Journal of clinical and diagnostic research

Association of Salivary Cortisol and Anxiety Levels in Lichen Planus Patients

Background: Oral lichen planus (OLP) is a frequently encountered chronic inflammatory disease of oral mucosa and skin, where the patients often relate the onset and aggravation of oral symptoms to increased levels of stress. Cortisol, also called as “stress hormone” has been used as an indicator in various stress evaluation studies. Aim: The aim of this cross-sectional study was to determine any association between anxiety and salivary cortisol levels in OLP patients. Materials and Methods: A total of 20 OLP patients along with same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects between 9.00 to 9.15 am to avoid diurnal variations of cortisol levels. The saliva samples were analysed for cortisol levels by competitive enzyme-linked immunosorbent assay (ELISA) method. Anxiety levels of 40 patients were measured by using Hamilton’s anxiety scale. Student’s t-test was used to compare the anxiety and salivary cortisol levels between both groups. Results: The mean salivary cortisol level of the OLP group showed highly significant difference (p<0.001) from the controls. The mean anxiety scores of the OLP group showed highly significant difference (p<0.001) from the controls. A positive correlation was found between anxiety and salivary cortisol levels in the OLP patients. Conclusion: These findings suggest that anxiety play a vital role in the pathogenesis of OLP, thus besides traditional treatment, psychological support is also needed.

Association of Elevated first Trimester Serum Uric Acid Levels with Development of GDM

Sunita Samal, Rasika C, Seetesh Ghose

Background: Early intervention and appropriate treatment in patients with GDM will help in preventing the adverse maternal and fetal outcome and protect them from long term complications. Several studies have shown the association of hyperuricemia with GDM. This study was undertaken to find out the association of elevated first trimester uric acid with development of GDM. Materials and Methods: This prospective observational study was conducted in Mahatma Gandhi Medical Collage and Research Institute, Pondicherry, India, between November 2010 and May 2012. A total of 70 pregnant women were included and parameters like age, parity, BMI, history of DM, serum uric acid at <15 weeks and at 24 to 28 weeks and one step test at 24 to 28 weeks were noted and compared. Results: There was no significant correlation between the demographic variables and GDM, but a moderate significance noted between the family history of DM and one step test (p=0.048). Though there is a proportional increase in the serum uric acid with increase in the BMI, it was not statistically significant. A significant correlation was seen between BMI and risk of development of GDM (p= 0.001). Though there is a significant correlation between serum uric acid at <15 weeks and at 24 to 28 weeks, serum uric acid at <15 weeks of gestation is a better predictor of GGI and GDM (Pearson’s correlation = 0.735). Conclusion: There is increase in the risk of development of GDM with increased levels of serum uric acid in the first trimester. Uric acid levels at <15 weeks of gestation is more significantly associated with risk of development of GDM than it’s levels at 24 to 28 weeks of gestation.

A Study on the Performance of Medical Students in Internal Assessment and its correlates to Final Examinations of 2nd MBBS Pharmacology Curriculum in a Medical College of Eastern India

Objectives: The present study was undertaken to assess whether performance in the continuous assessment method as determined by internal assessment, correlates to the final summative evaluation in 2nd professional MBBS students in Pharmacology for the last four years (2009-2012). Materials and Methods: This study was conducted over a period of three months at Nilratan Sircar Medical College and Hospital, Kolkata (West Bengal, India). It was a retrospective non-interventional record-based study based on the students’ score sheets of 2nd MBBS Pharmacology examinations. Results: The strength of correlation between internal assessment marks and total summative examination was fond to be highly significant at p < 0.0001, thereby implying that continuous assessment plays a vital role in influencing the overall performance of the undergraduate medical students. Conclusion: This study revealed that performance in the internal assessment and final examination have a direct correlation although not completely linear, thereby indicating that other possible variables would have influenced the final result of the 2nd MBBS Pharmacology curriculum.

Efficacy of Mannheim Peritonitis Index (Mpi ) Score in Patients with Secondary Peritonitis

Muralidhar V A, Madhu C P, Sudhir S, Madhu Srinivasarangan

Background: Despite advances in diagnosis, management and critical care of patients with peritonitis due to hollow viscus perforation, prognosis remains poor. Early assessment by scoring systems will influence the management and prognosis. Aim: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis. Materials and Methods: Prospective study of 50 patients admitted and operated for peritonitis in JSS Medical College Hospital. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software. Results: The overall mortality and morbidity was 14% and 38% respectively. MPI scores of = 20, 21-29, and = 30 had a mortality of 5%, 14%, and 50% respectively. MPI score of 25 had highest sensitivity of 72.09% and specificity of 71.43% in predicting mortality, 80.65% sensitivity and 57.89% specificity for morbidity. MPI score of > 25 were associated with 6.45 times higher risk of mortality (p=0.03), 5.72 times higher risk of morbidity (p=0.005) compared to patients with MPI score = 25. Conclusion: MPI is disease specific, easy scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice

Prevalence of Periodontal Disease and Characterization of its Extent and Severity in an Adult Population – An Observational Study

Introduction: Present study was undertaken to determine the prevalence of periodontal disease in an adult population and to further characterize the extent and severity of the disease. Materials and Methods: The study population consisted of 700 randomly selected individuals reporting to out patient department of dental college and hospital. Demographic details and lifestyle characteristics of the all the subjects were recorded and a thorough oral examination was performed. In order to evaluate the periodontal status of subjects, five indices (CAL, PD, OHI, PI and GI) were assessed and subjects having at least one site with clinical attachment loss (CAL) = 3mm were diagnosed as having periodontitis. Further, to analyse the extent of disease, subjects having periodontitis were divided into two groups as having at least one site with CAL = 5mm and having at least three sites with CAL = 5mm. Results: Results showed that there was a high prevalence of periodontitis amongst population with almost 72% of the individuals having at least one site with CAL = 3mm. A trend was noted in which periodontal status worsened as the age increased. Analysing the extent and severity of disease amongst the population, results revealed that almost 41% of population had at least one site with CAL = 5mm whereas almost 21% of individuals had at least three sites with CAL = 5mm. Conclusion: Present study provides with evidence of high prevalence of periodontal disease amongst the population. Importantly, this study also unveils the lack of awareness for dental health amidst the population.

Ultrasonographic Measurement of Normal Common Bile Duct Diameter and its Correlation with Age, Sex and Anthropometry

Nidhi Lal, Simmi Mehra, Vivek Lal

Background: Ultrasonography is the diagnostic method of choice for visualization and rational work-up of abdominal organs. The dilatation of the common bile duct helps distinguish obstructive from non-obstructive causes of jaundice. Availability of normal measurements of the common bile duct is therefore important. There exists significant variations in the anthropometric features of various populations, regions and races. Aim: Study was conducted to obtain data on sonographically measured diameters of common bile duct in a series of normal Rajasthani population and to measure its correlation with age, sex and anthropometry. Setting and Design: Cross-sectional hospital-based study conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, India. Materials and Methods: Study included 200 participants with equal proportion belonging to either sex. Common bile duct was measured at three locations- at the porta hepatis, in the most distal aspect of head of pancreas and mid-way between these points. Anthropometric measurements including height, weight, chest circumference, circumference at transpyloric plane, circumference at umbilicus and circumference at hip were obtained using standard procedures. Statistical Analysis: Univariable analysis with measures of frequency and standard deviation and bivariable analysis using correlation. Results: Mean age of study subjects was 34.5 years (Range 18-85 years). Mean diameters of the common bile duct in the three locations were: proximal, 4.0 mm (SD 1.02 mm); middle, 4.1 mm (SD 1.01 mm); and distal, 4.2 mm (SD 1.01 mm) and overall mean for all measures 4.1 mm (SD 1.01 mm). Average diameter ranged from 2.0 mm to 7.9 mm, with 95 percent of the subjects having a diameter of less than 6 mm. We observed a statistically significant relation of common bile duct with age, along with a linear trend. There was no statistically significant difference in common bile duct diameter between male and female subjects. The diameter did not show any statistically significant correlation with any of the anthropometric measurements. Conclusion: Our study reported the upper limit of normality as 7.9 mm. The diameter increased progressively from 3.9 mm among those aged 18-25 years to 4.7 mm among those in the age group more than 55 years. This was found to be statistically significant. Ductal diameters beyond these limits should prompt the need for further investigations.

Anthropometry and Prevalence of Common Health Problems among School Going Children in Surathkal, Karnataka

Aims: To measure the anthropometric data of school children and to compare with the CDC and Agarwal centile Growth charts. The prevalence of thinness, stunting, overweight and obesity were estimated. Children were also screened for hypertension, refractory errors, dental problems, skin disease and other abnormalities. Design: Study was conducted in November in a central school in Surathkal, Dakshina Kannada, Karnataka, India. All children from nursery up to 10th standard were screened. Materials and Methods: Weight and Height were measured using standard equipment and plotted on CDC and Agarwal Charts. BMI was calculated and plotted on both charts. Blood Pressure (BP) was taken using mercury sphygmomanometer by a trained nurse. Vision was tested using Snellens chart by refractionist. Dental evaluation was done by dentist. Statistical analysis: Chi-square test and Student’s unpaired t test were used for statistical analysis. A statistical package SPSS version 17.0 were used. p<0.05 was considered as significant. Results: Total 755 children were screened. Among these 392 (51.9%) were females and 363 (48.1%) were males. Eighty five (11.3%) children had short stature and 283 (37.5%) had under nutrition when plotted on CDC chart. Values were lower when plotted on Agarwal charts. Thinness was more prevalent than obesity and overweight. Majority were normotensive though hypertension was noted in 6(0.8%) children and prehypertension in 14(1.9%).112 children (16.3%) had undetected refractory error. Common skin disease noted was T.Versicolor in 27 children. Common dental problem noted was Caries teeth (22.9%). Conclusion: Weight and height were below the CDC centile charts. Under nutrition was more prevalent than overweight and obesity. Majority were normotensive. High prevalence of undetected refractory error and caries teeth were noted. Prevalence of skin disease was low.

Cross Sectional Imaging of Post Partum Headache and Seizures

Objectives: To evaluate spectrum of causes & their characteristic findings in peripartum head ache and seizures on computed tomography & magnetic resonance imaging. Materials and Methods: Forty patients with complaints of peripartum headache and seizures underwent cross sectional imaging with computed tomography and magnetic resonance imaging during period of June 2011 to May 2012. Age group of subjects in this study was 18 to 38 y. Out of 40 patients 15 had history of eclampsia and remaining 25 patients were normotensive. Subjects with complaints of headache and seizures after six weeks of delivery were excluded from the study. Intravenous contrast was administered in cases with diagnostic dilemma. All results were reported and informed to the referring physicians on priority bases. Results: Nine patients with peripartum headache and seizures revealed no brain parenchymal or cerebral vascular abnormalities on imaging. Eleven patients with a history of eclampsia showed features of eclamptic encephalopathy. Out 40 patients, 17 patients revealed cortical venous thrombosis with 14 patients showing parenchymal changes. One patient each showed features of meningoencephalitis, ischemic watershed territory infarct & region of gliosis. All results were analysed & tabulated. Conclusion: Eclamptic encephalopathy and cortical venous thrombosis are the major causes for post partum headache and seizures. Rational use of CT & MRI in the early course of the disease helps in characterizing the lesion and providing the appropriate treatment.

Effect of Oral Curcuma Gel in Gingivitis Management - A Pilot Study

H Nilofer Farjana, S C Chandrasekaran, Bagavad Gita

Background: Various modalities of treatments are available for gingival disease, but there are adverse effects of these conventional compounds. This led to the search of natural products which are highly beneficial and biocompatible. Turmeric is one such novel product obtained from plants, known for its varied medicinal value. In dentistry, it plays a role treating gingival and periodontal disease. Aim: To evaluate the clinical efficacy of oral curcuma gel in gingivitis and to assess any adverse effects of the gel. Materials and Methods: This pilot study comprises of 10 individuals with severe gingivitis. They were made to apply oral curcuma gel for a period of 21 days. The papillary bleeding index (PBI) were assessed before and after along with visual analogue scale. The obtained data was statistically analysed. Results: The data was analysed with Pearson Spearman’s correlation coefficient and paired ‘t’ test. The results were statistically significant with p<0.001. Conclusion: The gel containing curcuma longa extract was efficient in treating gingivitis by reducing its inflammatory components.

Role of Transvaginal Sonography and Diagnostic Hysteroscopy in Abnormal Uterine Bleeding

Veena.B.T, Nirmala Shivalingaiah

Introduction : A prospective study was carried out in Department of Obstretics and Gynaecology in KIMS Hospital Bangalore, India for a period of 18 mnth from 2005-2008. 60 cases were selected for this study from patients who were above the age of 40 y and who were presented with a history of abnormal uterine bleeding (after excluding pregnancy and its complications, Patients with local causes of bleeding, patients with carcinoma cervix and PID). All women underwent transvaginal sonography and hysteroscopy. Dilatation and curettage was done in cases with abnormal endometrial findings and sample sent for histopathology examination. Performance of TVS pick up rate in relation to hysteroscopy were analysed by various statistical methods. Results: In the present study, transvaginal ultrasound showed an accuracy of 83.3% in detecting the proliferative phase and 66.67% in detecting the secretory phase. TVS has a sensitivity of 0% for a local lesion (intra-cavitary) of endometrial cavity. TVS was also preferable in case of post-menopausal patients with endometrial thickness less than 4mm. Conclusion: Both TVS and hysteroscopy can detect endometrial intracavitary abnormalities with varying accuracies. These can supplement and enhance the accuracy of tissue diagnosis. Thus, the first procedure to which patients with AUB are to be subjected should be TVS followed by hysteroscopy and hysteroscopically directed biopsy, wherever required.

Hyaluronic Acid as an Adjunct to Scaling and Root Planing in Chronic Periodontitis. A Randomized Clinical Trail

Aim: Aim of the present study was to evaluate the adjunctive effect of local application of hyaluronon gel following scaling and root planing (SRP) in chronic periodontitis patients. Materials and Methods: In this randomized split mouth study 33 subjects with chronic periodontitis were evaluated after full mouth SRP. In the test sites hyaluronon gel was applied immediately after SRP and one week post therapy, the control sites were treated with SRP alone. Bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 4 wk and 12 wk. Results: Significant reduction in BOP scores was observed in both the groups at 12weeks (p<0.001). The hyaluronon group showed a greater reduction in BOP (p<0.001). In the hyaluronon group the mean PPD at baseline was 6.33±0.09 which reduced to 2.49±0.51 at 12weeks which was statistically significant (p<0.001). In the control group the mean PPD at baseline was 6.09±1.26 which reduced to 4.36±1.29 at 12 weeks which was statistically significant (p<0.001). The CAL measurements showed a significant difference between the groups (p<0.001) at 12 wk post therapy. Conclusion: Hyaluronic Acid (HA) has a beneficial effect on periodontal health in patients with chronic Periodontitis. HA appears to be a suitable candidate as an adjunct to SRP in chronic periodontitis patients.

Value of Preoperative Sonographic Vascular Evaluation of Haemodialysis Access in Upperlimb

Objective: To know the value of preoperative Dopplerultrasonography vascular mapping of upper limb for hemodialysis access placement. Materials and Methods: Prospective ultrasonographic assess- ment of upper extremity vessels was performed in 60 patients prior to hemodialysis access placement and potential access sites were selected (based on the standard criteria). The findings were correlated with the operative findings. Discrepancies found between ultrasonographic and operative findings were analysed. Results: All the 60 patients who underwent vascular mapping had vascular access placed. 80% of them had native arteriovenous fistulae (AVF) placed. In 95% of patients, at the selected sites, the vascular parameters as determined by ultrasonography matched with the operative findings. In 5% of patients there were discrepancies between the ultrasonography findings and operative findings. There was no negative surgical exploration. There was strong correlation between the diameters measured by ultrasonography and surgery. Conclusion: Preoperative ultrasonography vascular mapping prior to hemodialysis access placement has facilitated definite selection of potential sites in difficult patient population in whom evaluation by physical examination was inconclusive. It also helped in maximizing the native AVFs and decreasing the negative surgical exploration rates.

Intrarenal Doppler Indices in Acute Ureteric Obstruction

Umamageswari Amirthalingam

Context: Urolithiasis remains a major health problem despite advances in therapy. Obstruction results in an increase in pressure within the urinary tract, causing structural and physiologic changes. This study aimed to calculate the intra renal Resistivity Index (RI) of acutely obstructed kidney, to determine the significance of Resistivity Index Ratio (RIR) and difference in Resistivity Index of obstructed and contralateral non obstructed kidney. Materials and Methods: Prospective study with renal Doppler for patients presenting with acute unilateral ureteric obstruction. Seventy two patients between the age group 20-45 y presenting to the Department of Radiodiagnosis, between January – December 2006 with acute unilateral ureteric obstruction were included in the study. Gray scale and Doppler evaluation of the kidneys done; with assessment of the ureteric calculus. Renal Doppler indices calculated and follow up of the same done after relief of obstruction. Statistical Analysis: Statistical analysis was done using SPSS Software V13 and p-value <0.05 was considered as statistically significant. Results: Forty two patients (58.33%) had mild, 28 (38.89%) moderate and 2 (2.78%) severe hydronephrosis. The mean RI of the obstructed kidney was 0.66±0.88 and that of contralateral non obstructed kidney was 0.569±0.05. Delta RI between the obstructed and contralateral non obstructed kidney was 0.08±0.03. The mean RIR between the obstructed and non obstructed kidney was 1.12±0.04 and the same after relief of obstruction was 1.03±0.06. Conclusion: The intrarenal Resistivity indices are less sensitive indicators in predicting the diagnosis of acute ureteric obstruction, although Resistivity Index Ratio appears to be a better parameter. The indices within the normal range do not rule out the absence of obstruction. Hence these parameters should not be interpreted in isolation.

Micronuclei Frequencies and Nuclear Abnormalities in Oral Exfoliated Cells of Nuclear Power Plant Workers

Aim: Biomonitoring provides a useful tool to estimate the genetic risk from exposure to genotoxic agents. The aim of this study was to evaluate the frequencies of Micronuclei (MN) and other Nuclear abnormalities (NA) from exfoliated oral mucosal cells in Nuclear Power Station (NPS) workers. Materials and Methods: Micronucleus frequencies in oral exfoliated cells were done from individuals not known to be exposed to either environmental or occupational carcinogens (Group I). Similarly samples were obtained from full-time Nuclear Power Station (NPS) workers with absence of Leukemia and any malignancy (Group II) and workers diagnosed as leukemic patients and undergoing treatment (Group III). Results: There was statistically significant difference between Group I, Group II & Group III. MN and NA frequencies in Leukemic Patients were significantly higher than those in exposed workers &control groups (p < 0.05). Conclusion: MN and other NA reflect genetic changes, events associated with malignancies. Therefore, there is a need to educate those who work in NPS about the potential hazard of occupational exposure and the importance of using protective measures.

