with ovarian metastasis. We further concluded that the WS resulted from reduced mesenteric fat pad caused by DACa induced cachexia. The case highlights the elusive nature of duodenal malignancy and emphasises the importance of meticulous small bowel examination during exploration of ovarian masses.

Isoniazid Induced Cutaneous Leukocytoclastic Vasculitis in Extra Pulmonary Tuberculosis(Pott’s Spine): A Case Report

Sowmya Bondalapati, Dharma Rao V, Dilip Rampure, Rama Rao S

Anti-tuberculosis drugs frequently result in cutaneous adverse reactions but Isoniazid is known to have least toxic potential for cutaneous reactions. We report a rare case of Isoniazid induced cutaneous leucocytoclastic vasculitis. A 64-year-old male was diagnosed to have Pott’s spine with multiple vertebral body involvement (D8-12 vertebrae). Subsequently, he was treated with first line anti-TB drugs i.e., Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. On the fourth day of treatment with Anti Tuberculosis Treatment (ATT), the patient developed an erythematosus rash over right upper limb not associated with itching or pain, non-blanchable macules and papules over bilateral shins on lower limbs, petechiae on both forearms and hyper pigmented, scaly rash over right axilla and buttocks. The skin biopsy report was consistent with cutaneous leukocytoclastic vasculitis. Although rare, Isoniazid among anti-tuberculosis drugs should be considered as potential cause of drug-induced cutaneous leukocytoclastic vasculitis in the differential diagnosis of erythematosus rash with petechiae.

Hematometra Formation- A Rare Complication of Cesarean Delivery

Gurpreet Kaur, Sandhya Jain, Abha Sharma, Neelam Bala Vaid

Hematometra resulting from partial or complete obstruction of lower genital tract may be congenital or acquired. Commonest congenital causes are imperforate hymen and transverse vaginal septum. Acquired causes are senile atrophy of endocervical canal, scarring of the isthmus by synechiae, radiation and endocervical malignancy or due to surgical procedures. Various surgical procedures associated with hematometra are dilatation and curettage, cone biopsy, endometrial ablation, cryocoagulation and electrocautery. Hematometra following an abortion or cesarean delivery is rare. We report a case of hematometra following obstruction of outflow tract due to prior cesarean delivery.

Mandibular Plasmacytoma of Jaw – A Case Report

Meet Kamal, Parwinder Kaur, Rakhi Gupta, Shally Gupta, Simranjit Singh

The plasma cell neoplasm may present as Extramedullary Plasmacytoma (EMP) in soft tissues in bone as a Solitary Plasmacytoma of bone (SPB) or as a part of multi focal disseminated disease Multiple Myeloma (MM). The majority of 80% occurs in head and neck region. In our case, a 62-year-old male patient presented with a non tender swelling of short duration. The swelling was noted obliterating the vestibular depth in right lower mandibular region. The radiological features were non specific.

Marchiafava - Bignami Disease: A Case Report

Sunil Kumar K, Rimiki Challam, Naveen J, W. Jatishwor Singh

Marchiafava-Bignami disease (MBD) is a rare neurological disorder of chronic alcoholism characterized by demyelination and necrosis of corpus callosum. In this case report we present the MR imaging findings of MBD and review of the other imaging features of the disease.

An Silicone Auricular Prosthesis Along with Retentive Aids- A Case Report

Prasan Kumar, Joshi Shubha, Sowjanya P, Shalini BN, Jesudass G

Facial tissue loss presents with multiple functional and psychological problems. Its rehabilitation can improve the physical, mental and social well being of the patient. In conditions where surgical corrections are not favourable, the prosthetic approach to rehabilitate the missing structures can solve the problems, with added advantages of having complete control over Colour and morphological outcome to match the surrounding skin and the counter lateral part. This case report describes the rehabilitation of a patient with the right auricular defect who was treated with a silicon auricular prosthesis and few ornaments were used as the retentive aids.

