Journal of clinical and diagnostic research

The Prognostic Significance of Neuroendocrine Differentiation in Colorectal Carcinomas: Our Experience

Does Taste Perception Effect Body Mass Index in Preschool Children?

Introduction: Eating trends established early in life leads to chronic life style disorders such as obesity, which is hard to overcome as child comes of age. Energy expenditure is less but caloric intake is high leading to disparity of energy balance in turn leading to obesity. Obesity is the outcome of a disparity between energy expenditure and caloric intake. Genes play a role in establishing eating habits, which is termed as genetic sensitivity to taste. Aim: To determine taste perception effect on body mass index (BMI) in preschool central Indian urban children. Materials and Methods: A total of 500 children of 3-6 years were selected and genetic taste perception was assessed using PROP sensitivity test. Anthropometric measurements were recorded to obtain BMI value. Categorical variables were analysed using Pearson’s Chi square test. Results: Non tasters were mostly in overweight category i.e. 73.30% where as more number of tasters i.e. 59.70% were in underweight category. A significant correlation is seen between BMI and taste perception. No statistically significant correlation was seen between oral hygiene and taste perception. Females were predominant in both the tasters and non tasters categories. Conclusion: Taste perception showed significant relationship with BMI of children between 3-6-year-old children.

Frenulum Sparing Circumcision: Step-By-Step Approach of a Novel Technique

Objective: Circumcision, by most conventional methodologies, involves division of the frenulum and excision of the entire foreskin covering the glans. This seemingly simple procedure is occasionally associated with dreadful and devastating complications. We describe a new frenulum-sparing technique that circumvents some of the potential complications of conventional techniques and could also potentially help preserve preputial role in sexual function. Materials and Methods: An initial dorsal slit, three fourths of the way up to the corona is extended laterally and obliquely on either side, to meet the preputial edge, 3-4 mm from the frenulum. A broad sleeve of sub-coronal mucosa is thus preserved. The frenulum is left untouched, leaving a wide skin bridge connecting the mucosal sleeve with the shaft skin. The raw area is closed with interrupted, synthetic absorbable sutures. Over a three year period, 42 patients were circumcised using this technique. Results: No significant complications like frenular bleed, painful postoperative erections, chordee, meatal stenosis, or urethra-cutaneous fistula were observed in any patient. The cosmetic results were pleasing. Conclusion: The frenulum-sparing technique of circumcision is a promising modification to the various existing techniques. The method described is technically easier to perform than conventional frenulum-dividing procedures and has an acceptable cosmesis. Further randomised controlled studies on larger cohorts are necessary to establish the true benefits of this technique over established procedures.

Eosinophilic Structure: Should it be Included in Routine Cytology Reporting of Tuberculosis Lymphadenitis?

Panduranga Chikkannaiah, Mythri M Boovalli, Srinivasa Murthy Venkataramappa

Introduction: Fine needle aspiration cytology is a simple, rapid procedure routinely employed for the diagnosis of tuberculosis lymphadenitis. Positivity for acid fast bacilli (AFB) in Ziehl-Neilsen stained smear is still considered as gold standard for diagnosis of Tuberculosis, but all lesions may not yield AFB, thus pose diagnostic problems. Few cytomorphological changes i.e. Eosinophilic structure (ES) in the stained smears correlates with the presence of AFB thus, helping us in rapid diagnosis. Aim: To evaluate the correlation between AFB and ES in necrotic lymph node aspirates. Materials and Methods: This is a retrospective study conducted from January to December 2014. Lymphnodes upon purulent aspiration which were reported as granulomatous lymphadenitis suggestive of tuberculosis were included in the study. All the stained smears (H&E, MGG and ZN Stains) for each case were retrieved from the files and rescreened for the presence of ES, granulomas and AFB. Presences of ES were correlated with AFB. Statistical Analysis: Stastistical analysis was done using Chi-square test. Results: Our study included 103 cases. The common age group involved was 21-40 years, with female predominance. Cervical lymph nodes were most commonly involved. In relation to ES and AFB, four different cytological pictures were seen i.e., ES and AFB-(31%); ES-AFB+(16.5%); ES+, AFB+(39%); ES+AFB-(14.5%). Chi-square test showed a highly significant stastistical association between ES and AFB with p=0.001. Conclusion: Eosinophilic structure is one of the cytomorphological features to be considered in necrotic lymph node aspirate which has a significant correlation with AFB in the smears. Hence pathologist should search for this, and it should be included in routine cytology reporting of tuberculosis lymphadenitis.