Influence of Insulin-Like Growth Factor-I on Maturation and Fertilization Rate of Immature Oocyte and Embryo Development in NMRI Mouse with TCM199 and a -MEM Medium

Introduction: In vitro maturation (IVM) of oocytes and subsequent, in vitro fertilization (IVF) for the generation of embryos in the laboratory has important values. Growth factors are a component of a complex system of autocrine and paracrine factors that have a regulatory role in ovarian function and affect oocyte maturation. Therefore, the aim of this study is to evaluate the effect of IGF-I on IVM and IVF of mice oocytes during culture with a-MEM and TCM199 medium. Materials and Methods: Cumulus oocyte complexes (COCs) and denuded oocyte were obtained from 4-6 week old NMRI mice and underwent in vitro maturation and in vitro fertilization in presence or absence of IGF-I with a-MEM and TCM199. Result: Maturation rate (79.6%), fertilization rate (87.2%), two cells development rate (79.5%) and blastocyst rate(43.2%) was higher in COCs cultured in a-MEM with IGF-I, while lower maturation rate (50.6%) fertilization rate (61%), two cells development rate (48.8%) and blastocyst rate(14.6%) were seen in cultured denuded oocytes (DOs) in TCM199 without growth factor. As well as, maturation fertilization, two cells development and blastocyst rates in COCs were higher than DOs. Conclusion: Our findings have shown that IGF-I is involved in the oocyte biology and improve the oocyte maturation, fertilization and embryo development to blastocyst competence in vitro. In addition, it has also shown that cumulus cells are vital for oocyte development when IGF-1 added to the mediums.

Thoracic Part of Sympathetic Chain and its Branching Pattern Variations in South Indian Cadavers

Hemanth Kommuru, Swayam Jothi, P.Bapuji, Sree Lekha D, Jacintha Antony

Introduction: The sympathetic trunks are two ganglionated nerve trunks that extend the whole length of the vertebral column.The two trunks end by joining together to form a single ganglion, the ganglion impar. The thoracic part of the sympathetic chain runs downward and leaves the thorax behind the medial arcuate ligament. The preganglionic fibers which are grouped together to forms planchnic nerves and supply the abdominal viscera. Anatomical variations of the thoracic sympathetic trunk in relation to Intercostal nerves may be one of the reasons that cause surgical failures. Therefore our present study aimed to investigate the Sympathetic variations in the cadavers. Materials and Methods: In the present study we have investigated 31 embalmed cadavers thoracic cavities were eviscerated, the posterior thoracic walls were dissected carefully to expose the sympathetic chain and its branches. Results: Stellate ganglion was observed bilaterally in 4 cadavers and unilaterally in 15 cadavers. Greater splanchnic nerve highest origin was 4th ganglion and the lowest origin was 11th ganglion. Common origin for the lesser splanchnic nerve was from the 11th ganglion. Common origin for the least splanchnic nerves was from the 12th ganglion. Conclusion: Information on the variability of the anatomy of the thoracic sympathetic chain and splanchnic nerves may be important for the success of subdiaphragmatic neuroablative surgical approaches to pain control and splanchnic neurectomy for the management of chronic abdominal pain.

Evaluation of Correlation Between apical Diameter and File Size Using Propex Pixi Apex Locator

Aim : Aim of this study is to evaluate the influence of critical diameter of apical foramen and file size using propex pixi apex locator in working length determination Materials and Methods: In this study, ten single rooted teeth were selected. They were decoronated at cemento enamel junction. After determining the actual working length, they were embedded in alginate mold. Foramina were widened from 0.6mm to 0.8mm. The measurements were taken with electronic apex locator propex pixi with files from sizes 10 K to respective sizes. Statistical accuracy of propex pixi was calculated by using Anova test for different diameters and for the influence of file size. Results: Results showed that propex pixi apex locator was accurate when foramen diameter is 0.6 (60k file size), its accuracy diminished with increased foramen diameter Conclusion: Propex pixi is accurate for foramen diameter of 0.6mm, independent of file size. Its accuracy decreases as apical foramen widens, so care should be taken when using clinically

Five Year Retrospective Case Series of Adnexal Torsion

Sobha Nair, Smitha Joy, Jayashree Nayar

Aims and Objectives: Adnexal torsion is a rare gynaecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage .Our study is about clinical presentation and management approach of adnexal torsion in a tertiary care centre. Study Design:Retrospective study. Materials and Methods: Review of case records during the five years of 2008 November -2013 November in Amrita Institute of Medical Sciences, Kochi, India. Results: Adnexal torsion was found mainly in the reproductive age. Ultrasound was the most commonly used imaging modality. Benign tumours predispose to torsion. Torsion occurred during postovulatory period in many cases. Polycystic ovaries were a risk factor for unexplained torsion in younger age groups. Diagnosis of adnexal torsion was mostly intra operative by direct visualisation of the rotated adnexa. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was tried in majority of the child bearing age groups. Conclusion: Adnexal torsion is a rare emergency which requires a high index of clinical suspicion for diagnosis as the symptoms are non specific. Imaging helps in diagnosis but most of them are diagnosed intra operatively. Laparoscopic conservative surgery is the preferred surgical approach especially in younger age groups. An early surgical intervention helps in salvaging the adnexa and prevents further complications.

Musculo-skeletal Disorders among Video Display Terminal Users: A Cross Sectional Study in a Software Company, Kolkata

Rivu Basu, Aparajita Dasgupta, Gautam Ghosal

Introduction: IT has revolutionized economies throughout the world, more so in India. West Bengal has also got its share of IT boom. But with this, it has brought in the class of human resource of Video Display Terminal workers operators that and along with that can cause a host of occupational problems in them namely musculoskeletal, ocular and psychological systems. The current study had assessed some of the musculoskeletal disorders occurring due to VIDEO DISPLAY TERMINAL use. Materials and Methods: An analytical cross-sectional study was done in a Software Company of Sector V, Kolkata, the IT hub of West Bengal. Of all the employees, required sample size of 206 was selected by Simple Random Sampling. After proper permissions and consent, socio-demographic variables were collected by standardized instruments, musculoskeletal morbidity was collected by Nordic questionnaire, and ergonomic practices were obtained by checklists. Results: 90.78% of population showed some form of musculo skeletal symptoms. They were highest in fingers, elbows, wrist, shoulder, upper, while legs and lower back showed low morbidities. Increasing age, female sex, increasing years of work, repetition of work, poorer ergonomic scores all showed to have increased the symptoms. The regionwise ergonomic scores revealed how the poorer scores affected the musculo skeletal systems adversely. Several individual adverse ergonomic practices were also elicited. Discussion: The study goes hand to hand with many other studies throughout the world and also in India. However, a much higher morbidity has been found in this study probably due to a symptom based questionnaire. The adverse practices obtained here goes well with other relevant studies. Conclusion: This study puts occupational health problems of VIDEO DISPLAY TERMINAL users, and upholds the need of future multicentric cohort studies along with implementation of proper measures to ameliorate the effects of this occupational hazard.

Comparative Study of Renal Protective Effects of Allopurinol and N-Acetyl-Cysteine on Contrast Induced Nephropathy in Patients Undergoing Cardiac Catheterization

Objectives : To evaluate the difference in the renal protective effects of allopurinol and n-acetyl cysteine along with saline hydration in patients of contrast induced nephropathy (CIN) post cardiac interventions. Background: CIN remains a common complication of cardiac procedures. Radio contrast agents can cause a reduction in renal function that may be related to oxidative stress underlining various patho- physiologies. Conflicting evidence suggests that administration of allopurinol, a xanthine oxidase inhibitor can prevent CIN. Materials and Methods: This is a study of 500 patients undergoing angiography and coronary revascularisation in patients showing significant coronary block. The angiography positive patients (275) were prospectively randomised to different treatment protocol to study for their reno-protective effect. The patients received either of the three drugs saline hydration (SH, 1ml/kg/hr), n-acetylcysteine (SH+NAC, 600 mg bd) or Allopurinol (SH+ALLP, 300 mg/day) 12 hours before and after administration of radio contrast agent. Levels of serum creatinine and blood urea of the 275 patients recorded at 24 hour interval were noted post angioplasty over a course of 5 days in patients receiving either omnipaque (125) or visipaque (150) contrast media. All the 500 patients were also assessed for development of any kind of adverse drug effects/reactions with the two contrast media. Results: CIN occurred in 56 of 500 the patients (10.6%) who underwent angiography and 49 of 275 patients (17.8%) who underwent angioplasty. In the omnipaque group CIN occurred in 16/40, 8/40, nil/45 in patients receiving SH, NAC plus SH and SH plus ALLP respectively. In the visipaque group CIN occurred in 15/50, 10/50, nil/50 in the three treatments groups respectively. Allopurinol maintained a consistent fall in the serum creatinine & blood urea levels from the baseline values from the end of the 1st day (p < .01 & .001) in both the category. Visipaque proved to be better dye than omnipaque with less adverse drug effects/ reactions. Conclusion: Prophylactic oral administration of allopurinol (300 mg/day) along with hydration is better than n-acetylcysteine and saline hydration alone for protection against CIN in patients undergoing coronary procedures.

Multinucleate Giant Cells in FNAC of Benign Breast Lesions: Its Significance

Seema V., Kalyani R., Srinivasa Murthy.V

Introduction: Many studies have shown that the prevalence of celiac disease (CD) is increasing in the patients with irritable bowel syndrome (IBS), but the present evidences are controversy and all of the researches don’t suggest evaluation of the patients with IBS for the CD. Materials and Methods: In the cross-sectional study, 1000 patients that affected by IBS with the predominant feature of diarrhea who referred to the gastroenterology clinic were evaluated during 2009-2012 years. Blood samples were taken from the patients for ELISA of IgA tissue transglutaminase (TTG) Ab. Then biopsy was taken from the second part of duodenum of all of patients by endoscopy and the sample was referred to pathologist for histopathology evaluation in order to confirm diagnosis. Results: About half of the patients with IBS were women (50.3%) and the mean age ± Standard deviation of the men and women was 29.59±11.41 and 28.42±11.73, respectively. The mean titer of TTG IgA Ab in the women and men affected by IBS was 5.25±17.77 and 7.22±25.4, respectively. Seventy six cases (7.6%) that affected by IBS had high serum level of Ab titer (TTG IgA.Ab=10) that including 41 women and 35 men. In the patients with high serum level of Ab titer, 57 cases (75%) were affected by celiac disease (based on histopathology report). Therefore, the prevalence of CD was 5.7% among patients with IBS. Conclusion: In the current study the incidence of CD was evaluated 5.7 cases per each 100 people with IBS. It’s suggested that all of the patients with diarrhea predominant IBS and high serum level of TTG IgA Ab must be examined for evaluation of CD.

Evaluation of Different Staining Techniques in the Diagnosis of Trichomonas vaginalis Infection in Females of Reproductive Age Group

Razia Khatoon, Noor Jahan, Haris Manzoor Khan, Tamkin Rabbani, Siraj Ahmad

Background: Trichomonas vaginalis is a parasitic protozoan which causes most common non viral sexually transmitted disease trichomoniasis. Direct microscopic examination of vaginal fluid remains the most widely used diagnostic test. Although, wet mount examination is the most cost-effective diagnostic test, but it has low sensitivity resulting in under diagnosis of the disease. Therefore, to overcome this problem, various staining techniques like giemsa and acridine orange can be used along with wet mount examination for diagnosis of T. vaginalis infection. Objective: The present study was done to evaluate the efficacy of Giemsa and Acridine Orange staining in comparison with wet mount examination for the diagnosis of vaginal trichomoniasis. Materials and Methods: A total of 615 female patients of reproductive age group having vaginal discharge were included in the study and swabs containing vaginal fluids were taken to perform wet mount examination, giemsa staining and acridine orange staining. Result: Trichomonas vaginalis infection was detected in 37 patients with maximum cases (6.0%) detected by acridine orange staining, followed by giemsa staining (4.9%), whereas, wet mount examination was able to detect only 4.1% cases. Wet mount examination gave a sensitivity of 67.6%, whereas, the sensitivity of giemsa staining and acridine orange staining was found to be 80% and 100% respectively. Conclusion: Since the performance of both the staining techniques was found to be much better in comparison to wet mount examination, and they also detected several wet mount negative cases, they should be used as an adjunct to wet mount examination. This will also be beneficial to the overall health of the patient by early diagnosis and treatment of cases, thereby, reducing the development of associated morbidity.

Association of Child Temperament with Early Childhood Caries

Zohra Jabin, Seema Chaudhary

Background: Psychological variable may affect early childhood caries (ECC), but this aspect has not been explored satisfactorily. This study evaluates the child temperament as a risk predictor for ECC. Aim: To find the association of child temperament with ECC. Settings and design: The study is a cross-sectional survey of 1300 school children aged 3 - 6 years from Moradabad city. This survey was conducted during March 2008 to April 2009. The survey assessed the child temperament and analyzed its association with ECC. Materials and Methods: Children were examined for the evidence of caries, using dmft (decayed missing filled teeth) index based on W.H.O standard criteria (1997). Child temperament was assessed on the basis of five factors; namely, Sociability, Emotionality, Energy level, Attentivity and Rhythmicity using Malhotra Temperament Schedule MTS. Statistical Package for Social Sciences (SPSS) was used to analyse the data. Significance was deemed at p=0.05. Results: Out of 1,300 parents involved in filling questionnaire for assessment of child temperament, 1053 (81%) responded and their children were included in study. No caries were found in 731 (69%), while 322 (31%) had evidence of caries in one or more teeth. Of the five temperament factors, Sociability, Energy score, Attentivity and Rhythmicity significantly associated with ECC levels. No correlation could be established with emotionality. Conclusion: The children with ECC were found less sociable, less energetic, highly distractible and less rhythmic as compared to children without ECC.

JJ Stent Removal under Ultrasound Guidance in Women: It is Simple and Safe

Introduction: With the increase in number of patients treated for urological problems with endoscopic procedures, the number of patients with JJ stent is also increasing. The amount of workload thus incurred multiplies, even to the point that, sometimes we waste more time in the operating room removing JJ stents than the actual endourological procedures. Here in our institute, we have devised a very simple and effective way of removing JJ stents in women and also determined the efficacy, safety and cost of JJ stent removal under ultrasound guidance in women in comparison to cystoscopic removal. Materials and Methods: Two hundred women attending the Department of Urology from July 2012 to July 2013 at RIMS hospital were randomly divided into two arms. One hundred women had their JJ stent removed with cystoscope and another 100 women had their JJ stent removed under ultrasound guidance using simple surgical tools available at the hospital. The primary comparative points were waiting time for operating room appointment date, cost of the procedure, time taken for the procedure, discomfort or pain felt by the patient and urethral injuries. Results: In all the parameters, stent removal under ultrasound guidance was significantly better except for urethral injuries where both the procedures had similar outcomes. Conclusion: We concluded that JJ stent removal underultrasound guidance in women was simple, effective and safe.

Identifying Candida and Other Yeast-Like Fungi: Utility of an Identification Algorithm in Resource Limited Setting

Vidya Nerurkar, Suveb Khan, Sushma Kattungal, Simi Bhatia

Aim: The increasing recovery rates of unusual yeasts with innate drug resistance make accurate identification crucial for successful therapy and infection control measures. The current study was undertaken to study the utility of CHROMagar Candida (CC) and evaluate an identification algorithm, using germ tube test (GT), CC and a commercial identification kit, API ID 32C. Settings and Design: The prospective study was carried out at a private laboratory in Mumbai, India. Materials and Methods: Identification of 533 yeast and yeast like isolates was carried out using an identification algorithm, comprising of the GT, CC and API tests. Results: CC was useful to detect mixed cultures. We were able to identify 393/533, i.e. 73.7 % of isolates using GT and CC Tests only. This was because C. albicans and C. tropicalis, which can be reliably identified using CC, constituted 75.2 % of the isolates. We were unable to identify 140 isolates, i.e. 26.3 %, using GT and CC tests only and performed additional testing using API ID 32C. CC was not found to be reliable in identifying C. krusei. Conclusion: The diverse identification profile obtained in our study substantiates the need for all diagnostic microbiology laboratories to be better prepared for identifying unusual yeasts. Though GT or CC testing cannot alone suffice for identification of all clinically encountered Candida and yeast-like fungi, use of GT, CC and automated identification systems in a step-wise algorithm can enable the same in a more cost effective manner.

Problems Faced by Complete Denture-Wearing Elderly People Living in Jammu District

Harvinder Singh, Sumeet Sharma, Sarbjeet Singh, Nikhil Wazir, Rajiv Raina

Context: Poor oral health is increasing dramatically among old people especially those living in rural and remote areas. Various factors such as low education background, low income, poor living conditions, unhealthy lifestyle, inadequate oral hygiene and tobacco use lead to poor oral health among older people which in turn lead to risks to their general health. The older people especially from rural areas are apprehensive about seeing a dentist and do not visit them regularly. This may lead to various problems which may have a detrimental influence on their quality of life. Aim: To know the problems faced by complete denture wearers in rural areas in Jammu district. Materials and Methods: Fifty patients from rural area Bishna, initially treated with a complete denture in the maxilla or mandibles were examined. The data were collected with the help of a questionnaire. Results: The results revealed that majority of respondents were in the age – group of 65-70 y. Majority of respondents complained of "difficulty chewing", "sore spots”, “painful and swollen gums". Majority of respondents had difficulty in speech, it was difficult for them to interact and communicate with their dentures on. Most of the respondents had lost confidence and had low self esteem. Clinical observations revealed that the commonest condition associated with denture wearing was Oral Stomatitis/ Burning mouth Syndrome, Superimposed infection and Angular cheilitis. Conclusion: Older people should Communicate and visit dentists, regularly, so that the dentists can adjust the treatment and pace according to their needs. Behavioural therapy techniques can make dental visits relatively anxiety and pain-free.

Incidental Diagnosis of Filariasis in Superficial Location by FNAC: A Retrospective Study of 10 Years

Pratima Khare, Pooja Kala, Aditi Jha, Nidhi Chauhan, Priyanka Chand

Background: Filariasis, transmitted by the bite of various species of mosquito, is a common disease of tropical belt of the world. In South East Asia, including India, it is a major public health problem. The parasite is primarily confined to Lymphatic channel or lymph nodes where it can remain viable for more than two decades. The most common presentation of the disease is asymptomatic/ subclinical microfilaremia, Hydrocele, acute adeno-lymphangitis (ADL) and chronic lymphatic disease. However, the disease may rarely present as superficial swellings at unusual sites. Incidental findings of microfilaria on fine needle aspiration cytology in these situations, helps in prompt recognition of the disease. Aim: The aim of this retrospective study was to assess the incidental diagnosis of Filariasis on fine needle aspiration cytology (FNAC), done for swellings in superficial locations over last ten years at our institute. Materials and Methods: This retrospective study was conducted over a period of 10 years from April 2003 to March 2013 on the cases where FNAC was carried out on swellings in superficial locations of the body. Twenty cases of filariasis were diagnosed on routine FNAC material obtained from various superficial sites. Their data was retrieved and analyzed. Results: Among the 20 cases diagnosed as filariasis on FNAC, six cases involved lymph nodes, six involved testiculo-scrotal region, three cases of thyroid swelling, soft tissue swelling in three cases and breast lump in two cases. On FNA smears, microfilariae were seen in all 20 cases, eggs in three cases, adult female worm in two cases and adult male worm in one case. Adherence of inflammatory cells and macrophages to microfilariae was noticed in 4 cases. Eosinophilia was present in seven cases. Microfilaremia was present in only three cases. Causative agent was Wuchereria bancrofti in all cases. Conclusion: Although not so common, filariasis should be considered as one of the differential diagnosis of a superficial swelling particularly if clear fluid is obtained on FNAC. Careful screening of smears plays a significant role in recognition of the disease even in asymptomatic patients.