The Role of Nasendoscopy in the Fabrication of a Palatopharyngeal Obturator – A Case Report

Bhavya M. Amin, Meena A. Aras, Vidya Chitre, Praveen Rajagopal

Defects confined to the hard palate can be managed with relative ease because it is a static shelf creating oro- nasal separation. Since the soft palate is a dynamic separator between the oral and nasal cavities, defects involving the soft palate require careful consideration. Instrumental visualization methods can aid the fabrication of obturators in patients with such defects and prevent problems of under or over obturation. This case report presents the prosthodontic management of a patient with a Veau class II cleft palate using a palatopharyngeal obturator in order to re-establish normal functions of deglutition and speech. Nasendoscopy was used as an adjunctive procedure to assess velopharyngeal function with the prosthesis.

True Cyclopia–Very Rare Anomaly

K. R. Srinivasan, N. Abraham Ratna Joseph, P. Koteswary

During our routine postmortem examination, we found a female infant with “True Cyclopia.” The two entire eye balls had fused completely to form one midline organ. The infant was a female who weighed 2910 g. The gestation period was 35 weeks. Infant lived for a short period of less than 20 minutes. The birth was a product of a 4th pregnancy.

Pityriasis Rosea Like Drug Rash – A Need to Identify the Disease in Childhood

Maitreyee Panda, Nibedita Patro, Monalisa Jena, Mrutunjay Dash, Swati Mishra

Pityriasis rosea is a common dermatosis named by Gibert in 1860. It is an acute self limiting papulosquamous disease, probably infective in origin affecting healthy adolescents and young adults. It is characterized by distinctive skin eruptions and minimal constitutional symptoms. Drug induced pityriasis rosea tend to occur in older generation and resolution seen only after withdrawal of the offending drug. We report a case of 12-year-old boy with erythematous papules distributed over trunk and proximal arms after nimesulide therapy consistent with a clinical diagnosis of atypical pityriasis rosea. The relation of drug and development of pityriasis rosea is confirmed by dechallenge test of the suspected drug.

Aesthetic Essentiality Regained Using Implant- A Case Report

B.Eswaran, Rathika Rai, Suprabha Rathee, Babina Chirom, Menaga.V

The goal of implant therapy is to provide patients with a predictable, aesthetically and functionally satisfying treatment outcome with a low risk of aesthetic complications. Dental implants have been utilized by mankind for thousands of years, but only recently they have achieved widespread acceptance from the profession. Anterior sites are more likely related to aesthetic expectations and often represent a considerable challenge for involved clinicians and dental technicians, since various local risk factors have the potential to compromise the predictability of the result. In recent years, substantial efforts have been made to increase the appeal of implant therapy by shortening the overall treatment time and minimizing the number of surgical intervention. According to traditional protocol, a 12 month healing after extraction was suggested, but over the past few years alternative approaches have been proposed, such as immediate implant placement at the time of extraction or early implant placement following weeks of soft tissue healing. Common to all of these approaches is the requirement of adequate remaining bone volume. If there is no adequate bone volume, techniques like guided bone regeneration (GBR) are used for ridge augmentation before implant placement. The present case has utilized an endosteal root form implant and the advantage of guided bone regeneration technique in regaining aesthetic demands of the patient.

Clear Cell Carcinoma of Cervix in a 60- year-old Woman: A Case Report

Ramesh Kumar, Shruthi S A, Saraswati P, Rathnamala M Desai, Anil k

Clear cell carcinoma of cervix is a rare entity amongst cervical neoplasms especially post diethylstilbestrol era. It is hypothesised to have a bimodal distribution with spontaneous cases unrelated to DES exposure observed in elderly age group. We report a rare case of clear cell carcinoma of cervix (CCCC) in a 60-year-old Asian female with no history of diethylstilbestrol (DES) ingestion. She underwent radical hysterectomy and adjuvant radiotherapy and showed no signs of recurrence even after 6 moths of follow up. Review of relevant literature was done including possible aetiology, appropriate treatment and prognostic factors.

Cryosurgery Painless and Fearless Management of Mucocele in Young Patient

Aarti Garg, Abhaymani Tripathi, Swati Chowdhry, Ashish Sharma, Gautam Biswas

A mucocele is a common benign lesion of the minor salivary gland mucosa that most frequently affects children and young adults. A 6-year-old male patient reported to the Department of Pedodontics and Preventive Dentistry, with the chief complaint of a painless swelling on floor of the mouth on his left side. The purpose of this case report is to present the treatment of mucocele present in floor of the mouth in a child patient using liquid nitrogen cryosurgery. Also, discussed are the mechanism of action, current protocol of cryosurgery recommended in the management of mucoceles, clinical advantages and disadvantages together with the clinical outcomes.