Dermatoglyphs in Coronary Artery Disease Among Ningxia Population of North China

Background: Coronary artery disease (CAD) is an enormous health problem in the world. Dermatoglyphs are cutaneous ridges on the fingers, palms, and soles, formed by genetic regulation and control during early intrauterine life. The Dermatoglyphic traits do not change significantly as the growth of the age. They may be the phenotypic characters of individual genes and represent the predisposition to certain diseases. Aims and Objectives: The study was carried out to document characteristic dermatoglyphic patterns in coronary artery disease which could be useful in early diagnosis of the disease. Materials and Methods: Dermatoglyphic study of 258 male (129 coronary artery disease cases and 129 normal subjects) of Ningxia China were studied in the present cross-sectional study. It involved the digital patterns, ATD angles, A-B ridge counts on the hands. Chi-square test, t-test were used for the statistical analysis in this study. Results: The overall frequency of whorls was higher followed by loop and arch in both two groups. It was observed that there was significant difference of digital frequency of whorls and ulnar loops in patients in both hands as compared to controls (p=0.01). The mean value of finger ridge counts, total ridge counts were similar between two groups. The A-B ridge counts were significantly higher in coronary artery disease compared with controls on the right palm (p=0.01). However, the mean ATD angle values were significantly higher in cases than those of in normal on both hands (p<0.05). Conclusion: Abnormally high A-B ridge count, ATD angles and the frequency of whorls are characteristic dermatoglyphic patterns of coronary artery disease. Dermatoglyphics may have an important role in early diagnosis of coronary artery disease in future.

A Prospective Comparative Study of the Toxicity Profile of 5-Flurouracil, Adriamycin, Cyclophosphamide Regime VS Adriamycin, Paclitaxel Regime in Patients with Locally Advanced Breast Carcinoma

Jihana Shajahan, Pradeep Sadasivan Pillai, Krishnan Nair Lalithamma Jayakumar

Introduction: A 5-flurouracil, Adriamycin, Cyclophosphamide (FAC) and Adriamycin, Paclitaxel (AT) are two popular chemotherapeutic regimens for treatment of breast carcinoma. The most time tested and popular regimen is FAC. It is extensively studied for efficacy and toxicity. But data regarding toxicity profile and efficacy of AT regimen is sparse. Aim: To study the toxicity profile, severity of toxicities and clinical response rate of FAC and AT regimens in patients with locally advanced breast carcinoma. Materials and Methods: A prospective observational study with 50 patients in each treatment arm. Study duration was 12 months from November 2012 to October 2013. Consecutive patients with locally advanced breast carcinoma receiving treatment with either FAC or AT regimen, satisfying inclusion criteria were enrolled into the study after getting informed written consent. Prior to initiation of treatment detailed medical history was taken from all patients. General clinical examination, examination of organ systems and local examination of breast lump were done. After each cycle of chemotherapy and after completion of treatment patients were interviewed and examined for clinical response and toxicities. Toxicities were graded with WHO toxicity grading criteria. All data were entered in a structured proforma. At least 50% reduction in tumour size was taken as adequate clinical response. Statistical Analysis: Data was analysed using Chi-square test with help of Excel 2007 and SPSS-16 statistical software. Results: Different pattern of toxicities were seen with FAC and AT regimens. Anaemia, thrombocytopenia, stomatitis, hyperpigmentation, photosensitivity and diarrhoea were more common with patients receiving FAC regimen. Leucopenia, peripheral neuropathy, myalgia, arthralgia, vomiting and injection site reactions were more common in AT regimen. Both FAC and AT regimens gave 100% clinical response. Conclusion: FAC and AT regimens are equally efficacious but have different toxicity profiles. Patient’s predisposition to toxicities may govern the selection of a particular regime.

A Three–year (2011–2013) Surveillance on Animal Bites and Victims Vaccination in the South of Khorasan–e–Razavi Province, Iran

Hamed Ramezani Awal Riabi, Reza Ghorbannia, Seyed Behnam Mazlum, Alireza Atarodi

Introduction: Rabies is acute encephalitis caused by rabies virus and is transmissible between humans and warm blooded animals. The virus is belong to the family of Rabdoviridae and, of Lissavirus genus. Aim: To find out the success of rabies surveillance system to prevent victims of this deadly disease and to identify its risk factors in the community. Materials and Methods: This research is a cross-sectional analysis and the information pertaining to bite incidents was obtained from documents of the Centers for Disease Control of Rabies from 2011 to 2013. A questionnaire was used which included questions on demographics information (sex and age) of the victims, and the others. Results: A total of 616 cases (animal rabies) were brought to rabies treatment center during 2011- 2013 of which 81.2% of the cases were males and 18.8% were females. Most animal bites (37.5%) reported in 2011. The difference between the months and the number of biting were statistically significant (p = 0.001). Animal biting was more frequent among people of age group 21–30 years than other age groups which constituted roughly 27.2% of the cases. There was no significant relationship between the variables of gender and site of the bites victims, (p> 0.05). Domestic dog bite was most frequent, found in 66.7% cases. 83.9% victims had been uncompleted vaccinated and 16.1% were completed. Conclusion: Since, the cost of conservation was high for the health system after biting, preventive programs should be concentrated on public health instructions, particularly in villagers, free occupation and emphasis to ranchers that have collar dogs during the day.