Exploring Trends in Forensic Odontology

Narendra Nath Singh, Owais Gowhar, Tasneem S. Ain, Saima Sultan

Background: Forensic odontology nowadays has become a developing science and is of great importance to society. It is important that dental practitioners should have a proper knowledge of forensics as the need has increased greatly over the last decades due to the unprecedented demand from the criminal justice including terrorism in Kashmir valley (J&K India). Materials and Methods: Data was collected based on questionnaire survey among qualified dental practitioners related to their awareness of forensic odontology. Results: A total number of 235 dental practitioners responded to the questionnaire. Results showed that there was a low confidence, in handling of forensic odontology related cases among dental practitioners and majority of dental practitioners were not having any formal training in forensic odontology. Conclusion: Each dental practitioner has a responsibility to understand the forensic implications associated with the practice of his profession and thus he should work sincerely enough so to ensure his contribution in the field of forensic odontology.

A Prospective Hospital Based Study of Childhood Orthopaedic Problems - A Case Series

Sharat Agarwal

Introduction: Children may present to an orthopaedic surgeon with congenital bone diseases, nutritional disorders like rickets, infective or traumatic due to fall etc of bones and joints. Aim: To know the percentage, common orthopaedic problems and demographic profile of paediatric orthopaedic problem in patients attending the orthopaedic OPD of NEIGRIHMS. Materials and Methods: The prospective study was conducted for the duration of one year from May’2012-May’2013 in the Department of Orthopaedics in North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, India. Results: In our study majority of the patients were in the age group of 11-15 y (37.4%), followed by the group of 0-5 y (25.6%). Majority of the paediatric orthopaedic patients came from the group of Rs.10,000/- to 30,000/- monthly income families (56.2%). The study showed that in majority (51.6%) of the cases trauma was the major cause for bringing the child to the medical center. Male children were most commonly affected, with playing as the most common mode of injury especially outdoor (60.3%) and fractures especially of upper limb were the most common form of presentation. Conclusion: Our study here has given the bird’s eye view of various pediatric orthopedic disorders as may be found in a tertiary health care setting. This may help in formulating training modules for the medical students in the subspecialty of pediatric orthopedics. However, more community based cross-sectional studies may be required to be undertaken to determine the prevalence & incidence of the various disorders found in our patients.

Quantitative Assessment of Fluoride Release and Recharge Ability of Different Restorative Materials in Different Media: An In Vitro Study

Objective: To measure fluoride release and recharge ability of restorative materials in deionised water, artificial saliva and lactic acid. Materials and Methods: Pellets were prepared from GC2, Ketac N100 and Beautifil II. Each pellets were individually immersed in 10 ml deionised water, artificial saliva or lactic acid as per respective subgroup for 24 h and then elutes were collected. Specimens were reimmersed in respective container. Fluoride released was analysed after 24 h, 7th and 15th day. On 15th day all specimens were exposed to 1.23% APF gel and fluoride release in respective solution was measured on 16th, 22nd, 30th day. Result: Fluoride release was more after 24 h for all materials in all media then decrease gradually. GC2 shows more fluoride release than Ketac N100 at 24 hours and on 7th day but onwards Ketac N100 released significantly more fluoride. Beautifil II showed least fluoride release at all measured intervals in all media. Order of fluoride release in media was lactic acid > deionised water > artificial saliva for all materials. Conclusion: GICs are smart material which release more fluoride when environment become more acidic and also show tendency to recharge which helps clinically in caries risk children.

Prevalence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Children

Background: Invasive infections from community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly being encountered in healthy children. Nasal colonization of MRSA is associated with increased risk for acquiring invasive disease. The objective of this study was to determine prevalence and risk factors for CA-MRSA nasal colonization among a healthy paediatric population and to determine antibiotic susceptibilities of S. aureus isolates. Materials and Methods: Using a cross-sectional study design, children aged 1mnth-17y attending well-child clinic at an academic hospital and a local public school in Mangalore, India were screened for S. aureus colonization via nasal swabs. A questionnaire was administered and data on risk factors for nasal colonization was collected. Samples were obtained from the anterior nares and cultured quantitatively. S. aureus isolates were confirmed by growth on selective media and coagulase testing. Disk diffusion antibiotic susceptibility tests were performed according to Clinical and Laboratory Standard Institute guidelines. Results: Of the 500 children included in the study, S. aureus was isolated from the anterior nares in 126 (25%) children; four (3%) isolates were classified as CA-MRSA. Factors associated with S. aureus nasal colonization were children <6 y old (p=0.030) and members of joint families (p=0.044). Resistance to many classes of antibiotics were noted among S. aureus isolates including trimethoprim-sulfamethoxazole (39%), ciprofloxacin (16%), erythromycin (19%) and clindamycin (5%). Inducible clindamycin resistance (positive D test) was detected in 11 of the erythromycin-resistant strains not already classified as resistant to clindamycin. No resistance to vancomycin was observed. Conclusion: Children in India have a high rate of nasal colonization of S. aureus. Nasal colonization of community-associated methicillin-resistant S. aureus exists but is still low among healthy children. The high rate of resistance to many classes of antibiotics among S. aureus strains is of great concern warranting continued surveillance and antimicrobial stewardship.

Intraoperative and Immediate Postoperative Outcomes of Cataract Surgery using Phacoemulsification in Eyes with and without Pseudoexfoliation Syndrome

Neelam R Dwivedi, Arun K Dubey, P Ravi Shankar

Background: To compare the intraoperative and immediate postoperative behavior and complications in eyes with pseudoexfoliation (PEX) syndrome with eyes having senile cataract without PEX during cataract surgery using phacoemulsification (PKE). Materials and Methods: In this prospective study, 68 eyes of 68 patients were divided into two groups: Group 1 (test) comprised 34 eyes with immature senile cataract with PEX and Group 2 (control) included 34 eyes with immature senile cataract without PEX and any coexisting ocular pathology. Phacoemulsification (modern cataract surgery) was performed on both groups through stop and chop technique and comparative analysis of the incidence of intraoperative and immediate postoperative complications was made. Results: There was no significant difference in rates of intraoperative complications between PEX (2.9%) and Control (0%) group. The mean pupil diameter was significantly smaller in Group 1 (p<0.001). No eye in either group had phacodonesis. 58.8% of eyes in Group 1 and 29.4% in Group 2 had a harder cataract (nuclear sclerosis) = grade 3 (p=0.017). PKE was performed in all eyes with cataract in both groups. Intraoperative complication (zonular dialysis (dehiscence) was encountered in only 2.9% (1 case) of eyes with PEX. PC (posterior capsule) tear (rent) with vitreous loss was seen in 2.9% eyes of Group 1 and none in Group 2. Postoperatively, IOP (intraocular pressure) and aqueous flare response were comparable between the groups. Significantly higher inflammatory cell response was observed in Group 1 (p=0.014). BCVA (best corrected visual acuity) using Snellen chart with pinhole on postoperative day1 was significantly better in the control group compared to the group with PEX (p=0.027). Conclusion: Phacoemulsification can be safely performed by experienced hands in cataractous eyes with PEX. The incidence of intraoperative and immediate post-operative complications in eyes with PEX was not significantly different compared to eyes without PEX in our study. Further studies among a larger population are required .

Floatation of Decalcified Bone Marrow Core Biopsy – A Clue to Marrow Hypocellularity

Vijai Tilak, Subhajit Das, Gyan Prakash Singh

Background : Examination of bone marrow plays a pivotal role in the practice of haematology. It can be evaluated by three ways – bone marrow aspiration smears (BMA), bone marrow touch imprints (BMI) and bone marrow biopsy (BMB). BMB sections are considered to be the gold standard for assessing overall marrow cellularity. Aim and Objective: To evaluate the correlation, if any, between bone marrow cellularity and floatation pattern of the core biopsy specimen, after proper decalcification. Setting and Design: This study was carried out in the Department of Pathology, Institute of Medical Sciences, Varanasi over a period of 26 months. Materials and Methods: Specimens of BMA, BMI and BMB were collected from 182 cases. The core biopsy specimens were fixed in 10% buffered formalin for 24 hours, and were decalcified in 5% formic acid for 12 hours. The properly decalcified core biopsy samples were then put into adequate-sized container filled with 10% buffered formalin, and floatation pattern was documented. Statistical Analysis: All the observations were evaluated using simple and basic statistical tools, i.e. sensitivity, specificity, positive predictive value. Chi square test was applied for obtaining statistical correlation i.e. p-value. Results: Out of 182 core biopsy specimens, 32.4% (n=59) floated, while rests sank. Out of the 59 floating core biopsies, 57 were hypocellular. Seven core biopsies, among 123 specimens that sank, were hypocellular. The sensitivity and specificity of floatation pattern for hypocellular marrow were 89.2% and 99.1%, respectively. A strong correlation (p-value <0.001) between the floatation pattern and bone marrow cellularity was obtained. Conclusion: Assessment of floatation pattern of properly decalcified marrow core specimen is reliable for assessing marrow hypocellularity.

Scanning Electron Microscopic Evaluation of Root Canal Surfaces Prepared with LightSpeed & Endowave rotary system

Hema.B.S, G.S Chandu, Vijayakumar L Shiraguppi

Background and Objectives: The purpose of this in vitro study was to evaluate and compare the cleaning efficiency on root canal surfaces prepared with LightSpeed and Endowave rotary instruments. Materials and Methods: A total of 30 freshly extracted human mandibular premolars were subjected for the study. They were divided into two groups, each group consisting of 15 teeth. Group 1: The canals were prepared with LightSpeed system. Group 2: Endowave rotary system. All the groups were prepared according to manufacturer’s recommendation, using 5.25% sodium hypochlorite and 17% EDTA (dent wash, prime dent) alternately as an irrigants. Crowns of each tooth were removed with diamond disks at the level of cement enamel junction. Canal length was determined by placing a size 10 K-file. The working length was 0.5 mm short of canal length. Two longitudinal grooves were prepared on the lingual and buccal surfaces of each root to facilitate vertical splitting with a chisel after canal instrumentation. The sections were then observed under SEM for presence or absence of debris and smear layer and the photographs were taken at coronal, middle and apical 1/3 with a magnification of 200 X and 1000X respectively. The scores recorded were statistically analysed using one-way-ANOVA and Mann- Whitney test. Results: There was statistically significant difference between two groups. All groups resulted in significantly more debris and smear layer in the apical 1/3 of the canal, compared to coronal and middle 1/3 (p, <0.01). Interpretation and Conclusion: The study demonstrated that, LightSpeed instrumentation removed debris and smear layer more effectively on root canal surface than compared to Endowave instrument.

Severe Falciparum Malaria—Difference in Mortality among Male and Nonpregnant Females

Khadanga S, Thatoi P K, Mohapatra B N, Mohapatra N, Mohanty CBK, T Karuna

Background: There are many studies regarding the gender difference in severe falciparum malaria. But most of these studies indeed refer to pregnant females only. There are scanty and conflicting reports regarding the mortality trend in nonpregnant females. Materials and Methods: This is a case control study which is open, single centre, single blind, prospective and interventional study. SPSS 19 was used at the end of the study for all statistical analysis. Student’s t-test was used for nominal variables and chi-squared test was used for categorical variables. Results: The mean pre hospitalization illness period is significantly lower in females. Incidence of convulsion is significantly higher in females. The mean haemoglobin concentration in females is significantly lower. The mortality in females is significantly higher. Females over 40 years have higher mortality than females less than 40 years and also males over 40 years. Shock in female was associated with significantly high mortality. Conclusion: The mortality in females is significantly higher in males. The females had lower haemoglobin level and increased incidence of convulsion than their male counterparts. Shock in females has significantly higher mortality. So prompt treatment can save many lives. The increased mortality in females cannot be explained by relative inaccessibility of females to health care system as previously explained, because they have reached hospital earlier than males. Causes of shock and their association with increased mortality in females need further studies.

Comparative Study of Electrocardiographic Changes in Patients of Acute Mania Receiving Verapamil or Lithium Carbonate

Mukhtiar Singh, Sharanjit Kaur, Vijay Kumar Sehgal

Aim: TO compare the ECG changes in patients of acute mania receiving verapamil and lithium carbonate. Objectives: Verapamil used in resistant manic patients not responding to any drug therapy, should be considered for its side effects on cardiovascular system. It causes bradycardia and myocardial infarction in risk patients. So it is important to take clinical and other relevant history and do ECG before the patient to put on verapamil drug therapy. Materials and Methods: Patients with acute mania were randomized to receive lithium (n =25) or verapamil (n=25) in a 4-wk double-blind comparative study. Both groups were homogeneous with regard to demographic and disease variables. After giving first dose of verapamil, patients were observed for any cardiovascular side effects and ECG changes during the study. The study parameters were recorded at the baseline, after 7 d and 28 d of trial medication. Statistical Analysis: The Unpaired t-test was used for comparing baseline data in two groups and paired t-test was used for the interval data. A level of less than 5% value of p was considered statistically significant. Results: Both treatment groups showed no major differences in ECG changes during the trial except for the heart rate and T wave changes. The study showed that verapamil produces more bradycardia and T wave depression than with lithium in the treatment of mania. Conclusion: The baseline electrocardiogram should be done and heart rate should be monitored during the treatment.

Dengue and Typhoid Co–infection– Study from a Government Hospital in North Delhi

Background:Concurrent infection with two agents can result in an illness having overlapping symptoms creating a diagnostic dilemma for the treating physician. The symptoms of dengue may mimic other diseases such as leptospirosis, influenza A, Salmonella Typhi, Japanese encephalitis, chikungunya and malaria. There is paucity of data regarding dengue and typhoid co- infection both in the developed and developing countries. This study attempts to find the current co- infection rates in North Delhi. Materials and Methods: This retrospective study was done between August and November 2013. Medical records of 659 patients exhibiting febrile illness who visited Kasturba Hospital were studied. Dengue specific IgM antibodies were detected by Dengue IgM antibody capture ELISA test. Serodiagnosis of Salmonella infection was conducted by Widal test in the hospital. Results: Of the 659 febrile sera samples tested here, 141 (21.39%) tested positive for dengue. Of these 91 were females and 50 males. Of the dengue cases, eleven were co-infected with enteric fever (11/141= 7.8%). Maximum number of dengue positive cases seen in age group 0-10 y. Case Fatality Rate (CFR) was zero. Age groups of patients co-infected with dengue and typhoid were as follows: 0-10 y: 5, 11-20 y: 3, 21-30 y: 2, >60 y: 1. Conclusion: Co-infection should always be kept in mind while dealing with cases of dengue or enteric fever with or without atypical features. In order to reduce the burden of disease, along with improvement of sanitation and personal hygiene, emphasis should be given on vaccination against typhoid.

Delay in Specimen Processing-Major Source of Preanalytical Variation in Serum Electrolytes

Ankur Baruah, Parul Goyal, Saket Sinha, K L Ramesh, Rashmirasi Datta

Objective: To evaluate the stability of electrolytes in serum samples due to delay in analysis in a tertiary care government hospital in India, and the maximum time delay acceptable between sample centrifugation and analysis. Materials and Methods: We estimated serum electrolytes of 400 samples with different time intervals between centrifugation and sample analysis on automated analyser. Results: Values were compared using repeated measure ANNOVA and acceptable limit change using in house QC values of 6 months. During the time interval between centrifugation and sample analysis, the samples were kept uncovered in sample cups in the laboratory. Potassium values show significant changes within 1 h (T1, p<0.01) but sodium (T2, p <0.01) and chloride (T2, p <0.001) values are acceptable up to a time delay of 3 h between sample centrifugation and analysis. Conclusion: Samples for electrolytes should be analysed within 1-2 h of centrifugation and if there is any delay in analysis, the samples should be stored under proper conditions.

Celiac Disease Prevalence in the Patients with Irritable Bowel Syndrome in the Ilam Province; A Cross Sectional Study from Western Iran

Alireza Mahmoodi, Ali Jafarihaydarlo, Masood Yasemi, Karim Hemati, Hadi Peyman

Introduction: Many studies have shown that the prevalence of celiac disease (CD) is increasing in the patients with irritable bowel syndrome (IBS), but the present evidences are controversy and all of the researches don’t suggest evaluation of the patients with IBS for the CD. Methods: In the cross-sectional study, 1000 patients that affected by IBS with the predominant feature of diarrhea who referred to the gastroenterology clinic were evaluated during 2009-2012 years. Blood samples were taken from the patients for ELISA of IgA tissue transglutaminase (TTG) Ab. Then biopsy was taken from the second part of duodenum of all of patients by endoscopy and the sample was referred to pathologist for histopathology evaluation in order to confirm diagnosis. Results: About half of the patients with IBS were women (50.3%) and the mean age ± Standard deviation of the men and women was 29.59±11.41 and 28.42±11.73, respectively. The mean titer of TTG IgA Ab in the women and men affected by IBS was 5.25±17.77 and 7.22±25.4, respectively. 76 cases (7.6%) that affected by IBS had high serum level of Ab titer (TTG IgA.Ab = 10) that including 41 women and 35 men. In the patients with high serum level of Ab titer, 57 cases (75%) were affected by celiac disease (based on histopathology report). Therefore, the prevalence of CD was 5.7% among patients with IBS. Conclusion: In the current study the incidence of CD was evaluated 5.7 cases per each 100 people with IBS. It’s suggested that all of the patients with diarrhea predominant IBS and high serum level of TTG IgA Ab must be examined for evaluation of CD.

Evaluation of Subtle Left Ventricular Systolic Abnormalities in Adult Patients with Hypertrophic Cardiomyopathy

Ranjan Shetty, Jyothi Samanth, Krishnanand Nayak, Arohi Sarang, Ashok Thakkar

Background: Hypertrophic cardiomyopathy (HCM), an auto-somal dominant disorder due to mutation of genes encoding sarcomeric proteins, leads to left ventricular diastolic dysfunction. Recently, the research in this area suggests that systolic dysfunction exists in the patients with HCM even though traditional measures of systolic dysfunction are normal. So, we carried out this study to determine global systolic dysfunction in patients with HCM. Materials and Methods: A total of 18 patients, diagnosed with HCM according to echocardiography parameters, that is thickness of interventricular septum/posterior wall thickness >1.3 or hypertrophy involving apex only with or without left ventricular outflow tract obstruction, were included in the study and were compared with normal age-matched controls. We measured torsion and strain imaging by 2-dimensional echocardiography as well as strain imaging by tissue Doppler echocardiography. Result: The results of the study showed that there was considerable increased torsion in patients with HCM as compared to normal subjects (16.61±7.43 vs. 10.42±4.73, p=0.006). Tissue Doppler indices—systolic annular velocity (7.7±0.7 vs. 8.7±1.00, p=0.012) and lateral wall E/E’ (12.52±5.27 vs. 6.66±1.67, p<0.001) were significantly different in patients with HCM and normal subjects. The average systolic strain and strain rate as well as diastolic strain rate were significantly different in both the groups when strain imaging was performed by tissue Doppler echocardiography. We also observed significantly reduced global longitudinal, circumferential and radial strain in patients with HCM when strain analysis was carried out with 2-dimensional speckle tracking echocardiography. Conclusion: The global subtle systolic dysfunction, as measured by left ventricular torsion and strain imaging, is present in patients with HCM even though traditional measure of systolic dysfunction is normal.