Atypical Arterial Supply to the Spleen by Polar Branches of Splenic Artery and Accessory Splenic Artery – A Case Report

Naveen Kumar, Jyothsna Patil, Swamy Ravindra S, Anitha Guru, Satheesha Nayak B

Vascular anomalies of the spleen are usually asymptomatic. However, variant anatomy of splenic artery becomes clinically important, when the patients undergo diagnostic angiography for gastrointestinal bleeding or during transcatheter therapy. We report here a concurrent variant arterial pattern of the spleen. The splenic artery was unusually elongated and excessively tortuous. Prior to its normal termination into segmental arteries, it gave superior and inferior polar arteries which entered the spleen distal to corresponding ends of the splenic hilum. In addition to this, the spleen also received an additional blood supply from an accessory splenic artery arising from left gastro-epiploic artery. The accessory splenic artery entered the substance of the spleen through its lateral end. Presence of such kind of concurrent variant arterial pattern of spleen makes the surgeons obligatory to have prior knowledge to prevent bleeding during any surgical or radiological interventional procedures targeting the spleen, pancreas etc.

Multiple and Contemporary Coronary Thrombosis inspite of Low Platelet Function Response

We are reporting a clinical case of a 78-year-old male who had oppressive chest pain at rest, which regressed with the intake of sublingual nitrates. Coronary angiography showed a chronic total occlusion (CTO) of the left anterior descending (LAD) artery, a normal circumflex, a hypoplasic right coronary artery and a Cardiac Magnetic Resonance showing vital tissue in anterior wall. During the procedure of CTO-PCI on LAD, patient developed multiple and contemporary coronary thrombosis in spite of low platelet reactivity, which was assessed by using Multiplate. A manual thrombectomy was performed with a good final result only after drug eluting stents (DES) implantation.

Acrylic Finger Prosthesis: A Case Report

Rajeev Kumar Reddy K, Vinod Bandela, Bharathi M, Giridhar Reddy S V

Hands basic function is to grasp, hold and manipulate items. Hand gesture is perhaps the most blatant example of non-verbal communication. Finger and partial finger amputations are most frequently encountered forms of partial hand loss. Common causes are traumatic injuries, congenital absence or malformations present great clinical challenges. In addition to immediate loss of grasp strength, finger absence may cause marked psychological trauma. Individuals who desire finger replacement usually have high expectation for the appearance of prosthesis. This clinical report portrays simple method to retain acrylic finger prosthesis.

Cause of Death in “John Doe & Jane Doe”: A 5 year review

Ajay Kumar, Dasari Harish, Amandeep Singh

Sometimes the opinion regarding the cause of death in “John Doe or Jane Doe” i.e. on unknown dead bodies is a test of ability of the forensic expert and on many occasions it yields little or no results. Here the identification of the body as such poses problems; rest aside the opinion regarding the cause/ manner of death. The present 5yr study was undertaken in the Department of Forensic Medicine & Toxicology, Government Medical College & Hospital, Chandigarh to find the patterns of cause of death in unknown dead bodies, as very little literature is available with regard to John Doe or Jane Doe cases as a group, in India. Unidentified bodies comprised 4 % of the total 3165 cases brought for post-mortem examination to the department. Maximum cases belonged to the age group 41 - 50 years, 30 %. Majority of the opinions regarding the cause of death were given as “no definite opinion” (31%), followed by “cranio-cerebral damage” (30 %) and coronary insufficiency/ Cardiac disease/ aortic aneurysm rupture, (8.9%). Following measures should be undertaken to increase the chances of getting these unknown bodies identified and thereby increasing the chances of arriving at a definite cause of death: drafting of additional legislation for the management of unidentified dead bodies along with streamlining of work on the part of police, use of active investigation and modern investigative techniques, fixing the accountability of the police. Internet based sites of the police.