Opportunistic Screening of Vitamin B12 Deficiency in IT Professionals Presenting for Routine Health Check-up

Introduction: Vitamin B12 deficiency is mainly diagnosed in symptomatic patients. However, the deficiency may also be prevalent in asymptomatic patients. Our aim was to study the prevalence of Vit B12 deficiency in IT professionals (Information Technology Professionals from Software industry) who presented for routine health screening and to correlate the deficiency to various parameters. Materials and Methods: This was single centre, observational study comprising of 84 IT professionals. The data was collected in structured format. The study was designed to identify prevalence of Vit B12 deficiency and correlate to other factors such as type of diet, income level & regular use of medication (such as Antacid & Metformin). Results: Total 28 individuals were found to be deficient (33.34%). Prevalence of Vit B12 deficiency amongst Vegetarian and non vegetarian diet adhering subjects was 47.5% and 20.45% respectively. B12 deficiency was also prevalent in high income age group. Further chronic intake of PPI (Proton pump inhibitor) and Metformin was associated with prevalence of 37.5% and 33.34% in the present study. Conclusion: During health screening of IT Professionals, significant prevalence of Vit B12 deficiency was noted across all income groups & non vegetarian diet consuming subjects also. There is significant correlation between Vit B12 deficiency with chronic use of PPI and Metformin.

Impact of Quantified Smoking Status on Cognition in Young Adults

Introduction: Cigarette smoking is an addictive behaviour which continues to rise among young adults. It has been associated with various health hazards. Effect of smoking on cognitive function has been contradicting. Thus our aim was to compare cognitive performances between smokers and non smokers and also to observe the effect of varying intensity of smoking on cognition. Materials and Methods: This is a cross-sectional study. Thirty non smokers, 30 mild smokers, 30 moderate smokers, 30 heavy smokers within the age group of 25-35 years were involved in the study. Their cognitive performance were assessed by digit symbol substitution test (DSST), digit vigilance test (DVT), visual reaction time (VRT), letter cancellation test (LCT), word recall (WR), and object recall (OR). Result: The cognitive data were analysed using unpaired students t-test and ANOVA in SPSS 19. Smokers showed significant decline in their cognitive performances when compared to smokers (p = 0.05). Mild smokers showed significantly better performance in the DSST, DVT and VRT tests than the non smokers. This indicates the attention and alertness were better in mild smokers than the non smokers. With the increase in the intensity of smoking cognitive performances were also significantly declined. Conclusion: Thus the study indicates decreased cognitive performances in young adult smokers.

Oxidative Stress in Obese Postmenopausal Women: An Additive Burden for Atherosclerosis

Introduction: Coronary Artery Disease are on the rise in the general population and is the leading cause of death in both men and women. The impact of CAD is underappreciated in younger women when compared to men. Women have unique risk factors for CAD and postmenopausal women are at higher risk of developing CAD when compared to normal menstruating women. Aim: The aim of our study was to find out the difference in oxidative stress levels between obese postmenopausal women and normal menstruating women, also to compare the same in normal weight postmenopausal women. Materials and Methods: Thirty one normal and 29 obese postmenopausal women with age more than 45 years who visited obstetrics and gynaecology outpatient department for general clinical evaluation at a tertiary care centre were recruited in this cross-sectional study. Thirty normal menstruating women were compared. Anthropometric measurements were recorded and the body mass index was calculated. Serum Malondialdehyde and superoxide dismutase was measured using a spectrophotometer. Results: There was a significant difference in mean MDA levels in postmenopausal women (1.477 ± 0.359) when compared to normal menstruating women (0.666 ± 0.302) (p < 0.01). There was no significant difference in mean SOD levels in postmenopausal women (2.836 ± 0.899) when compared to normal menstruating women (2.986 ± 0.686) (p > 0.05). Also, there was a significant increase between mean MDA levels in obese postmenopausal women (2.48 ± 0.52) when compared to normal weight postmenopausal women (1.65 ± 0.36) (p < 0.01). There was a significant difference between mean SOD levels in obese postmenopausal women (1.36 ± 0.96) and normal weight postmenopausal women (2.56 ± 1.03) (p < 0.01). Conclusion: The oxidative stress was higher in obese postmenopausal women when compared to normal weight postmenopausal women and normal menstruating women.

