Journal of clinical and diagnostic research

Sternalis -An Accessory Muscle of Thoracic Wall

Virendra Budhiraja, Swati Bansal, Rakhi Rastogi, Shveta Swami, Rimpi Gupta

Sternalis muscle is an anatomical aberration among the muscle group of anterior chest wall. This accessory muscle was discovered bilaterally in a 40-year-old female cadaver. The muscle which emanated from the external oblique aponeurosis was fleshy throughout its extent except at the ends where it was aponeurotic. At the sternal angle, the muscle displayed inverted “V” shaped configuration and merged with the opposite pectoralis major muscle. It is clinically very important in female patients as compared to male patients because of mammary gland surgeries, lymph node irradiation, postoperatively can be confused with recurrence etc. The present case endeavors to discuss the anatomical, embryological and clinical relevance of a rare accessory muscle of the anterior chest wall.

Ruptured and Inflamed Epidermal Inclusion Cyst of Tongue- A Case Report

Nishant Sagar, Prerna Arora, Nita Khurana, JC Passey

Epidermal inclusion cyst (EIC) is rare in head and neck region with incidence in oral cavity being less than 0.01%, presenting as congenital or as acquired lesions. Clinically patient presents with dysphagia, difficulty in breathing and may be associated with various syndromes like Gardner syndrome, basal cell nevus syndrome and pachyonychia congenita. Pathogenesis of EIC includes implantation of ectodermal component along the embryological site of fusion or due to trauma. A case of EIC of tongue in a three year old male child is presented here along with review of literature.

Emphysematous Pyelonephritis Caused by E.Coli and Candida Albicans with Oral Candidiasis and Herpes Genitalis: A Dreaded Infection

Shyam Lal, Ankit Kaura, Pradhuman Yadav, Isha

Emphysematous Pyelonephritis (EPN) is a rare, potentially fatal necrotising pyelonephritis, with rising trend in diabetic patients (95%). E.coli is the most common uropathogen whereas Candida albicans is extremely rare. Mortality in EPN, with present management techniques, is 18%. It should be suspected in diabetic patients with pyelonephritis. Splenic abscess is an uncommon association. Contrast Enhanced Computed Tomography (CECT) of abdomen is cornerstone for diagnosis. Nephrectomy is mainstay of treatment in extensive disease. Herein, we report a rare case of EPN in 58-year-old female who presented with diabetic ketoacidosis and septicaemia caused by E. coli and Candida albicans with superadded Herpes genitalis and oral candidiasis which is unique. Right nephrectomy was done. Postoperatively, she developed splenic abscess which was managed by percutaneous drainage.

Posterior Tibial Artery Injury with Intact Posterior Tibial Pulse: A Case Report

The presence of distal pulses can be misleading and the presence of good vascularity to the affected part may be unrelated to the possibility of a vascular injury in orthopaedic trauma to the affected part. We report a case of Grade II open fracture of Proximal Tibia with Posterior Tibial Artery (PTA) tear. The case being presented came with an intact PTA pulsations clinically and with good vascularity to the lower limb, with no difference in the pulse rate between radial and posterior tibial pulse rate and no underlying bruits. The underlying PTA tear was found only incidentally on operating when the patient was taken up for open reduction with internal fixation with proximal tibial locking plate surgical procedure and the fracture site was opened. Arterial injuries following trauma may be missed without liberal use of arterial Arteriograms and Doppler study, unless looked for with a high degree of suspicion. If the arterial tear is identified early, patient and his limb can be saved without much morbidity to the patient, though diagnosing the injury is the hard part. Presence of intact and good peripheral pulses is not a sole criteria to rule out underlying vascular injury following orthopaedic trauma.

Socket Preservation using Platelet Rich Fibrin for Pink Aesthetics- A Case Report

Post extraction preservation of interdental papillae, poses a challenge to the clinicians exclusively when related to the restoration of missing anterior teeth. In the modern era, patients claim for aesthetics, has experienced an evolution due to enhanced consciousness of beauty. The ultimatum in achieving aesthetics is, well restored hard and soft tissues i.e., pink and white aesthetics. Pink aesthetics refers to soft tissues while white aesthetics is the natural or restored dentition. This case report provides an innovative clinical technique for maintaining papillary height and form following anterior tooth removal by an interdisciplinary approach.

Bilateral Unicondylar Hoffa Fracture Along with Tibial Spine Avulsion Injury in a Patient: Case Report

Sumit Gupta, Jaswant Kumar

Coronal fractures of distal femur are complex intra articular fractures. Various cases of unicondylar and bicondylar Hoffa fractures have been reported in literature. Bilateral unicondylar Hoffa fracture is a very rare injury and it is not reported in literature to best of our knowledge. We report a case of bilateral unicondylar Hoffa fracture associated with tibial spine avulsion in right knee and possible mechanism of injury in same patient.

Marsupialization of Inflammatory Dentigerous Cyst Associated with Pulpotomised Primary Second Molar-A Case Report

Ranu Bhandari, Seema Thakur, Parul Singhal, Deepak Chauhan, Cheranjeevi Jayam

Pulpotomy of a deciduous tooth is a standard procedure done in paediatric patients. Quite a few times it can give rise to side effects, one of the side effects being cyst formation in the periradicular area of pulpotomised tooth. Diagnosis of this cyst is difficult, as classifying them under radicular cyst or dentigerous cyst is reported dilemma in literature. This paper discusses the differential diagnosis of such periradicular cyst, the probable theory of pathophysiology of the infected dentigerous cyst, and treatment by marsupialization technique. The successful eruption of a horizontally impacted involved tooth was noted, with the alignment of the arch and healthy bone formation after treatment.

Malignant Peripheral Nerve Sheath Tumour of the Ovary

Malignant Peripheral Nerve Sheath Tumour (MPNST) of the ovary is a rare disease, and we hereby describe this entity in a 51-year-old lady who presented with an ovarian mass and disseminated peritoneal disease. She was treated initially with Neo Adjuvant Chemotherapy (NACT) thinking it to be a surface epithelial ovarian tumour and subsequently underwent interval cyto reduction. The nerve sheath origin was confirmed by Immunohistochemistry (IHC) studies. There are no standard treatment guidelines for this rare tumour of the ovary.

Massive Pyonephrosis Presenting as a Mammoth Tumour in Pregnancy: A Case Report

Shubha Rao, Shyamala Guruvare, Rajagopal Kadavigere, PS Roopa

The overall incidence of ovarian tumours in pregnancy is 2.4-5.7% and because of the asymptomatic nature of ovarian mass it is usually diagnosed in late pregnancy when there may be symptoms produced by it. Due to the similarity of symptoms there has always been perplexity when a patient presents with mass per abdomen in pregnancy. During pregnancy, mild hydronephrosis is considered a normal phenomenon and may be present in up to 90% of pregnancies. Dilation is usually more pronounced on the right kidney and after mid-pregnancy. Here, we present a case which presented as a huge abdominal mass in pregnancy which was mistaken to be an ovarian mass in pregnancy and then later diagnosed as pyonephrosis.

Angulated Custom Cast Post and Core Restoration for Traumatised Anterior Tooth-“Not as Straight as an Arrow”

Apra Butail, Parminder Dua, Ritu Mangla, Ananya Chauhan

Traumatic dental injuries are most common injuries afflicting young children and generally involve the maxillary anterior teeth. Increased overjet with protrusion of upper incisors and insufficient lip closure are significant predisposing factors to traumatic dental injuries. Anterior tooth trauma leads to discomfort and serious psychological, aesthetic, functional, and phonetic problems that can affect social relationships. Treatment of a traumatically injured single central incisor poses significant challenges to the dentist and the patient. The reduced tooth structure makes retention of extra coronal restoration difficult. The purpose of cast post is to provide retention for the core restoration, which replaces the lost coronal tooth structure. This case report describes aesthetic rehabilitation of a fractured labially inclined left maxillary central incisor. Aesthetic and functional reconstruction was achieved by customising the axial inclination of the core followed by cementation with Porcelain Fused to Metal (PFM) crown. Thus, endodontic approach combined with prosthodontics provides a quick, reliable and economic treatment option.

Varied Orbital Inflammations in Diabetics

Sumana J Kamath, Bindu Kolavala, Vasuraj Saini

Orbital cellulitis is purulent inflammation of the cellular tissue of the orbit. It is one of the clinical emergencies which need early diagnosis and treatment, especially in diabetics and immunocompromised patients. We report two rare presentations of orbital inflammations in diabetics, who recovered with early diagnosis and prompt treatment subsequently.

Vesicourachal Diverticulum: A Rare Entity

Partha Pratim Deb, Amarendra Nath Sarkar, Dawood Khan, Supriya Basu

The urachus is a tubular embryonic structure connecting the allantois at the umbilicus to the bladder during development of foetus. It gets obliterated at 12th week of gestation and remains as a fibrous cord like structure extending from the umbilicus to the dome of the bladder. Complete or partial failure of this process results in urachal anomalies. We are reporting a rare case of young lady presenting with features of dysuria and passage of jelly like material in urine which was subsequently diagnosed as vesicourachal diverticulum by cross sectional imaging, cystoscopy and managed with minimally invasive surgical excision.

Double Perineal Ani with Duplication of External Genitalia in a Septicemic Neonate: A Case Report

Bismay Das, C Mohanty, Rajniti Prasad, Braj Kishore Das

Double perineal ani, a rare congenital anomaly is due to persistence of urogenital septum with widening of hind gut. Only few cases have been reported in literature. We report a rare case of double perineal ani with duplication of external genitalia and ectopia vesicae in a septicaemic male child. Ultrasonography showed no duplication of internal organs. The treatment was started with intravenous cefotaxime and amikacin but died within 2 hours of admission. Autopsy could not be done. Early presentation to hospital and multidisciplinary approach is required for management of such cases.

Two Trunked Brachial Plexus: Multiple Variations in Formation, Course and Distribution

Pooja Singh, Manisha B. Sinha

Brachial plexus is a very complicated nerve network of upper limb. Many anatomical variations have been documented regarding its formation, course and distribution. Understanding of variations in brachial plexus is very important for clinicians, especially during surgical approach of axilla and neck region. Multiple variations in the left brachial plexus of about 70-year-old male cadaver, during routine dissection classes of upper extremities was noted in this variation of brachial plexus in which the middle trunk was absent. Other associated anomalies of same plexus were- all the three cords and their branches lie lateral to the axillary artery. Coracobrachialis was supplied by more than one branch of lateral cord. A loop was formed by joining of medial as well as lateral pectoral nerve around superior thoracic artery and there was also a connection present between lateral and medial root of median nerve. Therefore, the purpose of this paper was to unfold the complexity of brachial plexus. These changes may or may not affect the functioning of upper extremity of this person, but the knowledge of these variations are necessary during the surgical procedures as well as to evaluate unexplained sensory or motor loss after trauma. It also helps the clinicians for proper understanding of some previously unexplained clinical symptoms.

Schimke Immuno-Osseous Dysplasia with Growth Retardation- A Case Report

Schimke-Immuno-Osseous Dysplasia (SIOD) is a rare multisystem progressive disorder which has an autosomal recessive inheritance pattern. This disorder can present with disproportionate short stature, spondyloepiphyseal dysplasia, progressive renal disease, and signs and symptoms of impaired cellular immunity. In this report we present a case of SIOD, the second child of consanguineous (3rd degree) Iranian parents. A five-year-old girl was referred for evaluation of growth retardation. The patient had normal development but the growth rate was slower than normal. The case had the typical manifestation of SIOD which presented first by growth failure (11.3 kg and 86 cm - below 5% percentile for weight and height). Molecular genetic testing indicated biallelic pathogenic variants in SMARCAL1. The most important thing about the case was her parental consanguinity and having a sister with nephrotic syndrome who died early in life. It is recommended that in the cases with poor growth and such a suspected family history the diagnosis of SIOD should be kept in mind and further evaluations should be performed. In addition, proper short-interval follow up is recommended for cases with diagnosis of SIOD in order to have a better evaluation and management of the disease related complication.

Gestational Gigantomastia: Challenges in Management and Follow-up

Gestational Gigantomastia (GG) is a rare condition that presents with excessive enlargement of breast which becomes uncomfortable and embarrassing. Here is a case report of a primigravida who presented to us with GS at term. Post-delivery she had abscess formation and difficulties in breastfeeding. She was conservatively treated by abscess drainage and lactation suppression.

Double Barrel Oesophagus- A Case Report

Gulam Mohiuddin Marfani, Shivali Vaibhav Kashikar, Shraddha Singhania

Double barrel Oesophagus is a rare entity that involves a mucosal injury, thereby creating of a true and false lumen within the oesophagus. Diagnostically it is important to differentiate complete and partial dissection of oesophagus because the management of partial dissection is conservative and full dissection is a surgical emergency needing operative intervention.

Massive Lymphocytic Infiltration in the Uterus Mimicking Lymphoma-A Potential Diagnostic Challenge

Shailaja Shukla, Shivali Sehgal

Leiomyoma with lymphoid infiltration is an uncommon lesion which mimics lymphoma. Although, the polymorphous nature of the lymphoid infiltrate differentiates it from lymphoma, it may pose a diagnostic challenge at times. A 31-year-old female (Para 3, live issues 3) presented with menorrhagia. On sonography, a submucosal fibroid polyp measuring 2.5×2×1 cm arising from the anterior wall of the uterus was identified. Hysteroscopic polypectomy was carried out. Microscopy showed an exuberant lymphoid infiltrate in what appeared to be a leiomyoma. Numerous lymphoid follicles were observed, which on low magnification gave an impression of follicular lymphoma. Immunohistochemistry revealed their polymorphous character. It was diagnosed as leiomyoma with extensive lymphoid infiltration. It is important to know the range of histological alterations in leiomyomas, especially those with massive lymphoid infiltration since they simulate lymphoma clinically.

A Rare Case of Poorly-Differentiated Sertoli Leydig Cell Tumour of Ovary with Mesenchymal Heterology

Rahul Pandey, Yasmeen Khatib, Vinita Pandey, Archana Khade, Manisha Khare

Sertoli–Leydig Cell Tumours (SLCT) accounts for less than 0.5% of all ovarian neoplasms. Presence of mesenchymal heterologous elements in a poorly differentiated SLCT is extremely uncommon. It not only causes diagnostic difficulty but also renders an aggressive behaviour to the tumour. We report a rare case of poorly differentiated SLCT with cartilage and rhabdomyoblastic differentiation along with review of literature.

Sesamoid Bones in the Soft Tissue of Neck as Incidental Finding on Multidetector Computed Tomography

Gitanjali Khorwal, Rahul Dev, Pankaj Sharma

Sesamoid ossicles are round to oval small bones, usually seen in relation to tendon of a muscle or a joint with less frequent occurrence at other locations. They are asymptomatic in the vast majority of cases; however, predispose to increased risk of injury. In a few other cases, they may present as a palpable mass accompanied by vague neck pain or stiffness. Rarely, these bony structures can be seen in close relation to ligamentum nuchae or paraspinal muscles and may predispose to pain in the neck. They are known to be stable in size over time and show no evidence of recurrence after surgical excision. Histologically, they are considered fibrocartilagenous tumour formed secondary to fibrocartilagenous metaplasia triggered by localised repetitive trauma or chronic mechanical stress. We report two cases where sesamoid ossicles were detected within the nuchal ligament. Only few cases of this entity lesion have been reported previously.

Second Degree Mobitz Type 1 Block in Dengue Haemorrhagic Fever: A Rare Manifestation

Harpreet Singh, Gagan Deep Sukhija, Saroj Bala, Ruchi, Harveen Sodhi

Dengue is an arboviral disease caused by a Flavivirus. It is spread by the bite of Aedes aegypti mosquito. Spectrum of this disease ranges from mild self-limiting fever to potentially fatal severe multiorgan dysfunction with shock. Cardiac manifestations of dengue are uncommon but rhythm disturbances in the form of ventricular ectopics and different types of blocks have been reported with dengue haemorrhagic fever in the literature. Here, we present a case report of a young lady who developed 2nd degree Mobitz type I block during the de-fervescence stage of infection.

All Mycobacteria are not Tubercular: A Case Report

Laxma S Reddy, K Bhaskar, N Prashanth, Narendra Kumar Narahari, GK Paramjyothi

Mycobacterium tuberculosis is a common infection in developing countries with high morbidity and mortality. However, Non-Tuberculous Mycobacteria (NTM) are common environmental organisms which closely resemble tuberculosis but rarely present with disease in immunocompromised patients. They have different growth requirements, identification methods and treatment options when compared to tuberculosis and require individualised care. Here we present a case of Mycobacterium simiae infection in an immunocompetent patient presenting like tubercular infection with good outcomes after treatment.

Giant Cell Reparative Granuloma of Proximal phalanx of 4^th Toe-A Rare Case Report

Giant Cell Reparative Granuloma (GCRG) is locally aggressive, non-neoplastic lesion. It is an uncommon lesion commonly found in maxilla and mandible and rare in the toes. Due to absence of classical radiological features and rare incidence of GCRG at toe, clinically and radiologically this lesion is frequently misdiagnosed. So, histopathological evaluation is necessary to confirm the diagnosis of GCRG. This is a case of GCRG of proximal phalanx of right fourth toe in a young woman.

Isolated Renal Hydatid Disease-A Cytohistological Diagnosis

Hydatid disease caused by Echinococcus granulosus is a common occurrence in liver and lungs. Isolated renal hydatid cyst without liver or lung involvement is extremely rare. We present a case of solitary renal hydatid disease diagnosed radiologically as a renal malignancy and intraoperatively suspected as a case of renal tuberculosis due to the extensive necrotic material and as the patient was a treated case of pulmonary tuberculosis. Diagnosis of renal hydatid disease was confirmed on histopathology.

Fabrication of Conventional Complete Denture in Resorbed Mandibular Ridge with Deficient Keratinized Mucosa Using Free Gingival Graft

Monika Malik Vigarniya, Shagun Gulia, Vidushi Sheokand, Nupur Dabas

Long standing edentulism often results in dimensional changes in the bone as well as in the soft tissue. The severity of these changes depends upon the span of edentulism, systemic and oral well-being of the patient. Complete denture prosthesis rests on the basal seat area that primarily consists of oral mucosa and residual alveolar ridge. The oral mucosa underneath the denture has unique characteristic of being displaceable and compressible. This factor was described by Hanau as ‘resiliency and like effect’, Realeff Effect that plays an important role in all the steps of compete denture fabrication. In a case of extreme bone resorption, the bone and mucosa both diminishes with time. The reduced thickness of keratinized mucosa make denture bearing area more prone to trauma. This article describes a simple pre-prosthetic surgical technique for soft tissue augmentation in rehabilitation of extremely resorbed mandibular ridge with deficient mucosa to improve support for complete denture.

Fistulotomy Around The Sphincter (FATS) Procedure: A Simple New Sphincter-Sparing Concept to Treat High Fistula-In-Ano

Pankaj Garg

Fistulotomy Around The Sphincter (FATS) is a novel sphincter sparing procedure for high anal fistulas. In FATS procedure, the fistula tract from internal opening to external opening is laid open except that the sphincter complex is not cut and is completely preserved. The fistula tract passing through the sphincter complex (TISC-Tract Inside Sphincter Complex) is thoroughly cleaned, curetted and debrided but is not widened. The final wound should form a double cone, one each at internal as well as external opening. The wide end of the cone should be at the mucosa and the skin respectively whereas TISC should form the tip of both the cones. The wound heals by secondary intention (granulation tissue). The aim is that TISC heals first. Subsequently, both the wounds at the internal and the external openings heal, from TISC towards the respective openings. This article is about three patients with high fistula-in-ano in whom FATS was done. All of the three patients were males with a mean age of 43.0±0.5 years and with a median follow-up of 8 months. The fistula healed in all patients with no change in incontinence scores (Vaizy’s incontinence scores). FATS is a simple and effective novel sphincter-sparing procedure to treat high fistula-in-ano especially with wide internal opening.