Leuloplakia - Review of A Potentially Malignant Disorder

Leukoplakias are oral white lesions that have not been diagnosed as any other specific disease. They are grouped under premalignant lesions, now redesignated as potentially malignant disorders. Their significance lies in the fact that they have propensity for malignant transformation at a higher rate when compared to other oral lesions. This article reviews aetiology, epidemiology, clinical characteristics, histopathologic features, malignant potential and treatment of oral leukoplakia.

Reach the Unreached – A Systematic Review on Mobile Dental Units

Provision of health care facilities and the extent of their utilization is one of the indices of human development. The services for the masses need to be designed with the basic objective of alleviating and preventing the vast amounts of diseases of the mass. This could be achieved by mobile dental units (MDUs). The present systemic review access the efficacy of MDUs for community settings. A review of literature was performed both electronically and manually using MeSH Terms- Mobile Dental Units/clinics. Eight articles, which fulfilled inclusion and exclusion criteria were selected for the review. MDUs help in overcoming the accessibility, affordability and sustainability barrier. They are able to reach more people than fixed-site clinics. Even in Government sector, mobile dental vans can help reach the underserved at an affordable cost.The present systematic review revealed that MDUs prove to be an effective adjunct to the oral health service providers like dental colleges and private practitioners.

Enhancing Facial Aesthetics with Muscle Retraining Exercises-A Review

Raina D’souza, Ashwini Kini, Henston D’souza, Nitin Shetty, Omkar Shetty

Facial attractiveness plays a key role in social interaction. ‘Smile’ is not only a single category of facial behaviour, but also the emotion of frank joy which is expressed on the face by the combined contraction of the muscles involved. When a patient visits the dental clinic for aesthetic reasons, the dentist considers not only the chief complaint but also the overall harmony of the face. This article describes muscle retraining exercises to achieve control over facial movements and improve facial appearance which may be considered following any type of dental rehabilitation. Muscle conditioning, training and strengthening through daily exercises will help to counter balance the aging effects.

Role of Biological Sex in Normal Cardiac Function and in its Disease Outcome – A Review

K.Prabhavathi, K.Tamarai Selvi, K.N.Poornima, A.Sarvanan

Biological sex plays an important role in normal cardiac physiology as well as in the heart‘s response to cardiac disease. Women generally have better cardiac function and survival than do men in the face of cardiac disease; however, this is progressively lost when comparing postmenopausal women with age matched men. Animal model of cardiac disease mirror what is seen in humans. Sex hormones contribute significantly to sex based difference in cardiac functioning and in its disease outcome. Estrogen is considered to be cardioprotective, whereas testosterone is detrimental to heart function.

Aggregatibacter Actinomycetemcomitans – A Tooth Killer?

Manoj Raja, Fajar Ummer, C.P Dhivakar

Strong evidence is available on Aggregatibacter actinomycetemcomitans (A.a) on its role as the causative agent of localised juvenile periodontitis (LJP), a disease characterised by rapid destruction of the tooth-supporting tissues. This organism possesses a large number of virulence factors with a wide range of activities which enable it to colonise the oral cavity, invade periodontal tissues, evade host defences, initiate connective tissue destruction and interfere with tissue repair. Adhesion to epithelial and tooth surfaces is dependent on the presence of surface proteins and structures such as microvesicles and fimbriae. Invasion has been demonstrated in vivo and in vitro. The organism has a number of means of evading host defences which include: (i) production of leukotoxin; (ii) producing immunosuppressive factors; (iv) secreting proteases capable of cleaving IgG; and (v) producing Fc-binding.