Relationship of Inter-Condylar Distance With Inter-Dental Distance Of Maxillary Arch and Occlusal Vertical Dimension: A Clinical Anthropometric Study

Aim: To find out the anthropometric relationship of Inter-condylar distance to Inter-canine and Inter-molar distance of maxillary arch and occlusal vertical dimension in dentate individuals of South Indian population. Materials and Methods: A total number of 120 dentate individuals were randomly equally divided into Group A and Group B. According to the face form, each Group was again subdivided into four subgroups. Subgroup A1 and B1 contained Square face form, Subgroup A2 and B2 Tapered, Subgroup A3 and B3 Square tapered and Subgroup A4 and B4 Ovoid face form. The ratio of ICD to U3, U6 and OVD of Group A individuals were applied to the Group B individuals with similar face forms and the clinical significance of the ratios were evaluated. Results: No significant difference (p-value=0.841) was observed in the ratio of U6 to ICD (U6/ICD) in all the face forms. A significant difference (p-value = 0.010) in the mean value was observed when the ratio of OVD to ICD (OVD/ICD) was compared between the squared tapered face form of Group A (0.60 ± 0.01) and Group B (0.06±0.03). A significant difference (p value = 0.007) was observed between the measured (62.47 ±2.77) and calculated (64.99±2.61) values of OVD in square taper face form. Conclusion: In south Indian population, ICD can be used as a reliable guide line to determine the bucco-palatal position of maxillary first molar irrespective of the face forms.

Amino Acid Profile in Oral Submucous Fibrosis: A High Performance Liquid Chromatography (HPLC) Study

Background: Collagen is a significant structural protein, the integrity of which is essential to be maintained for proper homeostasis. Oral submucous fibrosis (OSMF), being a collagen metabolic disorder, may be subject to changes in amino acid profiling. Aim: The present study was attempted to evaluate the amino acid profile to assess its feasibility as a biological marker in OSMF. Materials and Methods: The study group comprised of 13 patents with OSMF and the normal group comprised of 13 normal patients without associated habits or systemic disorders. Venous blood was collected from the antecubital vein, plasma was separated and the plasma was then subjected to high profile liquid chromatographic analysis. Results: The assay levels of threonine, alanine and tyrosine did not yield any significant results. The decreased assay levels of valine, Isoleucine and the increased assay level of methionine and glycine observed in group II yielded significant results in correlation with the control group. The decreased assay level seen in phenylalanine in group II and III in correlation with group IV is statistically significant. Conclusion: A few amino acids have been identified which can be used as biological markers for the severity of the disease such as valine, methionine and phenyl alanine. Large scale studies are required to elucidate the potential of these biological markers.

Medical Students´ Research – Facilitators and Barriers

Background: Undergraduate research in medicine is important to expose and encourage the students towards the newer advances and research practices. The present study was taken up in a medical institute to assess the perception of the medical faculty about research undertaken by the medical undergraduates, and identifying the barriers faced by them in training undergraduate students for research. Materials and Methods: A questionnaire on perceptions, barriers and limitations towards undergraduate research was distributed to 105 participants included in the study. The responses of the participants were collected on a five point Likert scale and analysed using spss version 11.5. Results: There was a strong agreement among the faculty about students’ interest in carrying out research (95.1%), and that they had gained knowledge to design, conduct, present and publish their research from the projects undertaken by them (90.2%). Among the barriers for training undergraduate research, time consumption was perceived as a barrier by the participating medical teachers (37.7%) followed by lack of motivation and commitment among students (19.7%). Time constraint was the commonest reason for the faculty in not guiding undergraduate research (39.0%). A larger proportion of medical teachers suggested that incentives for students and teachers (62.7%) and frequent workshops for students related to undergraduate research (61.8%) are likely to encourage the students and teachers and thus, improve the scenario. Conclusion: It is suggested to address certain important issues like reducing the workload of faculty engaged in undergraduate research, and conducting frequent research methodology workshops for the under graduate students to improvise the standards of undergraduate research.

Oxidative Stress and Major Depression

Ashutosh Bajpai, Akhilesh Kumar Verma, Mona Srivastava, Ragini Srivastava

Background: Major causative factor for major depression is inflammation, autoimmune tissue damage and prolonged psychological stress, which leads to oxidative stress. The aim of this study was to know the association of free radicals and anti- oxidant status in subjects suffering from major depression. Materials and Methods: Sixty patients diagnosed as a case of unipolar depression as per DSM IV, fulfilling the inclusion and exclusion criteria were compared with 40 healthy age and sex matched controls. The sera of both the groups were collected taking aseptic precautions and were evaluated for the markers of oxidative stress and for the antioxidants. The age group of the sample and the controls was between 18-60 y, both males and females were equally represented in the groups. Results: A significantly high level of malondialdehyde (MDA) was found in the patients with major depression (1.95 ± 1.04 mmol/L) as compared to healthy controls (0.366 ± 0.175 mmol/L) (p < 0.0001). The serum level of nitrite was found to be lower in cases (23.18 ± 12.08 µmol/L) in comparison to controls (26.18 ± 8.68 µmol/L) (p = 0.1789). Similarly the serum level of ascorbic acid and superoxide dismutase (SOD) were significantly below as compared to healthy controls (all p < 0.0001). Ceruloplasmin levels were also depressed in cases (p = 0.3943). Conclusion: The study concluded that in the absence of known oxidative injury causative agents, the lowered levels of antioxidants and higher levels of MDA implicate the high degree of oxidative stress in unipolar depression.

Influence of Grape Seed Extract and Zinc Containing Multivitamin-Mineral Nutritional Food Supplement on Lipid Profile in Normal and Diet-Induced Hypercholesterolemic Rats

Shakta Mani Satyam, Laxminarayana Kurady Bairy, Rajadurai Pirasanthan

Background: Zincovit tablet is combination of grape seed extract and zinc containing multivitamin-mineral nutritional food supplement. Aims: To investigate the influence of single combined formulation of grape seed extract and zinc containing multivitamin-mineral nutritional food supplement tablets (Zincovit) on lipid profile in normal and diet-induced hypercholesterolemic rats. Materials and Methods: Anti-hyperlipidemic activity of combined formulation of grape seed extract and Zincovit tablets doses ranged from 40 to 160 mg/kg, p.o. was evaluated in normal and diet-induced hypercholesterolemic rats. Results: Hypercholesterolemic animals treated with combined formulation of grape seed extract and Zincovit tablets (nutritional food supplement) at 40, 80 and 160 mg/kg exhibited drastic decrease in serum triglycerides, total cholesterol, LDL-C, VLDL-C and rise of HDL-C in comparison to hypercholesterolemic control group animals. The anti-hyperlipidemic effect of single combined formulation of grape seed extract and Zincovit tablet was comparable with the standard drug atorvastatin treated animals and the variations were statistically non-significant. There was no significant impact of combined formulation of grape seed extract and Zincovit tablets on lipid profile among normal animals in comparison with normal control group. Conclusion: The present study demonstrated that the single combined formulation of grape seed extract and Zincovit tablet is the potential functional nutritional food supplements that could offer a novel therapeutic opportunity against diet-induced hypercholesterolemia in Wistar rats.

Irrational Fixed Dose Combinations & Need for Intervention: Understanding of Dental Clinicians and Residents

Kopal Sharma, Amit Sharma, Vikas Singh, Dinesh Pilania, Yogesh Kumar Sharma

Context: There is a growing concern about ever-burgeoning list of irrational fixed dose combinations (FDCs) which have flooded pharmaceutical market recently in India. Till date no structured study has evaluated the level of understanding among the dental clinicians and residents about these concepts. The present study is designed to fulfil that lacuna. Objective: To evaluate the knowledge, attitude and practice, regarding the use of FDCs by the dental residents and dental clinicians in a tertiary care teaching dental hospital. Materials and Methods: The present study was carried out among postgraduate students and dental clinicians working at Rajasthan Dental College, a tertiary care teaching dental hospital, in Jaipur, India. Sixty residents and 77 dental clinicians from the Departments of Orthodontics, Prosthodontics, Oral Medicine, Periodontology, Conservative Dentistry & Endodontics, Oral & Maxillofacial Surgery, Pedodontics who gave their informed consent were enrolled. A prevalidated questionnaire regarding knowledge, attitude and prescribing practice of fixed dose combinations was filled up. Data was analysed with suitable statistical tests. Results: Out of the 60 residents and 77 dental clinicians recruited for the study, none of them were aware about all of the advantages and disadvantages of FDCs. On an average, only 47% of residents and 61% dental clinicians were aware of FDC included in WHO Essential Medicines List (EML). Only 47% residents and 58% dental clinicians could recall a single banned FDC in India. Common sources of information about FDCs were Monthly Index of Medical Specialities (MIMS), medical representatives and internet. The most commonly prescribed irrational FDC was diclofenac + paracetamol combination, 42% residents and 41% dental clinicians and residents believed that regular Continuous Medical Education (CMEs) stressing upon rational use of medicine could reduce the magnitude of this problem. Conclusion: It is the need of the hour to reduce the magnitude of this problem by sensitizing dental residents and prescribers regarding the efficacy, safety, suitability, rationality and cost benefit of FDCs available for patient use.

Evaluation of Internal and Marginal Fit of Two Metal Ceramic System – In Vitro Study

Introduction: The high strength porcelain fused metal crowns have been extensively used in dentistry. However the fit is the most encountered problems in porcelain fused metal crowns. This mainly depends on the fabrication technique. Aim: The purpose was to compare the internal and marginal fit of laser sintered and conventionally casted Cobalt-Chromium copings. Materials and Methods: Twenty stainless steel dies of dimension 15 x 10 mm with 1 mm finish margin were fabricated using CAD-CAM technology. Twenty dies were divided into two groups Group 1 and Group 2 containing 10 samples each. All 20 dies were scanned using LAVA 3M scanner and data were used to fabricate metal copings using Laser sintering technique (Group-1) and Conventional casting technique (Group-2). Copings were cemented onto respective dies and finished and standardized sectioning were made. The sectioned models were scanned under stereomicroscope at 50 x magnification for internal and marginal fit evaluation. Results: Mean and standard deviation of internal and marginal discrepancy of laser sintered copings/conventional cast metal copings was 107.6 ± 10.9µ and 102.1 ± 17.2µ/187.09 ± 11.47 µ and 176.57 ± 25.82 µ respectively. Statistical analysis showed the laser sintered copings have lesser internal and marginal discrepancy than conventional casted copings with p value < 0.001. Conclusion: The laser sintered Co-Cr copings showed better internal and marginal fit when compared to that of conventional Co-Cr casted copings.

Study on Association Between Lipid Profile Values and Psychiatric Disorders

Shiny John, Kavitarati Dharwadkar, Manjunath V Motagi

Background: Cholesterol is especially abundant in nervous system, where it plays important role in different aspects of cellular structure (e.g. fluidity of cell membranes) and function (e.g. membrane). Several studies showed that there may be a link between depression and low cholesterol because of altered central serotonergic functions. On the other hand, some studies also showed either no such association or yielded inconsistent results. However, many studies have related low cholesterol with different psychiatric disorders. Hence, we intend to see the possible link between the two. Aim: To study the association between lipid profile and psychiatric disorders. Materials and Methods: Patients attending Amala Institute of medical science, Psychiatry clinic in the month of January 2013 and whose lipid profile data before the start of treatment is available. Design: Descriptive study. The patients were classified into Neurotic and Psychotic spectrum after being diagnosed with the psychiatric diseases based on International Classification of Diseases, 10th edition (ICD10) by a Psychiatrist. There lipid profile (Total cholesterol; LDL=Low Density Lipoprotein; HDL=High Density Lipoprotein; TAG=Triacylglycerol) were estimated before the initiation of anti-psychotic treatment. Results: The lipid profile values though showed some statistically significant association between the psychotic and neurotic spectrum, there was no statistical significance between the low lipid profile and different psychiatric diseases. Conclusion: We have found that there is no significant association between low lipid profile and any psychiatric diseases.

Serum hsCRP: A Novel Marker for Prediction of Cerebrovascular Accidents (Stroke)

Introduction and Objectives: Strokes are caused by disruption of the blood supply to the brain. This may result from either blockage or rupture of a blood vessel. Yearly 15 million people worldwide suffer a stroke. India ranks second worldwide in terms of deaths from stroke. The incidence of stroke increases with age affecting the economically productive middle aged population. Hypertension and male sex are other risk factors for stroke. C-Reactive Protein (CRP) is an acute phase protein whose concentration rises in blood following inflammation. Formerly, assays for CRP detected its rise only after significant inflammation. However, recently developed high sensitivity assays (hsCRP) enable the measurement of CRP in individuals who are apparently healthy. Several studies indicate that hsCRP is elevated in individuals who are at risk of developing Coronary Artery Disease or Cerebrovascular events, the elevation may be found years before the first detection of vascular problems. In the absence of other biochemical markers, the present study aimed to evaluate the predictive and diagnostic role of hsCRP in stroke. Materials and Methods: The study consisted of 50 patients of acute stroke admitted in Gauhati Medical College and Hospital. The control population consisted of two groups – 50 age and sex matched controls with hypertension (Hypertensive control group) and 50 age and sex matched controls with no obvious disease constituted the Normal control group. hsCRP levels were measured in all the groups and compared statistically. Results: The mean age of stroke patients was 58 y. The highest frequency of stroke incidence was in the 51–60 y age group. The rise in hsCRP in stroke patients (40.8±11.06 mg/L) was found to be significant in comparison to that in hypertensives (8.181±2.539 mg/L) and in normal controls (1.143±0.725 mg/L). Conclusion: hsCRP is an acute phase reactant whose concentration rises in stroke as well as in those at risk. The rise may be identified even before the appearance of risk factors. Hence, hsCRP may be useful as a predictive and diagnostic marker in stroke.

Evaluation of Diabetic Foot Complications According to Amit Jain’s Classification

Kalaivani V

Background: Wagners classification has been one of the commonly used grading system for diabetic foot lesions. Amit Jain’s classification is a new classification which includes almost all the common problems affecting diabetic foot. The aim of our study was to include the patients with Diabetic foot in different sub groups as per the new classification and to evaluate the outcome. Materials and Methods: This retrospective study was conducted by analyzing the records of the inpatients in the Department of Surgery in a tertiary care teaching institute at Bangalore, India, between June 2013 to December 2013. Results: Males (82.11%) were more commonly affected than females, the ratio being 4.6:1. Type 1 diabetic foot complications (91.06%) were the most common type of diabetic foot complication seen at our centre. Wet gangrene (35.7%) was the most common type of type 1 diabetic foot complication. Twenty (16.26%) patients underwent major amputations out of which 12.2% belonged to type 1 complications. Conclusion: Majority of the diabetic foot patients in a tertiary care hospital belonged to type 1 complication. Most of the major amputations in a diabetic occurred in type 1 diabetic foot complication. This classification was found to be very easy and almost all the diabetic foot complications were placed effectively and appropriately in this classification.

Growing Old is Mandatory But Growing Up is Optional: An Explanation to Geriatrics

Growing old is an inevitable process and aging graciously requires a healthy body where oral cavity occupies an important place. Geriatric dentistry is a specialized multidisciplinary branch of general dentistry designed to provide dental services to elderly patients. The rise in life expectancy has attributed to the substantial reduction in mortality which brought about by improved health care facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions. The goal of geriatric treatment is to achieve optimal oral health, thus enhancing overall health. This begins with a concerted effort between the patient and the healthcare and dental teams. When medical problems exist, the physician and other involved healthcare professionals should be consulted, as these diseases can affect the safety and efficacy of various dental treatments. Thus a unified approach should be followed to assist geriatric patients to maintain optimal oral health and a high quality of life. Here in, this article we have reviewed the categories geriatric patients are divided to, various aging theories, changes occurring in various systems with their effects on system along with the various dental effects and age changes in them and treatment needs and strategies’ concerning the elderly population.

Effect of Zinc Supplementation on Viral Response in Patients with Chronic Hepatitis C and Beta Thalassemia Major, A Pilot Study

Introduction: Zinc deficiency has been reported in patients with both hepatitis C and beta thalassemia major. Zinc supplementation in addition to antiviral therapy of chronic hepatitis C has been accompanied by some success in patients with chronic hepatitis C. Objective: The aim of the present pilot study is to determine the effect of 30 mg elemental zinc on biochemical and virological response in a population of patients with chronic hepatitis C with beta thalassemia major. Materials and Methods: A prospective, double blind,placebo controlled trial included 40 patients being treated with Pegylated interferon Alfa (Peg IFN-a) and ribavirin. Biochemical and virological parameters and plasma zinc levels were determined before starting treatment. Patients were randomly selected to receive either zinc or a placebo in addition to Peg IFN-a and ribavirin for a period of one year. AST, ALT, sustained viral response (SVR), and zinc levels were measured after treatment.Of the original 40 eligible patients, eight withdrawn from the study and 32 patients completed the study; 16 in the zinc group and 16 in the placebo group. Analysis of the data shows that there is no difference between the two groups in AST, ALT, SVR or zinc level following one year of treatment (p=0.224, p=0.616, p=0.670, p=0.999, respectively). Conclusion:The results of this study indicate that using 30 mg/day elemental zinc did not significantly improve the outcome of treatment in thalassemia patients with chronic hepatitis C. In future studies, we recommend trying higher doses zinc in patients with hepatitis C who had beta thalassemia major.

Correlation of Serum and Salivary Biochemical Parameters in end Stage Renal Disease Patients Undergoing Hemodialysis in Pre and Post-Dialysis State

C. Seethalakshmi, D. Koteeswaran, V. Chiranjeevi

Aim: The aim of this study is to compare the salivary urea, creatine, sodium, potassium and phosphate in pre dialysis and post dialysis state in end stage renal disease patients and compare with the serum counterpart. Materials and Methods: The study group was selected from patients undergoing hemodialysis due renal failure of any cause, who are undergoing dialysis for at least one year duration in a private hospital in Chennai. The total number of subjects was 30. The venous blood was collected from the study group just prior to the dialysis and after the dialysis from the venous catheter which is placed for the purpose of hemodialysis. The collected samples were immediately (within 15 min) submitted to the laboratory for the biochemical examination of urea, creatinine, sodium, potassium and phosphate by an automated biochemical analyser. Unstimulated whole saliva was collected by spitting method from study group both before and after dialysis. The collected samples were immediately submitted to the laboratory for the biochemical examination of urea, creatinine, sodium, potassium and phosphate by an automated biochemical analyser. Result: The paired t-test analysis was done in pre and post blood urea, creatinine, potassium and phosphate which was significant with a p-value of < 0.0001 and the same analysis was done in salivary urea in pre and post-dialysis state which also gave a significant reduction in the parameters with a p-value of < 0.0001.