Retroperitoneal Teratoma Mimicking Renal Calculus

Debansu Sarkar, Arun Kumar Maurya, Debasish Chakraborty, Dilip Kumar Pal

Double Teeth in Deciduous Maxillary Incisor Region: A Rare Anomaly

Khushboo Singh, Anshul Mahajan, Sunita Gupta, Jatinder Kaur

Jategaonkar’s Modification of Brooke’s End-Ileostomy

Anti-hypertriglyceridemic Activity of Cornus Mas in Diabetic Rats

Sajedeh Gholipour, Tahoora Shomali, Mahmoud Rafieian-Kopaei

Introduction: Hypertriglyceridemia is among the multiple metabolic derangements seen in diabetes mellitus. Cornelian cherry (Cornus mas L.), belongs to the family Cornacea and has been shown to be helpful in treating hyperlipidemia. Aim: The study investigates mechanisms of action of dietary Cornelian Cherry fruit Dried Powder (CCDP) for ameliorating hypertriglyceridemia in diabetic rats. Materials and Methods: An experimental study with parallel controls was performed. Fifty six male adult rats were randomly assigned into 8 equal groups and treated as follows for 4 weeks. Negative control: Normal rats, basic diet; positive control: streptozotocin-induced diabetic rats, basic diet; T1 to T4 groups: diabetic rats fed with diets containing 0.25, 0.5, 1 and 2 g/ 100 g BW CCDP, respectively; T5: diabetic rats fed with basic diet plus 100 mg/kg BW of fenofibrate in drinking water and T6: normal rats fed with basic diet containing 1 g/100 g BW CCDP. Selected serum biochemical parameters, Lipoprotein Lipase (LPL) level as well as Adipose Tissue Hormone Sensitive Lipase (HSL) and Hepatic Peroxisome Proliferator-Activated Receptor Alpha (PPARa) levels were assayed. Analysis of data was performed by one-way ANOVA followed by Tukey’s test with p<0.05 as the significant level. Results: Treatment with CCDP at all dosages as well as fenofibrate decreased serum triglycerides and VLDL levels as compared to positive control. Serum AST significantly decreased in T1, T3 and T4 groups as compared to positive control rats. Serum LPL levels in the diabetic positive control group decreased significantly as compared to negative control. Rats in T1, T2, T4 and T5 groups showed increased serum LPL levels as compared to positive control. No significant difference was observed in hepatic PPARa levels among CCDP-treated and negative or positive controls. Positive control rats showed a significant decrease in adipose tissue HSL levels. Administration of CCDP in T3 group significantly increased HSL values as compared to positive control. CCDP in healthy rats did not change any of these parameters. Conclusion: Findings of the present study confirms positive effects of C. mas fruit on some liver function enzymes and hypertriglyceridemia and clarifies that increased serum LPL levels is at least partly responsible for hypotriglyceridemic effect of the fruit in rats with STZ-induced diabetes mellitus.

Effect of Magnesium Sulphate and Dexmedetomidine on Blood Loss during Lumbar Spinal Fusion Surgeries

Introduction: Spine surgeries pose unique challenges to the anaesthesiologist in maintaining stable haemodynamics, relatively dry operative field and concerns over patient positioning during surgery. Aim: The present study was aimed at comparing the effect of magnesium sulphate and Dexmedetomidine in minimizing blood loss and maintaining haemodynamic stability during spinal fusion surgeries. Materials and Methods: Forty two patients aged 18-60 years of ASA 1 and 2 were randomly divided into two groups A and B. Group A received 30 mg/kg bolus followed by 10 mg/kg/hr of magnesium sulphate and group B received 1mcg/kg bolus followed by 0.4mcg/kg/hr of Dexmedetomidine till the end of surgery. The study drugs were started after intubation and positioning prone. Both the groups were observed for changes in haemodynamic parameters and for amount of blood loss. Blood loss was assessed by weighing the soaked sponges and gauze and calculating against the dry weight. A 1ml of blood was considered to be equal to 1gram weight. Statistical analysis was performed using SPSS version 21. Results: The mean blood loss in group A was 516±8.029 ml and 499±5.34 mL in group B (p>0.05). The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were lower in group A compared to group B at various time intervals throughout the study (p<0.05) and it was statistically significant. Conclusion: Both magnesium sulphate and Dexmedetomidine can be used for minimising blood loss during lumbar spinal fusion surgeries with Dexmedetomidine maintaining better haemodynamic stability.

Role of TNF- α on the Function of Erythropoietin and Haematological Profile in Pulmonary Tuberculosis Patients

Harish Bhat, Jeevan G Ambekar, Anand Kumar Harwalkar, Nilima Dongre, Kusal K Das

Introduction: Pulmonary Tuberculosis (PTB) is one of the major causes for morbidity and mortality to the mankind and India accounts for over one fourth of global Tuberculosis (TB) burden. In PTB, the expression of inflammatory cytokine Tumour Necrosis Factor-Alpha (TNF-a) increases with increase in bacterial burden, which in turn interfere with Erythropoietin (EPO) action and play a vital role in pathophysiology of anaemia. Aim: To study the role of TNF-a on EPO function and its correlation with haematological profile in different grades of PTB. Materials and Methods: The present cross-sectional study was conducted at Navodaya Medical College Hospital and Research Centre, Raichur, Karnataka, India from January 2016 to January 2017. The study included 180 newly diagnosed sputum positive PTB cases and 100 healthy controls. The PTB was confirmed by microscopic examination of sputum specimen of the cases for the detection of Acid Fast Bacilli (AFB). Both cases and controls were subjected to haematological analysis by automated cell counter and serum TNF-a and EPO by ELISA method. The statistical analysis was performed by using SPSS version 16.0 software. The results were analysed with descriptive statistics, wherever appropriate. Results: The mean haematological parameters between PTB cases and controls showed statistically significant differences (p<0.05). We reported statistically significant differences in serum levels of TNF-a and EPO among PTB cases and controls (p<0.001 and p<0.001 respectively). We compared mean values for serum TNF-a, EPO and Haemoglobin (Hb) levels in PTB patients with different sputum AFB grading and noted statistically significant association between AFB grading and TNF-a, AFB grading and EPO and also AFB grading and Hb (p<0.001 respectively) in PTB. We observed inverse correlation between TNF-a and EPO (r=-0.49, p<0.001) and TNF-a and Hb (r=-0.58, p<0.001) in PTB cases. Further, we found no correlation between EPO and Hb (r=-0.101, p>0.05) in PTB cases. Conclusion: Increased bacterial burden was associated with increased TNF-a and relative deficiency of EPO. Increased TNF-a and proportionately decreased EPO values were accordant with Hb level and further anaemia in PTB. Hence, during the treatment, therapeutic administration of recombinant human EPO could be useful to combat anaemia and also for better prognostic impact in PTB.

Impact of Metered Dose Inhaler Technique Education in a Medical Out Patient Department

Introduction: Asthma and Chronic Obstructive Pulmonary Disease (COPD) patients constitute a major portion of the inflow of a medical Out Patient Department (OPD). Incorrect use of Metered Dose Inhalers (MDI) is a significant barrier in improving the quality of medical care given to most patients with chronic respiratory diseases. Aim: This study was carried out to analyse the issues pertinent to incorrect MDI use and to assess the impact of a quality improvement initiative involving practical demonstration of correct technique using a standardized checklist. Materials and Methods: This was an interventional pre and post-test study conducted in medical OPD among COPD or asthma patients already on MDI. A baseline assessment of correctness of MDI use technique was done based on ADMIT-GINA guidelines, following which a practical demonstration of correct technique was done. These patients were followed up after one month and their technique was reassessed. The mean score was calculated for each patient pre and post intervention based on the correctness of steps and was compared using paired t-test. Results: Total 56 out of 102 patients completed the study. The mean score of MDI technique knowledge was 3.5±1.5, which increased to 6.7±1.2 after intervention (p<0.001). Only 27 (48.2%) patients reported having received prior educational training regarding MDI use and only 22 (39.3%) patients were using spacers. Conclusion: The current level of knowledge of correct steps of MDI use with spacer is low among patients. Practical demonstration of correct MDI use technique using a standardized checklist reduces errors in MDI use and thus helps in patient education.

Effect of an Abdominal Muscle Strengthening Program on Blood Glucose Levels in Persons with Type II Diabetes Mellitus

Introduction: Diabetes has become a global issue and epidemiological evidence suggests that effective control and prevention programmes are necessary to prevent escalation of the global diabetes burden. People with abdominal obesity are more prone for developing Type 2 Diabetes Mellitus (T2DM). Abdominal obesity is seen to be closely associated with diabetes, but the effect of abdominal strengthening on blood sugar levels has not been studied so far. Aim: To study the effect of a prospectively effective abdominal strengthening protocol named Abdominals on non-communicable diseases (ABON), on blood glucose levels and compare it with the effect of other general exercises. Materials and Methods: A pre-post experimental trial with control was conducted for 12 weeks on a 100 participants divided into two groups. Experimental Group A (n=50) underwent a regular abdominal muscle training protocol named ABON, containing a set of abdominal strengthening exercises. The control Group B (n=50) were instructed not to involve in any form of abdominal muscle training for three months and were taught to do breathing exercises, general body stretches, encouraged to do walking and continue regular lifestyle. The outcome measures were Random Blood Glucose (RBS) and Glycosylated Haemoglobin (HbA1C) obtained using the High Performance Liquid Chromatography (HPLC) method. Results: Wilcoxon signed rank test showed that the experimental Group A had a significant difference (p<0.01) in both RBS and HbA1c with the values before and after treatment. Comparison of HbA1c and RBS values between the two groups using the Mann-Whitney U test, showed a significantly higher improvement in the experimental group in both the outcome measures when the differences before and after treatment were compared (p< 0.01). Conclusion: The abdominal training program ABON is a simple effective way in which blood glucose levels can be decreased, and can be used to control diabetes mellitus.

Enhancing Knowledge Integration in Biochemistry among Undergraduate Medical Students through Active Learning Strategy

Chandrika D Nayak

Introduction: Medical education today, encourages modification of traditional didactic lectures with innovations to promote active learning strategies to enhance integration of knowledge and critical thinking skills among students. Learning independently is challenging in year 1 of the undergraduate medical curriculum. However, defining the learning goals clearly by the instructor to the students will make them appreciate it and mould them into successful learners with deep approach. Aim: To enhance self-directed learning skills and to promote concept mapping ability to integrate the study of various metabolic functions and fundamental concepts in biochemistry. Materials and Methods: First year MBBS Student volunteers (n=127) in their second semester having an experience of over 30 weeks of learning biochemistry in an integrated system-wise approach were involved in this study. They were exposed to a self-directed active learning strategy for a period of 10 weeks, for linking important biochemical terms from the current learning objectives to various concepts and topics learnt earlier in the year. Student’s perspective regarding the above activity was documented by obtaining their responses in a closed ended questionnaire using Likert scale and was expressed as percentage. Results: Majority of the students (n=100, 79%) opined that it was a unique way of learning biochemistry and that they (n=111, 87%) were required to read up previous portions. Many students (n=100, 79%) felt that it made them more than mere rote learners and were able to integrate biochemistry topics more efficiently (n=109, 86%). Many students also felt that it helped them to improve their test scores (n=79, 62%). Conclusion: Active participation in the current study has made them learn the concept building skills in biochemistry and has proved to be an effective exercise of revisit to topics learnt throughout the year. Innovative curriculum delivery strategies should be designed to teach preclinical subjects in a medical school so that they shall infuse integrated learning approach in students. Concept building activities in a lecture set up shall generate curiosity in the process of learning and transform students into deep approach learners.

Child Sexual Abuse-Perceptions among Health Professionals in a Tertiary Setting

Introduction: Child Sexual Abuse (CSA) is one of the India’s largest open social secret that leaves enormous physiological and psychological impact on the health and development of children. It is a complex and context-bound phenomenon that exists in every society, but perceptions about it may vary among lay persons, teachers and health professionals. Aim: This study was aimed at understanding the perceptions of health professionals on child sexual abuse in a tertiary setting in the southern state of India. Materials and Methods: In a descriptive cross sectional study, 185 health professionals including doctors and nurses in a tertiary setting were enrolled. A self-administered questionnaire which was developed by the researcher (content validity index: 0.8) along with demographic profile sheet to assess the perceptions of health professionals on child sexual abuse was used. Data analysis was done by descriptive and inferential statistics using SPSS 16.0 software and p-value of <0.05 was considered to be significant. Results: Majority of the participants (82.7%) agreed that girls are at increased risk of being abused, and belong to the teenage group (62.2%). A good proportion of health professionals agreed that the perpetrators are usually male (65.9%) aged between 15-35 years (48.6%). Appearing in the court for legal proceedings (50.8%) and the after effect of child being stigmatized in the society (64.9%) were found to be significant barriers in reporting child sexual abuse. Majority (85.9%) of them perceived that the adult should take responsibility of the protection of children and 86.5% of them agreed that children should be taught about “good touch” and “bad touch” as preventive strategy in child sexual abuse. Conclusion: The present study has shown that perceptions on child sexual abuse vary among health professionals. Though they are aware about the risk factors, perpetrator characteristics, preventive strategies, still barriers in reporting child sexual abuse exists.

Shear Bond Strength Evaluation of Composite Resin Bonded to Nickel Chromium Alloy

Introduction: In modern dentistry, as the patient’s demand for aesthetic dentistry increases, the use of tooth-coloured restorative material increase correspondingly. One among them is the use of Porcelain Fused to Metal (PFM) restorations. However, fracture of PFM crown is a common problem in restorative dentistry. Various methods have been advocated to repair fractured porcelain. Aim: The aim of present study was to evaluate the efficiency of the two different bonding systems in reference to three different surface treatments on Nickel Chromium (Ni-Cr) alloys by evaluating the shear bond strength at metal and resin interface. Materials and Methods: A total of 80 Ni-Cr alloys measuring 1x1 cm square blocks were cast using lost wax technique. After casting, the specimens were grouped into four groups based on the surface treatments planned. The four groups were further subdivided into two subgroups based on the bonding technique. The subgroup A samples was treated with Single Bond Universal (SBU) and subgroup B samples was treated with Alloy Primer (AP) and SBU. After surface treatment of the sample, a clear plastic tube measuring 4 mm diameter and 4 mm length was placed and composite resin was packed and cured. Shear bond testing of all the groups was performed on Universal testing machine. Results: The means and standard deviations of SBS values in MPa were calculated for each group, and the results were statistically analysed with one-way ANOVA and Tukey HSD tests. All statistical analyses were performed using the SPSS software version 10.0. Conclusion: Within the limitations of this in vitro study, Erbium-doped Yttrium Aluminium Garnet (Er-YAG) Laser treated alloy surfaces bonded along with AP displayed highest shear bond strength and subgroup B samples bond strength was significantly higher.

Study of Pupil Dilatation Characteristics in Patients from Southern India with a Single Drop of Topical Tropicamide-Phenylephrine

Introduction: Dilatation of the pupil is essential for eye examinations and procedures, and when the characteristics are known it will help the clinical work flow. Tropicamide-Phenylephrine combination is the most commonly used dilating agent in ophthalmic clinical practice. Aim: To study the pupil dynamics and properties on dilatation with Tropicamide (0.8%) + Phenylephrine (5%) combination drops. Materials and Methods: This was a cross sectional observational study conducted on 132 eyes (right eye) from 132 patients. Baseline measurement of the pupil and pupil dynamics were noted after dilatation with a single drop of Tropicamide-Phenylephrine (5%). Pupil Diameter was measured with Optical Biometer at every 2 minutes till 44 minutes or till the patient achieved full dilatation. Data was analysed using t-test, Mann-Whitney U test and ANOVA was used to compare data between groups. Results: The average onset of dilatation in our study population was at 9.02±5.2 minutes (2 to 24 min) from the time of instillation of drops. The mean time taken for full dilatation was 33.02±5.09 minutes (22 to 42 min) with mean amplitude of 2.39±0.68 mm (0.9 to 4.2 mm). The rate of dilatation of the pupil was 0.07±0.022 mm/sec (0.03 to 0.14 mm/min). A 98.4% of patients maximally dilated in an average time of 33.03 minutes. Conclusion: Instillation of a single drop of Tropicamide-Phenylephrine combination drop was effective and provides adequate dilatation for all ophthalmological clinical situations.

Clinical Predictors of Outcome in Buerger’s Disease using BVAS and DEI.Tak Scoring Systems

Prasanta Padhan, Sunil Agarwal, Debashish Danda

Introduction: Buerger’s disease is an unclassifiable vasculitis of the small and medium-sized distal arteries and superficial veins. BVAS (Birmingham Vasculitis Activity Score) is a validated disease activity index for vasculitis of different types. DEI.Tak (Disease Extent Index. Takayasu’s arteritis) scoring system is a validated disease extent Index used for Takayasu arteritis. Aim: The aim of this study was to assess outcome in patients with Buerger’s disease using various clinical features, laboratory parameters, BVAS and DEI.Tak scoring system. Materials and Methods: Case records of 136 patients diagnosed with Buerger’s disease in our hospital between August 1996 and July 2006 were studied retrospectively. Various clinical features (smoking history, claudication pain, loss of pulse), laboratory parameters, treatment modalities and outcome measures were recorded in a defined proforma. BVAS and DEI.Tak scoring was done using the data from medical records documented during the patients’ last visit to the hospital. Outcome of any patient requiring amputation was considered as bad outcome. Others, who could be managed by antiplatelet drugs, sympathectomy and revascularization procedures without any amputation were classified within the good outcome subset. Statistical analysis was done using Chi-square test and Non parametric MannWhitney test was performed to correlate outcome with all the recorded parameters including those embedded in BVAS and DEI.Tak scoring systems. Results: Sixty eight patients were in each group, namely the good outcome and bad outcome subsets. The mean BVAS score were 10.29±1.26 and 10.88±2.57 and mean DEI.Tak score were 5.29±1.75 and 7.93±2.43 and these scores were observed to be significantly different (p=0.038, p=0.014 respectively) among the good outcome subsets and bad outcome patients with respectively. Proportion of patients with claudication pain and absent upper limb pulse were observed significantly higher in the bad outcome group. Conclusion: Buerger’s disease with higher DEI.Tak score has significantly higher risk of bad outcome. DEI.Tak score can be used as an important predictor of outcome in Buerger’s disease.

Capsular Serotyping and Antimicrobial Drug Resistance of Klebsiella pneumoniae Strains Isolated from a Tertiary Care Hospital, Southern India

Lathamani Kotekani, Subbannayya Kotigadde, Bhaskaran Thulicheri Nair

Introduction: The rapid spread of Hypervirulent Klebsiella pneumoniae (hvKP) and Multi Drug Resistant (MDR) strains among the clinical isolates of K.pneumoniae is a great deal of concern. The drug resistance and limited treatment options are the major threats. However, the spread of drug resistant strains is through plasmid which may carry virulence determinants such as capsular antigens. Aim: To know the occurrence of hvKP; to study the occurrence of various capsular serotypes such as K1, K2, K3 and K4 among the isolates of K. pneumoniae using Co-agglutination (Co-A) test; to know the occurrence of beta lactamase genes (bla genes) among the K1, K2, K3 and K4 positive serotypes of K. pneumoniae. The study also tried to assess the reproducibility of Co-A test by comparing the result with PCR. Materials and Methods: A prospective study was carried with a total of 60 consecutive, non-duplicate isolates of K. pneumoniae recovered from various clinical specimens obtained from both outpatients and inpatients between April to December 2017. To determine the occurrence of hvKP by string test, the identification of various serotypes was done by Co-A test and PCR. The determination of beta lactamase genes such as blaTEM, blaSHV and blaCTX-M among the capsular serotypes was done by PCR study. Results: Rate of typability by Co-A was found to be 13(21.67%), 0(0%), 32(53.33%), 7(11.67%) for K1, K2, K3 and K4, respectively. Eight (13.33%) of them remained untypable. The rate of typability among the K. pneumoniae K1 serotype by Co-A test and PCR remained somewhat similar. Conclusion: Co-A test is a good method of serotyping and can be used not only for diagnostic purpose but also for epidemiological study.

Screening for Postpartum Depression in a Neonatal Intensive Care Unit and Postnatal Ward with Its Impact on Newborn Care Practices: A Hospital Based Survey

Introduction: Depression is the fourth leading cause of disability and is estimated to rise to second place by the year 2020. Women of child bearing age are at an increased risk of depression, with an even higher risk seen in postpartum period. Maternal depression adversely effects child’s functioning in cognitive, social, and developmental areas including failure to thrive, and poor physical and emotional/behaviour development. Aim: To find the prevalence and associated factors of Postpartum Depression (PPD) in mothers with hospital deliveries. Materials and Methods: A hospital based cross-sectional study of 14 months duration was conducted recruiting mothers admitted in the postnatal ward, or having their newborn admitted in neonatal intensive care unit or neonatal intermediate care unit. All these mothers were screened for PPD using Gujarati version of Edinburgh Postnatal Depression Scale (EPDS). A separate questionnaire was used for assessing newborn care practices and some more factors that might be associated with PPD. Logistic regression applied for finding contributors for PPD. Results: Two hundred and five mothers with a mean age of 25.6 (SD 4.82, range 17-42 years) participated in the study. A total of 48 had abnormal depression scores (23.4%). Mothers not exclusively breast feeding the children were observed to have 12 times higher odds of getting depression. The odds of depression in mother of a child not covered properly are 24 times more than the mother whose child is well covered with clothes. Conclusion: The findings suggest that depression in mothers is associated with poor maternal infant feeding outcomes and care practices including covering the baby. Screening of mothers in early postpartum period is necessary for betterment of mother-baby unit.