Ghrelin: Ghrelin as a Regulatory Peptide in Growth Hormone Secretion

Background: Ghrelin is a type of growth hormone (GH) secretagogue that stimulates the release of GH. It is a first hormone linking gastrointestinal-pituitary axis. Objective: This review highlights the interaction of ghrelin with GHRH and somatostatin to regulate the secretion of GH and intends to explore the possible physiological role of the ghrelin-pituitary-GH axis linkage system. Observation: Ghrelin is highly conserved among species and is classified into octanoylated (C8:0), decanoylated (C10:0), decenoylated (C10:1) and nonacylated,ghrelin. Acylated ghrelin is the major active form of human ghrelin. The primary production site of ghrelin is the stomach, and it interacts with stomach ghrelin as well as hypothalamic GHRH and somatostatin in the regulation of pituitary GH secretion. Ghrelin stimulate GH release through the GHS receptor to increase intracellular Ca2+ ([Ca2+] levels via IP3 signal transduction pathway. Ghrelin is a specific endogenous ligand for the GHS receptor and provides a definitive proof of the occurance of a GHS–GHS receptor signalling system in the regulation of GH secretion. Conclusion: Studies suggests that ghrelin is a powerful pharmacological agent that exerts a potent, time-dependent stimulation of pulsatile secretion of GH.

Comparative Evaluation of Sorption, Solubility and Microhardness of Heat Cure Polymethylmethacrylate Denture Base Resin & Flexible (thermoplastic polyamide nylon) Denture Base Resin

Jay Shah, Nilesh Bulbule, Shilpa Kulkarni, Riddhi Shah, Dilip Kakade

Aim: The aim of the study was to evaluate and compare sorption, solubility and microhardness of heat cure polymethylmethacrylate (PMMA) denture base resin and flexible (thermoplastic polyamide nylon) denture base resin. Materials and Methods: Sorption, solubility and microhardness were assessed to determine compliance with ADA Specification no. 12. Results were assessed using statistical and observational analyses. Result: All materials satisfied ADA requirements for sorption, solubility and microhardness. Heat cure (PMMA) showed more sorption, solubility and microhardness than flexible (thermoplastic polyamide nylon). Conclusion: Flexible (thermoplastic polyamide nylon) resin absorbs less water, is less soluble and is more flexible than (PMMA).

Effect of Power Bleaching on the Fluorosis Stained Anterior Teeth Case Series

Parinitha M S, Annapoorna B M, Sunil Tejaswi, Suneeth Shetty, Sowmya H K

Bleaching is a conservative method for restoring the colour of intrinsic discoloration of teeth. The combination of McInnes solution and power bleaching is effective procedure for bleaching of fluorosis stained teeth. Definitely bleaching with McInnes bleaching agent gives instant results, not dependent on patient’s compliance as other office based procedures, no dehydration of the tooth occurs with no damage to the pulp. Bleaching with this solution is esthetically pleasing and minimally invasive option for young patients rather than a complete coronal covering. The dentist is in complete control of the process throughout the treatment. It is a fast process the results are evident even after a single visit.

Aetiological Profile and Antibiotic Susceptibility Pattern in Patients with Urinary Tract Infection in Tripura

Jayanta Debnath, Pradip Kr. Das, Munmun Debnath, K.K. Haldar

A Rare Occurrence of Non-Syndromic Hypo-Hyperdontia in the Mandibular Anterior Region

Amit Kumar Tamrakar, Manu Rathee

Effective Use of Pause Procedure to Enhance Student Engagement and Learning

Rachna Bachhel, Richa Ghay Thaman

Introduction: Active learning strategies have been documented to enhance learning. We created an active learning environment in neuromuscular physiology lectures for first year medical students by using ‘Pause Procedure’. Materials and Methods: One hundred and fifty medical students class is divided into two Groups (Group A and Group B) and taught in different classes. Each lecture of group A (experimental Group) undergraduate first year medical students was divided into short presentations of 12-15 min each. Each presentation was followed by a pause of 2-3min, three times in a 50 min lecture. During the pauses students worked in pairs to discuss and rework their notes. Any queries were directed towards the teacher and discussed forthwith. At the end of each lecture students were given 2-3 minutes to write down the key points they remembered about the lecture (free-recall). Fifteen days after completion of the lectures a 30 item MCQ test was administered to measure long term recall. Group B (control Group) received the same lectures without the use of pause procedure and was similarly tested. Results: Experimental Group students did significantly better on the MCQ test (p-value<0.05) in comparison to the control Group. Most of the students (83.6%) agreed that the ‘pause procedure’ helped them to enhance lecture recall. Conclusion: Pause procedure is a good active learning strategy which helps students review their notes, reflect on them, discuss and explain the key ideas with their partners. Moreover, it requires only 6-7 min of the classroom time and can significantly enhance student learning.