Anatomical Variations of Brachial Artery - Its Morphology, Embryogenesis and Clinical Implications

Background: Accurate knowledge of variation pattern of the major arteries of upper limb is of considerable practical importance in the conduct of reparative surgery in the arm, forearm and hand however brachial artery and its terminal branches variations are less common. Aim: Accordingly the present study was designed to evaluate the anatomical variations of the brachial artery and its morphology, embryogenesis and clinical implications. Materials and Methods: In an anatomical study 140 upper limb specimens of 70 cadavers (35 males and 35 females) were used and anatomical variations of the brachial artery have been documented. Results: Accessory brachial artery was noted in eight female cadavers (11.43%). Out of eight cadavers in three cadavers (4.29%) an unusual bilateral accessory brachial artery arising from the axillary artery and it is continuing in the forearm as superficial accessory ulnar artery was noted. Rare unusual variant unilateral accessory brachial artery and its reunion with the main brachial artery in the cubital fossa and its variable course in relation to the musculocutaneous nerve and median nerve were also noted in five cadavers (7.14%). Conclusion: As per our knowledge such anatomical variations of brachial artery and its terminal branches with their relation to the surrounding structures are not reported in the modern medical literature. An awareness of such a presence is valuable for the surgeons and radiologists in evaluation of angiographic images, vascular and re-constructive surgery or appropriate treatment for compressive neuropathies.

Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients- ARTICLE RETRACTED

Mohamed Mansor Manan, Akhma Radzuanna Husin, Ali Saleh Alkhoshaiban, Yaser Mohammed Ali Al-Worafi, Long Chiau Ming, Interplay between Oral Hypoglycemic Medication Adherence and Quality of Life among Elderly Type 2 Diabetes Mellitus Patients (Published in Journal of Cilinical and Diagnostic Research. 2014 Dec: 8(12):) JC05–JC09. The editor and publisher regretfully retract the article as per request of authors," upon the careful consideration of the issue". We apologize to all affected parties for the inconvenience caused.

Pocket Money: Influence on Body Mass Index and Dental Caries among Urban Adolescents

V.C. Punitha, A. Amudhan, P. Sivaprakasam, V. Rathnaprabhu

Objective: To explore the influence of pocket money on Dental Caries and Body Mass Index. Materials and Methods: A cross-sectional study was conducted wherein urban adolescent schoolchildren of age 13-18(n=916) were selected by two stage random sampling technique. Dental caries was measured using the DMFT Index. The children’s nutritional status was assessed by means of anthropometric measurements. Body Mass Index using weight and height of children was evaluated using the reference standard of the WHO 2007. Results: Results showed that 50% of children receive pocket money from parents. The average amount received was Rs. 360/month. There was a significant correlation between age and amount of money received (r=0.160, p=.001). The average amount received by male children was significantly higher (Rs. 400) when compared to female children (Rs. 303). It was observed that income of the family (>30,000 Rs./month) and socioeconomic status (Upper class) was significantly dependent on the amount of money received by children (p<0.05). There was no significant difference in the occurrence of caries among children receiving pocket money or not. When BMI categories and pocket money were considered, statistically significant difference was seen among overweight and obese and normal weight children (p<.05). Higher proportion (40.1%) of overweight and obese adolescent children frequented the fast food restaurants every week when compared to the underweight (31.7%) and normal weight children (29.9%). Conclusion: Adolescent children receiving pocket money from parents could influence their eating habits in turn affect general health. Parents and teachers should motivate children on healthy spending of their pocket money.

Giant Cell Tumour of the Tendon Sheath: Analysis of 35 Cases and their Ki-67 Proliferation Indexes

Recep Bedir, Mehmet Sabri Balik, Ibrahim Sehitoglu, Hasan Güçer, Cüneyt Yurdakul

Introduction: A giant cell Tumour of the tendon sheath (GCTTS) is a slow-growing benign Tumour originating from the synovial cells of the tendon sheath. It is the second most common Tumour of the hand. The aim of this study was to perform a retrospective clinicopathological evaluation of GCTTS cases and determine whether the proliferative activity of giant cell tumour of tendon sheath is related to its recurrence rate and local aggressiveness. Materials and Methods: The age, gender, Tumour location and diameter, treatment mode, Ki-67 proliferation index, mitotic rate, and recurrence were retrospectively evaluated in 35 patients diagnosed with GCTTS in the Department of Pathology, School of Medicine, Recep Tayyip Erdogan University between 2009 and 2014. Results: Of the 35 GCTTS cases, 23 were female, and 12 were male. The mean age was 45 y (range 10–70). Sixteen tumours were located in the right hand and 14 in the left hand, and five were in the feet. The mean Tumour diameter was 2.3 cm (0.6–6 cm). All patients underwent marginal excision. The mean postoperative follow-up period was 4 y (range 28 months–5 y). Only six patients showed recurrence. In these cases, the site of GCTTS recurrence was the phalanx of the hand. The mean Ki-67 index in the recurrence cases was 6.5%, whereas it was 2.3% in those without recurrence. Conclusion: The Ki-67 proliferation index and mitotic activity were increased in recurrent cases compared to nonrecurrent cases. Therefore, these parameters may be helpful in predicting recurrence of GCTTS. However, adequate surgical excision and complete removal of the Tumour are important steps to minimize the recurrence rate.

Attitude of Medical and Dental First Year Students Towards Teaching Methods in a Medical College of Northern India.

Aditya Jain, Ramta Bansal, KD Singh, Avnish Kumar

Background: Teaching in most Asian countries is still dominated by teacher-centered classrooms in which students passively receive information from the teacher. Studies have shown that students’ inactivity in traditional teacher-centered classes makes them bored that consequently decrease their concentration and learning. To counter these problems active learning methods are being promoted to enhance their interest in studying. This present study was done to explore effective teaching system from a student’s perspective. The aim of the study was to examine the attitude of medical and dental first year students towards teaching methods. Materials and Methods: The study was undertaken at on 150 Medical and Dental first year students. The study was conducted using general questionnaires along with feedback form to know their opinion about different teaching methodology. Results: A 94.67% of the students were unsatisfied with traditional Lecture teaching. 89.33% favoured combination of traditional lectures and active learning techniques, 74.67% students find active learning methods to be interesting, 77.33% found them as attention seekers, 89.33% are motivated for in-depth study and 85.33% students are motivated for independents learning. 100% students agreed that active learning methods provide opportunities of student interaction while 86.67% students are happy with the teacher–student interaction it provides. Audio-visual aids are the most favoured (94.67%) and test questions are most criticized active teaching method. Conclusion: Our study disclosed that the majority of student’s positively believe in using different active learning techniques for classroom activities.

Self-Medication Practice and Perceptions Among Undergraduate Medical Students: A Cross-Sectional Study

Background: Self-medication practice is widespread in many countries and the irrational use of drugs is a cause of concern.It assumes a special significance among medical students as they are exposed to knowledge about diseases and drugs. Aim: To assess practice and perception of self medication among undergraduate medical students Materials and Methods: It is a cross-sectional study in which study population consisted of undergraduate medical students of Mahadevappa Rampure Medical College Gulbarga, Karnataka, India. This study was conducted from March to April 2014. Total 448 students were taken. Out of which 8 incomplete questionnaires were excluded and 440 were analysed. The students who took self-medication during last six months were included. Written informed consent was obtained from each volunteer prior to the study. Students were given a questionnaire that include both open and close ended questions about self-medication practice. Ethical approval: Ethics Committee approval was obtained from the Institutional Ethics Committee of Mahadevappa Rampure Medical College, Gulbarga, India, prior to the commencement of the study. Statistical Analysis: Data was analysed and presented as counts and percentages. Results: It was found that 388 (88.18%) students practiced self medication. The principal morbidity for seeking self medication was cold and cough as reported by 304 (78.35%) students. Antibiotics were most commonly self medicated as reported by 248 (63.91%) students, out of which only 92 (37.1%) students completed the full course of antibiotic regimen. Only 176 (40%) students opined that self medication is part of self care. Conclusion: Self-medication is widely practiced among undergraduate medical students. In this situation, we should educate the students about advantages and disadvantages of self medication.

Serological Profile of HSV-2 in STD Patients: Evaluation of Diagnostic Utility of HSV-2 IgM and IgG Detection

V.P.Amudha, Rashetha, G.Sucilathangam, B.Cinthujah, C.Revavathy

Background and Objectives: The present study was undertaken to determine Herpes Simplex Virus-2 seroprevalence in sexually active adults aged 20-49 and to investigate the correlation with sociodemographic characteristics and to find its association with other sexually transmitted diseases especially HIV and also to assess the proportion of primary and reactivated HSV-2 cases. Materials and Methods: This prospective study was carried out for a period of six months in a tertiary care hospital. Serum samples were taken from 91 patients attending the out Patient clinic of the Department of Venereology. The serological testing for HSV-2 was performed on all the specimens by using Euroimmun anti-HSV2 (gG2) IgM ELISA and IgG ELISA. Results: Out of the 91 STD patients in the study group, 18 males (34.62%) and 14 females (36.84%) tested positive for HSV-2 antibodies. Seropositivity rate is 35.16%. More number of HSV-2 positive cases were seen among males, older age, rural residence, low socioeconomic status, single marital status, irregular condom usage during the sexual intercourses with new partners and with higher number of sexual partners during lifetime. HSV-2 IgM alone was positive in three cases, HSV-2 IgG alone was positive in 26 cases and three had a positive HSV-2 IgM and IgG result. Addition of IgM testing increased rate of detecting seroconversion, 31.87%, when only IgG ELISA was used, to 35.16 % patients when IgM test was added. In the study group four cases tested positive for VDRL, and one of them was a known positive case. Among the 55 HIV positive cases in the study group, HSV 2 was positive in 17 cases and among the 36 HIV negative cases HSV 2 was positive in 15 cases. (30.91% and 47.22%).Though the number of HIV cases were high, HSV 2 positivity among them was statistically not significant. Conclusion:The purpose of screening for HSV-2 is not only to identify seropositivity, but to help seropositive people identify symptoms and protect themselves from acquiring HIV and to protect their partners and seronegative people from acquiring HSV-2 and/or HIV.

Dermatoglyphics and Karyotype Analysis in Primary Amenorrhoea

Background: Dermatoglyphics is the scientific study of the skin ridge patterns on the fingers, toes, palms of the hands and soles of feet. Dermatoglyphics is in use as a supportive diagnostic tool in genetic or chromosomal disorders as well as in clinical conditions with genetic etiologies. Primary amenorrhoea and Dermatoglyphics, both have the suspected multifactorial (genetic and environmental) aetiologies. Objective: In the present study the finger dermatoglyphic patterns were studied in primary amenorrhoea cases and age matched fertile control females and also attention was given to find out whether a specific dermatoglyphic trait exists in primary amenorrhoea cases and whether it was statistically significant. Materials and Methods: To study the role of dermatoglyphics in primary amenorrhoea, a study was conducted on 30 subjects with primary amenorrhoea (as cases) and compared it with equal number of age matched fertile females (as controls). We studied fingertip patterns in all the subjects enrolled. Simultaneously we have assessed the Karyotype of primary amenorrhoea cases. Result and Conclusion: Two subjects in experimental group have shown abnormal Karyotypes. The most significant finding in present study was increased total finger ridge count (TFRC) in primary amenorrhoea cases which was statistically significant. We also found higher frequency of loops and arches in primary amenorrhoea with abnormal karyotypes. This type of study may be quite useful as a supportive investigation, in stating the predisposition of an individual to primary amenorrhoea and referral of an individual for karyotyping.

Psychological Evaluation of Patients in Critical Care/Intensive Care Unit and Patients Admitted in Wards

Gaurav Sharma B, Maben EVS, Kotian MS, Ganaraja B

Background: Psychological assessment for depression, anxiety and stress among ICU patients and the patients admitted to ward in a hospital in India. This aspect did not get much attention in India so far. Such studies were common in developed countries. Therefore we decided in this study, to analyse the psychological status responses from the hospitalised patients in Mangalore using a validated questionnaire. Aim: to assess and compare the depression, anxiety and stress Scores from the patients admitted in Intensive Care Unit (ICU) and those admitted to ward. Materials and Methods: Eighty patients admitted to hospital, 40 from ICU and 40 admitted to ward were recruited. They were explained the procedure and after taking an informed consent, they were administered Depression, Anxiety, Stress Scale(DASS)Questionnaire, which contains 42-item questionnaire which includes three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The responses were computed and tabulated. We analysed the responses with Student’s t-test and Chi-square test, p<0.05 accepted as statistically significant. Results: The results revealed significantly elevated stress, depression and anxiety among the ICU patients when compared to those in the ward (p<0.001). Above normal anxiety and stress levels were also seen in the ward patients, compared to the scores in normal range. 50% and 25% respectively showed mild and normal depression scores in ward patients, compared to 12% and 5% in those admitted to ICU. This trend was also true for Anxiety and stress scores. Conclusion: From the results we found that there were elevated depression, anxiety and stress levels among the patients and this was significantly higher in ICU patients. Various factors could influence the psychological wellbeing of the patients, including the hospital environment, care givers, presence of family members nearby apart from the seriousness of illness, apprehensions about possibility of death. Such studies were rare among Indian patients. The findings of this study could be useful in incorporating suitable psychological help to the patients in hospitals to improve their recovery and wellbeing.

Epidemiology of Dyspepsia and Irritable Bowel Syndrome (IBS) in Medical Students of Northern India

Sumeena Basandra, Divyansh Bajaj

Background: Dyspepsia and Irritable Bowel Syndrome (IBS) are perhaps one of the most common gastrointestinal diseases universally. The prevalence of dyspepsia ranges from 7-40% while the prevalence of IBS ranges between 3-22% in population based studies worldwide. Aim: This study was conducted to estimate the prevalence, socio-demographic and lifestyle associated risk factors of Dyspepsia and IBS among medical college students of urban Delhi, Northern India. Settings and Design: It is a cross-sectional study and was carried out from January to March 2014 at Maulana Azad Medical College, New Delhi, India. Materials and Methods: A total of 210 students from a Medical College were asked to complete a semi-structured questionnaire based on identification and socio-demographic data, questions pertaining to lifestyle and Rome III criteria. Results: Of the valid 200 subjects, 90(45%) were males and 110(55%) were females, with a mean age of 20.43± 1.05 y. Majority of the subjects (diagnosed with uninvestigated dyspepsia and IBS) were in the age group of 18-20 y with female gender having higher odds for both. The prevalence of dyspepsia was 18% while that of IBS was 16.5%.Consumption of fatty food, cigarettes and low physical activity were observed as most significant correlates. Conclusion: Rome III criteria enables symptom based diagnosis of dyspepsia and IBS.The prevalence of dyspepsia and IBS in college students from Delhi is observed to be higher. Association with lifestyle related factors highlights the importance of modifications in their prevention.

Influences of Gender on Postoperative Morphine Consumption

Sivakumar Periasamy, Raja Poovathai, Srinivasan Pondiyadanar

Background: Gender related differences on morphine consumption during postoperative period following abdominal surgeries. Materials and Methods: Four hundred and fifty ASA I & II patients of either sex (male =239, female = 231), between the age group of 18-65 y undergoing elective intra abdominal surgeries under general anaesthesia were included for the study. Patients with preexisting pain either acute or chronic preoperatively were excluded from the study. Anaesthesia and analgesia protocol during surgery was standardized. Postoperatively, a loading dose was given to achieve the visual analogue scale (VAS) of = 30 and subjects were connected to patient control analgesia (PCA) pump containing 0.4 mg/ml of morphine configured to deliver a bolus dose (1 mg) with a 5 min lock-out period. The total analgesic requirements along with VAS (visual analog scale) score were analysed between males and females in the first 24 h postoperatively. All demographic data and between group comparisons were analysed with student t-test. Within group comparisons were done by using one-way-ANOVA test and Tukey’s Honestly significant Difference test. Results: During the first 24 h, males consumed significantly higher amount of morphine (34.35 ± 6.68 mg) when compared to females (26.78 ± 7.14 mg), p < 0.001. Conclusion: We conclude that men require more morphine in the postoperative period than women

Stenotrophomonas Maltophilia in Lower Respiratory Tract Infections

Kiran Chawla, Shashidhar Vishwanath, Ashu Gupta

Background: Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia due to its characteristic inherent resistance to many broad- spectrum antibiotics. In this study we evaluated the demographic, clinical and microbiological profile of patients with lower respiratory tract infection due to Stenotrophomonas maltophilia. Materials and Methods: A retrospective analysis of 33 patients diagnosed with Stenotrophomonas maltophilia lower respiratory tract infections during a period of two years from 2012 - 2013 was done. Results: The predominant predisposing factor observed was mechanical ventilation in 17(51.5%) cases. Fluoroquinolones were the most effective antibiotic (26;78.8%) followed by trimethoprim-sulfamethoxazole (24;72.7%). Among the 19 patients treated with proper antibiotic, 13(68.4%) showed clinical improvement. Among the 14 patients who did not receive appropriate antibiotic for Stenotrophomonas maltophilia infection, 8(57.1%) showed improvement. Two (6%) had blood culture positive for Stenotrophomonas maltophilia . Mortality rate was 21.2%. Conclusion: Stenotrophomonas maltophilia is emerging as an important nosocomial pathogen with increased risk in patients on mechanical ventilation in ICU. Empiric therapy should include agents active against S.maltophilia such as newer flouroquinolones and trimethoprim-sulfamethoxazole

Comparative Evaluation of Multiplex PCR and Routine Laboratory Phenotypic Methods for Detection of Carbapenemases among Gram Negative Bacilli

Background: Carbapenem resistant pathogens cause infections associated with significant morbidity and mortality. Objective: This study evaluates the use of Multiplex PCR for rapid detection of carbapenemase genes among carbapenem resistant Gram negative bacteria in comparison with the existing phenotypic methods like modified Hodge test (MHT), combined disc test (CDT) and automated methods. Material and Methods: A total of 100 Carbapenem resistant clinical isolates, [ Escherichia coli (25), Klebsiella pneumoniae (35) P. aeruginosa (18) and Acinetobacter baumannii (22)] were screened for the presence of carbapenemases ( bla NDM - 1 , bla VIM , bla IMP and bla KPC genes) by phenotype methods such as the modified Hodge test (MHT) and combined disc test (CDT) and the molecular methods such as Multiplex PCR. Results: Seventy of the 100 isolates were MHT positive while, 65 isolates were positive by CDT. All the CDT positive isolates with EDTA and APB were Metallo betalactamase (MBL) and K. pneumoniae carbapenemase (KPC) producers respectively. bla NDM - 1 was present as a lone gene in 44 isolates. In 14 isolates bla NDM - 1 gene was present with bla KPC gene, and in one isolate bla NDM - 1 gene was present with bla VIM , gene. Only one E. coli isolate had a lone bla KPC gene. We didn’t find bla IMP gene in any of the isolates. Neither of the genes could be detected in 35 isolates. Conclusion: Accurate detection of the genes related with carbapenemase production by Molecular methods like Multiplex PCR overcome the limitations of the phenotypic methods and Automated systems.