Evaluation of Correlation between Serum Levels of Vitamin D and Coronary Artery Disease: An Existing Debate

Introduction: Coronary Artery Disease (CAD) is the global leading cause of death. Previous studies have been controversial on whether lower serum vitamin D levels could enhance the risk of CAD or its extent. Aim: To evaluate the association between serum vitamin D levels and CAD by using a novel and promising angiographic index the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. Materials and Methods: In the present cross-sectional study, 227 consecutive patients with suspected CAD referred for Coronary Angiography (CAG) were included. The patient’s clinical and demographic data were recorded. Blood sample was taken from each subject to measure serum 25-Hydroxy vitamin D (25(OH)D) concentration at the time of admission. Then CAG was performed and patients were divided according to their degree of CAD. Stenosis more than 50% in at least one main coronary artery was defined as significant CAD. Among the patients with significant CAD, the severity of the disease was assessed using the SYNTAX score. Statistical analyses were performed using chi-square and independent t-test. Analysis of Variance (ANOVA and Spearman’s correlation coefficient (?) and scatter plot were also used to detect the relationship between quantitative variables. Results: The mean serum vitamin D concentration of the participants was 32.1±21 ng/mL. CAG confirmed 150 patients had significant and 77 had non-significant CAD. Mean serum vitamin D concentration was higher among the non-significant CAD group than the other group, but not statistically significant (p=0.94). In patients with significant CAD, the mean SYNTAX score was 11.7±6.8 and mean serum vitamin D was 30.3±12.4 ng/mL. Correlation analysis revealed a weak and not significant inverse correlation (r=-0.037, p=0.67) between serum vitamin D levels and the SYNTAX score. Conclusion: The CAD and its severity may not be associated with serum vitamin D levels. Future large investigations will reveal more detailed results.

Relationship between Demographic Characteristics and Ethical Reasoning of Nurses Working in Medical Wards

Introduction: Professional ethics and moral reasoning are among the critical factors influencing professional nursing practice, the quality of patient care, and the patient’s health outcome. Aim: This study aimed to determine the relationship between demographic characteristics of nurses and their ethical reasoning in the medical wards. Materials and Methods: This was a cross-sectional study with descriptive-analytical approach that was conducted in 2016. The study participants consisted of 180 nurses working in the medical wards of hospitals affiliated to Tabriz university of Medical Sciences. The census sampling method was implemented. Data collection tools included a demographic questionnaire and the Nursing Dilemma Test questionnaire (NDT) designed to measure the ethical reasoning among nurses in pre-conventional, conventional and post-conventional levels. Data were analysed by using SPSS version 21.0 with, one-way ANOVA, t-test and Pearson correlation tests. Results: The results indicated that the mean score for ethical reasoning among nurses in medical wards was 45.7±6.1, where nurses scored 37.5%, 35.08%, and 27.42% for pre-conventional, conventional and post-conventional levels respectively. Researchers found a statistically significant relationship between nurses ethical reasoning and nurses’ shift (p-value <0.05). There were no significant relationships between age, sex, work history and other demographic characteristics, and ethical reasoning scores (p>0.05). Conclusion: Nurse’s ability to accurately identify and manage ethical dilemmas was among the factors that influenced their ethical decision making process. The relationship between nurses’ shift and type of work contributed to the way ethical reasoning was applied. These findings are essential for healthcare administrators to design strategies towards the highest quality nursing care.

Relationship between Disability and Psychopathology Severity in Subjects having Acute Exacerbation of Schizophrenia on Treatment over three Month’s Duration

Praveen Arathil, Podila Satya Venkata Narasimha Sharma

Introduction: Schizophrenia is a disorder which has a chronic course frequently with subjects having significant disability. Understanding what the symptoms during initial period are, which predict level of disability in future would be useful. Aim: To assess the change in disability and its correlation with psychopathology among patients with schizophrenia having acute exacerbation. Materials and Methods: The study was conducted among 40 patients admitted in the hospital for acute exacerbation of schizophrenia. The subject was assessed with Positive and Negative Syndrome Scale (PANSS) for Schizophrenia (for symptom severity), Schedule for Assessment of Psychiatric Disability (SAPD) scale (for disability). Then at the end of three months after first assessment the PANSS, SAPD were re-administered. Paired t-tests for changes in severity of symptoms and Pearson’s correlation of statistics were used to assess relation between symptom severity and disability. Results: Forty patients were enrolled into the study, 3 did not complete the study. The PANSS positive subcategory score showed maximum change (mean=12.054, t=14.214, p<0.01). The SAPD change maximum was for behavioural functioning score (mean=7.783, t=12.337, p<0.01). Change in PANSS score correlation with endpoint SAPD showed total score, change in positive domain score, change in negative domain score had significant negative correlation to all disability domain scores. Conclusion: Improvement in disability in subjects having schizophrenia appears to be significantly related to negative symptoms, excitement symptoms and disorganization symptoms.

Social and Psychological Safety of Adolescents with Intellectual Disabilities in Special and Inclusive Schools of Russia

Introduction: The number of children with disorders of intellectual development in Russia in recent years have increased significantly around five percent. A significant proportion of adolescents with mental retardation (according to parents) are not satisfied with the safety at school and in its territory. Requirements to ensure the social and psychological safety of adolescents with disabilities in school are increasing. Aim: To compare the levels of sociopsychological safety of younger adolescents with mental (intellectual) disabilities enrolled in special boarding school and junior adolescents with mental (intellectual) disabilities enrolled in special classes in mainstream educational schools. Materials and Methods: The study was conducted from 10 January to 20 February, 2017 in Moscow (Russia) on the basis of a special (correctional) boarding school number 102 and college of services number 10. Total 42 of adolescents from special (correctional) boarding school and 38 adolescents from special class of inclusive schools took part in this study. The sampling criterion was the presence of F70-mild mental retardation in the subjects of diagnosis, age 12-14 years. Psychodiagnostic methods included "The scale of subjective well-being" (Perrudet-Badoux, Mendelssohn and Chiche, authors adaptation) and "Hostility questionnaire Bass- Durk" (A. Bass, E. Durk, authors adaptation). Results: Calculation of U-criterion of Mann-Whitney showed that the level of subjective well-being of younger adolescents with intellectual disabilities studying in special school was found to be significantly higher than in younger adolescents with intellectual disabilities enrolled in special classes in regular school (U=35.5, p=0.01). Calculation of U-criterion of Mann-Whitney showed that the level of aggressiveness of younger adolescents with intellectual disabilities studying in special school was significantly lower than in younger adolescents with intellectual disabilities enrolled in special classes in regular school (U=39.5, p=0.01). Conclusion: The state of social and psychological security in terms of optimal subjective well-being, less hostility and aggressiveness is more effectively achieved by adolescents of special (correctional) boarding school compared with a special class of inclusive school. The obtained results indicate the necessity of development and implementation in educational organisations with inclusive education, a comprehensive psychopedagogical support of social and psychological safety of children with developmental disabilities. It must create conditions to facilitate adaptation to the social environment, the development of safe social interactions, decrease aggression and the formation of social tolerance, through training and education.

Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

Anju Verma, Praveen Nalla Mothu, Usha Kalawat, Siva Kumar Vishnubhotla

Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) is a well established treatment modality for End Stage Renal Disease (ESRD) which has advantages in providing mobility and more independence to the patient but at the same time some complication are more commonly associated with it. Fungal Peritonitis (FP) is one of such complications which although rare, is a serious concern with failure of the technique and fatal outcome. Aim: To analyse the incidence, associated risk factors and the outcome of FP in CAPD patients. Materials and Methods: This was a ten year (2008-2017) retrospective study conducted on 180 ESRD patients who were on continuous ambulatory peritoneal dialysis. Case sheets were retrieved from medical record department section and data was analysed. Results: The incidence of FP was 10%, with female’s preponderance (55.5%). The most common fungus isolated was Candida albicans in 61.1% patients (11), followed by Aspergillus niger 22.2% (4), Curvularia lunata 11.1% (2) and Fusarium spp in 5.5% (1) in descending order. On the diagnosis of FP, catheter was removed immediately and the patient was treated appropriately. Re-insertion was done in 22.2% of patients, whereas 33.3% patients were shifted to haemodialysis and 44.4% patients expired. Filamentous fungi were the cause for 75% of the mortality. Conclusion: Candida spp remains the most common cause of FP but filamentous fungi are more commonly associated with fatal outcome.

Mapping the Healthcare Service Quality Domain: A Bibliometric Analysis

Introduction: Quality in healthcare services has become a subject of study, acquiring a special connotation for both individual and collective health services. Aim: To examine the scientific literature on healthcare service quality indexed in SCOPUS between 1994 and 2015. Materials and Methods: A bibliometric study was conducted using the SCOPUS database along with a structured search equation. A total of 256 academic publications were retrieved and analysed for quantity, quality and structure bibliometric indicators. Results: The interest in the present topic has been increasing exponentially during the past years. The year of 2014 was the most productive period, with 34 research papers published. Likewise, it is worth noting that the existing literature has focused on quality and satisfaction-related issues. Conclusion: Studies conducted between 1994 and 2015 aimed to measure the level of satisfaction among the users of healthcare services using the SERVQUAL model, proving its applicability for quality management in healthcare.

Unipolar Austin Moore’s Prosthesis versus Cemented Bipolar Arthroplasty in Displaced Neck of Femur Fracture, in Elderly Patients

Balaji Zacharia, Jojo Inassi, Dhiyaneswaran Subramaniyan, Sandesh Pacha

Introduction: The incidence of hip fracture among the Asian population has been on the rise. Due to higher rate of complications in osteosynthesis, arthroplasty is a preferred treatment. Hemiarthroplasty can be done using uncemented unipolar Austin Moore prosthesis and cemented bipolar arthroplasty. Aim: To assess out the anatomical and functional outcome in elderly patients, treated with unipolar/bipolar prosthesis for displaced fracture neck of femur. Materials and Methods: A prospective comparative study was conducted, involving 48 patients. Elderly patients between 60 and 75 years of age, with displaced fracture neck of femur, were included. 29 patients were operated with Austin Moore Prosthesis (AMP) and 19 with bipolar prosthesis. Results on continuous measurements are presented on mean value (minimum –maximum) and results on categorical measurements are presented in number (%), variables were correlated wherever relevant. The functional hip score was assessed using Harris Hip Score (HHS). The statistical software SPSS 15.0 (Statistical Package for Social Sciences) was used for the analysis of data and Microsoft’s Word and Excel were used to generate tables and figures. Results: The average duration of time for AMP was 44.97 minutes and for bipolar 53.05 minutes. The total blood loss was 263.1 mL (intraoperative) and 319 ml (postoperative) in the AMP group. The blood loss was about 329.37 ml (intraoperative) and 393.15 mL (postoperative) in bipolar group which showed a statistically significant difference. Harris Hip Score was 60.64 and 70.84 for AMP and Bipolar group respectively at final follow up. There was no significant difference in pain score between the two groups. There were three cases of femoral stem subsidence and two cases of acetabular erosion in the AMP group. Conclusion: Cemented bipolar prosthesis is a better choice for displaced fracture neck of femur in the elderly.

To Study the Association between Duration of Sleep and BMI in Young Indian Adults

Shilpa Khullar, Jaswant Singh, Mitasha Singh, Harpreet Kaur

Introduction: Sleep is a physiological function, considered essential for functions like growth, tissue repair, learning and consolidation of memory. It is a significant determinant of various anthropometric parameters besides conventional factors like level of physical activity, dietary habits and genetic composition of an individual. An average adult needs 7-9 hours of sleep/day. Aim: To determine the effect of duration of sleep and level of physical activity on various anthropometric parameters. Materials and Methods: The study was conducted on 408 subjects, divided into two groups, based on their sleep duration: adequate sleep duration (=7 hours/day) and inadequate sleep duration (<7 hours/day). The subjects were also assessed for their day – time sleepiness and level of physical activity using the ESS (Epworth Sleepiness Scale) and GPPAQ (General Practice Physical Activity Questionnaire) respectively. Various anthropometric measurements were done in each of the subjects: weight, height, hip circumference, waist circumference, Waist/ Hip ratio (W/H) ratio and Body Mass Index (BMI). Chi-Square test was used to compare the data between the two groups. Results: There was no statistical difference in the ESS scores when comparison was made between the two groups. Most of the subjects were found to be moderately physically active in both the groups. All the anthropometric parameters except the W/H ratio were found to be higher in those getting inadequate sleep. Conclusion: Participants sleeping for less than 7 hours/day were found to have higher anthropometric parameters in comparison to those getting adequate sleep. Duration of sleep was found to be negatively correlated with most of the parameters, but its significance could only be established for HC and W/H ratio.

Comparative Efficiency of Muscle Energy Technique and Static Stretching in Enhancing Triceps Surae Flexibility

Introduction: Flexibility is termed as resilience and painless extensibility of a joint. The reduced flexibility will lead to decreased performance and results in abnormal coordination of movements. To prevent such damages, there are number of treatments based on stretching that will enhance the functionality of the subject. Flexibility exercises on triceps surae are regularly prescribed as a component of lower extremity rehabilitation programs. Aim: To investigate the difference in the effectiveness of Muscle Energy Technique (MET) and static stretching along with foam roller in increasing the flexibility of triceps surae muscle in male athletes. Materials and Methods: Experimental study with 30 subjects of age between 18-25, divided into 2 groups equally, A and B, treated with muscle energy technique and static stretching along with foam roller respectively. Flexibility of muscles following pre and post training were analysed by Foot and ankle ability measure questionnaire and goniometer. The data analyses were done using student t-Test, with significance level of p <0.001. Results: Foot and Ankle Outcome Measure (FAAM) and goniometer analysis showed a significant difference in triceps surae muscle flexibility between pre and post training of Group A and B and it was clear that there was an increase in the triceps surae muscle flexibility with the use of muscle energy technique with foam roller rather than static stretching with foam roller. Conclusion: It was clear from the experimental study that MET along with foam roller gives better flexibility of triceps surae muscles than static stretching with foam roller exercise.

Are Automated Blood Pressure Apparatus Reliable? Automated versus Manual Measurement of Blood Pressure

Introduction: With hypertension becoming a global burden, it is necessary to validate the Blood Pressure (BP) recordings, used to screen and follow-up patients for hypertension. Since three different devices (mercury manometer, aneroid meter, and digital) are commonly used throughout the world, a study was proposed to compare the recordings of the three devices. Aim: To evaluate the validity of aneroid and digital BP monitors as compared to mercury manometer. Materials and Methods: BP was measured in 240 healthy subjects of both sex (Male=127, Female=113) using mercury manometer, aneroid and digital BP monitor from the same arm consecutively with five minutes interval between each recording. The data were analysed using SPSS 21, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) readings of aneroid and digital monitors were compared with mercury manometer. British Hypertension Society (BHS) protocol, Association for the Advancement of Medical Instrumentation (AAMI) standards and Bland Altman scatter plots were used to validate the aneroid and digital BP monitors. Results: The difference in SBP measured using mercury manometer and aneroid meter was 0.675±7.12 mmHg and mercury manometer and digital monitor was 1.65±11.08 mmHg. The difference in DBP using mercury manometer and aneroid meter was 1.75±6.3 mmHg and mercury manometer and digital was 2.76±8.8 mmHg. While aneroid meter satisfied the AAMI criteria, digital monitor did not. The BHS grade for aneroid meter was C (poor) and digital D (very poor). According to Bland-Altman plot, the bias in SBP for aneroid was minimal with 0.675 (-13.28-14.63), for digital -1.41 (-21.66-18.84) and in DBP for aneroid was 1.75 (-10.6-14.1), for digital was the highest with 2.76 (-14.47-20.01). Conclusion: BP measured using aneroid and digital monitors varied significantly from the mercury manometer and showed higher levels of inaccuracy and hence should be used with caution in clinical setting.

Evaluation of Retinal Thickness in Neurodegenerative Diseases using Spectral Domain Optical Coherence Tomography

Bindu Madhavi Manapragada, Shobha G Pai, Susan D Souza, Madhurima K Nayak

Introduction: Neurodegenerative diseases are characterised by axonal lesions throughout the central nervous system, including the eye with changes in macular thickness and Retinal Nerve Fiber Layer (RNFL) on histopathologic evaluation. Optical coherence tomography facilitates retina as a surrogate measure of neurodegenerative disease activity. Aim: To evaluate macular thickness and retinal nerve fiber layer thickness in patients with neurodegenerative diseases using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: An analytical observational case control study was carried out over a period of two years. Cases consisted of patients (n=20) with neurodegenerative disorders and controls were age and sex matched healthy individuals. RNFL thickness was measured using the SD OCT. The visual functions tested included the Best Corrected Visual Acuity (BCVA) and colour vision. Fundus examination was done to look for any gross retinal pathologies. All these tests were carried out for cases and controls once during the study. Statistical data analysis was performed by using Mann-Whitney U tests. SPSS for windows, version 17.0 was used to do the analysis. p-values smaller than 0.05 were considered significant. Results: The study included 13 cases of central neurodegenerative diseases and 7 cases of peripheral neurodegenerative diseases. Mean duration of disease in cases was 37.85 months with 11 cases having more than 24 months duration and 9 cases having less than 24 months duration. The mean right eye average (RNFL) thickness in cases was 87.05 µm and that of control was 87.40 µm (p=0.932). The mean left eye average retinal nerve fiber layer thickness in cases was 86.47 µm and control was 89.26 µm (p=0.419). The mean macular cube average thickness of right eye was 271.05 µm in cases and 270.85 µm in controls. The mean macular cube average thickness of left eye was 266.63 µm in cases and 269.42 µm in controls. Conclusion: Retinal segmentation techniques extend the utility of OCT to neurodegenerative disorders, enabling the in vivo objective assessment of retinal neurons in addition to axonal integrity.

The Effect of Vitamin D3 on Depression in Iranian Women

Zeinab Mehrabani Far, Mehdi Rahnema, Hussein Qafelehbashi

Introduction: Depression is one of the most common psychiatric illnesses that it associated with a variety of symptoms, high rates of relapse, and many physical and psychological disorders. Aim: To determine the effect of vitamin D3 supplements on depression in women referred to health centres in Qazvin, Iran. Materials and Methods: Overall, 374 patients were evaluated with Beck's depression test. A total of 65 patients were included in the study after they were diagnosed with moderate and severe depression. Individuals with moderate depression were divided into two groups: 1) Cognitive Behavioural Therapy (CBT); and 2) CBT plus vitamin D3 (50,000 units of eight tablets for eight weeks). Subjects with severe depression were divided into two groups: 1) drug therapy; and 2) drug therapy plus vitamin D3. Beck's test and vitamin D3 blood sample measurements were performed before and eight weeks after intervention. Independent sample t-test was used to compare the means of control and intervention groups. Results: Depression scores of patients in post-test stage were significantly lower than depression scores of patients in pre-test stage in all intervention methods (p<0.01). Mean depression score (11.4±2.5) of patients in post-test stage of intervention with CBT plus vitamin D3 was significantly lower than the depression score (14.7±2.7) of patients in post-test stage of intervention with CBT (p<0.05). The difference of mean depression scores in post-test stage of drug therapy (20.4±3.7) and drug therapy plus vitamin D3 (15.8±3.3) intervention methods was significant (p<0.05). Conclusion: The use of vitamin D3 supplements can be helpful in the treatment of depression in women.

Validation of a Rapid Stool Antigen Test for the Diagnosis of Helicobacter pylori Infection in Dyspeptic Patients-A Study from Central Kerala

Suryakala Ravi Nair, Prithi Nair Kannambra, Saji K Sebastian

Introduction: Accurate diagnosis of Helicobacter pylori infection in dyspeptic patients is highly essential to institute eradication therapy and to prevent complications. The introduction of ‘test and treat strategy’ using validated rapid stool antigen tests can significantly reduce the burden of H.pylori infection in developing countries. Aim: To validate a rapid monoclonal immunochromatographic stool antigen test, Epituub® fecal H.pylori antigen test kit for the diagnosis of Helicobacter pylori infection among dyspeptic patients. Materials and Methods: Stool samples were collected for Epituub® fecal H.pylori antigen test from randomly selected patients undergoing upper gastrointestinal endoscopy for the evaluation of dyspepsia. Gastric biopsy samples were also collected for urease test and histopathology. The diagnostic criteria for H.pylori infection was defined as a positive test result for both rapid urease test and histopathology examination. All other combination of the results was considered as negative. The test performance was assessed by determining sensitivity, specificity, positive predictive value and negative predictive value with reference to histopathology examination and rapid urease test. Results: Based on the reference criteria, 31% (35/113) patients were diagnosed as H.pylori infected and 41% (46/113) were rapid stool antigen test positive. The sensitivity, specificity, positive predictive value and negative predictive value of the Epituub® fecal H.pylori antigen test kit were 88.5%, 80.76%, 67.3% and 94.02% respectively. Conclusion: Epituub® fecal H.pylori antigen test can be used as a valid alternative to invasive tests for the diagnosis of H.pylori infection. It is also relatively cheap, fast and easy to perform.