Ultrasonography Guided Fine Needle Aspiration Cytology with Preparation of Cell Blocks in the Diagnosis of Intra- Abdominal Masses

B S Sumana, Bharathi Muniyappa

Background: Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) is currently the most favoured and increasingly used pre-operative diagnostic procedure in various deep seated neoplastic and non-neoplastic mass lesions. Cell blocks prepared from residual fine needle aspiration (FNA) material can aid in better morphologic assessment and contribute to establish a more definitive cytopathologic diagnosis. Aim: To assess the value of ultrasonography guided FNAC in the diagnosis of intra-abdominal (non-pelvic) masses. Objectives: To determine the reliability of ultrasonography guided FNAC in distinguishing neoplastic from non-neoplastic intra-abdominal mass lesions. To assess the usefulness of cell block as a complimentary diagnostic material in the morphologic evaluation of the lesions. Materials and Methods: Aspirate material was collected from 62 patients with clinically and/or radiologically detected abdominal mass under ultrasonographic (USG) guidance. Pelvic masses were excluded from the study. In every case an attempt was made to prepare cell block (CB) from any residual material after preparation of routine smears. The final cytomorphologic diagnosis was correlated with clinical and radiologic findings, histopathologic diagnosis, follow up and response to therapy information. R esults: The diagnostic yield of USG guided FNAC was 96.77%. The cases included 42 malignant (67.74%), two (3.23%) benign, and 16 (25.8%) non-neoplastic lesions. Two (3.23%) smears were unsatisfactory for evaluation. In 45 out of 62 cases (72.58%) CB preparations were available. There was a good agreement between smear diagnosis and that observed on CB section. Additionally CB yielded better diagnostic material in 15.55% of cases and aided in establishing a more precise final cytopathologic diagnosis. Confirmation of diagnosis in the form of biopsy and/or surgically resected specimen and follow up was available in 56 cases. The overall diagnostic accuracy of USG guided FNAC was 96.43% with a sensitivity, specificity, positive predictive value and negative predictive value of 95.35%, 100%, 100% and 86.66% respectively. C onclusion: USG guided FNA procedure provides a good diagnostic yield for intra-abdominal masses. Also it has high sensitivity and specificity in differentiating benign from malignant lesions. Cell block preparations facilitate better diagnosis of lesions when reviewed along with cytological smears.

Assessing the Validity of Friedewald’s Formula and Anandraja’s Formula For Serum Ldl -Cholesterol Calculation

P. Krishnaveni, Vanitha MN Gowda

Introduction: An important aspect of the assessment of cardiovascular risk for a dyslipidemic subject is the estimation of serum Low-Density Lipoprotein Cholesterol (LDL-C). There are many homogenous assays currently available for the estimation of serum LDL-C. Most clinical laboratories determine LDL-C (mg/dL) by Friedewald’s formula (FF), LDL-C = (TC) - (HDL-C) - (TG/5). Recently Anandaraja and colleagues have derived a new formula for calculating LDL-C, AR-LDL-C = 0.9 TC- (0.9 TG/5)-28. Aim & Objectives: The aim of the study was: a) to determine if, and to what extent, LDL-C level was underestimated/overestimated when it was calculated using the formulae compared with direct measurement of LDL-C, and b) to determine which of the calculated formulae show maximum correlation with direct LDL cholesterol method at different TG levels. Setting & Design: A cross-sectional study. Materials and Methods: Record analysis was done from the 370 (TG <400mg/dl) lipid profile reports of patients above 18 years. LDL-C estimation was done by homogenous assay and also calculated using the Friedewald’s Formula and Anandaraja’s Formula. Results: The mean LDL-C levels were 105.17± 43.4, 102.98 ±42.5, and 98.20 ±43.7 mg/dl for D-LDL-C, F-LDL-C and AR-LDL-C, respectively. A good correlation was found between the calculated LDL-C methods and Direct Low-Density Lipoprotein Cholesterol method (D-LDL-C) assay, that is, F-LDL-C versus D-LDL-C (r = 0.937) and AR-LDL-C versus D-LDL-C (r= 0.918). Bland–Altman plot for FF-LDL-C & AR-LDL-C showed minimal negative bias. Conclusion: FF-LDL-C correlated maximally with D-LDL-C estimation at all levels of triglycerides except at TG < 100mg/dl. At TG < 100mg/dl, Anandaraja’s Formula works better. FF-LDL-C can be used in place of D-LDL-C when the direct method cannot be afforded.

Architectural Analysis of Picrosirius Red Stained Collagen in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma using Polarization Microscopy

Introduction: Collagen degradation is important both for carcinogenesis and in its progression. Research regarding the co-relation of collagen with Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) is less explored. Aim: To elucidate the nature of collagen in Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) using Picrosirius Red Stain (PSR) under polarizing microscopy. Materials and Methods: The study consisted of a total 40 samples which were divided into three groups. Group I included buccal mucosa as negative and irritation fibroma as positive control, group II consisted of OED and group III consisted of Oral Squamous Cell Carcinoma (OSCC). A histochemical analysis was conducted using PSR-polarization method by two independent observers. Results: The control group shows predominantly reddish–orange birefringence. In OED with the advancement of grades, the colour changed from yellowish-orange colour to yellow-greenish with progressive increase in greenish hue. As OSCC regresses from well to poorly differentiated, the colour changed from reddish-orange to yellowish orange to greenish-yellow suggesting a transition from mature to immature collagen. Conclusion: An observable gradual change in collagen of both OED and OSCC was noted as they were proceeding from benign to critical step. Thus, PSR is a useful tool for studying stromal changes as supporting collagen shows the transition in the form besides the alterations in epithelial cells.