A Study of VO2 Max and Body Fat Percentage in Female Athletes

Anjali N. Shete, Smita S. Bute, P.R. Deshmukh

Introduction: Aerobic capacity of athletes is an important element of success in sports achievements. It is generally considered the best indicator of cardio respiratory endurance and athletic fitness. Body fat percentage affects VO2 max and thus the cardiovascular status of the athletes. The present study was undertaken to assess the VO2 max and body fat percentage in athletes. The secondary objective of the study was to study the relationship between VO2 max and body fat percentage. Materials and Methods: Twenty five female athletes of age group 17-22years were selected for the study. VO2 max was determined by Queen’s college step test and body fat percentage by skin fold calipers. The VO2 max and body fat percentage were determined in non athletes of same age group for comparison. The statistical analysis was done by Student’s t-test and Pearson correlation test. Observation and Results: The mean VO2 max in athletic group was 39.62 ± 2.80 ml/kg/min. In non-athletic group, VO2 max was 23.54 ± 3.26 ml/kg/min. The mean body fat percentage in athletes was 24.11 ± 1.83% and in non-athletes it was 29.31 ± 3.86%.The difference in VO2 max and body fat percentage was statistically significant in our study. The VO2 max and body fat percentage in both the groups showed negative correlation by Pearson test but, was not statistically significant. Conclusion: The present study showed a statistically significant higher VO2 max in female athletes. The study showed a negative correlation between VO2 max and body fat percentage but was not statistically significant.

Evaluation of MRI Versus Arthroscopy in Anterior Cruciate Ligament and Meniscal Injuries

Aims and Objectives: To find out the incidence of ACL & meniscal injuries, to co-relate MRI findings with arthroscopy by calculating Sensitivity, Specificity, Positive And Negative Predictive Values (PPV & NPV) keeping arthroscopy as a gold standard, to find out the degree of subluxation and to grade it and to find a threshold value of fluid in knee. Settings and Design: Prospective analytical study. Materials and Methods: MRI of 230 patients with 71 arthroscopic co- relation in year 2012-14 was analysed. Statistical Analysis: Descriptive statistics using Chi square test and predictive values was done. The spearman correlation coefficient was done by using statistical software SPSS 17.0. Results: The sensitivity, specificity, PPV and NPV was calculated (in %). For ACL it was 87.87, 81.57, 80.55, 88.57 for MM 93.54, 87.50, 85.29, 94.59 and for LM 77.77, 81.81, 72.41, 85.71 respectively. We found 35.6% incidence of anterior tibial subluxation with maximum patients having grade 1 category subluxation. Two hundred and one cases showed joint fluid in lateral aspect of the suprapatellar pouch (AP diameter >10mm) with internal derangement. Conclusion: MRI is helpful in diagnosing meniscal and cruciate ligament injuries. Arthroscopy still remains gold standard for definitive diagnosis.

Comparative Evaluation of Vital Parameters During Third Molar Surgery Under Local Anaesthesia with and without Sedative Agents

Jigar M Dhuvad, Rajesh A Kshisagar, Mukesh M Dhuvad

Aims: To compare vital parameters; operator’s comfort; and patient’s satisfaction during impacted third molar removal under local anaesthesia, with or without sedative agents. Materials and Methods: Ninety patients undergoing elective third molar surgery were randomly divided into three groups of 30 each: Group A received propofol along with local anaesthesia; Group B received midazolam along with local anaesthesia and Group C received local anaesthesia alone. After the local anaesthesia, with or without sedative agents, the impacted third molars were removed in Operation Theater. Results: Group A clearly showed advantages over Group B & C on all the parameters that we have selected. Conclusion: Even though the cost of propofol is high, suitable operating conditions, faster onset of sedation, rapid recovery, and minimal side effects support the use of this drug for conscious sedation for third molar surgery.

Prescribing Pattern of Anti-malarial Drugs with Particular Reference to the use of Artesunate in Complicated Plasmodium Vivax Cases

Ashutosh Kumar Singh, Mohd Sajid Khan, Farhan Ahmad Khan

Background: In developing countries, Malaria has been found to be one of the most common cause of fever and morbidity, particularly among infants and young children. Therefore, its drug utilization studies should be carried out to know the rationality of treatment. Aim: To evaluate the use of antimalarial agents in children with a diagnosis of Malaria and visited to OPD & IPD Paediatric department of a tertiary care teaching hospital. Materials and Methods: This was a prospective six months study based on a Medication Utilization Form, which has been designed in consultation with the paediatrician. 183 children <12 y of age were selected on the basis of inclusion and exclusion criteria. Results: Out of One hundred eighty three patients, 110 were infected with Plasmodium falciparum (60.10%) and 73 with Plasmodium vivax (39.89%). Most of the patients were male, 56.83% and 43.16% were female patients. Most of the complicated cases were found from Plasmodium falciparum (n = 110) than Plasmodium vivax (n=15). In prescriptions with monotherapy, Artesunate (n=101) was found to be the most commonly prescribed drug and in prescriptions containing more than one drug, Artesunate – lumefantrine (n=125) combinations were frequently used. Most of the drugs were prescribed by oral route (n=285), than the parenteral route (n=140). The average number of drugs per encounter was 2.32 and only 4.50% drugs were prescribed by generic name. Average drug cost per prescription in complicated cases was found to be higher (185.5 INR) than uncomplicated cases (115 INR). Conclusion: Artemisinin were used as first line drugs irrespective of the causative agent for malaria, which is not recommended, however has been found to be effective in complicated cases of Plasmodium vivax also. The cost of the prescription was higher. Interventions to rectify over prescription of injectables necessary to further improve rational drug use in our facility. Also, there should be an awareness program, especially in slum areas to cut down the transmission of disease.

Role of Hyaluronic Acid in Early Diagnosis of Knee Osteoarthritis

Sudhir Singh, Dharmendra Kumar, Nishant Raj Sharma

Introduction: Osteoarthritis of knee is traditionally diagnosed on the basis of clinical and radiological findings. Usually joint tissue degeneration is already advanced by the time a clinical diagnosis is made, hence the research focus has now shifted to use of biomarkers to diagnose the condition at an early stage of the disease. Aims & Objectives: The aim of this study was to assess the efficacy of serum HA levels in early detection and grading of the severity of primary knee osteoarthritis and it’s co-relation with Western Ontario and McMaster university osteoarthritis index (WOMAC scores) and Kellgren -Lawrence grading (K-L grade). Materials and Methods: The study included 150 subjects (100 cases and 50 controls) and all were subjected to WOMAC scoring and K-L grading and estimation of serum HA levels. Results: Age and WOMAC scores have significant correlation with HA levels, but multivariate analysis shows only WOMAC score as an independent variable associated with HA levels. The results show statistically significant high HA levels in cases than in normal population. HA levels are also able to differentiate between various clinical severity grades. ROC Curve analysis suggests cut-off levels of HA between mild, moderate and severe cases. Conclusion: HA levels are able to differentiate between normal asymptomatic population and symptomatic cases and also between various severity grades of osteoarthritis

Novel Therapeutic Approach for the Treatment of Periodontitis by Curcumin

Aims and objectives: The aim of the present study was to evaluate the clinical and microbiological efficacy of locally delivered 1% curcumin gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Materials and Methods: The study group consisted of 25 patients, belonging to both sex, aged between 21-45 years. All patients diagnosed as chronic periodontitis with periodontal pockets of depth >5mm bilaterally were randomly selected. A split mouth design was followed and the patients received a complete prophylaxis including scaling and root planing. Examination of plaque index, bleeding index, probing pocket depth and clinical attachment level were measured for each patient. The test group received 1% curcumin gel along with scaling and root planing whereas the control group received scaling and root planing alone followed by microbiological samples taken at baseline, 1, 3 and 6 months interval. Results: The 1% curcumin gel appeared to provide significant improvements in clinical parameters. Microbiological counts of Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and capnocytophaga showed significant reduction in periopathogens at the test sites after six months when compared with that of control sites. Conclusion: Locally delivered 1% curcumin gel was more effective in inhibiting the growth of oral bacteria when used as an adjunct to SRP in the treatment of chronic periodontitis.

Effect of Pranayama and Suryanamaskar on Pulmonary Functions in Medical Students

P. Shyam Karthik, M.Chandrasekhar, Kondam Ambareesha, C.Nikhil

Background: Pranayama improved lung functions in numerous studies. Yoga involve isometric contraction and improves skeletal muscle strength. Yoga training improves the strength of expiratory as well as inspiratory muscles. Aim: The present study is planned to find the effect of pranayama on pulmonary functions in medical students. Materials and Methods: This study is conducted on 50 students doing lst year M.B.B.S. Consent form has been taken from them. They have been given yoga training 30 min daily for 2 mnth under the guidance of a trained yoga instructor. Vital capacity (VC), Tidal volume (TV), Expiratory Reserve volume (ERV), Breath holding time (BHT), 40 mm endurance, Peak expiratory flow rate (PEFR) are measured before & after yoga training. Results: VC has increased from 2972 ± 213.151 to 3372 ± 528.7722. TV has increased from 496 ± 84.06347 to 588 ± 150.8863. ERV also shows increase in values from 888 ± 183.303 to 1096 ± 386.7385. BHT also shows increase in values from 33 ± 5.773503 to 58.6 ± 12.78019. 40 mm endurance also shows increase in values from 30.8 ± 5.139715 to 53.52 ± 15.68736. PEFR also shows increase in value from 388.8 ± 15.36229 to 425.2 ± 38.74274. Conclusion: There is a statistically significant increase in all the above mentioned pulmonary functions following yoga training. Yoga practice can be advocated to improve pulmonary functions in healthy individuals and hence to prevent respiratory diseases in future.

Measurement of Intra-abdominal Pressure in Critically-ill Children

Jyoti Singhal, Preeti Shanbag

Introduction: It is being increasingly recognized that intra-abdominal hypertension is an important cause of organ dysfunction. This pilot study was done to determine the feasibility of measuring intra-abdominal pressures (IAP) in critically-ill children using simple inexpensive equipment available in the PICU. Materials and Methods: This was a prospective study done in the paediatric intensive care unit (PICU) of a tertiary care general hospital. Thirty-two consecutive patients admitted to the PICU, staying for more than 24 h and requiring a urinary catheter were studied. IAP was measured by the intravesical method, using a disposable manometer, twice a day for seven days or till discharge/death, Risk factors associated with IAH were recorded. Results: The majority of the patients had an IAP less than 5 mm Hg. Three patients had grade 1 intra-abdominal hypertension (IAP>12 mm Hg). Conclusion: It is feasible to measure IAP in paediatric patients without the use of sophisticated equipment

Comparison of Mast Cells and Inflammatory Cells within Periapical Lesions and Comparison of Degranulated Mast Cells Between Fibrous and Inflamed Area in Radicular Cysts: An Immunohistochemical Study

Objective: The role of mast cells as the key effector of allergic inflammation, anaphylactic inflammatory reactions and in the pathogenesis of chronic inflammation, is well-known. The present study is adopted to compare mast cells and inflammatory cells within periapical granuloma and cysts and localize the mast cells and quantify their number in the periapical cysts so as to propose a role of mast cells in the pathogenesis of this lesion. Materials and Methods: Biopsy specimens of 30 periapical lesions were stained with hematoxylin–eosin, and immuno - histochemical Mast Cell Tryptase from Bio SB (IHC detection system kit) antibody. The tryptase positive mast cells and mono - nuclear inflammatory cells were counted in 10 consecutive high power fields (100X) using the binocular microscope from Motic attached to a computer with Motic Advanced Images 3.2 software. Results: Comparative microscopic analysis indicated that periapical cyst shows more percentage of mast cells and less percentage of inflammatory cell than periapical granuloma (comparison of mean and standard deviation of total number of mast cells and inflammatory cells, mast cells 3.15±1.39 in the granuloma group and 4.43±1.91in the cyst group, inflammatory cells, 67.11±1.2 in the granuloma group and 52.66±0.8 in the cyst group). Numerous degranulated mast cells were observed in the fibrous wall than the inflammatory infiltrate of the periapical cysts. The mean and standard deviation of degranulated mast cells between the inflammatory and fibrous zone within the cyst group, being 0.95±1.10 and1.68±1.34 respectively. The values varied significantly between the two zones. Conclusion: The number of inflammatory cells in the cyst group is less than periapical granuloma and total number of mast cells in the cyst group is more as compared to periapical granuloma. The degranulated cells were quantified and they were higher in the fibrous area of the cysts than the inflammatory zone. This study could support the fact that the various mediators released on degranulation play a role in the connective tissue remodeling, chronicity and expansion of the periapical lesion.

“Dentinal Microcracks After Root Canal Preparation” A Comparative Evaluation with Hand, Rotary and Reciprocating Instrumentation

Introduction: The purpose of this study was to compare the incidence of dentinal micro cracks after instrumentation with various types of NiTi files in rotary and reciprocating motion. Materials and Methods: One hundred human extracted mandibular central incisors were taken and divided into 10 groups (n=10 teeth per group). Group 1- No preparation, Group 2 – Hand instrumentation, Groups 3,4 - ProTaper files in rotary and reciprocating motion, Groups 5,6 - ProTaper Next files in rotary and reciprocating motion, Groups 7,8 – Oneshape files in rotary and reciprocating motion, Groups 9,10 – Reciproc files in rotary and reciprocating motion. Specimens were sectioned horizontally at 3,6 and 9 mm from the apex and dentinal micro cracks were observed under a stereomicroscope. Results: There was a statistically significant difference between the groups (p<0.05). There were no significant differences in crack formation between the groups (Protaper Next - Rot, Protaper Next - Rec, Reciproc – Rec); (ProTaper - Rot, ProTaper - Rec, Oneshape – Rot), (Oneshape – Rot, Reciproc – Rot), (One shape Reciproc, Reciproc – Rec); (p >.05). Conclusion: Least cracks were seen in canals instrumented with Pro Taper Next files both in rotary and reciprocating motion. Full sequence rotary systems showed less cracks than single file systems and full sequence rotary systems showed less cracks in reciprocating motion than in rotary motion.

Bone Forming Potential of An-Organic Bovine Bone Graft: A Cone Beam CT study

Purpose: An-organic bovine bone graft is a xenograft with the potential of bone formation. The aim of this study was to evaluate the bone density using cone beam computed tomography scans around functional endosseous implant in the region of both augmented maxillary sinus with the an-organic bovine bone graft and the alveolar bone over which the graft was placed to provide space for the implants. Materials and Methods: Sterile freeze dried bovine bone graft produced by National Tissue Bank, University Sains, Malaysia was used for stage-1 implant placement with maxillary sinus augmentation in a total of 19 subjects with 19 implants. The age of all subjects ranged between 40-60 years with a mean age 51±4.70. All subjects underwent a follow up CT scan using PlanmecaPromax 3D ®Cone beam computed tomography scanner at the Radiology department, Hospital University Sains, Malaysia. The collected data was then analysed to evaluate bone density in Hounsfield Units using PlanmecaRomexis™ Imaging Software 2.2 ®which is specialized accompanying software of the cone beam computed tomography machine. Results: There was bone formation seen at the site of the augmented sinus. A significant increase (p<0.005) in bone density was reported at the augmented site compared to the bone density of the existing alveolar bone. Conclusion: An-organic bovine bone graft is an osteoconductive material that can be used for the purpose of maxillary sinus augmentation.

Torque Loss in En-Masse Retraction of Maxillary Anterior Teeth Using Miniimplants with Force Vectors at Different Levels: 3D FEM Study

Objective: This FEM study was conducted to quantify the amount of torque loss in maxillary anterior teeth by applying force vectors from different levels to the anterior retraction hook at various heights and comparing with that of molar anchorage system. Materials and Methods: Five 3D FEM models were constructed with force vectors at different levels: HOT-High Orthodontic Traction (13.5mm from archwire) to ARH1– Anterior Retraction Hook (5mm), HOT to ARH2 (8mm), LOT- Low Orthodontic Traction (8 mm) to ARH1, LOT to ARH2 and from conventional molar hook to ARH1. Mini-implants were placed buccally between the roots of second premolar and first molar. Torque loss was calculated by measuring the displacement of the teeth at crown tip and root apex in two planes i.e. sagittal and vertical using Y and Z axis respectively in all the five models. The results were statistically analyzed by using Kruskal Wallis ANOVA and Mann-Whitney U-test. Results: HOT to ARH1 showed that the anterior teeth moved bodily (p =0.5127), followed by molar hook - ARH1(p=0.0495*) which showed mild uncontrolled tipping. Whereas the HOT- ARH2, LOT - ARH1,and LOT - ARH2 models exhibited uncontrolled tipping with maximum torque loss in LOT - ARH1 (p=0.0001*). Conclusion: It can be concluded that bodily movement with very minimal torque loss was observed in HOT-ARH1 model whereas the maximum torque loss was recorded in LOT-ARH2 model. Conventional molar anchorage group showed uncontrolled tipping with some amount of extrusion and anchor loss of posteriors.

The Assessment of Sagittal Changes with Twin Block Appliance in Patients with Decelerating Growth Phase

Introduction: The main reason for seeking orthodontic treatment for Class II malocclusions is aesthetic improvement. Growth modification treatment procedures offer better results for a patient with significant potential growth. Aim: The aim of this cephalometric clinical study was to distinguish skeletal and dental corrections on skeletal class II division I growing subjects with Twin Block therapy (TB) and the changes were assessed using SO-analysis by Pancherz. Materials and Methods: Strict diagnostic protocol viz. growing individuals with horizontal growth pattern, skeletal class II due to retrognathic mandible with positive VTO, bilateral class II molar relation, minimal crowding in either arch or overjet more than 5mm was used. Out of 28 selected cases,17 patients received TB therapy and 11 patients were maintained as control group. Standard removable TB appliances with lower incisor capping were delivered to treatment group. The horizontal advancement was about 8mm and 2-3mm vertical opening between the upper and lower central incisors were maintained for all the cases. The mean time interval between the initial (T1)and post treatment (T2) cephalograms of Twin-Block group was 11 month,with a range of 8 month to 13 month. In the control group, the mean time interval between the first (C1)and second (C2) cephalometric films was 12 month,with a range of 10 month to 14 month.T1and T2 cephalograms were traced and S-O analysis was used to segregate dental and skeletal effects. Statistical Analysis: SPSS software was used for statistical analysis. Results: Skeletal Changes: In this study, the mean movement of maxilla was 0.67mm which represents significant restriction of forward maxillary growth in contrast to control groups. Dental Changes: In this study the maxillary molars appear to move distally with a mean value of 0.13mm. Comparing this to the movement of maxillary jaw base itself, maxillary distal movement of molar is less. But still it contributes to Class II correction. Conclusion: The overjet reduction and molar relation correction are more skeletal in nature.