Effect of Residential Yoga Camp on Psychological Fitness of Adolescents: A Cohort Study

Astha Choukse, Amritanshu Ram, HR Nagendra

Introduction: Discovering and promoting ways that improve adolescents’ psychological fitness has been a recurrent concern in the field of health and psychology. Adolescence, as a period of transition, is highly prone to have mental health risks and unhealthy behaviour pattern. Thus, it is the right time to promote healthy practices to prevent problems of health and behaviour in adulthood. As, Yoga provides practical solutions for mental health, we anticipated that exposure to it should improve psychological fitness among adolescent. Aim: To evaluate the effectiveness of short term residential yoga intervention on psychological constructs in adolescents. Materials and Methods: A pre, post-yoga interventional study was carried out in 10 day residential camp. Three independent cohorts of adolescents from India, in three batches (1, 2 and 3), with sample size of 148 (87 boys and 61 girls), 167 (122 boys and 45 girls) and 195 (121 boys and 74 girls), respectively were examined. A holistic integrated yoga module with eight hours of yoga sessions per day was given as an intervention. Emotional Intelligence (EI), emotional regulation strategies, Clinical anger and self-concept parameters were studied using psychometric scales like Schutte Emotional Intelligence Scale (SEIS), Cognitive Emotion Regulation Questionnaire (CERQ-short), Clinical Anger Scale (CAS) and Self-concept Scale respectively. Authorised scales and software were used for assessments and analyses. Results: Significant (p<0.05) improvements in EI, emotional regulation and anger management were observed in all the three batches. However, no significant improvement was found in self-concept in either of the cohort. The observation of the results of assessed outcome measures in all the three batches confirms the positive effect of Yoga intervention on psychological fitness. The pattern of changes was consistent across all three batches. Conclusion: Residential Yoga camp improves the psychological fitness among adolescents. Even short term courses are effective and induce positive behavioural signatures.

Reliability of Beta-Human Chorionic Gonadotropin in Ectopic Pregnancy

Sathya Selvarajan, Jothimalar Ramalingam

Introduction: A fertilized ovum implanting external to the uterine cavity is an Ectopic Pregnancy (EP). It is one of the leading causes of first trimester maternal morbidity and mortality around the globe. Aim: To assess the clinical manifestation, predisposing factors, beta-hCG values and mode of treatment associated with EP in a tertiary care hospital. Materials and Methods: Analysis of patients, admitted with EP to Sri Ramachandra Medical College Hospital for one year, was done. All the data was collected from the case records of 116 patients. Charts were reviewed to determine patient symptoms, gestational age, ultrasound findings, beta-hCG assay values and mode of treatment. Results: Maximum (49.2%) cases belonged to the age group of 26 to 30 years and most of cases (40%) were multiparous. Major risk factor was the usage of assisted reproductive technologies besides having previous bad obstetric histories. Most patients presented with complaints of bleeding per vaginum and/or pain abdomen. Majority of women presented at the 7th week of gestation. There was a weak correlation (0.392) between the weeks of gestation and the beta-hCG values. Major modality of treatment was surgery (56.3%) while the remaining patients were managed medically or conservatively. No mortality was encountered in this series. Conclusion: Women with risk factors like assisted reproductive technologies and bad obstetric history should be screened for EP in their subsequent pregnancies. There is an overlap of values of beta-hCG obtained in EP with normal pregnancy, especially during the 4th and 5th weeks of gestation. Further studies with an increased sample size, from 6th week of gestation onwards, will throw light on this issue.

Role of CSF C-Reactive Protein for Rapid Diagnosis and Differentiation of Different Forms of Meningitis in Children

Nihar Ranjan Mishra, Bijay Kumar Sahoo, Rashmi Ranjan Das

Introduction: Timely diagnosis and prompt initiation of therapy in pyogenic meningitis decreases morbidity and mortality. Measurement of Cerebrospinal Fluid (CSF) C-Reactive Protein (CRP) may help in the early diagnosis of pyogenic meningitis. Aim: To evaluate the usefulness of CSF CRP (by immunoturbidimetric method) in the rapid diagnosis of pyogenic (acute and partially treated meningitis) and to differentiate the same from other forms of meningitis. Materials and Methods: This cross-sectional study was conducted in the department of Paediatrics of a tertiary care teaching hospital from November 2013 to October 2015. CRP in the CSF of suspected meningitis cases was measured by using the immunoturbidimetric method. All data were analysed by using appropriate software (SPSS 24/Microsoft Excel 2016). ANOVA was used for analysis. ROC curves were constructed, and diagnostic odds ratios were calculated. Results: Of 198 cases, 31 were acute bacterial meningitis, 61 were partially treated meningitis, 10 were tubercular, 57 were aseptic, and 39 were without meningitis. A statistically significant difference in the CSF CRP level (mg/dL) between groups was found {F (4,193)=59. 470, p<0.001}. Sensitivity and specificity of CSF CRP for acute bacterial meningitis was 87.1% and 94.87%, respectively; and for partially treated meningitis was 88.52% and 94.84%, respectively. The cut-off value of CSF CRP for both acute bacterial and partially treated meningitis was evaluated as =0.62 mg/dL and =0.55 mg/dL, respectively. Conclusion: CSF CRP measurement seems to be a valid early diagnostic test for pyogenic meningitis. It also helps in differentiating pyogenic from other forms of meningitis. The cut off value of CSF CRP for both acute bacterial and partially treated meningitis was =0.62 mg/dL and =0.55 mg/dL, respectively.

Self-Image and Quality of Life among Head and Neck Cancer Patients

Shalini G. Nayak, Mamatha Shivananda Pai, Linu Sara George

Introduction: Cancers affecting the parts of head and neck hugely impact the patients. Among Head and Neck Cancer (HNC) patients, the visible signs and symptoms of the disease or the side effects of treatment modalities can cause various degrees of functional impairment such as mastication, swallowing and communication or disfigurement. Aim: To study the relationship between self-image and quality of life among head and neck cancer patients. Materials and Methods: This was a descriptive cross sectional survey conducted among 54 head and neck cancer patients. Data were collected through self-administered demographic proforma, disease related proforma, self-image scale and Functional Assessment of Head and Neck Cancer (FACT; H&N). Association between self-image and demographic and disease related variables were assessed by computing Chi-square. Kruskal Wallis was computed to find the association between quality of life and demographic and disease related variables. Results: Majority of patients i.e., 36 out of 54 (66.7 %) were above 50 years, 43 (79.6%) were men, 47 (87%) were married, 46 (85.18%) had the disease duration of less than six months, 43 (79.6%) were receiving both radiation therapy and chemotherapy as a mode of treatment, 49 (90.7%) of them did not have any co-morbidity, 16 (29.6%) had a mode of feeding other than oral (ryles tube and PEG feeding) and six (11.1%) had undergone tracheostomy. There was a significant association between self-image and monthly income, treatment modality and radiotherapy dose with p =0.013, 0.006 and 0.046 respectively. Kruskal Wallis test value for mode of feeding (4.881) was also statistically significant (0.027) with quality of life. There is positive correlation (r=0.613, p=0.001) between self-image and quality of life of head and neck cancer patients. Conclusion: HNC patients suffer with the disease 24 hours a day. Self-image and quality of life of these patients is interrelated. As the self-image improves, the quality of life will be better and vice versa.

Translation, Cross-Cultural Adaptation and Reliability of the Lower Extremity Functional Scale into a Gujarati Version and Validation

Bhoomika Gunvantbhai Brahmbhatt, Megha Sandip Sheth

Introduction: Lower Extremity Functional Scale (LEFS) is one of the most commonly used scales to assess wide range of patients with lower extremity problems. It was originally developed in English and later was translated to many other languages. The LEFS is currently not available in Gujarati language so there is a need to develop a Gujarati version of LEFS which can be used by the Gujarati language speaking population, other researchers and even clinicians throughout Gujarat. Aim: To translate and cross-culturally adapt the LEFS into the Gujarati language and to test the validity and reliability of this version. Materials and Methods: A two-stage observational study was conducted. The LEFS was initially translated to Gujarati language through double forward and backward translation and then it was cross-culturally adapted. The translation and its comparative analysis with the original version was assessed and approved by the experts of the committee formed. The reliability and validity of finalized version of Gujarati LEFS was subsequently completed with the sample size of 10 participants including both the genders for various lower limb conditions. Results: The Gujarati version of the LEFS has high internal consistency (Cronbach’s a=0.809) and test-retest reliability (intraclass correlation coefficient=0.809, 95% CI: 0.58, 0.94). Conclusion: The translation of the LEFS into a Gujarati version was successful in preserving the semantic and measurement properties of the original version and was shown to be valid and reliable in a Gujarati population.

Evaluation of Performance Characteristics of Enzyme Chemiluminescence Immunoassay (ECLIA) and Rapid Diagnostic Test (RDT) for HBV, HIV and HCV Infections

Dipmala Das, Sudipta Roy, Suman Mondal

Introduction: The incidence of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) in India has increased over the past two decades. These infections cause significant mortality and morbidity. This increasing trend is alarming and is emerging as a global health problem. India has one of the largest reservoirs of HIV, HBV and HCV and many of its cases remain undetected. Due to the large sero-prevalence in India, serological tests for HBsAg, anti-HCV and anti-HIV are done for diagnosing the respective diseases, and screening of antenatal, preoperative cases and of blood donors. Aim: To find out the efficacy of Rapid Diagnostic Test (RDT) and Enzyme Chemiluminescence Immunoassay (ECLIA) in comparison to Enzyme Linked Immunosorbent Assay (ELISA) for diagnosis of HBV, HCV and HIV infections in patients. Materials and Methods: This cross-sectional study presented a comparative analysis of test results of HBsAg, anti-HCV and anti-HIV antibodies by different methods namely RDT and ECLIA taking ELISA as reference standard. A total of 198 serum samples were taken from patients and tests were done for HBsAg, anti-HCV and anti-HIV by three different methods i.e. ECLIA, RDT and ELISA and sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy were calculated. The agreement between the results was computed using Kappa coefficient. Results: The findings demonstrated that for HBsAg, the results of RDT and ECLIA were same. For anti-HIV 1 and 2, sensitivity of RDT and ECLIA was similar. For anti-HCV, ECLIA showed better sensitivity than RDT and RDT showed better specificity than ECLIA. Strength of agreement was almost perfect for HBsAg and anti-HIV, where as for anti-HCV it was substantial. Conclusion: There were some variations in certain results by different methods. It was observed that RDT and ECLIA are good screening tests for HIV and HBV infections. On the other hand, we inferred that for HCV, ECLIA is a better screening test than RDT.

Comparative Evaluation of Two Different Doses of Dexmedetomidine for Tympanoplasty under Monitored Anaesthesia Care

Introduction: There are several advantages of performing tympanoplasty under Monitored Anaesthesia Care (MAC) and Dexmedetomidine is a good sedative-analgesic for MAC. Aim: To compare the analgesic and sedative efficacy of two different loading doses of dexmedetomidine for tympanoplasty under MAC. Materials and Methods: After taking ethical committee approval, patients were allocated into two groups of 40 each. Group I and Group II patients received injection dexmedetomidine at a loading dose of 1.0 µg/kg and 0.5 µg/kg respectively over 10 min followed immediately by a continuous infusion of 0.4µg/kg/h. Degree of sedation and pain intensity were assessed using Ramsay Sedation Score (RSS) and Visual Analogue Scale (VAS) respectively. Total rescue doses of Fentanyl and Midazolam as well as surgeon and patient satisfaction scores (Numerical Rating Scale NRS 0-10) were noted. Student t-test, paired t-test and chi-square test were used for statistical analysis. Results: Requirement of higher rescue doses of Fentanyl was more in Group II (100%) as compared to Group I (15.00%) (Z=61.760;p<0.001) and that of Midazolam was also more in Group II (92.50%) as compared to Group I (2.50%) (Z=65.234; p<0.001). Surgeon Satisfaction score was higher in Group I (8.75±0.54) than Group II (6.95±0.50) (Z=7.784;p<0.001). Patient Satisfaction score was also higher in Group I (8.70±0.56) than Group II (6.28±0.60) (Z=7.914;p<0.001).No postoperative complication was seen in any group. Conclusion: A loading dose of 1 µg/kg of dexmedetomidine over 10 min provides better sedation, analgesia, patient satisfaction and surgeon satisfaction than 0.5 µg/kg over 10 min without causing any per-operative problem and seems to be a safe and effective primary sedative technique for tympanoplasty under MAC.

Correlation of Cytological Grading in Lymphocytic Thyroiditis with Thyroid Hormones and Antibodies - A Retrospective Study in the Era of Bethesda System of Thyroid Reporting

Supreetha Megalamane, Hemalatha Anantharamaiah, Shashidhar Nagaraj Kurpad

Introduction: Thyroid disorders are the most common endocrine disorders affecting about 42 million people in India. Among all the disorders, Lymphocytic Thyroiditis (LT) is the second most common thyroid lesion diagnosed on cytology next to goiter. Aim: The present study was done to grade cytological smears of LT and correlate grades with clinical presentation, Thyroid Stimulating Hormone (TSH) and antithyroid antibodies. Materials and Methods: The present study was a retrospective study of 185 cases from June 2014 to June 2016 conducted at Sri Devaraj Urs Medical College and Research centre, Kolar, Karnataka, India. Institutional ethical clearance was obtained before the start of study. Patient’s clinical and demographic details, relevant cytology smears were retrieved and graded based on Bhatia A et al., criteria. Thyroid function tests were done in 98 cases and antithyroid antibody levels values was available in 59 cases. Chi-square test and Pearson’s correlation coefficient were used and p=0.05 was considered as significant for statistical analysis. Results: Female preponderance in the age group of 7-60 years with diffuse thyroid enlargement was the common presentation. Maximum numbers of cases were of cytological grade 2 with euthyroid and hypothyroid status. A p-value was significant for correlation of all cytological grades with TSH values. Combination of Anti Thyroid Peroxidase (ATPO) and TSH together had positive correlation with cytological grade 3. Conclusion: Cytological grading helps in assessing the severity of the disease as it reflects the TSH levels and ATPO levels.

A 12-Week “Silver Yoga” Program Enhances Lung Function in Elderly Women Residents of a Hospice

Meena Ramanathan, Ananda Balayogi Bhavanani

Introduction: “Silver Yoga” program has been devised by Centre for Yoga Therapy, Education and Research (CYTER) of Sri Balaji Vidyapeeth, Pondicherry. Participants practiced the protocol that was specially designed for senior citizens, keeping in mind their health status and physical limitations. Aim: The present study was planned to evaluate possible changes in lung functioning assessed through Pulmonary Function Test (PFT) in senior citizens following 12 weeks of an integrated Silver Yoga programme. Materials and Methods: In this comparative pre-post study, 40 elderly women inmates of the hospice were randomised into two groups of 20 each. Yoga group (Group A) received training in the integrated Silver Yoga programme while control group (Group B) did not receive any yoga training. Both the groups however participated in all the routine activities of the Hospice. Anthropometric data, respiratory rate and lung function parameters were recorded before and after the 12-week study period. Intra-group and inter-group comparisons of pre and post study data were done using Student’s paired and unpaired t-test respectively. A p-value less than 0.05 was considered to indicate significant differences between means. Results: After the 12 weeks of Silver Yoga, both weight and BMI showed significant reduction (p<0.05) in Group A, whereas there was an insignificant increase in Group B. Lung function tests such as FVC, FEV1, PEFR, and FIVC increased significantly (p<0.05) after yoga training, whereas FVC decreased significantly (p<0.05) in the Group B. Group A showed significant decrease in both Respiratory Rate (RR) (p<0.01) and Lung Age (p<0.001) while FEF25-75 increased significantly in both groups. Conclusion: Results of this pilot study give preliminary evidence that incorporation of Yoga as part of senior’s lifestyle can help in promoting health thereby, modifying age related disorders. It is however, limited by the smaller sample size, also limited to a single centre. Further multi-centric studies with larger populations can deepen understanding of intrinsic mechanisms by which these changes are occurring in Silver Yoga.

Prevalence of Gestational Glucose Intolerance and Gestational Diabetes in a Tertiary Care Centre in Northern India

Smriti Agrawal, Vinita Das, Anjoo Agarwal, Amita Pandey, Namrata

Introduction: Many centres in India have adopted a one-step method known as Diabetes in Practice Study Group in India (DIPSI) criterion to diagnose Gestational Diabetes Mellitus (GDM). Prevalence of GDM is increasing and becoming a public health problem in our country. However, data regarding prevalence of Gestational Glucose Intolerance (GGI), which is considered a precursor to developing GDM is lacking. Aim: To determine the prevalence of gestational diabetes and GGI in a Tertiary Care Centre in Northern India. Materials and Methods: All the pregnant women attending antenatal outpatient department at Department of Obstetrics and Gynaecology, KGMU, Lucknow, Uttar Pradesh, India, from January 2016 to December 2016 underwent blood sugar testing 2 hours after taking 75 gm glucose by glucometer irrespective of last meal (DIPSI criterion advocated by Government of India guidelines). Test was done at first prenatal visit and again at 24-28 weeks of gestation, if initially negative. Women were diagnosed with GDM if blood sugar =140 mg/dL and managed accordingly. Women with blood sugar =120-139 mg/dL were diagnosed with GGI. Results: A total of 5855 tests using DIPSI criterion were performed at the centre over one year. Prevalence of GDM was 13.9% (814/5855). Prevalence of women with GGI was 19.8% (1164/5855). Women in last quarter of year (Oct-Dec) had the highest prevalence (279/1285; 21.7%) of GDM. Conclusion: The DIPSI criterion detected high prevalence of GDM and GGI at a tertiary care centre in Northern India. Almost one-third (33.7%) pregnant women attending this centre either had GDM or GGI. Glucose intolerance was seen more often in winter months.

The Relation of Social Happiness and Adjustment with Vandalistic Behaviour of the Children and Young Adults in the Families under Supervision of Welfare Office

Introduction: Vandalism is a new social phenomenon known as a type of sick morale and tendency to destroy intentionally and knowingly, the public properties and installations. Aim: This study was conducted to examine the relation of social happiness and adjustment with vandalistic behaviours of the children and young adults in the families under the supervision of welfare office. Materials and Methods: A descriptive and correlative study was done on 150 children and young adults of the families under the supervision of welfare office in Bandar Lengeh city, Iran.They were selected by census method. The data were collected by vandalistic behaviours questionnaire, Oxford happiness questionnaire, and Bell adjustment inventory. Then, the data were analysed by Pearson statistic and regression tests. Results: The findings indicated that social happiness and the adjustment had a significant and inverse relation with vandalistic behaviours appearance (p-value<0.05). Also, the statistic regression test indicated that the variables: social adjustment (Beta=-0.268) and happiness (Beta=-0.397) predict vandalistic behaviours appearance. Conclusion: Social happiness and adjustment may decrease the vandalistic behaviours appearance in the young people.

Role of Sonourethrogram in Evaluation of Anterior Urethral Stricture and its Correlation with Retrograde Urethrogram and Intraoperative Findings-A Prospective Study

Introduction: Urethral strictures are common in young adult males causing significant morbidity and discomfort. Retrograde Urethrography (RGU) and Sonourethrography (SUG) have been widely used to diagnose and characterise anterior urethral strictures. Aim: To analyse the role of SUG in the evaluation of anterior urethral stricture and its correlation with RGU and intraoperative findings. Materials and Methods: This was a prospective study conducted between August 2012 to July 2014. Male patients aged more than 18 years with confirmed diagnosis of anterior urethral stricture and who underwent RGU and SUG preoperatively were enrolled. Intraoperative stricture length and spongiofibrosis were assessed. Results: A total of 30 patients were enrolled. The mean age was 39 years. The median (IQR) length of urethral stricture was 21 (11) mm, 30.5 (13) mm and 32 (14) mm for RGU, SUG and intraoperative procedure, respectively. The median SUG length correlation was up to 94% when compared with intraoperative method (p<0.001). Conclusion: Results showed that that SUG is a valuable diagnostic technique that provides dynamic and precise assessment of anterior urethral strictures.

Comparison of Continuous Flush with Pulse Flush Technique in Clearing Blood Contamination of Small Bore Intra Vascular Catheter: A Randomized Control Trial

Deepti Thandaveshwara, Vani Krishnamurthy, HV Prajwala

Introduction: Peripheral vascular catheters are mainly used to administer fluids and drugs in the new born. Improper flushing of the catheters after the drug has been given could lead to blood contamination at the hub which thus, becomes a nidus for infection. There is no standard method of flushing the catheter hub. Hence, we have tried two different methods of flushing to know which of them would result in lesser contamination. Aim: To compare the effectiveness of continuous flush technique with pulse flush technique in clearing the blood contaminated peripheral vascular catheter hub. Materials and Methods: The study was a single blind cross over A randomised control study in which health care professionals flushed the catheter that was filled with blood with one ml of normal saline and the flush was discarded. The technique of flushing (continuous or pulse) was as per the random sequence. After a washout period of 30 minutes, the same experiment was repeated with the other technique. The hub residue was obtained in an EDTA vacutainer by flushing 0.2 ml saline and 1 ml of air and analysed by the pathologist for the RBC count. Results: Sixty-four subjects participated in the study and flushed a catheter with the technique that was suggested in the envelope and subsequently another one by the alternative technique. All the samples obtained by both techniques showed RBCs. Minimum and maximum RBC counts with continuous flush was 8000 and 656000/cu mm respectively. Similarly, minimum and maximum RBC counts with pulse flush were 10240 and 928000/cu mm respectively. The difference was not statistically significant with a p-value of 0.412. Conclusion: Our study shows there was no significant difference between the techniques used for flushing the catheter after use with respect to clearing the hub from blood.