Can Postoperative Nutrition be Favourably Maintained by Oral Diet in Patients with Emergency Temporary Ileostomy? A Tertiary Hospital Based Study

Introduction: Temporary ileostomy is an emergency procedure performed in cases having septic peritonitis in presence of perforation or obstruction or gangrene of small intestine. These patients usually suffer from gross malnutrition following surgery. Aim: To measure nutritional status of patients with emergency temporary ileostomy and to determine whether their postoperative nutrition can be favourably maintained by oral diet alone. Materials and Methods: Sixty patients were enrolled for the study on the basis of inclusion and exclusion criteria during the study period from January 2012 to December 2013. Oral feeding was started as soon as ileostomy started functioning and patients expressed hunger, about 48-72 hours postoperatively. An individualized diet chart was formulated for each patient using Harris Benedict Equation. Nutritional assessment was done on 1) 1st day of oral feeding, 2) After 7 days of oral feeding, 3). After three months of oral feeding. Nutritional parameters (anthropometric, biochemical) employed were tabulated and statistically analysed with SPSS v 17,Chicago. Results: Out of 60 patients, 36 males and 24 females were enrolled in the study. The patients were in the age group of 20-60 years with a mean age of 45 years. After 7 days of oral nutrition the nutritional status deteriorated with a significant decrease in body weight (p<0.001) and serum haemoglobin (p <0.001). However, at the end of the study, the patients had their nutritional status restored satisfactorily with normalization of basic parameters like bodyweight, haemoglobin and serum albumin (p<0.001). Conclusion: Proper dietary advice and oral nutrition were found to be sufficient for gradual restoration and maintenance of satisfactory nutritional status in the postoperative period.

Knowledge, Attitude and Practice of Ear Care in Coastal Karnataka

Deviprasad Dosemane, Keerthan Ganapathi, Jayashree Kanthila

Introduction: Ear as an organ is necessary for the perception of sound and body balance. Ear infection, diabetes mellitus, hypertension and excessive use of mobile phone for listening to music at high volume all can reduce hearing. No earlier study was available in the costal Karnataka population, regarding the practice of ear care. The study objective was to ascertain the level of knowledge of the community regarding ear care, to find out whether some of the common conditions affecting hearing are known and to find out the common practices involved in maintaining ear hygiene. Materials and Methods: This cross-sectional study was conducted on 500 subjects in two tertiary care hospitals by convenient sampling, using self-administered questionnaire. Knowledge, Attitude and Practice across the age groups, religion & education background were studied. Results: Across different education groups, 66.7%-90% did not know that ‘cold’ can cause ear infection and 46.7%-75.0% did not know that diabetes and hypertension can reduce hearing. When there is ear pain or discharge, people put ear drops available at home in 48.3%-75.0% across 3 age groups; 58.5%-61.5% across 3 religions and 44.8%-67.9% across 5 education groups. No statistically significant difference was found in the practice of pouring oil into ears across religions. A total of 58.6%-100% daily clean inside the ear and 70-100% use cotton buds. Conclusion: General perception of the people is that ear is necessary only for hearing. Majority did not know that nasal infection can affect the ear and that DM and hypertension can cause hearing loss. When there is ear pain and discharge, most of the adults put drops that are available at home. Pouring oil into the ears and cleaning inside the ear canals is routinely practiced in costal Karnataka.

Need of Revision of Lower Limb Amputations in a North Indian Tertiary Care Centre

Inrtoduction: Amputation of the extremity is a big challenge to mankind. Revision rate of primary amputations stands high despite of maximum care at tertiary care centres. The purpose of this study was to establish cause for the revision, identify preventable cause and to assess outcome of revision amputation surgery. Materials and Methods: We performed a retrospective study on lower limb revision amputations in Department of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, King George Medical University between Jan 2012 to Jan 2015. All patients of any age group and gender admitted for revision amputation were included in the study population. Results: A total of 32 patients who required revision amputation of lower limbs was included in the study, out of these 62.50 % were male and 37.50 % were female. Age of the patients ranged from 5 to 72 years with mean of 42 years. Most common level of initial amputation was below knee (56.25 %) followed by above knee amputation (31.25%). Most common indication for initial amputation was trauma (43.75%) followed by infection, vascular diseases, malignancy and leprosy. Poor stump formation was found to be most common indication for revision amputation (37.50%) followed by infection (25%), recurrent ulceration (18.75%), stitch abscess (6.25%), neuroma (6.25%), and necrosis (6.25%). All patients were treated successfully. Conclusion: Revision amputation increases morbidity. Poor stump formation at the time of initial amputation and infection are the most common indication for revision surgery. These are the preventable causes and every effort should be made to alleviate these as well as other preventable causes.