Prevalance of ABO and Rhesus Blood Groups in Blood Donors: A Study from a Tertiary Care Teaching Hospital of Kumaon Region of Uttarakhand

Parul Garg, Saloni Upadhyay, Sanjay Singh Chufal, Yuman Hasan, Ishwer Tayal

Backround: ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, in resolving medico-legal issues and more importantly for the immunologic safety of blood during transfusion. Aims: This study is aimed to determine the distribution pattern of the ABO and Rh blood groups among blood donors in Kumaon region of Uttarakhand and compare it with other data from similar studies within the India and all over the world. Design: It is a retrospective study carried out at blood bank of Shushila Tewari Hospital of Government Medical College, Haldwani from January 2012 to December 2013. Materials and Methods: The study was conducted on 12,701 blood donors. ABO and Rh typing was done using slide agglutination method with antisera ABO and Rh (Tulip diagnostics ltd). Doubtful cases were confirmed by tube agglutination method and reverse grouping using known pooled A and B cells. The age group and sex of donors, frequency of ABO and Rh blood groups were reported in simple percentages. Results: The predominant donors belonged to age group between 18-35years (84.28%). Male donors were more than female donors, ratio being 352:1. Replacement donors (99.71%) were much more than voluntary donors (0.91%). The most common blood group was B (32.07%) and least common being AB (10.53%). Blood group ‘O’ and ‘A’ had same frequency. The prevalence of Rhesus positive and negative distribution in the studied population was 94.49% and 5.51% respectively. Blood group frequency with respect to ABO and Rhesus positive was found to be shown by formula B> O>A >AB. The frequency for ABO and Rhesus negative was given by the formula B>A>O>AB. Conclusion: Knowledge of frequencies of the different blood groups is very important for blood banks and transfusion service policies that could contribute significantly to the National Health System.

Determining the Effect of Gutkha on Serum Levels of Vitamin B12 and Folic Acid as Compared to Smoking among Chronic Periodontitis Subjects : A Cross-Sectional Study

Background: Periodontitis, being a common inflammatory disease has a multifactorial origin, with smoking and gutkha as few of the causative entities. The role of smoking as a risk factor for periodontitis is been well documented in literature. Cigarette smoke also affects vitamin B12 and folic acid mechanisms. Nutritionally derived vitamin B12 occurs mainly as either hydroxycobalamin or deoxyadenosycobalmin. Folic acid is also heat sensitive and water soluble, closely linked to vitamin B12 in its metabolism. However, effect of smokeless tobacco in form of gutkha on serum levels of vitamin B12 and folic acid is yet to be explored. Aims and Objectives: To estimate and correlate serum vitamin B12 (VB12) and folic acid (FA) levels among periodontally healthy subjects and Chronic Periodontitis (CP) subjects with habit of smoking and gutkha chewing. Materials and Methods: The study included 111 subjects ranging in age from 18 to 60 y. Participants were divided into four groups: 30 healthy subjects (Group I), 29 subjects with CP (Group II), 25 smokers with CP (Group III) and 27 gutkha chewers with CP (Group IV). Clinical parameters included pocket probing depth (PPD), clinical attachment level (CAL) & gingival index (GI) following which VB12 and FA levels were estimated through UV-spectrophotometry method and data was analysed using Statistical Package for Social Scientists software, Mann-Whitney U-test and Pearson correlation coefficient. p-values less than 0.05 were considered as significant. Results : Pairwise comparison by Mann-Whitney U-test showed an increase in the serum VB12 in Group IV when compared to Group I (p=0.01) and Group II (p=0.01). Although serum FA levels were found to be low in Group III (7.61 ug/ml) & Group IV (8.64 ug/ml), Group III was found to be statistically significant (P=0.046). The clinical parameters GI, PPD and CAL among the four groups of patients were also statistically significant (p < 0.05). Conclusion: The study results suggested that among the patients with periodontal disease, serum VB12 levels are directly related while serum FA levels are inversely related to inflammation and tissue destruction in periodontium as occurred in Group IV.

Diffuse large B – Cell Lymphoma Involving the Maxilla in a Minor

Garish Kumar, Nupur Hingad, Navneet Singh, Gagandeep Kaur Sidhu

Lymphomas can be simply defined as malignant neoplasms of lymphocytes and their precursor cells. We report a case of a diffuse large B-cell lymphoma of the maxilla, in an 11-year-old male patient who reported with a diffuse swelling of the maxillary labial mucosa accompanied with oral candidiasis. A subsequent biopsy and immunohistochemistry were instrumental in this diagnosis. What makes this case significant is that the incidence of primary DLBCL in the oral cavity of a minor which is not very common and has rarely been specified earlier in the literature.

Peripheral Osteoma of the Palate: Report of a Case and Review of Literature

Weihsin Hu, Sandeep Thadani, Mohit Agrawal, Neeta Sharma, Suket Tailor

Osteomas are benign osteogenic lesions with very slow growth, which may arise from proliferation of either cancellous or compact bone. Peripheral osteomas of maxilla are relatively rare. Excluding the maxillary sinus, there are few cases of maxillary osteoma reported in the English-language literature. This paper reports an additional case of osteoma in the palatal region in a 34-year-old female patient. The aim of this paper is to present an unusual case along with an analysis of the literature in order to contribute to the knowledge concerning the pathogenesis, differential diagnosis, and management of these lesions.

A Rare Case of Perforation Peritonitis with Jejunal Stricture in a Patient Recently Treated for Pulmonary Tuberculosis

Naveen N, Avijeet Mukherjee

Abdominal tuberculosis (ATB) constitutes 12% of the extra pulmonary disease and is a rare but well-documented cause of perforation peritonitis, occasionally occurring in cases where the diagnosis has been delayed but may occur even after antituberculous therapy has been initiated. Most patients with tuberculosis strictures respond well to medical treatment and should be resorted to surgery only if drug therapy fails. Despite surgical intervention, tuberculosis perforation has a high complication and mortality rate. We present a case of 54-year-old male patient with a perforated jejunal stricture who had completed his treatment for pulmonary tuberculosis one month earlier. This case was unusual because of the age of patient at presentation (usually seen in young – 25 to 45 y), involvement of jejunum (commonly ileocaecal region), initial presentation with subacute obstruction followed by peritonitis (refused treatment at first instance) and patient having completed treatment for pulmonary tuberculosis recently.

An Unusual Case of Multiple Intraoral Manifestations of Neurofibromatosis Type 1: Case Report with Literature Review

Sheejith M, Benny Joseph, Sameera G Nath, Bhavya Sheejith

The various oral manifestations of neurofibromatosis in dentulous patients have been documented in literature. Although most of the previous documents have discussed on common findings like a prominent lingual papillae, or solitary overgrowth of gingival soft tissue, this article focuses on a relatively rare occurrence of multiple nodular manifestations of Neurofibromatosis–1 on an edentulous alveolar ridge, tongue, palate and lips of an elderly female patient.

Accuracy of Cone Beam Computed Tomography in Diagnosis and Treatment Planning of Periodontal Bone Defects: A Case Report

Diagnosis of periodontitis depend mostly on traditional two-dimensional (2-D) radiographic assessment. Regardless of efforts in improving reliability, present methods of detecting bone level changes over time or determining three-dimensional (3-D) architecture of osseous defects are lacking. To improve the diagnostic potential, an imaging modality which would give an undistorted 3-D vision of a tooth and surrounding structures is imperative. Cone beam computed tomography (CBCT) generates 3D volumetric images which provide axial, coronal and sagittal multi-planar reconstructed images without magnification and renders image guidance throughout the treatment phase. The purpose of this case report was to introduce the clinical application of a newly developed, CBCT system for detecting alveolar bone loss in 21-year-old male patient with periodontitis. To evaluate the bone defect we took an intraoral radiograph and performed CBCT scanning on mandibular left first molar tooth and compared their images. CBCT images of mandibular left first molar showed the extension of furcation involvement, its distal root is devoid of supporting bone and it has only lingual cortical plate which were not shown precisely by the conventional intraoral radiograph. So we consider that the use of latest adjuncts like CBCT is successful in diagnosing periodontal defects.

A Unique Method of Retention for Gum Stripper- A Case Report

Santosh S. Doddamani, Priyanka. T.S

Successful restoration of partially edentulous situations, especially kennedy’s class-I, II &IV requires lot of contemporary and conventional treatment approaches. Semi precision attachments play a major role in retention of clinically challenging partially edentulous situation. Attachment retained partial dentures can be one of the successful treatment option in prosthdontics. This article presents a unique technique of retaining gum stripper using semi precision attachments.

Bullous Lichen Planus treated with Oral Minipulse Therapy: A Rare Case Report

Kotya Naik Maloth, K.Sunitha, Ramanaryana Boyapati, Shravan Kumar D.R.

Oral Lichen planus (OLP) is a common mucocutaneous disorder with a multifactorial aetiology, affecting the women more commonly than men. Most OLP are asymptomatic, except the atrophic and erosive forms.Till date many treatment modalities are implicated to treat this disorder, but no therapy is considered as the single most effective, without side-effects and remission of the lesion. As the treatment of OLP is challenging to the oral practitioners, here we report a case of successful management of extensive, symptomatic bullous and erosive oral lichen planus with a novel treatment protocol- oral minipulse therapy with betamethasone.

A Rare Case Report of Clear Cell Variant of Oral Squamous Cell Carcinoma

Purshotam Nainani, Harkanwal Preet Singh, Aparna Paliwal, Neelu Nagpal

Clear cell squamous cell carcinoma (SCC) is an extremely rare heterogenous group of malignant tumour with incompletely understood aetiology. We, hereby present a case of clear cell variant of squamous carcinoma on buccal mucosa in 52-year-old male patient. Histopathology showed sheets of squamous cells with clear cell differentiation and malignant features. Histochemical findings showed negative staining for Periodic Acid-Schiff (PAS), mucicarmine and Oil Red O. Immunohistochemical investigations revealed positive staining for CK 8-18 and negative for S-100. We conclude by emphasizing on the need of careful analysis of all the histopathological and IHC investigations. To predict the exact prognosis of this rare variant more number of case reports are expected to be published in future.

Management of Giant Cell Tumour Radius in a Three Year old Child with an Improvised Technique

Ajay Puri, Vipin Sharma, Ashish Gulia, Seema Sharma, Amit K Verma

Giant cell tumours of immature skeleton have a very low incidence and epi-metaphyseal location. We are presenting giant cell tumour distal radius in a skeletally immature patient, an uncontained defect with a large soft tissue component which was managed by wide excision and reconstruction with an improvised technique.

Arnold Chiari Malformation with Spina Bifida: A Lost Opportunity of Folic Acid Supplementation

In Arnold Chiari (kee-AHR-ee) II malformation elongated cerebellar tonsils are displaced inferiorly through the Foramen Magnum into the upper cervical spinal canal. It is a complex anomaly with skull, dura, brain, spine and cord manifestations. Meningomyelocele is seen in all cases. We present a case of type II Arnold Chiari Malformation diagnosed in utero in a pregnant lady .There was no periconceptional folic acid supplementation. As the role of the Methylene Tetra Hydro Folate Reductase gene polymorphism in neural tube defects is becoming evident, a simple opportunity as folic acid supplementation should not be missed. Folate supplementation as fortification of cereal grains will also prevent other conditions like congenital heart defects, urinary tract anomalies, orofacial defects, limb defects and pyloric stenosis.

A Case of Atypical Cleft Hand - Reported with Ontogenetic Review

Sujit Kumar Kundu, Hironmoy Roy, Abhijit Datta

An asymptomatic atypical U shaped cleft hand has been found in a 21-year-old lady attending OPD. On digital skiagram it was found that central digits were absent with remnants of bases of the metacarpals, which have fused with the carpal bones. Moreover, the scaphoid and trapezium had fused to form a single mass. There was no other anomaly in other limbs, so far searched for. An endeavor has been made to explain the anomaly with ontogenetic review.

Occipital meningoencephalocele with Cleft Lip, Cleft Palate and Limb Abnormalities- A Case Report

Arthi Ganapathy, Sadeesh T, Mary Hydrina Swer, Sudha Rao

A 21-week-old still born female fetus with occipital encepholocele, cleft lip and cleft palate was received from the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry and was studied in detail. It was born to Primigravida, of a second degree consanguineous marriage, with unremarkable family history. The biometric measurements were noted which corresponded to the age of the fetus. Further the fetus was embalmed and dissected. On examination an encephalocele of 2.7×1.5 cm was seen in the occipital region with a midline defect in the occipital bone and herniated brain tissue. Other anomalies observed were right unilateral cleft lip, right cleft palate, and bilateral syndactyly of the lower limbs and associated Congenital Talipus Equino Varus of the right foot. Other internal organs were developed appropriate for the age of the fetus

Mesenteric Lymph Node Hamartoma (Castleman’s Disease) in Association with Superior Mesenteric Arteriovenous Fistula

Vikas Deep Goyal, Satish Kumar, Narvir Chauhan, Ankit Shukla, Rashmi Kaul

We present a case of 21-year-old female patient with history of pain abdomen and abdominal distension. The patient also had oedema of the limbs, puffiness of the face, pallor and palpable mass in the abdomen. Ultrasonography of the abdomen and computed tomographic angiogram was done and it showed presence of vascular mass along with arteriovenous malformation in the mesentry of small gut between distal branches of superior mesenteric artery and vein. Surgical excision of the mass with ligation and division of the arteriovenous malformation was done through midline laparotomy. Histopathological examination was consistent with the diagnosis of Castleman’s disease. The Patient recovered well and was discharged after seven days.

A Rare Presentation of Gastric Signet Ring Cells: Signet Ring Cell Lymphoma

We herewith present a rare and interesting case of gastric signet ring cell lymphoma (SRCL) in a 40-year-old retroviral positive lady. SRCL is a rare morphological variant of nodal lymphomas.Biopsy from the suspected lesion in the stomach showed diffuse sheets of cells with a large central vacuole displacing the nucleus to the periphery of the cell, imparting signet ring cell morphology. Negative reaction to PAS (Periodic acid Schiff) stain and subsequent strong positivity for the immunohistochemical markers such as CD45 (Leucocyte commonantigen) and CD20, a B-cell marker helped us to arrive at a diagnosis of signet ring B- cell lymphoma.

Bottle Gourd (Lagenaria Siceraria) Toxicity: A “Bitter” Diagnostic Dilemma

Khalid Ismail Khatib, Kapil Sharad Borawake

Consumption of a glass of bottle gourd juice is thought to work as a health “tonic” and part of traditional healthy living practices in India. The juice may in certain circumstances turn bitter with increased levels of the cytotoxic compound called Cucurbitacins. If the bitter juice is consumed it causes a toxic reaction in the gut, leading to abdominal discomfort/pain, vomiting, hematemesis, and hypotension which may be rarely fatal, especially in persons with pre-existing illness. In the absence of clear cut history regarding the consumption of the bitter bottle gourd juice and the initiation of symptoms, the differential diagnosis for the above symptoms will include diseases causing gastrointestinal bleed with hypotension and/or shock. We report a case of bitter bottle gourd poisoning presenting with abdominal symptoms, hematemesis and shock and with an initial differential diagnosis of septicemia with septic shock and multi-organ involvement. We conduct a literature review and ponder the various differential diagnoses of this clinical scenario

Radiographic Patterns of Soft Tissue Calcinosis in Juvenile Dermatomyositis and its Clinical Implications

Juvenile Dermatomyositis (JDM) is a rare autoimmune inflammatory disease of muscles affecting children and adolescents with soft tissue calcification and varying systemic involvement. Though diagnosis is primarily by clinical, biochemical and histopathological tests, Imaging has unique significance from characterizing the calcinosis, detecting early changes in muscle in active phase of the disease, diagnosing potential complications,rule out other important differentials, guide biopsies ,and assessing the progress on follow up. Four distinct patterns of calcinosis have been described in relation to dermatomyositis which need to be differentiated from other aetiologies of soft tissue calcification and myopathies.

Lead Poisoning Mimicking Acute Porphyria!

Akshatha L N, Rukmini M S, Mamatha T Shenoy, Sadashiva Rao P, Prashanth. B

We are presenting a case of a 13-year-old autistic boy whose urine porphyrin test came positive on three separate occasions. The child was brought to emergency department of Kasturba Medical College Hospital, Attavar, Mangalore, India, with fever and acute abdominal pain, with no previous history of any serious illness. Investigations revealed thalassemia trait,microcytic hypochromic anaemia while the other biochemical and haematological parameters were normal. False positive urine porphyrin test may be seen in porphyria induced by liver cancer, hepatitis and heavy metal poisoning such as lead, arsenic and mercury. Blood lead (PbB) level was 59.5µg/dl. Further evaluation revealed a daily consumption of native medicine in the form of syrup.

Acute Pelvic Pain: A Ball Pen May Be a Cause?

Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of self- inflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment

Non Traumatic Spinal Epidural Haematoma in a Woman with HELLP Syndrome: A Case Report

Juhi Bansal, Ravishankar Pillenahalli Maheshwarappa, Amit Gupta, Alka Goyal

Spinal epidural haematomas (SEH) is a potentially reversible cause of spinal cord and nerve root compression which needs prompt surgical decompression for satisfactory neurological recovery. SEH occurs very rarely in pregnant woman with HELLP syndrome (hemolysis, elevated liver enzyme levels, and low platelet levels). Most of the SEH cases reported in HELLP syndrome in the literature are due to iatrogenic interventions. We report a still rarer case of non traumatic spinal epidural haematoma in a pregnant woman with HELLP Syndrome.

Benign Triton Tumour of Upper Lip- A Rare Neoplasm at an Extremely Uncommon Site

Hemalatha A.L, Sanjay. M, Anoosha. K, Ashok K. P, Shantha Kumari. B.R

Benign Triton tumours are exceedingly rare tumours occurring predominantly in young children. Fewer than 20 cases have been reported in literature. The tumours develop as masses in various large nerve trunks, the most common of them being the brachial and the sciatic. They are very rarely encountered in the head and neck region. Neurological symptoms may manifest due to their strategic locations. Various case studies in literature support their benign nature. Early diagnosis and complete excision avoids deformities and other associated complications. We present one such rare case of benign triton tumour of the head and neck region in a 10 year old female child who presented with a diffuse nodular swelling in the upper lip involving the philtrum and extending upto the left ala of the nose along with a brief review of literature.

Accessory Branch of Median Nerve Supplying the Brachialis Muscle: A Case Report and Clinical Significance

A very rare case of an accessory branch of the median nerve taking its origin in the region of the right arm was observed to supply the infero-medial portion of the brachialis muscle in a male cadaver. Simultaneously, the ipsilateral musculocutaneous nerve was innervating the muscles of the anterior compartment of the arm. Such an aberrant muscular branch of the median nerve for the brachialis muscle is very rarely reported in the literature. Lesion of the median nerve proximal to the branch’s origin site could induce weak flexion of the elbow, whereas injury of the musculocutaneous nerve could lead to misinterpretation of symptoms. We discuss the patterns of brachialis muscle innervation as well as the clinical applications of such a variant.