Serum 25-hydroxy Vitamin D levels as an Indicator of Bone Mineral Density in Osteoporosis

P Modagan, Santhi Silambanan, Gopinath Menon, P Arunalatha

Introduction: Osteoporosis is a silent disease; the complications of disease are, an increased risk of fractures resulting in major health and economic impact. The 25-hydroxy vitamin D {25(OH) vitamin D} deficiency linked with osteoporosis and has been related to the low Bone Mineral Density (BMD). Aim: The aim was to evaluate the 25(OH) vitamin D status and BMD in osteoporosis and to compare the status of vitamin D and BMD in osteoporosis group with normal control and osteopenia group. Materials and Methods: A total of 90 subjects in the age group between 30 to 90 years of both sexes were included in the study. They were grouped into three, based on DEXA T-score of BMD as Group I -Normal bone mass, Group II-Osteopenia and Group III-Osteoporosis. The anthropometric data were measured and biochemical parameters were analysed for calcium, phosphorus and 25 (OH) vitamin D. One-way ANOVA was used for statistical interpretation. Results: Statistical significant difference was observed in BMD at neck of femur (p<0.001), BMD at lumbar spine (p<0.001), 25(OH) vitamin D (p=0.009) and calcium (p=0.003) when compared between the three groups. In this study the 25(OH) vitamin D deficiency was higher in osteoporosis 19(63.3%) and the insufficiency was higher in osteopenia 13(43.3%) compared with other groups. Conclusion: Decreased BMD performs a central role in the development of osteoporosis. The 25 (OH) vitamin D deficiencies may suggest the interrelation between bone remodeling disturbances in osteoporosis. The study shows that the 25(OH) vitamin D concentrations indicate the bone mineral status and thus the extent of the disease.

A Study on Association of Antioxidant Status of Red Blood Cells with Type 2 Diabetes

Introduction: Oxidative stress plays a role in the pathogenesis of type 2 Diabetes either by effecting insulin secretion or increasing resistance to insulin. Oxidative stress is dealt by the body with the help of several antioxidant systems. The antioxidant levels in disorders causing oxidative stress such as diabetes mellitus are found to be low. Total Antioxidant Capacity (TAC), Superoxide dismutase (SOD) and Glutathione peroxidase (GPx) levels are found to be depleted in diabetic groups when compared to control group comprising healthy individuals. The activities of SOD and GPx are significantly low in diabetic patients. Aim: To determine the total antioxidant capacity and levels of antioxidants such as SOD and GPx in patients with type 2 diabetes and association between antioxidant levels and type 2 diabetics as well as type 2 diabetes and its associated complications. Materials and Methods: The study population comprised of 150 individuals, 50 subjects belonging to each subgroup of type 2 diabetics, type 2 diabetics and its associated complications and healthy subjects. Study was conducted in a tertiary care centre in Mangalore, Karnataka during a study period of September to December 2016. Total antioxidant capacity of RBC, fasting blood levels of SOD and GPx were estimated by phosphomolybdenum method, NBT reduction method and Rotruck method respectively. Results: The results of our study showed that total antioxidant capacity, SOD and GPx were lower among diabetics and diabetic patients with complications as compared to normal non-diabetic subjects. No significant differences in oxidative stress were found between patients with and without chronic complications of diabetes. Conclusion: It is evident from the results of our study that there exists significant deficiency of markers of antioxidant defence in diabetics as well as diabetics with its associated complications. This indicates that there is a scope for antioxidant supplementation in individuals at risk of developing diabetes in general population and diabetic patients at risk of developing its chronic complications.

Validation of Gujarati Translated Version of Stroke Impact Scale

Shraddha Jasmin Diwan, Zarna Ronak Shah, Pranav Bhanubhai Joshi

Introduction: Stroke Impact Scale (SIS) is an outcome measure for assessment of quality of life in post stroke patients. SIS version 3.0 and SIS-16 has been translated by MAPI Research Institute into various languages like Turkish, Spanish etc. The need to translate a questionnaire is apparent if the target population is known to be of different language from source questionnaire. Aim: To validate the Gujarati translation of SIS version 3.0 and SIS 16 for clinical and research work. Materials and Methods: SIS version 3.0 and SIS 16 were translated into Gujarati from English using Forward-Backward-Forward method. To ensure the face and content validity using group consensus method, each item was examined by group of experts having mean experience of 11.78 years in the field of neuro rehabilitation. Each item was analysed for content, meaning, wording, format, ease of administration and scoring. Each item was scored by expert group as either accepted, rejected or accepted with modifications. Procedure was continued until 80% of consensus for all items. Concurrent validity was examined on 26 chronic stroke survivors with mean age 55.23±12.47 (35-74 years) by correlating different domains of SIS with domains of suitable standardized tests. Results: Out of 8 domains and 59 items spread across the domains, 48 items were accepted with >80% consensus in phase 1. Total 9 items were modified in phase 2 as per suggestions given by experts with no change in meaning of original English item. Pearson’s and spearman’s correlation coefficients were used to assess the strength of association between the measures. Moderate positive correlations were found for Memory, Communication, Activities of Daily Living, Mobility and Hand function domains of SIS while weak positive correlation was found for participation and physical domains of SIS 3.0. Conclusion: Gujarati translated version of SIS 3.0 and SIS 16 is a valid tool to be used in clinical practice for quality of life of chronic stroke patients.

Oxidised LDL and Serum Paraoxanase Activity in Ischemic Stroke Patients: A Case Control Study

Poornima Bijumon, Geetha Ananthashenoyi, Thomas Iype

Introduction: Oxidative stress by producing lipid peroxidation products like Oxidised Low Density Lipoprotein (LDL) acts as independent risk factor in ischaemic stroke. When lipid peroxidation overwhelms antioxidative defense mechanism; it results in enhanced formation of oxidized LDL which promotes atherosclerosis. Human serum Paraoxanase (PON 1) which is an ester hydrolase synthesized in the liver prevents the oxidative modification of LDL. Aim: To investigate the level of oxidized LDL as oxidative stress marker and paraoxonase activity as an antioxidant enzyme in ischaemic stroke patients and also the relation between Oxidized-Low Density Lipoprotein (Ox-LDL) level and Computed Tomography (CT) findings in ischaemic stroke patients. Materials and Methods: The subjects in this study comprised of 40 ischaemic stroke patients and 40 age and gender matched controls. Fasting plasma glucose, serum paraoxanase activity, plasma oxidised LDL level, fasting lipid profile were determined. Data was analysed using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Ischaemic stroke patients had significantly lower paraoxanase activity (<53 kU/L), elevated levels of oxidized LDL (>2.26 µg/ml), total cholesterol (>200 mg%) and fasting plasma glucose levels (>126 mg%). Conclusion: Oxidised LDL level >2.26 µg/ml, paraoxanase activity <53 kU/L and FBS >126 mg% were independent risk factors for stroke. Significantly higher levels of oxidized LDL were seen in patients with infarct in anterior circulation. This study implies that raised oxidized LDL level and low serum paraoxanase activity are independent risk factors of ischaemic stroke in patients with no other risk factors.

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

Rachna Sabharwal, Pallavi Mahajan

Introduction: Vitamin D deficiency is considered as one of the most common undiagnosed medical conditions in the world. Studies from India have reported prevalence of vitamin D deficiency varying from 30 to 100%. Among children, vitamin D deficiency can affect skeletal growth and development. A 25-hydroxyvitamin D (25(OH)D) provides single best assessment of vitamin D status as it has a half life of about 3 weeks, making it suitable indicator of vitamin D status. Aim: This cross-sectional study was conducted to find out the prevalence of vitamin D deficiency in healthy children = 15 years of age and their relation with seasonal variation. Materials and Methods: Laboratory data of 25(OH)D was prospectively collected from apparently healthy children aged 7 days to 15 years in the Government Medical College, Jammu, India. Serum vitamin D was analysed by Chemiluminiscent microparticle immunoassay. Serum 25(OH)D level <5 ng/ml was considered severe vitamin D deficiency, 5-10 ng/ml as moderate and 10-20 ng/ml as mild hypovitaminosis. The data was analysed with the help of SPSS version 20. Results: It was observed that out of total 150 children, prevalence of vitamin D deficiency (25-(OH)-D < 15 ng/ml) was present in 76 (50.67%) and insufficiency in 63 (42%) children. Ten children (6.67%) had severe vitamin D deficiency (< 5 ng/ml), 22 (14.67%) children had moderate hypovitaminosis (5-10 ng/ml) and 107 (71.33%) had mild (10-20 ng/ml). Only 11 (7.33%) children had normal levels of serum 25(OH)D (>20 ng/ml). The mean serum 25(OH)D concentrations were significantly lower from October to March (Winter) as compared from April to September(Summer) in children. Conclusion: Vitamin D deficiency was observed among the younger age group. Thus adequate awareness among the masses should be done about the exposure of sunlight, dietary rich sources of vitamin D and fortification of foods with vitamin D for prevention and control of vitamin D deficiency.

Comparison of Parental Satisfaction and Clinical Evaluation of KIDS Strip Crown versus 3M ESPE Crown in Primary Anterior Teeth-An in vivo Study

Divya Subramanyam, Ganesh Jeevanandan

Introduction: Restoration of primary anterior teeth is important to preserve and promote the integrity of primary dentition. Aim: The aim of this study is to assess the parental satisfaction and investigate the clinical success of primary anterior teeth restored with 3M ESPE and KIDS strip crowns. Materials and Methods: This study was performed in primary anterior teeth treated with 3M ESPE and KIDS strip crown. Parental satisfaction concerning the aesthetics of the crowns was evaluated by a preformed questionnaire using Likert scale. The clinical success of the crowns was evaluated at recall appointment after one-month interval by using USPHS criteria for retention, marginal adaptation, surface texture, anatomical form and secondary caries formation. Parental satisfaction was also evaluated after one month. Chi-square test were used to analyse the statistical significant difference between the two groups of restorative materials. Results: The present work studied the overall clinical success for KIDS crown group and 3M ESPE crown group with one month follow-up. There was no statistical significant difference seen between both the groups regarding overall clinical success. (p>0.05) Most of the parents felt that the original colour was highly retained in 3M ESPE crown group compared to KIDS crown group (p<0.05). Conclusion: The parental satisfaction and the overall clinical success for both the groups were found to be similar. KIDS Strip crown can be used as an alternative restorative option to 3M ESPE crown in primary maxillary anterior teeth.

Effect of Hydroalcoholic Extract of Arnebia Euchroma on the Treatment of Cutaneous Leishmaniasis

Introduction: The growing resistance of the Leishmania parasites to the available anti-leishmanial drugs has been reported from different areas of the world, including Iran. Aim: To assess the effect of hydroalcoholic extract of Arnebia euchroma, for treatment of cutaneous leishmaniasis induced by Leishmania major in BALB/c mice. Materials and Methods: Arnebia euchroma extract was provided by medicinal herb garden in Yasuj, in the south of Iran. To facilitate the application of the extract, 5% gel with Arnebia extract and Carboxymethylcellulose (CMC) was prepared. Mice infection was done by subcutaneous inoculation of amastigotes form of Leishmania major. Lesions were developed after about three weeks of inoculating. Mice were divided into four groups, (six mice in each group), where the first group was treated with 5% of the extract and the second group with 5% gel of Arnebia euchroma. The third group was treated by meglumine antimoniate. The negative control group received only normal saline. Treatments was started from the day open lesion were observed and carried out every third day for 21 days. The size of lesion on tail base were measured weekly. Results: Mean sizes of lesions in mice treated with the extract or topical gel were lower than the controls. However, the differences were not statistically significant (p>0.05). Conclusion: Findings of the study showed that Arnebia euchroma extract in doses which have been used in this study (5%) and in comparison with meglumine antimoniate had no considerable effect in treatment or control of cutaneous leishmaniasis.

Road Traffic Injuries among Drivers and Pillion Riders using Two-Wheeler Motorized Vehicle in Western Uttar Pradesh

Urfi, Ali Amir, Salman Khalil, Mohd. Fakhrul Huda

Road Traffic Injuries (RTIs) today is public health and development problem. It is among the leading cause of head injury as well. Motorized Two-Wheeler (MTW) users are at distinguished risk for same. Though these vehicles are mostly driven by males, but females being pillion riders are too at increased risk. To explore the pattern of head injury among MTW users, a hospital based cross-sectional study was planned at Jawaharlal Nehru Medical College and Hospital, Aligarh between August 2010 and July 2011. A total of 340 cases of Road Traffic Accidents (RTAs) with Head Injury aged 15-45 years were included in the study using purposive sampling. There was a marked male preponderance with 261 (76.76%). However, among the pillion riders females outnumbered the males. The most vulnerable age group was 15-24 years. Distribution of scalp and brain injury was similar among the drivers and pillion riders. Most frequent of all scalp injuries was bruise/superficial injury. Severity of head injury and its outcome was similar with no significant difference between drivers and pillion riders.

Role of Salivary Electrolytes in Prevalence of Dental Caries among Diabetic and Non-Diabetic Adults

UK Ambikathanaya, Usha Hegde, Tippeswamy, Mohamad Ayas

Introduction: Diabetes mellitus has been linked with an increased risk of caries, gingivitis and periodontal disease. Dental caries is more prevalent and even more severe in diabetic patients than non-diabetics. The aetiology and pathogenesis of dental caries are known to be multifactorial. The secretion rates and quality of saliva are important not only in caries development but also for remineralisation. As there is an alteration of the salivary constituents in diabetic patients its constituents has gained much importance as a diagnostic and therapeutic tool. Various factors that regulate the caries activity balance are the pH of saliva and concentration of various ions including free calcium, phosphate, sodium, chloride, potassium and fluoride ions in the saliva. Aim: To investigate the association of salivary electrolyte concentration with dental caries among diabetic and non-diabetic individuals, of different age groups. Materials and Methods: Ninety-six Patients were evaluated for the study in which forty eight were considered for control and forty eight for diabetic, in which these control group and diabetic group were further subdivided into young adults (20-39 yrs) and old age adults (40-64 yrs) with twenty four patients each. Young adult age group and adult age group had sub groups with caries and without caries group having twelve patients each respectively. Saliva was collected from the individuals, centrifuged and the supernatant obtained was assessed for the salivary electrolytes: sodium, potassium, calcium, phosphorous and chloride levels using an Erba autoanalyser. The results obtained were tabulated, statistically analysed using Independent sample t-test and conclusions drawn. Results: The salivary electrolytes– sodium, potassium, calcium, and phosphorous showed a significant decrease in caries active diabetic patients of young adult group. But in the older adult group K and Cl levels were statistically higher in caries active patients. Potassium & Phosphorous were statistically higher in young adult age group (Diabetic and Non diabetic) without caries and Potassium only in adult age group. Conclusion: Salivary electrolyte plays a significant role in prevalence of dental caries in young diabetic individuals when compared to non-diabetic individuals and old age adults with and without diabetics. Therefore, maintaining the salivary electrolyte concentration in young diabetic individuals helps in remineralisation of the tooth which prevents decay.

Assessment of Glycaemic Status of Physicians in a Diabetes Conference in India

Prabhat Kumar Agrawal, Vivek Kumar Verma, Sudhir Kumar Yadav, Dheeraj Kela

Introduction: Diabetes is taking the form of a pandemic. All ages and all sections of society are affected by it and physicians are no exception to it. Aim: To know the glycaemic status and level of glycaemic control among the physicians who were attending a National Diabetes Conference. Materials and Methods: A cross-sectional study was conducted at a national conference “Diabetes India” held in Delhi in February 2017. Physicians and Endocrinologists were the delegates. All physicians willing for assessment of their Glycaemic status were included and HbA1C was done. Data was analysed and mean, percentage and p-value were calculated. Results: Out of 108 physicians, 3 (2.78%) had impaired glucose tolerance, 54 (50%) had diabetes mellitus and 51 (47.22%) were euglycaemic. Out of 51 physicians, only 3 physicians (5.88%) had HbA1C less than or equal to 5.6, 9 (17.65%) had HbA1C more than 6.5, 39 (76.47%) had impaired glucose tolerance. Conclusion: Very high incidence of diabetes mellitus and impaired glucose tolerance was found among physicians and endocrinologist in this study and the alarming result warrants further research with more participants.

Effect of Thyroid Peroxidase Antibody on Pregnancy Outcome among Hypothyroid Women

Shashikala Bhat, AP Ashwini, AP Suma, Shashikiran Umakanth

Introduction: Thyroid disorders are among the most common endocrine disorders affecting pregnant women. About 2 to 3% of pregnant women are affected by subclinical hypothyroidism and about 0.3%-0.5% by overt hypothyroidism. Thyroid autoantibodies are found in 5-15% of women in childbearing age and have been associated with adverse pregnancy outcomes. Aim: To compare the pregnancy outcomes in thyroid peroxidase antibody positive and thyroid peroxidase antibody negative hypothyroid women. Materials and Methods: This was a retrospective study done in Dr TMA Pai Hospital, Udupi, Karnataka, India from January 2015 to December 2016. All singleton pregnant women with hypothyroidism were included and multiple pregnancy, pre-existing hypertensive or diabetic pregnancies were excluded. Serum Thyroid Stimulating Hormone (TSH) levels were estimated during booking visit for all pregnant women and if >2.5µIU/ml, free T3, T4, and Thyroid Peroxidase Antibody (TPO-Ab) levels were done. Data were retrieved from the hospital records and divided into TPO-Ab negative and TPO-Ab positive groups. The analysis was done using SAS v9.3. Chi-square test and Fisher-Exact test were used for testing equality of proportions. The p-value <0.05 was taken as significant. Results: 2385 antenatal women screened with TSH during the booking visit in study period, 169 (7.08%) were hypothyroid. 100 were TPO-Ab negative and 69 were TPO-Ab positive with 40.8% prevalence of TPO-Ab positivity among the hypothyroid pregnant women. The initial TSH and the average Levothyroxine requirement was 37% (p-value 0.206) and 16% (p-value 0.388) higher in the TPO-Ab positive group than in TPO-Ab negative group. Though the odds for having miscarriage was 2.36 (0.94,5.92), gestational hypertension was 2.71 (0.76, 9.69) and gestational diabetes was 2.88 (0.92,9.03) times higher in the TPO-Ab positive group as compared to TPO-Ab negative group, the p-value for miscarriage was 0.061, gestational hypertension was 0.125 and that for gestational diabetes was 0.062 and hence, statistically not significant. However, there was no difference in the preterm delivery rate in our study. Conclusion: Presence of thyroid peroxidase antibodies may slightly increase the risk of miscarriage, gestational hypertension and gestational diabetes mellitus in pregnancy in the Indian population.

Clinical Profile, Neuroimaging Features and Aetiology of Cerebral Venous Thrombosis in a Tertiary Care Centre in Southern India

Joe James, Sajeeth Kumar Keeriyatt Govindan, James Jose

Introduction: Cerebral Venous Thrombosis (CVT) refers to thrombus formation within the venous sinuses draining the brain and represents 0.5% to 3% of all stroke types. The clinical presentation and aetiology varies widely among different populations. A systematic study of CVT is lacking from Kerala. Aim: To study the clinical profile, neuroimaging features and the aetiology of CVT presenting to a tertiary care teaching centre in northern Kerala. Materials and Methods: During the one-year study period (June 2015 to June 2016), consecutive cases admitted to the departments of Internal medicine and Neurology, Government Medical College Kozhikode, Kerala, who had CVT on Magnetic Resonance Venography (MRV) were included in the study. A detailed history, physical and neurological examination and aetiological work up was done in all cases. Results: Of the total 35 cases included in the study, 21 (60%) were females and 14 (40%) were males. The mean age of onset was 32.7±15.5 years. The common presenting features were headache in 28 (80%), vomiting 15 (42.9%), generalised seizures 12 (34.3%), visual abnormality 11 (31.43%) and altered sensorium 9 (25.7%). Focal neurological deficits were seen in 10 patients (28.6%). Computed Tomography (CT) brain was done in 27 patients and was abnormal in 24 (88.9%). Superior sagittal sinus 24 (68.6%) and transverse sinus 14 (40%) were the common sinuses involved. The most common aetiology was polycythemia 5 (14.3%) and drugs 5 (14.3%) followed by thrombophilia 4 (11.4%). Conclusion: CVT presents with a wide variety of symptoms and hence diagnosis requires a strong clinical suspicion. Neurogenic fever, previously unreported in CVT, was present in some cases. Superior sagittal sinus was the most common sinus involved. Polycythemia, drugs and inherited thrombophilia were the common risk factors.