Evaluation of Coronary Artery Status by Coronary Angiography after First Survival of Acute Myocardial Infarction

Introduction: Acute Myocardial Infarction (AMI) is a life threatening medical emergency which needs urgent medical attention. It is one of the major cause of mortality and morbidity throughout the world. Aim: The aim of the present study was to assess the coronary artery status by Coronary Angiography (CAG) after first survival of the Acute Myocardial Infarction (AMI) and to correlate the CAG findings with Coronary Artery Disease (CAD) Risk Factor (RF) and effect of early thrombolysis. Materials and Methods: CAG was done on 870 patients consecutively from June 2013 to May 2015. Age, Gender, Body Mass Index (BMI), CAD risk factors (RF) such as Type 2 diabetes mellitus (T2 DM), hypertension, dyslipidaemia, smoking status and history of thrombolyctic status were recorded. The correlation between the CAD risk factors (RF) and the CAG findings were statistically analyzed. Results: Coronary heart disease risk factors analysis revealed = three RF in 23.88%, two RF in 29.88% and one RFin 45.86% of patients. CAG showed Single Vessel Disease (SVD) in 236 (27.1%) patients, double vessel disease (DVD) in 220 (25.2%) patients, Triple Vessel Disease (TVD) in 252 (28.9%) patients. Multiple coronary artery involvement were found in the high risk group patients, which was found statistically significant (p-value<0.0001). A total of 348/870 (40%) patients were thrombolysed amongst them 80 (22.9%) revealed minimal and/or normal coronary artery which was found statistically significant (p-value<0.0001). Conclusion: Higher the coronary risk factors, more the chance of the multiple coronary arteries involvement. All AMI patients should be thrombolysed as early as possible to get the benefit of recanalization of the culprit vessel.

Efficacy, Safety and Treatment Satisfaction of Glimepiride vs Sitagliptin in Combination with Metformin in Type 2 Diabetes Mellitus

Subodh Kumar, Anuj Kumar Pathak, Dibyajyoti Saikia, Amish Kumar

Introduction: Metformin is a preferred drug for starting treatment in type 2 diabetes mellitus. But, eventually most of the patients need additional drug to control blood sugar level. The choice of drug depends upon several factors including patient specific criteria, economical factors and treatment satisfaction. Aim: The aim of the present study is to investigate the effects of adding sitagliptin or glimepiride on efficacy, safety and treatment satisfaction in patients with type 2 diabetes mellitus. Materials and Methods: It was a retrospective observational study on 50 patients each in sitagliptin and glimepiride group, who are receiving treatment for at least 12 weeks and are stable on respective treatment regimen. Glycated haemoglobin (HBA1c) was the primary measure of efficacy. Safety was assessed by checking weight gain/loss, hypoglycaemia episodes and other laboratory investigations. Patient satisfaction was assessed by Diabetes Treatment Satisfaction Questionnaire. Results: The HbA1c level after 12-24 weeks of treatment was not found to be significant compared to each other or from baseline. Compared to baseline fasting plasma glucose & postprandial plasma glucose were lower in glimepiride group. Sitagliptin was associated with less episodes of hypoglycaemia. Weight gain was associated with glimepiride but it was non-significant (p=0.08). Overall treatment satisfaction score were better for sitagliptin but were not statistically significant. Conclusion: The efficacy of sitagliptin was comparable. Sitagliptin had superior adverse effect profile with less chances of hypoglycaemia and weight gain. Questionnaire scores were higher for sitagliptin indicating better treatment satisfaction compared to glimepiride.

Correlation among Radiographic, Arthroscopic and Pain Criteria for the Diagnosis of Knee Osteoarthritis