Botryoid Odontogenic Cyst: A Diagnostic Chaos

Anuradha. A, Urmila. U, Vijay Srinivasvas . G, Sabitha Deviramisetty, Puneeth HK

Botryoid Odontogenic cyst (BOC) originally described by Weathers and Waldron (1973) is a variant of a lateral periodontal cyst characterized by macroscopic and microscopic multilocular growth pattern. We report a case of BOC in a 21-year-old male patient. Orthopantamogram revealed a multilocular radiolucency extending from 43 to 47. The histological examination of incisional biopsy revealed a thin 2-4 layered non keratinised epithelium without rete ridges resembling a reduced enamel epithelium with few localised plaque like thickenings and occasional mural bulges. These features were suggestive of BOC. The excisional biopsy revealed histological features similar to those of incisional biopsy except for the presence of 5-6 epithelial follicles with outer columnar cells and inner stellate reticulum like cells. CD56 and calretinin immunohistochemical staining (IHC) was done. This paper highlights the unusual appearance of follicles in BOC with differential diagnosis and IHC staining characteristics.

Congenital Rubella Syndrome with Blueberry Muffin Lesions and Extensive Metaphysitis

Mohemmed Ajij, Sushma Nangia, Bhavna Sharma Dubey

We report a case of Congenital Rubella Syndrome (CRS) in a newborn. The baby had blueberry muffin skin lesions, long bone metaphysitis and congenital heart defects. With this case report we would like to highlight the existence of congenital rubella syndrome in the community, prompt the clinicians to make a diagnosis of CRS in children with suggestive clinical signs, and to create awareness against this vaccine- preventable disease and consideration to include MMR vaccination in nation immunization schedule.

Soft Tissue Myxoma- A Rare Differential Diagnosis of Localized Oral Cavity Lesions

Myxomas have a common histologic appearance of myxoid ground substance and are classified in group of soft tissue tumors. According to literature myxomas occurring in every decade of life have been reported. Very often intraoral soft tissue myxoma can be misinterpreted as malignant and are difficult to differentiate from the other tumours with myxoid stroma. Of the different variants of soft tissue myxoma, intraoral is extremely rare, slow growing, benign mesenchymal tumour. We report a case of a 22-year-old male who presented with swelling in the right cheek and mass in the right buccal mucosa that appeared gradually over two year. No history of pain over the lesion or bleeding on touch. On intraoral examination a lesion measuring 3 X 3 cm was seen in the right buccal mucosa. Biopsy of the lesion revealed oral soft tissue myxoma. Wide excision with clinically clear margins was done under general anaesthesia. Histopathological report revealed the diagnosis as to be oral soft tissue myxoma. A case of oral soft tissue myxoma is presented for its rarity and for differential diagnosis of localized oral cavity lesions.

Intraocular Metallic Foreign Body: Role of Computed Tomography Radiology

Suthar Pokhraj P., Patel Jigar J., Mehta Chetan, Patel Narottam A.

Orbital foreign bodies remain a serious diagnostic problem, despite development of diagnostic imaging techniques. Non-metallic orbital foreign body will not be detected in routine x-ray. Here we are presenting a case of 32-year-old male presented with acute pain in left eye immediately after he had been pounding a metal object with a metal chisel. Following this event patient develop blurring of vision in left eye with tearing. Patient’s vision in left eye was found to be hand motion with conjunctiva mildly injected, left corneal central 1 mm Seidel-negative full-thickness laceration and dense traumatic cataract was seen on ocular examination. Dilated fundus examination of left eye was not possible due to traumatic cataract. Vitreous hemorrhage, vitreous detachment and a echogenic foreign body present in posterior segment in B–Scan sonography. Well-defied hyperdense foreign body producing streak artifacts with vitreous hemorrhage was seen in the posterior chamber of left eyeball in CT orbit. The patient was diagnosed with a corneal laceration, traumatic cataract, vitreous hemorrhage and a metallic intraocular foreign body. He was brought to the operating room urgently for corneal laceration repair, pars plana vitrectomy, lensectomy, and removal of the metallic intraocular foreign body done.

Iatrogenic Cushing Syndrome to Facial Nerve Palsy: Via Intracranial Tuberculoma-An Interesting Journey

Subrata Chakrabarti

Isolated Facial nerve palsy is a less common neurological manifestation of intracranial tuberculoma. Again, tuberculoma can arise following development of Cushing syndrome after prolonged intake of steroids due to origin of immunosuppressed state. Thus exogenous steroid administration leading to iatrogenic Cushing Syndrome which again causing tuberculoma, with facial nerve palsy developing as a manifestation of tuberculoma is not unnatural but definitely a unique scenario. The author reports an interesting case where a patient developed left sided facial palsy following development of intracranial tuberculoma from iatrogenic Cushing syndrome after longterm intake of Dexamethasone as a treatment for low back pain. This situation is rarely reported before.

Hepatic Epithelioid Hemangioendothelioma in an Eight Year old - A Case Report

Geetha Vasudevan, Bhavna Nayal, Bhawna Nagel, Lakshmi Rao

Hepatic epithelioid haemangio-endothelioma (HEHE) is a rare vascular tumour of endothelial origin. The etiology of this tumour is unknown and has a variable clinical outcome. It usually affects adults and is extremely rare in children. Histologically, HEHE is characterized by epithelioid to dendritic tumour cells with intracytoplasmic lumina containing RBCs and a myxoid to sclerotic stroma. Being a rare entity, awareness and a high degree of suspicion is required to correctly identify this tumour. We report a case of hepatic hemangioendothelioma in an 8-year-old child.

Leclercia Adecarboxylata Isolation: Case Reports and Review

Mokkapati Anuradha

Leclercia adecarboxylata is usually isolated as a part of polymicrobial cultures in immunocompetent patients, and as a pure culture in immunocompromised persons. Although generally sensitive to most antibiotics, there are reports of resistant strains. Two case reports of L. adecarboxylata isolation in the lab in pure culture in immunocompetent persons are presented here, L adecarboxylata being isolated from a vaginal swab in the first case and from a gluteal abscess in the second case. Both the isolates were sensitive to most of the antibiotics tested.

Scrotal Hemangioma: A Case Report

Deepak Chavan, Anita P Javalgi

We report a case of scrotal-hemangioma in a 14-year-old boy. Subcutaneous scrotal-perineal hemangioma may mimic an inguinal hernia, thus forming a diagnostic and therapeutic challenge. Histopathological study confirms the diagnosis. Definitive treatment by en bloc excision is recommended.

Septicaemic Melioidosis: Case Report from a Non-Endemic Area

Smita Sood, Raghuvir Singh Khedar, Shabbar HK Joad, Rajeev Gupta

Melioidosis is a clinically diverse disease caused by the facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei. In recent times melioidosis has been increasingly reported in India especially from the southern and coastal states. We report a fatal case of septicaemic melioidosis from the state of Rajasthan with a view to increase awareness about the existence of this disease in an area yet unrecognized.

A Case Series Of Scrub Typhus In Obstetrics

Poomalar G K, Rekha R

Scrub typhus is endemic and re-emerging in eastern and southern Asia. Illness varies from mild and self-limiting to fatal. Only few studies were published about its effect in maternal and neonatal outcome. A retrospective analysis was done in six prenatal and two postnatal women with scrub typhus. Details about clinical presentation, investigations, treatment given, response to treatment and pregnancy outcome were collected. The common symptoms were fever with chills, vomiting, myalgia, headache and abdominal pain. Typical features of eschar and lymphadenopathy were noted in only two cases. Two patients presented with jaundice and altered liver function test. Two patients presented with breathlessness. One patient developed oligohydramnios. Two postnatal women developed scrub typhus following blood transfusion for postpartum haemorrhage. Because of its high prevalence, scrub typhus should be included in fever investigations in endemic areas, even in the absence of eschar. Early diagnosis of cases will help in less severe organ damage and easy recovery with antibiotics. Few evidences state that scrub typhus can spread through blood transfusion. Correlation between blood transfusion and scrub typhus has to be further evaluated

Management of Grade III Mobile Anterior Tooth in Function Using Endostabilizer – A Case Report

Vandana B.Kokane, Swapnil N.Patil

Impact of implant dentistry is such that today very few dentists think about saving grade III mobile anterior teeth. A patient with grade III mobility of central incisor due to apical root resorption was treated by using 80 no.stainless steel ‘H’ file as endostabiliser and one year follow up was done. Endostabiliser reduced the mobility of grade III mobile teeth drastically, immediately after its placement. Tooth was absolutely asymptomatic throughout one year follow up.

Regaining Vision from No Perception of Light after Radiotherapy for a Case of Suprasellar Meningioma

Bhargavi Ilangovan, Janos Stumpf, Major Raghavan, Rathna Devi R, Subathira B

Meningiomas are tumours of the arachnoid cap cells. Usually they are referred to according to their location. They are primarily treated with surgery. They tend to recur following surgery. Suprasellar meningiomas frequently present with visual disturbances. Our patient is a case of recurrent suprasellar meningioma. The visual acuity in one eye was No Perception of Light(NPL). From NPL, the visual acuity improved to 6/12 in six months after High Precision Irradiation (HPI). This case emphasizes the importance and the need for aggressive management. It also shows the use of radiotherapy techniques used in synergy to produce the necessary results.

Prosthetic Rehabilitation of Hypophosphatasia with Precision Attachment Retained Unconventional Partial Denture: A Case Report

Deficiency of the alkaline phosphatase isoenzyme can lead to a rare hereditary disorder called Hypophosphatasia. It is characterized by defective mineralization of the skeletal and dental structures of the body. Hypophophatasia is classified into six clinical forms namely, perinatal lethal, perinatal benign, infantile, childhood, adult and odontohypophosphatasia. This clinical report describes the prosthetic rehabilitation of an 18-year-old girl with Hypophosphatasia with partial anodontia and no occlusion. A precision attachment retained unconventional removable partial denture in the maxillary arch and conventional removable partial denture in the mandibular were fabricated to establish an acceptable masticatory function, speech, occlusion and aesthetics for the patient.

Xanthogranulomatous Appendicitis with a Fulminant Course: Report of a Case

Gaurav Kochhar, Sudipta Saha, Manoj Andley, Ashok Kumar, Ajay Kumar

Xanthogranulomatous inflammation is a well-described entity with involvement of various body organs. But the involvement of vermiform appendix in the disease process is quite rare with only few cases are reported in literature. This case report describes a 50-year-old man, who was diagnosed as a case of acute appendicitis with appendicular lump on the basis of clinical history, physical examination, and hematological and radiological investigations. Patient underwent surgical interventions twice. But, he succumbed to the disease. We are reporting this case in view of rarity of the disease and the fulminant course, which has not been described in any other reports.

Co-infection of Plasmodium Vivax Malaria and Cytomegalovirus in an Immunocompetent Neonate

Sudha Chandelia, Sarika Jain

Co-infections when occur can pose substantial diagnostic and treatment challenges for clinicians. In this case report we describe a neonate with co infection of plasmodium vivax malaria with Cytomegalovirus and discuss whether it can be the result of reactivation of one by the other infection postnatally or if these infections can affect and facilitate the transplacental transmission of each other from the mother.

Non Syndromic Familial Bilateral Decidious Taurodontism – A First Case Report

Taurodontism is anatomical and morphological alteration in the shape of the tooth. In taurodontism the crowns appear larger and the roots shorter compared to the normal anatomy of the respective tooth. The incidence of taurodontism in deciduous is very low and is also not very common in permanent dentition. The endodontic treatment protocol of taurodontic tooth is challenging. Taurodontic tooth requires a very cautious approach in identifying the root canal orientation and presence of any extra or lateral canals.

The Road To Radiation Protection: A Rocky Path

Pooja Khare, Preeti Nair, Amit Khare, Vandana Singh, Rhiti Chatterjee

Radiation has intrigued us with its magnificent properties of imaging and healing. But this discovery, like many others, came with a heavy price. The pioneers of this form of energy themselves often succumbed to its devastating effects and hence, paved a way for future generations to be wary of it, while continuing to use it. This paper attempts to salute those masters who have helped make the radiation world a safer place to live and work in.

Maspin as a Tumour Suppressor in Salivary Gland Tumour

Maspin is a protein that belongs to serin protease inhibitor (serpin) superfamily. The purpose of this study was to review the literature concerning the expression of maspin in salivary gland tumours. A literature search was done using MEDLINE, accessed via the National Library of Medicine PubMed interface. Statistical analysis was not done because only seven studies were available in literature, the collected data were different and the results could not be compared. Expression of maspin was down regulated in more aggressive salivary gland tumours. Maspin may function as a tumour suppressor in salivary gland tumours.

Maxillofacial Prosthetic Materials- An Inclination Towards Silicones

Aparajita Mitra, Sunita Choudhary, Hemlata Garg, Jagadeesh.H.G

There have been constant searches and researches which are taking place in the field of dental materials to best suit the ideal selection criteria to satisfy the functionality, biocompatibility, aesthetics as well as the durability as a maxillofacial material. Among all the different materials, Silicone is the most popularly used, but still studies are carried out to overcome their weaknesses and to come out with a material which can be labeled as the “ideal maxillofacial prosthetic material”. This article comprises the materials which were and are in use and the reason for their unpopularity. It also gives us a scope to understand the major fields where the materials lack and thus needs improvement to render an individual with the best maxillo-facial prosthesis.

Oral Manifestations of Tuberculosis: Step towards Early Diagnosis

Pankaj Jain, Isha Jain

Tuberculosis, as known universally, is a chronic infectious disease that can affect any part of the body including mouth. It usually affects the lungs, TB bacilli can spread hematogenously to other parts of the body and this also includes mandible or maxilla. It can occur in the mouth involving the tongue with very unusual features and forms. So oral lesions, although rare, are very important for early diagnosis and interception of primary tuberculosis.

Evolution of Barrier Membranes in Periodontal Regeneration-“Are the third Generation Membranes really here?”

George Sam, Baiju Radhamoni Madhavan Pillai

In the last decades, Guide Tissue Regeneration (GTR) technique has been applied for the treatment of various periodontal defects such as intrabony defects, furcation involvements and localized gingival recession defects. From early days of using membranes with the simple aim of minimizing toxic response in the host, membranes have come a long way. Third generation membranes not only act as barriers but also as delivery devices to release specific agents. Many clinical trials have focused on using membranes as delivery devices for antibiotics and growth factors. In this article we take a brief look at the evolution of barrier membranes and future avenues with regard to third generation membranes.

Botox : Broadening the Horizon of Dentistry

Pranav Nayyar, Pravin Kumar, Pallavi Vashisht Nayyar, Anshdeep Singh

Botox has been primarily used in cosmetic treatment for lines and wrinkles on the face, but the botulinum toxin that Botox is derived from has a long history of medically therapeutic uses. For nearly 13 years, until the introduction of Botox Cosmetic in 2002, the only FDA-approved uses of Botox were for crossed eyes (strabismus) and abnormal muscle spasms of the eyelids (blepharospasm). Since then botulinum A, and the seven other forms of the botulinum toxin, have been continuously researched and tested. Botox is a neurotoxin derived from bacterium clostridium botulinm. The toxin inhibits the release of acetylcholine (ACH), a neurotransmitter responsible for the activation of muscle contraction and glandular secretion, and its administration results in reduction of tone in the injected muscle. The use of Botox is a minimally invasive procedure and is showing quite promising results in management of muscle-generated dental diseases like Temporomandibular disorders, bruxism, clenching, masseter hypertrophy and used to treat functional or esthetic dental conditions like deep nasolabial folds, radial lip lines, high lip line and black triangles between teeth.

Role and Efficacy of L-PRF matrix in the Regeneration of Periodontal Defect: a New Perspective

Anuroopa P, Padmavathi Patil, Vinaya Kumar R, Krishna Kripal

The ultimate goal of periodontal therapy is to achieve complete wound healing and regeneration of the periodontal unit. The therapeutic use of L-PRF matrix constitutes a relatively new biotechnology that has been a breakthrough in the acceleration of hard and soft tissue healing. Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The slow polymerization during PRF preparation seems to generate a fibrin network very similar to the natural one. Such a network leads to a more efficient cell migration and proliferation and thus cicatrization. This article proposes an overview of use of platelet-rich fibrin in management of periodontal hard and soft tissue defects and goes on to describe the clinical benefits of PRF and its advantage over PRP.

Canal Shaping with One Shape File and Twisted Files: A Comparative Study

Aim: The aim of this study was to compare the shaping ability of two different rotary Nickel –Titanium (Ni-Ti) files, One shape file and Twisted files in a simulated artificial canals. Materials and Methods: A total of 40 endodontic training blocks were used in this study and divided in two groups consisting of 20 each (n = 20) and the shaping ability was accessed based on the left over ink stain in the artificial canal. Results: Image proplus analysis software and stereomicroscope were used for analysing the shaping ability of the files and statistical analysis was done by SPSS software. Twisted files showed better shaping ability compared to one shape file both experimentally and statistically. Conclusion: It can be concluded that twisted files shaped the canals better then one shape file

Mounier-Kuhn syndrome (MKS) - Pathognomonic Findings

Saurabh Kumar, Alok Kumar Mittal

Growth of Streptococcus pneumoniae on Macconkey Agar: Possibility of Impossible?

Shikha Ranjan, G Bakthavathsalam, Vidhya Vijaya Raghavan, Sindhu Ravi Kumar

An Unusual Presentation of a Patient with Multiple Endocrine Neoplasia- 1

Nitin Kapoor, Sahana Shetty, Hesarghatta Hyamasunder Asha, Thomas V Paul

Hepatosplenomegaly and Pernicious Anaemia

Turgay Ulas, Emel Yigit Karakas, Cemal Bes, Fatih Borlu, Hakan Buyukhatipoglu

Heterotopic Pancreas in the Stomach Masquerading Neoplasm

Dynamics of Anidulafungin use in a Tertiary Care Hospital

Controlled Vestibular Stimulation: A Physiological Method of Stress Relief

Kumar Sai Sailesh, Archana R, Mukkadan J K.

Emperipolesis – A Review

Varun Rastogi, Rachna Sharma, Satya Ranjan Misra, Lalita Yadav, Vandana Sharma

Emperipolesis is an uncommon biological process, in which a cell penetrates another living cell. Unlike in phagocytosis where the engulfed cell is killed by lysosomal enzymes of the macrophage, the cell exists as viable cell within another in emperipolesis and can exit at any time without any structural or functional abnormalities for either of them. This process can either be physiological or pathological and may be a pathognomonic feature of certain diseases. Histiocytes and Megakaryocytes are involved in Emperipolesis normally but tumour giant cells in Hodgkin’s disease and Rosai-Dorfman disease are pathologic conditions in which this process is seen. We report a mini review as this process is rare and not much reported in the literature.