Efficacy and Adverse Effects of Topical Latanoprost with Respect to Preservative in Patients of POAG

Gyanendra Kumar, Rakesh C Chaurasia, SP Singh

Introduction: Primary open angle glaucoma (POAG) is the most common form of Glaucoma and elevated IOP is one of the leading risk factor. It is shown that reduction in IOP slows the disease progression. Prostaglandin analogues (PGAs) demonstrated points of interest over other restorative medications and are presently the initial medication of choice. PGAs are dispensed in multi-dose bottles that contain preservative to guarantee sterility. Benzalkonium chloride (BAK, quaternary ammonium compound) is the most generally utilized preservative in ophthalmic solutions. Unfriendly Ocular impacts may occur due to regular use of these BAK containing ophthalmic preparations. Aim: To evaluate and compare the effect of benzalkonium chloride (BAK) containing and benzalkonium chloride free latanoprost ophthalmic solution on ocular surface in patients with primary open angle glaucoma. Materials and Methods: Forty six newly diagnosed POAG patients were included in this prospective study. Patients were randomly divided in two groups. Patients in Group1 (n=23) were treated with BAK preserved latanoprost 0.005% and patients in Group2 (n=23) were treated with BAK free latanoprost 0.005%. Intraocular pressure (IOP), hyperemia score and Tear Break Up Time (TBUT) were assessed at baseline, week 4 and 3 month after starting treatment by using the paired t-test (for intra-group comparison) and unpaired t-test (for inter-group comparison). Results: IOP decreased in all patients from baseline to 3 month final visit (26.25±2.69 mmHg versus 16.97±1.88 mmHg; p<0.0001 for Group 1 and 25.36±1.93 mmHg versus 17.26 ±1.83 mmHg; p<0.0001 for Group 2). Hyperemia score for group1was increased (0.39±0.48 vs 0.68±0.15; p<0.012) at week 2 and statistically remained same for group 2 (0.41±0.49 vs 0.45±0.38; p=0.747) at week 2. Mean TBUT decreased from 12.00±2.22 seconds at baseline to 8.02±1.81 seconds at 3 month final visit (p<0.0001) for Group1. Mean TBUT decreased from 11.91±2.10 seconds at baseline to 11.63±1.79 seconds at 3 month final visit (p=0.192) for Group2. Conclusion: This study showed that BAK preserved latanoprost 0.005% and BAK free are effective medication in newly diagnosed POAG patients. Long term use of BAK containing latanoprost may negatively influence ocular surface health.

Study of Awareness of Patients’ Rights among Undergraduate Medical Students

Ramnika Aggarwal, Sumita Sethi, Renu Garg, Rajesh Kumar

Introduction: Patients’ rights are those owed to the patient as a human being, by physicians and by the state. Patients’ rights are influenced by country related and social factors of the area and thus vary in different countries. Medical students have important roles in helping patients to understand their health care rights, contributing to a safe and high quality health care system. Aim: To study the awareness of patients’ rights among under-graduate students in a government medical college. The goal was to sensitise the students about the importance of these rights in clinical practice and in research. Materials and Methods: Based on literature search of previous research studies and guidelines by Medical Council of India, a pre-structured questionnaire with 12 questions about patients’ rights was developed. Students studying in first, second and third professionals were asked to respond to this questionnaire on a three-point Likert scale– agree, neither agree nor disagree and disagree. The analysis included frequency table, percentages and association of variables based on Chi-square test. Yates’ corrections were used for 2x2 contingency table or method pooling and Fisher exact test was used (for higher order than 2x2 table). All statistical tests were seen at two-tailed level of significance (p =0.01 and p=0.05). Results: A total of 339(84.75%) out of 400 students participated; 337 (99.4%) of students agreed that health care is a right; the least agreed upon statement 277(81.7%) was that the patients has right to know about his doctor’s qualifications. The difference in the responses of the junior (first and second professional) and senior (final professional part I and II) students was found to be statistically significant in four statements; right to be told all the facts about his illness, right to agree or refuse to participate in research activities, right to address his grievances to respective medical councils courts, right towards his privacy while examination, irrespective of age and sex. Conclusion: Students at our institute had a fair but not adequate understanding of patients’ rights; more of senior students in comparison to junior students were in disagreement to certain patients’ rights. Incorporating more information on patients’ rights in undergraduate curriculum would enhance the quality of medical graduation as it will help curb the unethical practices in our profession.

Correlation between Chronic Obstructive Pulmonary Disease and Cardiovascular Abnormality: A Cross-sectional Study

Introduction:Cardiovascular manifestation is one of the common co-morbidity and also the complication of Chronic Obstructive Pulmonary Disease (COPD). Electrocardiography and echocardiography are rapid, non-invasive and accurate methods of investigation, to evaluate the cardiac changes. Aim: To evaluate the cardiovascular changes in COPD patients and its correction with the severity of COPD. Materials and Methods: In the present cross-sectional observational study, we analysed the cardiovascular abnormalities in COPD patients at Veer Surendra Sai Medical College, Burla, Odisha, India, from September 2014 to August 2016. Based on medical history, clinical examination and spirometry, stable COPD patients were included in the study. X-ray chest, electrocardiography, echocardiography was done for all patients. Collected data were analysed like continuous variables as mean and categorical variables as proportion. Chi-square test, fisher’s-exact test, kruskal-Wallis test were used as per applicability. Results: Out of 80 COPD patients, on the basis of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, there were two (2.5%) patients in Stage I, 34(42.5%) patients in Stage II, 28 (35%) in Stage III and 16(20%) in Stage IV. ECG changes like; P pulmonale, right axis deviation, right ventricular hypertrophy and low voltage QRS were seen more in GOLD stage IV COPD group than the GOLD III group. Echocardiography finding like; right ventricular dilatation, Left Ventricular Hypertrophy (LVH), Left Ventricular diastolic dysfunction and Pulmonary Hypertension was seen more in GOLD Stage IV than Stage III. Left Ventricular systolic dysfunction was seen in 10% of study group and exclusively in GOLD Stage IV group. Conclusion: Right ventricular pathology is common in severe forms of COPD. Left ventricular pathology is seen in GOLD stage IV COPD. The frequency as well as the severity of Pulmonary Hypertension increases as the severity of COPD increases.

Aortic Knob Width as an Indicator of Cardiovascular Risk in Chronic Kidney Disease Patients

Jerin J Ovett, Ajay N Bhat, Venkatraya Prabhu

Introduction: The most common cause of mortality in Chronic Kidney Disease (CKD) patients is due to cardiovascular events. The Aortic Knob Width (AKW) has been found to positively correlate with the severity of coronary artery disease. This study describes the use of chest x-ray in evaluating CKD population who are at risk for cardiovascular events. Aim: To measure the Aortic Knob Width (AKW) by chest x-ray in CKD patients and compare Aortic knob width with Framinghams’ risk score and other parameters like urea, creatinine, magnesium, calcium, phosphate, albumin, haemoglobin and C-reactive protein Materials and Methods: A cross sectional study was done between September 2015 and September 2017 in 60 patients belonging to stage 3 to stage 5 CKD. The aortic knob width as measured using chest x-ray was compared with the Framingham’s risk score and other lab parameters like urea, creatinine, magnesium, calcium, phosphate, albumin, haemoglobin and C-reactive protein routinely measured in CKD patients. Statistical package SPSS version 17.0 was used. p<0.05 was considered as significant and Receiver Operating Characteristic(ROC) curves were used to arrive at a cut-off for AKW which correlated with increased cardiovascular risk. Results: The mean AKW was 3.2±0.43 cm. The AKW had a significant positive correlation with Framingham’s 10-year cardiovascular risk scoring (p<0.0001). Using the Receiver Operating Characteristic (ROC) curve, we found that AKW more than 3.1 centimetres corresponds with moderate to high risk as calculated using Framingham’s scoring system with a sensitivity of 82% and specificity of 86%. Karl Pearson’s correlation test showed no significant correlation between AKW and Duration of disease as well as various parameters like urea, creatinine, magnesium, calcium, phosphate, albumin, haemoglobin and C-reactive protein. Conclusion: The findings of the study allow us to use chest x-ray as a screening tool in CKD patients who are at increased risk of adverse cardiovascular events.

Vaccine Therapy in Chronic Hepatitis B Carriers: A Randomised Double-Blind Controlled Trial

Introduction: Chronic carriers of Hepatitis B Virus (HBV) are persistent sources of the virus and may transmit HBV to healthy individuals. Aim: This study was conducted to assess therapeutic effects of HBV vaccine on Chronic HBV Carriers (CHC). Methods and Materials: This clinical trial was conducted on CHCs aged 20-65 years, randomly allocated into four groups. Group 1 (control) did not receive vaccine. Group 2, 3 and 4 (vaccine groups) received different doses of HBV vaccine. HBV viral load (IU/mL) was assessed at baseline and two months after the last dose of HBV vaccine. Reduction or elimination of HBV viral load was considered as positive response. Absolute Response Rates (ARR) was calculated for each group. Subgroup analysis was done on subjects with baseline viral load of <100,000 and negative HBeAb. Relative Response Rates (RRR) was defined as ARR in vaccine group divided by that of control. RRRs were calculated for total participants (overall RRR) and the above-mentioned subgroup of subjects (subgroup RRR). Results: In total, 97 CHCs were recruited. No adverse reaction was reported. There was no significant difference in ARRs between study groups (p-value=0.09). An overall RRR of 0.78 and a subgroup RRR of 1.18 has been reported. A 50% increase was found in the RRR in subgroups of subjects with baseline viral load of <100,000 and negative HBeAb compared to the overall RRR. Conclusion: It may be worth future studies to assess the therapeutic effects of HBV vaccine.

Versatility of Transconjunctival Approach in Maxillofacial Trauma-A Prospective Study and Review of Literature

Introduction: Maxillofacial injuries are multiple and complex type of injuries which require multi-specialty management. Maxillofacial trauma can involve the skin, soft tissues, as well as bones resulting in single or multiple fractures. As a result of maxillofacial trauma that leads to disfigurement of the involved areas, patients experience temporary or long-term psychological issues. Aim: The objective of this study was to evaluate the advantages and disadvantages of transconjunctival approach in management of Zygomatico Orbito Maxillary Complex (ZOMC) fractures. Materials and Methods: A total of 160 cases of ZOMC fractures were treated from April 2009 to March 2010, in which 37.5% of them had orbital trauma and needed surgery based upon the bony displacement. A total of 10 patients who had sustained zygomatic maxillary complex and orbital fractures were included in this study with follow-up period of 3 years. Post-operative evaluation in the form of assessment of wound healing, functional stability, aesthetic appearance, and associated ocular complications, ectropion, entropion, granuloma formation, canthal displacement, epiphora, diplopia, and infection were evaluated in this study. Results: Mean age of patients was 31.5 years; Mean time of exposure was 20.6 minutes and intra-operative complication was seen in 20% of the cases. In all cases post-operative aesthetic results were satisfactory and good. Acceptable minimal scar was seen in 2 cases (20%) with lateral canthal incision. Conclusion: The transconjunctival incision offers a simple alternative for orbital floor and infraorbital rim fracture, without post-operative complications. This study shows that there were no disadvantages to transconjunctival retro-septal approach, if performed meticulously by an experienced surgeon with sound knowledge of the anatomy of periorbital tissues.

Impact of Long versus Short Duration Diabetes on Sensory Nerve Conduction Velocity in Type 2 Diabetes Mellitus

Introduction: Diabetes is a metabolic disorder with debilitating complications which affects several million people worldwide. Neuropathy is the most common chronic complication of Type 2 Diabetes Mellitus (T2DM). Diagnosing peripheral neuropathy at subclinical stage and knowing the effect of duration of diabetes in it is important. Study of Sensory Nerve Conduction Velocity (SNCV) can help us to diagnose this problem at an early stage. Aim: To determine the correlation of duration of diabetes with SNCV of Median, Ulnar, Superficial Peroneal and Sural nerves. Materials and Methods: The present cross-sectional study was conducted in Department of Physiology, in collaboration with Rajeev Gandhi Centre for Diabetes and Endocrinology on patients of T2DM attending Diabetes clinic in Jawaharlal Nehru Medical College and Hospital (JNMCH) from 2014 to 2016 after approval from the Ethical Committee of JNMC. A total of 90 subjects were taken; among them 60 subjects were diagnosed cases T2DM, which were further divided in two groups on the basis of duration of diabetes. Rest 30 subjects were non-diabetic control group. SNCV study was done for assessing peripheral neuropathy. Statistical analysis was performed using SPSS version 21.0. One way ANOVA with Post-Hoc Tukey test were used for comparison of means between three groups. The association between continuous variables was tested by linear correlation using Pearson’s coefficient. Results: In shorter duration of diabetes (3.31±1.72 years T2DM), significant (p<0.05) negative correlation was seen between duration of diabetes and SNCV of Median, Superficial Peroneal and Sural nerves, while in longer duration of Diabetes (12±4.42 years T2DM), there was significant (p<0.05) negative correlation between duration of diabetes and SNCV of all four nerves; namely Median, Ulnar, Superficial Peroneal and Sural. Conclusion: Chronic hyperglycaemia in diabetes leads to the degeneration and damage of peripheral nerves.

Decompressive Hemicraniectomy versus Intensive Medical Management in Patients with Malignant Middle Cerebral Artery Infarction

Madhavarao Veeramalla, Bhuma Vengamma, Dusyanth Babu Jasti

Introduction: Decompressive Hemicraniectomy (DHC) is a surgical technique which involves the removal of some part of skull to relieve the raised intracranial pressure, in setting of large cerebral mass effect. Some of the recent randomised clinical trials in western world have well established the role of ‘DHC’ in malignant Middle Cerebral Artery Infarction (mMCAI) to reduce death risk. However, Indian data regarding the same is scarce. Aim: The present study aimed to compare the outcomes of ‘DHC’ and best medical management in mMCAI. Materials and Methods: This study was a prospective, non-randomised intervention study conducted at the Neurology department of ‘Sri Venkateswara Institute of Medical Sciences’, Tirupati from November 2015 to October 2016. The study comprised of 60 patients having mMCAI out of which 20 underwent surgery and 40 received the best medical management alone. DHC was performed within 48 hours of the stroke onset. Both the groups were followed-up for six months and observed for difference in mortality and disability using modified Rankin Score (mRS). Good functional outcome was defined as mRS=3. Split data analysis was performed for patients with age =60 and >60 years. Results: Cumulative death rate at the end of six months in medical and surgical group was 55% and 30% respectively, with a non-significant Absolute Risk Reduction (ARR) of 25% with surgery. Subgroup analysis revealed a significant mortality reduction at six months with surgery in patients with age =60 years (14% vs 68%, p=0.004). On the contrary, patients older than 60 years who underwent surgery had a non-significantly higher death rate at six months (67% vs 39%). Good functional outcome as defined by mRS=3 at six months was more frequent in surgery group (6/20, 30%) as compared with medical management group (10/40, 25%). This difference was not statistically significant. Conclusion: DHC in mMCAI is life-saving in Indian patients with age =60 years, per contra, may increase the chances of death in patients older than 60 years.

Effect of Yoga on Cardio-Respiratory Health Markers: Physical Fitness Index and Maximum Oxygen Consumption (VO2 Max)

Vishnu D Udhan, Sharadchandra G Wankhede, Sangita R Phatale

Introduction: Sedentary lifestyle is one of the major Cardio-vascular risk factor. Although, yoga is used as a mind-body exercise to increase physical fitness, data on effectiveness of long-term training of yoga on cardio-respiratory fitness in healthy adults is least available. Aim: To find out the effect of Yoga practice on Physical Fitness Index (PFI) and Maximum Oxygen Consumption (VO2 max) in healthy adults. Materials and Methods: A pre-post interventional study was conducted on 200 (120 male and 80 female) healthy subjects. An intervention of Yoga (Asanas, Pranayama and Meditation) for six months (one hour per day, six days per week) was given. Weight, Body Mass Index (BMI), Basal Metabolic Rate (BMR), Physical Fitness Index (PFI) and VO2 max were determined. PFI and VO2 max were determined by using modified Harvard Step Test (HST) and modified Queen’s College Step Test (QST), respectively. Data was collected at baseline and after six months of yoga training. Collected result data was analysed by using paired t-test. Results: Yoga practice for six months caused significant reduction in weight and BMI (p<0.0001) and significant increase in BMR (p=0.005), PFI (p<0.0001) and VO2 max (p<0.0001). Conclusion: The findings of this study suggest that yoga is an effective mind-body modality to enhance cardio-respiratory fitness and reduce adiposity in healthy adults.

Diagnostic Accuracy and Reliability of Sonographic Evaluation in Overhead Athletes with Shoulder Impingement Syndrome

Saurabh Sharma, M Ejaz Hussain, Abhinav Jain, Jamal Ali Moiz

Introduction: Real Time Ultrasound (RTUS) is a suggested mean to assess and measure Acromiohumeral Distance (AHD), however due to limited researches, conclusive evidence of its use in overhead athletes with Shoulder Impingement Syndrome (SIS) is lacking. Aim: To determine intra-rater reliability, diagnostic property, relationship of isometric shoulder external rotation with AHD and variation in AHD at varied shoulder angles. Materials and Methods: In this case-control test-retest observational study, the total number of participants were 26. The participants were divided into three groups i.e., healthy individuals group, healthy athlete group and SIS athlete group as per their presenting features. The mean age of the athlete group was 22.15±2 years and the normal individual had a mean age of 21.9±1.5 years. They were tested for intra-rater test retest reliability at 0°, 45° and 60° shoulder abduction in SIS group, cut-off point AHD was determined for athletic groups and finally relationship of AHD and isometric shoulder External Rotation (ER) along with AHD differences was examined on dominant side across three groups. The test retest reliability measurement was measured using kappa statistics. One-way ANOVA was used to compare the three group differences. ROC analysis was used to estimate the sensitivity and specificity. Results: Intra class coefficient (ICC 2,1) score ranged from 0.96-0.97 (standard error of measurement=0.30-0.35 mm and minimum detectable change with 95% confidence=0.83-0.98 mm) for intra-rater reliability. ROC curve of dominant side concluded Area Under the Curve (AUC) to be 0.975 (p<0.001). The cut-off on dominant side of the athletic groups was reported to be 10.20 mm (sensitivity 0.90, p<0.001). Positive strong correlation were found between AHD and isometric ER strength on dominant side (r=0.924, p<0.05). Finally, at 0°, 45°and 60° dominant shoulder abduction revealed that acromiohumeral distance in SIS athletes were significantly different from other two groups (p<0.05). Conclusion: RTUS measurement of AHD has excellent test retest reliability, diagnostic accuracy and AHD and isometric external rotation are correlated in overhead athletes with SIS.

Effect of Subgingival Irrigation with Natural Products as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis- A Systematic Review

Sudharsana Anandakumar, Sankari Malaiappan

Introduction: Various chemotherapeutic agents such as ‘Chlorhexidine’ (CHX), ‘Metronidazole’, ‘Povidone-iodine’ are used as a subgingival irrigant for management of periodontitis, but they have their own drawbacks. There has been renewed interest in naturally occurring products such as ‘Curcumin’, ‘Honeybee extract’ etc., which claim to have the same or even more anti-microbial effect and anti-inflammatory effect without adding any chemicals. Aim: To systematically review the role of subgingival irrigation of natural products as an adjunct to scaling and root planing in chronic periodontitis based on clinical and microbiological outcomes. Materials and Methods: A Search was performed on electronic databases, such as PUBMED, Cochrane central register of controlled trials, Google scholar and Science, direct using various search terms such as “Sub gingival irrigation”, “Natural products”, “Plant products”, “Herbal products”, “Non-surgical therapy”, “Scaling and root planing”. Literature search of articles was done from October 2006 to October 2016. No language restrictions were applied during the electronic search to include all the possible clinical trials. The article search was then narrowed down by the reviewer according to the inclusion criteria of the present systematic review to include all the RCTs in English language only and the article involving management of chronic periodontitis by using natural products for subgingival irrigation. Additional search was also carried out in all relevant journals from October 2006 to October 2016. Results: The literature search resulted in 91 articles out of which 87 articles were excluded based on title, in-vitro studies, chemical plaque control used during the study period, studies in which control group was not present. Finally, four studies which satisfied all the inclusion criteria were included and evaluated. Out of four studies, there was lack of homogeneity among the studies, hence pooling of data was not possible. Three studies showed significant difference in clinical parameters on using natural products as subgingival irrigant. Conclusion: Based on the results obtained from present systematic review it can be concluded that natural products when used as a subgingival irrigant along with scaling and root planing in management of chronic periodontitis, there is significant reduction in microbial count (found in three studies) and a significant difference in clinical parameters (found in two studies). But further studies evaluating various other natural products and long term randomised control trial are needed to give strong conclusive evidence.