Introduction: Osteoarthritis (OA) is the most common degenerative joint disorder leading to functional impairment and dependency in older adults. Early detection and intervention is of paramount importance in decreasing the morbidity. Radiography is the first investigation of choice for OA patients presenting with knee pain. But, there is a high degree of discordance between clinical and radiographic findings. Arthroscopy aids in accurate diagnosis of OA knee. Aim: In view of the conflicting reports in the literature the present study was undertaken to report the correlation among radiographic, arthroscopic and pain findings in knee OA patients to facilitate early and precise diagnosis. Materials and Methods: Twenty eight cases (14 males and 14 females) of primary OA knee (7 each from radiographic grade 1 to 4) were screened and selected for the study. Spearman’s rank correlation coefficients (Rho/r estimate) were calculated to determine the relationship between pain, radiographic and arthroscopic grades in patients with knee OA. Results: Among 28 patients, 10.71% had grade 1, 14.28% had grade 2, 25% had grade 3 and 50% had grade 4 arthroscopic findings. Overall Spearman's correlation coefficient (r) for radiographic and arthroscopic grades was 0.8077, 0.8212 for radiographic and pain grades and 0.7634 for arthroscopic and pain grades. Correlation coefficient could not be calculated for individual grades in isolation which would otherwise represent the factual correlation. The Mean arthroscopic grade for radiographic grades 1 to 4 were 1.57, 3.42, 3.57,4.0 respectively and the Mean pain grades for radiographic grades 1 to 4 were1.57, 2.57,3.28, 3.57 respectively. Radiological findings were found to lag behind the arthroscopic findings significantly. Conclusion: Arthroscopic findings represent the exact extent and degree of the pathology of OA knee. Kellgren-Lawrence grading read with conventional Antero-posterior standing radiographs of knee underscores the arthroscopic findings significantly in grades 1, 2 and 3. Radiological and clinical findings (Apley’s pain grading) in combination should be considered in concluding the final diagnosis and treatment of OA knee. Improvised criteria for precise diagnosis have to be evolved.

The Role of Potentially Retrievable Inferior Vena Cava Filters in High-Risk Patients Undergoing Joint Arthroplasty

Introduction: Some patients undergoing total joint arthroplasty are at increased risk for venous thromboembolism (VTE). The aim of the present study was to evaluate the safety and efficacy of prIVCF in preventing PE in patients undergoing joint replacement surgery who are at high-risk for VTE. Materials and Methods: In this prospective, IRB-approved study, prIVCF were placed in consecutive patients who met specific high-risk criteria (history of VTE or hypercoaguable state) prior to total joint arthroplasty. Patients were followed until the IVC filter was removed. Outcomes and complications were recorded per Society of Interventional Radiology guidelines. Results: One hundred and nine potentially retrievable IVC filters were placed in 105 patients, who all subsequently underwent joint arthroplasty. One hundred eight IVC filters (98.9%) were retrieved successfully in a mean time of 44.1 days (range 13-183 days). There was 1 failed IVC filter retrieval attempt (0.9%) at 46 days post implantation. Two patients (1.9%) presented with recurrent PE and were successfully treated with anticoagulation prior to IVC filter retrieval. There were no fatalities from perioperative PE. In 1 patient (0.9%), a fractured filter leg had embolized during retrieval. Conclusion: Potentially retrievable IVC filters are safe and effective for prophylaxis against PE in patients at high-risk for VTE undergoing joint arthroplasty.

Serum Zinc and Metabolic Health Status in Siblings of Patients with Type 2 Diabetes Mellitus

Dhia J. Al-Timimi, Hivi M. Mahmoud, Dilveen A. Mohammed, Idris H. Ahmed

Introduction: There is increasing evidence on the association between lower serum zinc levels and metabolically unhealthy status in normal weight individuals’. Aim: Our aim was to investigate serum zinc levels in a sample of siblings of patients with type 2 diabetes mellitus and to ascertain its relation with metabolic syndrome components. Materials and Methods: Serum zinc was determined in 331 apparently healthy individuals, 201 were siblings of patients with type 2 diabetes mellitus (type 2 DM) and 130 individuals with negative family history of diabetes (healthy controls), with age range 20-40 years. The association between components of metabolic syndrome and serum zinc levels was examined. Results: The siblings of patients with type2 DM exhibited significantly lower serum zinc levels than did the healthy controls (94.1±20.8 ug/dl vs. 103.2±15.6 ug/dl, p=0.012). The mean serum zinc levels were lower in siblings exhibited higher levels of waist circumference, fasting blood glucose and triglycerides. Those categorized as metabolically obese, normal weight (MONW) exhibited lower serum zinc levels than did the non-MONW, but the difference was not significant (93.7+20.9 ug/dl vs. 96.2+18.1ug/dl, p=0.059). The correlation between serum zinc levels and fasting blood glucose was inverse among the siblings (r=- 0.233, p=0.001). Conclusion: A low zinc status is present in 13.9% of the siblings of patients with type 2 DM, particularly among MONW individuals. This finding may have clinical implications due to the increased risk of future metabolic disease.