Elevated MDA Level Correlates with Insulin Resistance in Prediabetes

Kaushik Kar, Agnihotri Bhattacharyya, Baishakhi Paria

Introduction: Various metabolic changes in obesity may increase oxidative stress, which if persists continuously may predispose to insulin resistance and diabetes mellitus. Oxidative stress will generate Reactive Oxygen species (ROS) which affects proteins, lipids, carbohydrates and cell membrane. Malon-Di-Aldehyde (MDA) is a lipid peroxidation product found to be elevated in diabetes. Measurement and reduction of oxidative stress in prediabetes may prevent the grave consequences of diabetes. Aim: The present study was aimed at evaluating MDA levels in prediabetics and diabetics and correlating it with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) of the same subjects. Materials and Methods: Plasma MDA and serum insulin were measured in 96 prediabetics and 101 diabetics selected for study and their Body Mass Index (BMI) was calculated. Prediabetic and diabetic patients were divided into two groups, one with BMI>25 kg/m2, and other with BMI<25 kg/m2. Serum MDA was analysed by Thiobarbituric Acid Reactive Substances (TBARS) method. Serum insulin was analysed by Enzyme Linked Immunosorbent Assay (ELISA). HOMA-IR was evaluated from fasting plasma glucose and serum insulin levels. Results: Insulin resistance was significantly increased in prediabetic (p=0.02) and diabetic (p<0.0001) patients when BMI was >25 kg/m2. Statistically significant positive correlation was observed between MDA and insulin resistance in prediabetic group (p<0.0001). Conclusion: Findings indicated that raised MDA level correlates with insulin resistance in obese prediabetic patients.

Evaluation of Immunological and Molecular Methods for Rapid Diagnosis of Herpes Simplex Type-1 Encephalitis

Introduction: Herpes Simplex Encephalitis (HSE) is an acute or subacute illness that causes both general and focal signs of cerebral dysfunction. There are no pathognomonic clinical findings associated with HSE and the exact incidence of the disease is difficult to estimate since only severe cases report to hospital. Rapid diagnosis of Herpes simplex virus related infections of CNS is required to initiate antiviral therapy and thereby, reducing the morbidity and mortality associated with the disease. Aim: To evaluate molecular and immunological methods for rapid diagnosis of HSE. Materials and Methods: Study was conducted over a period of two years in Department of Microbiology in collaboration with Department of Neurology, JIPMER. Cerebrospinal Fluid (CSF) samples were collected from all clinically suspected cases of viral encephalitis and tested by two methods- Nested Polymerase Chain Reaction (PCR) for detection of glycoprotein D gene for HSV and Dot-ELISA (Enzyme Linked Immuno-Sorbent Assay) for HSV antigen detection. Results: A total of 45 CSF samples were collected, out of which 4 samples were positive by Nested multiplex PCR. None of the samples were positive by Dot-ELISA. Conclusion: Rapid diagnosis of HSE by molecular methods is helpful for early diagnosis and timely initiation of acyclovir therapy leading to a better clinical outcome. Nested PCR of the CSF is a useful method for diagnosis of HSE while antigen detection has little or no practical value.

A Clinical Audit on Technical Difficulties during Epidural Catheter Placement

Nitin Choudhary, Anju Bhalotra, Kavita Rani Sharma, Gunjan Manchanda

Introduction: Epidural catheter placement is a routinely performed invasive procedure conducted by anaesthesiologist’s world over. A functional epidural catheter improves, not only the quality of anaesthesia but also patient satisfaction. Placing an epidural catheter is a skill which has its own set of technical difficulties. Aim: To conduct an audit to study the common technical difficulties faced during epidural catheter placement and their management. Material and Methods: The audit was conducted by evaluating the responses to a structured, self-administered questionnaire consisting of 10 questions distributed to post-graduate students, senior residents and consultants working in the Department of Anaesthesiology and Intensive care at a tertiary care centre in New Delhi during June 2017. The questions pertained to the respondent’s years of experience in Anaesthesiology and their response and management of the common technical difficulties encountered during epidural catheter placement. Results: Out of a total of 111 respondents, 64.86% had less than 5 years and 13.51% had more than 10 years of experience in the field of anaesthesiology. Almost 92% used air for locating the epidural space by the Loss Of Resistance (LOR) technique. Varied responses were obtained regarding difficulties in catheter advancement and management of presence of CSF or blood in the catheter and regarding the use and benefits of placing an intrathecal catheter and the duration of keeping an intrathecal catheter in situ. Only 2.70% had experienced shearing of an epidural catheter and in all the cases, this was during catheter removal in the postoperative period. Conclusion: There are no standard guidelines available for management of technical difficulties encountered during epidural catheter placement and this audit identified certain lacunae in knowledge and management of these difficulties.

N-Terminal-pro Brain Natriuretic Peptide in Assessing the Severity of Stable Coronary Artery Disease

Introduction: Coronary Artery Disease (CAD) occurs due to atherosclerosis which results in progressive narrowing of coronary artery lumen. N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) has been used as a marker of heart failure. However, its role in stable coronary artery disease without left ventricular dysfunction is limited. Aim: To measure and compare the serum NT-proBNP levels in stable coronary artery patients and controls and to correlate serum NT-proBNP levels with severity of CAD. Materials and Methods: The present study was conducted in Department of Biochemistry in collaboration with Department of Cardiology Kasturba Medical College, Manipal after the approval from Institutional Ethics Committee. A written consent was obtained from 86 study subjects (controls 36, cases 50). Serum NT-proBNP was measured using ELISA kit. Severity of CAD was graded by angiogram based Gensini scoring system. Mann-Whitney U-tests and spearman’s correlations were used. Serum NT-proBNP was expressed in median and interquartile range. The p-value<0.05 was considered to be significant. Results: Median values of serum NT-proBNP levels in cases (151.9 pg/mL) were significantly higher as compared to that of controls (99.31 pg/mL), (p<0.001). There was a significant positive correlation of serum NT-proBNP with the respective Gensini scores in patients with stable coronary artery disease (r=0.263, p=0.014). Conclusion: As Serum NT-proBNP levels were significantly associated with severity of stable CAD without left ventricular dysfunction, it can be a potential tool in effective management of stable CAD.

A Prospective Study on the Prevalence of Pulmonary Artery Hypertension in Thyroid Dysfunction

Introduction: Though rare, thyroid dysfunction is known to cause Pulmonary Artery Hypertension (PAH) which is also known to be reversible by restoration of euthyroid state. Hence, timely diagnosis and institution of medications can prevent as well as treat the secondary PAH in these patients. Aim: To analyse the prevalence of PAH in newly diagnosed, treatment naïve patients with thyroid dysfunction (hypoth-yroidism/hyperthyroidism) and to analyse the association of thyroid dysfunction with occurrence of PAH in treatment naïve patients. Furthermore, to see the improvement of PAH in those diagnosed, with treatment given, after 6 months. Materials and Methods: It was an observational prospective study which included 67 newly diagnosed patients with thyroid dysfunction. All were subjected to 2D echocardiography with detailed history and physical examination. Repeat echocardiographic assessment was done after 6 months of treatment for few patients to look for resolution of PAH. The statistical analysis was carried out to determine the association of PAH with thyroid dysfunction using student’s t-test and chi-square test of association. Results: The study included 56 (84%) females and 11 (16%) males. PAH was present in 19 (28.3%) patients, with a mean age of presentation of 34.3±10.70 years. In the echocardiographic assessment of patients with PAH, tricuspid regurgitation (100%), pericardial effusion (26%), dilatation of right heart chambers (21%), reduced LVEF (16%) and pulmonary regurgitation (5%) were the main findings recorded. Repeat echocardiography after 6 months of treatment (Eltroxin 1.6 microgram/kg for hypothyroid patients and Carbimazole (5/10 mg BD/TDS) for hyperthyroid) was performed in 7 of the 19 patients only (those who were diagnosed with PAH at the time of diagnosis of thyroid dysfunction) and reduction in Pulmonary Artery Systolic Pressure (PASP) was observed in 3 of them. Conclusion: High prevalence (28.3%) of PAH was observed in patients with thyroid dysfunctions at the time of diagnosis in the treatment naïve patients in the current study and it also reversed with treatment in three out of 7 patients on repeat 2D-echo with treatment. It is, therefore, suggested that every patient of thyroid dysfunction should be screened for PAH, even though further studies are needed to substantiate this, due to an inherent small sample size of the study.

Female Care Givers of Children with Cerebral Palsy: Quality of Life, Knowledge and Practice Regarding Ophthalmic Evaluation – A Study from Coastal Town of Southern India

Vidya Hegde, Rashmi Jain, Anupama Bappal, Rashmi Shambu, Himani Kotian

Introduction: A family centered approach to the care of children with disability is a widely accepted concept. Traditionally in India, mothers or females in family are the primary care givers. Taking care of children with special needs may have an impact on the physical and mental health of care givers and hence it needs to be investigated. Aim: To know the Quality Of Life (QOL) of female caretakers of children with Cerebral Palsy (CP). The study also assessed the knowledge of the caretakers about the need for ophthalmic evaluation of these children. Materials and Methods: Thirty six consenting female care takers were administered self-designed validated questionnaire that had 22 items. It included demographic data and items to know the awareness amongst the caretakers regarding the need for ophthalmic evaluation to know the awareness amongst the caretakers regarding the need for ophthalmic evaluation. Chi-square test was used to know the association between mean QOL score and age of care taker, educational qualification and number of children in the family. It was also used to know the association between the five domains and mean QOL score. Results: The mean age of the study group was 31.39±0.707 years. Among the care givers, 41.66% were from rural background and 75% were unemployed. The mean QOL score was 40.47. Out of 36 participants, 20 (55.6%) had a mean score < 41 (good QOL), 16 (44.4%) had a mean score > 41 (poor QOL). Chi-square test showed significant statistical association between the mean QOL score and limitation of physical activities and burden (p<0.05). Out of 36 participants, 24 were not aware about the need for eye examination of CP children. Conclusion: The QOL of female caregivers of children with disabilities is influenced by several factors. There exists poor awareness regarding the need for ophthalmic evaluation among care givers.

Does GLUT-1 have a Role in Prognosis of Breast Carcinoma of Egyptian Patients?

Introduction: Breast Cancer (BC) is the most common malignancy in females worldwide. It constitutes 38.8% of all malignant tumours among Egyptian females. Triple negative breast cancer has not confirmed therapeutic molecular target and has a poor prognosis, so identification of new biological key pathways might aid in finding targets of potential interest for therapeutic blockade. Glucose transporter 1 (GLUT-1) has important role in the transport of glucose in malignant cells and overexpressed in different types of human cancers but its expression in breast carcinoma tissues is controversial. Aim: To evaluate the role of GLUT-1 in breast carcinoma in Egyptian patients. Materials and Methods: Retrospective study included 79 Invasive Duct Carcinoma (IDC) specimens retrieved from the archival cases of Pathology Department, faculty of medicine, Menoufia University, Egypt, spanning the period between January, 2010 and December, 2017. All cases were stained for GLUT-1 antibody. Results: Eighty percent of the studied IDC cases showed positive GLUT-1 expression, positive cases are divided into +1, +2 and +3 and 55% of positive cases were +3. There was a highly statistical significant association between positive GLUT-1 expression and advanced nodal stage (p=0.001) and advanced T stage (p=0.000). Furthermore, there was a highly statistical significant association between positive GLUT-1 expression and poor degree of differentiation (Grade III) (p=0.000). Moreover, there was a statistical significant association between (+3) GLUT-1 positivity and advanced stage (III and IV) (p=0.018). Also, there is a trend of significance between GLUT-1 expression and hormonal status as 94.1% of triple negative cases showed positive GLUT-1 expression (p=0.078). There was no statistical association between GLUT-1 expression and overall survival and univariate survival analysis revealed the bad prognostic impact of negative hormonal status (p=0.002). Conclusion: GLUT-1 is a poor prognostic marker in view of association between positive GLUT-1 expression and advanced nodal stage, advanced T stage, advanced stage grouping (III and IV) and poor degree of differentiation (Grade). Furthermore, inhibition of GLUT-1 might play a therapeutic role for triple negative breast cancer.

Screening and Assessment of Polyneuropathy in Diabetic Patients and the Effect of Vitamin B₁₂ Administration on the Course of Neuropathy

Alpesh Chauhan, Ashwini Patil, Uma Bhosale, Shreepad Bhat

Introduction: Diabetic polyneuropathy is a specific form of axonal neuropathy that includes peripheral neuropathy of sensory nerve fibers with eventual autonomic and motor involvement. Screening and identification of polyneuropathy offers a crucial opportunity to prevent further complications by using vitamin B12. Aim: To assess the occurrence of polyneuropathy in patients with type I and type II diabetes mellitus and evaluate the effect of vitamin B12 administration on the course of polyneuropathy. Materials and Methods: This prospective open label study was carried out in 50 patients in medicine Outpatient Department (OPD) at Smt. Kashibai Navale Medical College and General Hospital, tertiary care hospital in Pune, Maharashtra, India. Fifty patients, aged 18-60 years of type I and type II diabetes mellitus were screened for polyneuropathy from June 2016 to June 2017. Thirty two out of 50 patients showed evidence of neuropathy based on either of the parameters including Diabetic Neuropathy Symptom (DNS) questionnaire; Survey of Autonomic Symptoms (SAS) questionnaire; standardized nerve conduction studies and peripheral neuropathy testing {ankle reflex and Diabetic Neuropathy Examination (DNE)}. These 32 patients were given a tablet methylcobalamin 1.5 mg daily for three months after which all the above parameters were repeated to evaluate the course of neuropathy by paired t-test. Results: Mean baseline DNS score was 1.63±0.75 which improved significantly (p=0.032) to 1.41±0.80 after three month methylcobalamin treatment. Mean baseline SAS score was 4.94±2.60 while post methylcobalamin therapy it was 4.59±2.39, suggesting significant improvement (p=0.009). Nerve conduction velocity of ulnar nerve in every patient was normal before and after methylcobalamin therapy. Mean baseline DNE score (3.34±1.73) improved significantly (p=0.027) to 3.06±1.54 after completing three months of methylcobalamin therapy. Conclusion: Strong positive association was found between diabetes-Vitamin B12 deficiency and polyneuropathy. Administration of methylcobalamin therapy is warranted as it significantly improves symptoms of polyneuropathy in diabetic patients.

Incidence and Risk Factors for Prolonged Stay in Children Hospitalised with Pneumonia

Nirmal Kumar Mohakud, Madhusmita Mishra, Ratikanta Tripathy, Manas Ranjan Mishra

Introduction: Lower Respiratory Tract Infection (LRTI) is one of the common causes of morbidity and mortality in children and is responsible for hospitalisation. Aim: The current descriptive epidemiological study aimed to analyse the risk factors for the prolonged hospital stay in children suffering from LRTIs. Materials and Methods: From August 2016 to July 2017, a total of 245 patients admitted for LRTI in the Department of Paediatrics, KIMS was included in the current investigation. Current diagnosis, demographic profile and length of hospital stay were examined and data were analysed using GRAPH-PAD-PRISM software version 7.0. Results: All the 245 children were identified with LRTI. Gender wise distribution showed 173 (70.6%) males and 72 (29.4%) females. The mean hospital stays for female patients (6.15 days) were higher than males (7.07 days) (p<0.05) with an average duration of 6.8 days. The hospital stay was significantly higher in children with an age range of 11-14 years in comparison to 1 mo-1 year aged children (p=0.001). Among different groups of LRTIs, patients suffering from Pneumonia had a longer duration of hospitalisation (8.15 days). Conclusion: Among children, the duration of hospitalisation was higher in males indicating that gender has a role in susceptibility and severity of the disease. Prolonged hospital stay was observed in children >10 years of age. Therefore, early diagnosis and treatment options should be made for this age group of children to prevent prolonged hospitalisation.

Psychiatric Counsellors Experience of Caring for Schizophrenic Patients at Psychiatric Nursing Home

Sheetal Bhaurao Barde, Sheela Upendra, Seeta Devi, Kalpana Sawane

Introduction: Schizophrenia is a grave mental illness, that hampers a person’s ability to think clearly, manage emotions, make decisions and relate to others. Counsellors are the primary care giver of the patients in the setting where the study was conducted. Therefore, a need was felt to study their experiences while caring for the patients. Aim: To explore psychiatric counsellor’s experiences of caring for inpatients diagnosed with schizophrenia. Materials and Methods: The setting was a Psychiatric Nursing home in Pune, Maharashtra, India. Psychiatric counsellors were recruited. Semi structured interviews were conducted. The data included demographic profile of the counsellors and structured interview questionnaire. To participate in this study, individuals had to be the psychiatric counsellor. Interpretative phenomenological design was used for the present study to understand the experiences of psychiatric counsellors caring for the schizophrenic patients for more than one year. Results: Two main categories developed: challenging and collaborative relationship between counsellor and patient, promoting well-being through counselling and support. The primary meaning of the main categories was interpreted and formulated as a hidden theme; promoting person-centered counselling support to patients suffering from schizophrenia. Conclusion: The study highlighted that psychiatric counsellors use different methods and strategies when promoting the well-being of schizophrenic patients.

Bouveret’s Syndrome: A Rare Case Presentation

Introduction: Suturing is a conventional method for pterygium surgery. Owing to its several disadvantages newer techniques like autologous fibrin glue have been introduced as an alternative method of graft attachment. Aim: To compare suture versus patient’s own blood for conjunctival autografting in pterygium surgery. Materials and Methods: A pilot study was conducted in a Tertiary care hospital from October 2014-June 2016. Seventy-two adult patients with primary progressive pterygium undergoing pterygium surgery with conjunctival autograft were evaluated in this study. Thirty-six patients underwent primary pterygium excision and conjunctival autografting with autologous fibrin glue (glue group) and 36 with 10-0 monofilament polyamide (suture group). Parameters such as mean operating time, presenting complaints like pain, watering, burning and foreign body sensation and graft stability were compared between the two groups on 1st and 5th postoperative days. Categorical data were analysed by Fisher-exact test and continuous data were analysed using Student’s t-test and Wilcoxon signed rank test as applicable. Results: There was statistically significant difference in the mean operating times between the two groups with results favouring the glue group (p<0.05). The difference in pain (p<0.05 each), watering (p<0.05; p=0.032),burning sensation (p<0.05; p=0.023) and foreign body sensation (p<0.05 each) was found to be statistically significant between the two groups on 1st and 5th postoperative days respectively. The difference in graft stability between the two groups was not statistically significant (p=0.114). Conclusion: In present study we found that autologous fibrin glue was associated with significantly shorter duration of surgery, lesser postoperative discomfort compared to suturing.

Hyponatremia in Patients Admitted with Stroke

Sivakumar Karunanandham, Thamarai Rajappa, Kalavathy Selvaraju

Introduction: Many studies have focused on association of serum electrolytes with hypertension. In recent years status of serum sodium have established an important role in the distinguishing the two entities of hyponatremia in Cerebrovascular Accidents (CVA). Aim: To estimate the serum sodium levels and to determine the incidence and aetiology of electrolyte disturbances in patients with newly diagnosed CVA. Materials and Methods: This was the cross-sectional study conducted at the tertiary care teaching hospital, Trichy. 202 diagnosed stroke patients were evaluated for presence of hyponatremia. The data was analysed using independent t test using SPSS software 21. Results: Among the 202 CVA patients, 78 patients (38.61%) presented with hyponatremia. Among the 78 patients, 43 (21.28%) were ascertained as Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH), in which ischemic stroke and haemorrhagic stroke were diagnosed in 31 and 12 patients respectively. Fifteen patients (7.42%) had Cerebral Salt Wasting Syndrome (CSWS), in which 5 patients had ischemic stroke and 10 patients had haemorrhagic stroke. A total of 20 (9.90%) cases had hyponatremia with unknown aetiology. The hospital stay of patients with hyponatremic CVA was more than patients with normal serum sodium level (mean 21 days). Conclusion: This study shows that hyponatremia was observed in 38.61% of stroke patients. Among hyponatremia stroke cases, 21.28 % had SIADH and 7.42% had CSWS. The hospital stay of hyponatremic CVA patients was longer, hence monitoring of serum sodium is absolutely essential in patients admitted with stroke. Close observation and prompt diagnosis are needed to identify the cause of electrolyte disturbance, because their treatments are completely dissimilar.

Comparative Study of Knowledge and Awareness about Leprosy among Medical College Students Pre and Post State Leprosy Sensitisation Program in Mewat, Haryana, India

Introduction: Leprosy is a chronic infectious disease which still remains a serious public health problem causing various disabilities. The prevention of leprosy ultimately lies in the early diagnosis and awareness about the disease. Changing leprosy scenario has led to requirement of leprosy education among the health workers and health care providers. However, the knowledge of medical college students on leprosy remains unknown. Aim: To assess the knowledge and awareness about leprosy among medical students pre and post state leprosy sensitisation program. Materials and Methods: A questionnaire based, cross-sectional study was conducted among 135 medical students before the sensitisation and 107 medical students after sensitisation program, of different years starting from second year and onwards in the month of July 2017. Results: Among the medical students, who participated in the study, 67% (90) of pre sensitisation students were male and 33% (45) of them were females and 65% (70) of post sensitisation students were male and 35% (37) of them were females. Increase in knowledge and awareness about leprosy was found among medical students of all years from SHKM Government Medical College post sensitisation program as compared to previous knowledge and awareness before sensitisation program. Conclusion: These observations suggest that the basic and in-depth knowledge of medical students’ pre and post sensitisation program shows significant difference in their knowledge and awareness about leprosy owing part of their curriculum and sensitisation program. However, there is still a need to organise sensitisation programs for health care providers at regular intervals for early diagnosis, prevention and better management.

Vaccination Coverage and Perceived Barriers to Immunization as Identified by Mothers of Under Five Children in Rural Areas of Udupi District, Karnataka, India

Anusha, YN Shashidhara, K Jeyalakshmi

Introduction: Vaccines are the most effective and safe public health interventions available to prevent serious disease and death of children. Maternal knowledge regarding immunization is very important for increasing the immunization rate, and for decreasing immunization errors. Aim: The survey was conducted to find out the immunization compliance of children under the age of five and to identify the perceived barriers for immunization among mothers of children under five years in selected rural areas of Udupi district, Karnataka, India. Materials and Methods: Quantitative approach with descriptive survey design was used for the study. Study was conducted in four Primary Health Centers (PHC) and 22 Anganwadis of Udupi district. Participants were selected by non-probability purposive sampling method. Data was collected by providing questionnaires from January 10th to February 15th of 2017. Results: Out of 310 mothers, 74.2% had taken their children to PHC for immunization and 64.5% of mothers were not aware on due vaccine of their child. Immunization coverage was highest for BCG and least for DPT second dose i.e. 98.6% and 54.2% respectfully. Children who received measles vaccine among them, 96.3% and 90.1% had received first and second dose respectively. The reasons for incomplete immunization were related to knowledge and organizational factors. Barriers related to knowledge among mothers included poor awareness of immunization schedule and vaccine preventable diseases. Immunization was delayed due to common childhood illness. Barriers to utilization of immunization services included economic constraints, long distance to health care facility, and lack of effective communication with health personnel. Conclusion: Regular health education sessions and reminders among mothers will solve the problems of immunization.

Effect of Obesity on Pulmonary Functions among the Adolescent Students of a Private University in Malaysia

Introduction: Obesity is a risk factor for many conditions including respiratory disorders. However, studies investigating pulmonary functions in obese adolescents from Malaysia are few in number. Aim: To investigate the effect of obesity on pulmonary function variables in the adolescent obese students of a private university in Malaysia. Materials and Methods: A Cross-sectional comparative study was conducted in a total of 100 (50 obese and 50 non obese control) adolescent students of both sexes aged 16-19 years. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1 as a percentage of FVC (FEV1/FVC%), maximum mid expiratory flow rate (FEF25-75%) and peak expiratory flow rate (PEFR) were measured using a computerized spirometer (Spirobank II MIR via Del Maggiolino125, 00155 Roma, Italy). Body weight, height, Waist Circumference (WC) and Hip Circumference (HC) were measured. Student’s t-test and Pearson’s product moment correlation (r) were used to interpret the data. The p-values less than 0.05 were considered as statistically significant. Results: There was no significant difference in mean pulmonary function parameters between obese and non-obese control group. However, five obese subjects had mild restriction, whereas no obstructive impairment was detected in any subject of the obese and control groups. In obese group, BMI, WC, HC and Waist Hip Ratio (WHR) had negative significant (p<0.01) correlation with FEV1/FVC%, whereas FVC and FEV1 had positive significant (p<0.05) correlation with WC and HC. However, in normal weight control group, FVC and FEV1 had positive significant association with WC and WHR, whereas, rest of the dynamic pulmonary measurements had no significant correlation with measured anthropometric obesity indices. Conclusion: Our study did not find any significant effect of obesity/overweight on dynamic lung volumes among adolescent students. Significant negative correlation between BMI, WC, HC and WHR with FEV1/FVC% suggests that obesity decreases FEV1/FVC% and obese are more prone to obstructive lung diseases.

Awareness of Yemeni Paediatricians and Other Physicians about the International Malaria Management Guidelines in the Major Public Hospitals in Sanaa, Yemen

Introduction: Malaria still represents a substantial morbidity burden in the developing countries including Yemen. Keeping updated with the latest evidence-based prevention and treatment guidelines will improve the overall picture. Hence, this study was undertaken to assess the knowledge of the Yemeni physicians and paediatricians about the same. Aim: To assess awareness of the Yemeni paediatricians compared to other physicians toward the new 2015 World Health Organisation (WHO) Malaria treatment guidelines. Materials and Methods: This cross-sectional descriptive study was performed on 175 physicians from different specialties mainly paediatricians in the four major referring hospitals in Sanaa. A questionnaire was developed with questions related to the diagnosis, treatment and prevention of malaria. Results: Among the respondents, 134 (76%) of the total participants in the study and 47 (74.6%) within the group of paediatricians has correctly recognised issues of clinical diagnosis of malaria. Vulnerable groups to malaria infection were correctly recognised by 44 (69.8%) of the paediatricians. Good proportion of paediatricians knew the correct combination and duration of Artesunate Combination Therapy (ACT) according to the new guidelines. However, only 3 (4.7%) of the paediatricians has recognised correctly the treatment of choice of acute severe malaria. Conclusion: Despite the special situation in Yemen, most paediatricians are aware to the latest guidelines of Malaria management. However, National program should run more awareness and training activities to improve prevention and treatment performance of Yemeni physicians.

Comparing the Effects of Hot Shower and Intravenous Injection of Hyoscine on the Pain Intensity and Duration of Active Phase of Labour in Nulliparous Women

Introduction: Parturition is a painful process and one of midwives’ duties is to reduce the pain during labour. Aim: To compare the effect of hot shower and intravenous injection of hyoscine on the pain severity and duration of active phase of labour (primary outcomes) and adverse events during intervention (secondary outcomes) in nulliparous women. Materials and Methods: A randomized controlled study was conducted in which 162 nulliparous women were assigned into 3 groups. The first group (n=53) received hyoscine, the second group (n=55) received hot shower, and the control group (n=54) received routine care. Pain intensity was measured once every hour during the active phase of labour by Visual Analogue Scale (VAS) and duration of active phase was recorded. One-way analysis of variance test and general linear model were used to compare active phase duration and pain intensity, respectively. Results: There was no statistically significant difference in terms of socio-demographic characteristics in all groups (p>0.05). According to general linear model, by adjusting the baseline values, average pain intensity in hot shower group was significantly less than control group (adjusted mean difference=-1.1; 95% Confidence Interval=-1.6 to -0.6) and hyoscine group (-1.3; -1.8 to -0.8). The mean duration of active phase of labour was 221.2±87.2 minutes in hyoscine group, 201.9±147.4 minutes in hot shower group and 312.6±198.0 minutes in control group. There was statistically significant difference among groups (p<0.001). Conclusion: Using hot shower as a non-pharmacological method reduces the pain and the duration of active phase of labour. Therefore, we believed that the use of this method should be advisable for all women in labour.

Histogram Based Synovitis Scoring System using Ultrasound Images of Rheumatoid Arthritis

RJ Hemalatha, V Vijayabaskarin

Introduction: The gray scale Ultrasound (US) imaging aids in assessing activity of Rheumatoid arthritis condition through classification of synovitis and is able to estimate the disease progression. The gray shades in the synovial region help in identifying the disease condition. Aim: To grade rheumatoid arthritis based on the severity of the disease condition using histogram analysis. Materials and Methods: A total of 276 ultrasound gray scale images of the arthritis affected finger joints from MEDUSA database were evaluated. The image was preprocessed using filtering to remove speckle noise and the quality was enhanced using CLAHE technique. The region of interest (synovial region) was analysed using histogram and the respective histogram features were obtained. Based on the histogram analysis the images were graded into different grades. The histogram analysis was applied to reference image (annotation done by medical expert). A comparative study between the reference images and test images were performed. Results: Based on the histogram analysis the images were graded into Grade 0- no disease, Grade 1- less severity, Grade 2- moderate, Grade 3- more severity. The performance of the histogram method on reference and test image was compared. Using the histogram analysis, 93% sensitivity, specificity of 94% and an accuracy of 93.5% were achieved. Conclusion: Ultrasound image of synovial thickness is an important tool in identifying early stages of rheumatoid arthritis. The histogram based scoring approach gives gray level variations in US image. Based on this mean, median and standard deviations are calculated. Average value of all these parameters was very high for Grade 0, and very low for Grade 3. The outcome of suggested system demonstrates effective and satisfactory performance for different set of synovitis images of RA patients; which would be helpful for early diagnosis of the disease.

Lipoma of the Parotid Gland-A Rare Entity

Mona Bargotya, Kiran Agarwal, AS Saumya, Nitin Sood

Lipomatous tumours are the most commonly encountered benign neoplasms of mesenchymal origin. The lipomas consisting entirely of mature fat are the most common soft tissue tumour of the body occurring predominantly in upper back, shoulder and abdomen; but have been virtually reported arising in every location where fat is normally present. The incidence of lipoma in parotid gland is rare and it commonly presents as gradually progressing painless mass. Hence, it is seldom considered in the differential diagnosis of parotid swelling. Fine Needle Aspiration Cytology (FNAC) has been proved to be unreliable in diagnosing parotid lipomas, but histopathology helps in making the correct diagnosis. Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) can lead to an accurate pre-operative diagnosis of parotid lipoma as well as to evaluate the location of the tumour to programme the correct surgical approach. The present case was of parotid lipoma involving the superficial lobe in a 40-year-old male who presented with left parotid swelling. Lipomas are rarely observed in the parotid gland and this case was being presented because of the relative rarity of lipomas in the parotid region.

Clinical Significance of Non-candidal Yeast like Genera with Special Reference to Trichosporon and Malassezia

Introduction: The incidence of opportunistic fungal infections is increasing world over. This is mainly due to increase in risk factors like prolonged antimicrobial use, prolonged catheterisations both urinary and vascular, increased patients with immune compromised conditions, co-morbidities like hypoalbuminemia or anaemia to name a few. Along with these newer aetiological agents are emerging as pathogens. Over the years, the predominance of C. albicans changed to non-albicans Candida and now Non-Candidal Yeast-like Genera (NCYG) are slowly emerging as pathogens. They include Trichosporon, Malassezia and others. Recently these are implicated in superficial, mucosal and systemic infections from immunocompetent patients also. Hence, this study was carried out to determine the incidence of NCYG in immunocompetent patients. Aim: To isolate and identify NCYG in clinical samples. Materials and Methods: This retrospective study included clinical specimen received over a one-year period from immunocompetent patients from suspected fungal infections. All samples were processed for fungal follow-up as per standard protocol. This included microscopy, culture on Sabouraud Dextrose agar with and without antibiotics. Incubations were carried out at 37°C and at room temperature. Identification of growth was carried out as per follow-up for yeasts and automated VITEK ID was used for all isolates. Results: Among various clinical specimens, fungal growth was obtained in 30.42% of samples. Of the yeast isolates, 85.47% were Candidal isolates. NCYG were isolated in 13.72%. Trichosporon was isolated in 46.15% of these NCYG. Malassezia was isolated in 26.93%. Sporothrix, Pichia, Rhodotorula, Stephanoascus and Prototheca were the other genera isolated. Conclusion: The study highlights the presence of NCYG in clinical samples from immunocompetent patients. Identification and speciation of these emerging pathogenic yeasts should be done for better therapeutic management.

Single Nucleotide Polymorphisms of XRCC1 and the Risk of Head and Neck Cancer

Introduction: Head and Neck Cancers (HNCs) accounts for more than 550,000 cases and 380,000 deaths annually, worldwide. Overall, 57.5% of global HNCs occur in Asia especially in India in both sexes. Single Nucleotide Polymorphisms (SNPs) of DNA repair genes in cancer are the most common form of genetic variations found in the human population. Aim: To draw an association, if any, between polymorphic 347 bp and 445 bp variants of XRCC1 gene and the risk of HNC in a Southern Indian population. Materials and Methods: In the present case-control study, 120 HNC cases were selected from the Department of Radiotherapy, Government General Hospital, Guntur, India. Characteristics were considered for risk assessment in 120 (76 male and 44 female) HNC Cases and XRCC1 gene single nucleotide polymorphisms (SNPs) were analysed in 30 HNC cases (random sampling) and 30 healthy subjects (controls, not habituated to alcohol and/or smoking) to compare the frequency of polymorph variants. DNA was isolated from peripheral blood and after DNA extraction SNPs were genotyped by direct sequencing. Deviations from the Hard-Weinberg Equilibrium (HWE) were tested by using online calculator, chi-square test was used to compare between two variables. Results: In the present study, out of 120 cases, 76 (63.33%) were males and 44 (36.66%) were females. About 72 (60%) cases of males had the habit of smoking and only 7 (15.91%) cases of females were smokers. Among male cases alone, 75.50% constitute smokers. A total of 57 cases, consisting of 18 (23.68%) males and majority of females 39 (88.63%) responded that they never consumed alcohol. In the present study, data showed no significant allelic associations for SNP of XRCC1 347bp/445bp and HNC. Conclusion: The present study confirms the principle role of cigarette smoking and alcohol consumption in HNC. This is significant and positive interaction between these two factors. The frequency of heterozygous genotype (A/G) of XRCC1 gene in both cases and controls showed no significant difference and hence, There was no association between them. In addition, further studies are required for evaluating the effect of gene to gene and gene to environment interactions on these gene polymorphisms with HNC susceptibility, in Indian population.

Information and Consent in Dentistry

Consent is the essential expression of the patient’s will, and thus, must be preceded by a procedure. The need for consent is based on ethical principles, legal regulations, codes of conduct and judicial doctrine. In order to be able to give valid consent, one must have the ability to make decisions. In any event if the patient is not able to do so, as in the case for minors or those with mental impairments, specific legal and medico-legal provisions must be made.

Prevalence of Dental Caries in India among the WHO Index Age Groups: A Meta-Analysis

Chandrashekar Janakiram, Bobby Antony, Joe Joseph, Venkitachalam Ramanarayanan

Introduction: Dental caries is widely prevalent globally but the distribution and severity of dental caries varies across countries and regions. In the absence of surveillance or real time monitoring of dental caries in India, there exist a need to assess the prevalence in the country for planning and implementation of oral health programs. Aim: To assess the combined prevalence and mean DMFT of dental caries in India among the WHO index age groups (5, 12, 15, 35-44 and 65-74 years). Materials and Methods: Epidemiological/point prevalence studies conducted (among index age groups) in various parts of India from January 2000 to April 2016 were retrieved from Pubmed central database using ‘Dental caries’ AND ‘India’ as MeSH terms and information from the only National Oral Health Survey and Fluoride Mapping (2002-2003) in India were used. The combined mean deft/DMFT and pooled prevalence of the dental caries was assessed region wise for each age group. Results: The mean deft/DMFT was 2.36, 1.95, 3.31 and 7.01 among 5, 12, 15 and 65-74 years respectively. The SiC index shows steady increase from 3.36 to 8.11 across the groups. The mean prevalence of dental caries is almost similar at 5 years and 12 years at 49% while it shows steady increase from 15 years (60%) to 35-44 years (78%) and peaks at 65-74 year group (84%). In the Eastern and Western regions of India, the 15 year old had higher caries prevalence and mean DMFT compared to the 12-year-old. Across India, the 60-74-year-old had the highest DMFT of 7.01. In North and South India, 65-74-year-old had the highest caries prevalence of 84% and 85% respectively. Conclusion: Irrespective of age groups, the prevalence of dental caries was found to be high and varied across India. This data could help health policy makers to tailor region specific oral health interventions.

A Review on Newer Tyrosine Kinase Inhibitors and their Uses

Nithu M Kumar, Meenu Mathew, KN Anila, S Priyanka

Tyrosine Kinase Inhibitors (TKI) can reversibly or irreversibly block the signaling pathway occurring in the extracellular part of the receptor by inhibiting Tyrosine Kinase (TK) phosphorylation. This review included the drugs that were newly marketed or drugs with newer approved uses after 2015, such as Gefitinib, Osimertinib, Crizotinib, Alectinib, Ibrutinib, Cabozantinib. Brigatinib and Lorlatinib are investigational drugs that have not been approved and have shown promising results in trials for the treatment of Anaplastic Lymphoma Kinase (ALK) positive metastatic Non Small Cell Lung Carcinoma (NSCLC). Gefitinib, Osimertinib, Crizotinib, Alectinib were approved for treating NSCLC. Cabozantinib and Lenvatinib were approved for treating renal cell carcinoma and thyroid carcinoma. Ibrutinib was approved for treatment of Chronic Lymphocytic Leukaemia, Small Lymphocytic Lymphoma, Waldenström macroglobulinemia, previously treated Mantle cell lymphoma and relapsed or refractory Marginal zone lymphoma. TKI have promising efficacy in treating a wide range of oncologic diseases. Hand-foot-skin reaction are the most common side effect of drugs in this category, however, TKI are found to have relatively fewer side effects compared to other anti cancer drugs.

Comprehensive Classification System for Furcation Involvement – Incorporating Additional Variables

The presence of furcation involvement is one of the clinical indicators of periodontal disease which is considered an extremely demanding situation by clinicians in terms of successful management. With a continuous improvement in the understanding of periodontal conditions and advent of better therapeutic modalities, it becomes imperative to maximise inclusion of differentials in clinical manifestations involving severity of alveolar bone destruction and gingival inter-relationships while categorising furcation involvement. This has been one of the major limitations of the existing classification of furcation involvement. Furcation involvement is classified taking into account the vertical component, horizontal component and the position of gingival margin. This paper attempts in developing a classification system which relates to the severity of alveolar bone destruction in the furcation and the gingival positions.

The Prevalence of Urinary Tract Infections in Iranian Children: A Meta-Analysis and Systematic Review

Introduction: Urinary Tract Infections (UTIs) are the most common infections in children worldwide, however, data from Iran is not very well studied. Aim: The aim of the present study was to evaluate the prevalence of UTIs in Iranian children. Materials and Methods: From the beginning of databases to November 2017, International {PubMed, Web of Science (WOS) and Google scholar} and National {Scientific Information Database (SID), Magiran} databases were searched for related observational studies that were conducted in Iran including only on Iranian children and published in English and Persian languages. The quality of the articles was evaluated using the Hoy D tool. Results: Out of 515 initial studies, 14 and 6 studies were included in systematic review and meta-analysis, respectively. The overall prevalence of UTI in 3926 children was 4.92% (95% CI:2.32, 7.52; I2=93.58%). The prevalence of UTI in male and female children was 2.59% and 4.78%, and the difference was non-significant. Conclusion: Considering the prevalence of UTIs in Iranian children, it is recommended that studies should be conducted in the field of research at the national level to determine the precise incidence and risk factors for UTIs in children.

Standardization and Quality Improvement of Laboratory Services in India: Need and Challenges

Ajay Gajanan Phatak, Pradnya Ajay Phatak

Quality is a subjective term – subjective with respect to individual and time. Quality concepts were introduced and implemented by industry during world war II. In health care system, these concepts were introduced later. Indian health care system is transforming. The publically funded system run by the Government is focusing on coverage but quality of service is doubtful. On the other hand, corporate ‘for profit’ hospitals claim quality but with humongous cost. Laboratory services are crucial in today’s health care. The laboratory service provisioning in India is very complex with respect to structure, facilities rendered as well as governance. This sector faces many internal and external challenges in affirming quality. Accreditation provides a first step towards quality assurance of laboratory services. This monograph discusses the need and challenges in accreditation of laboratory services in India.

Retroperitoneal Multicystic Mesothelioma in a Young Male

Anshul Singh, Mamta Bhatt, Preeti Singh, Vatsala Misra

Multicystic Peritoneal Mesotheliomas (MPMs) are rare tumours characterised by recurrent mesothelial inclusion cysts. Less than 200 cases have been reported worldwide. Only 10 cases have been reported from India. Though they have strong predilection for peritoneum of the pelvic and abdominal organs, few cases have been reported in extraperitoneum and retroperitoneum too. MPMs are mainly a tumour of females of reproductive age group who have had some abdominopelvic pathology/surgery. Very few cases have been reported in men, mostly in the middle to elderly age group and like their female counterparts, associated with a history of some past abdominopelvic pathology/surgery. Only one case has been reported in a young male in the literature till date. We document here a case of multicystic mesothelioma presenting in an 18-year-old young male in the retroperitoneum who had no such significant past history.

Correction :2017 Jan: 11(1): BC05–BC08

Sheetal Pahwa, Ritu Sharma, Balwant Singh, Role of Glutathione S-Transferase in Coronary Artery Disease Patients with and Without Type 2 Diabetes Mellitus (Published in Journal of Clinical and Diagnostic Research. 2017 Jan: 11(1)). In this article correction has been done in first author affiliation and acknowledgment.