Usefulness of Gamma Glutamyl Transferase as Reliable Biological Marker in Objective Corroboration of Relapse in Alcohol Dependent Patients

Siddharth Dixit, Parduman Singh

Introduction: The development of reliable diagnostic tool for assessing alcoholism is an utmost necessity in treating and preventing damage due to alcoholism to both individual and armed forces as alcoholism represents a serious health issue with major socioeconomic consequences. Aim: To observe, gamma glutamyl transferase (GGT) can serve the practical utility of firmly establishing alcohol dependence /relapse in Armed Forces patients and aid in fair disposals. Materials and Methods: Fifty two consecutive cases of alcohol dependence syndrome admitted to a peripheral hospital were evaluated for the biological marker gamma glutamyl transferase (GGT) and compared against the gold standard of psychiatrist assessment. The cases were followed up for one year at three months, six months, nine months and 12 months interval. The GGT value of the cases was correlated with the abstinent /relapse status to find the cutoff levels of the GGT as a biological marker. Results: At cutoff level of 50 IU/lit GGT exhibited specificity of 100% and sensitivity varying from 56% to 100%. At lower cut off levels chances of false positive cases with adverse consequences on service prospects of the individuals are high. The mean difference in GGT levels across relapse and abstinent group reached significant statistical proportion at admission and during follow-up at 3 months /6 months/9 months and 12 months. Conclusion: GGT can serve the practical utility of firmly establishing alcohol dependence syndrome in armed forces to aid in fair disposal of cases. It helps in providing motivational inputs to patients. Clinician should pay due consideration to clinical profile, ward observation and unit report as the diagnosis of alcohol dependence syndrome has serious implications towards service prospects of a soldier.

Long Term Patient Satisfaction of Burch Colposuspension with or Without Concomitant Total Abdominal Hysterectomy

Introduction: Urinary incontinence negatively affects the quality of life. Various methods are used in the treatment of stress incontinence. Burch colposuspension (BC) is the classical treatment of urinary incontinence. Aim: To compare the long-term satisfaction in patients receiving BC with or without concomitant total abdominal hysterectomy. Materials and Methods: One hundred and twenty patients with stress incontinence underwent burch colposuspension with or without concomitant total abdominal hysterectomy. Ninety-three (77.5%) patients were interviewed by telephone. Of these, 91(75, 8%) patients agreed to participate in the study. The patients were divided into two groups according to the type of the surgical procedure. Group 1(N=48, 52.7%) had received burch colposuspension with concomitant total abdominal hysterectomy. Group 2 (N=43, 47.3%) had received burch colposuspension without concomitant total abdominal hysterectomy. Results: In Group 1, 41 patients (85%) were satisfied with the surgery and did not complain of urinary incontinence (p<0.05). In Group 2, 37 (86%) patients were satisfied with the surgery (p<0.05). Conclusion: There were no difference in patient satisfaction between hysterectomy and BC and only BC to treat incontinence.

To Establish Bethesda System for Diagnosis of Thyroid Nodules on the Basis of FNAC with Histopathological Correlation

Sameep Garg, Nandini J.Desai, Dimple Mehta, Mitsu Vaishnav

Introduction: In October 2007, “The National Cancer Institute (NCI), Thyroid Fine Needle Aspiration State of the Science Conference” was held in Bethesda, Maryland hosted by the NCI with the intention of formulating internationally acceptable guidelines for reporting of thyroid cytopathology. This was because, thyroid FNAC have a reporting confusion due to multiplicity of category terminologies. To overcome this, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced for unifying the terminology and morphologic criteria along with the corresponding risk of malignancy. The Bethesda system for reporting thyroid cytopathology represents a major step towards standardization, reproducibility, improved clinical significance, and greater predictive value of thyroid fine needle aspirates (FNAs). Aim: The aim of this study was to elucidate the diagnostic utility of the Bethesda system in reporting thyroid FNAs and to assess the effectiveness of FNAC in the evaluation of thyroid nodules by comparing the results with histopathological evaluation. Materials and Methods: The present study was carried out in our institute during the July 2012 to September 2014. In this study, 100 FNACs done which were classified according to the Bethesda system and out of them, 60 histopathological evaluations obtained from this group were evaluated. The sensitivity, specificity, positive and negative predictive values were evaluated. Results: Out of 100 FNACs, 06% were Non-diagnostic, 78% were Benign, 04% were Atypical follicular lesion of undetermined significance (AFLUS), 04% were suspicious for Follicular neoplasm (SFN), 01% were suspicious for Follicular neoplasm Hurthle cell type, 03% were suspicious for malignancy (SM), and 04% malignant. In 60 cases, data of follow-up histopathologic examination (HPE) were available. The sensitivity was 88.89% and specificity was 84.31%. The positive and negative predictive value were 50% and 97.7%, respectively. Conclusion: The Bethesda system is very useful for a standardized system of reporting thyroid cytopathology, improving communication between cytopathologists and clinicians, and inter-laboratory agreement, leading to more consistent management approaches. An additional point which is in favor of the implementation of this system is that the classification is directly related to the risk of malignancy in each category, which in turn, prompts the recommended clinical management of that category, thus truly embodying the clinico-pathological correlation in its true spirit. The correlation of FNAC with histopathology is necessary before starting treatment.

A Cross-Sectional Study on Pattern of Alcohol Consumption and Body Mass Index Among Health Institution Students in Bagalkot

Introduction: Adolescence is a vulnerable period, where they try to initiate new things, sometimes wicked habits or high risk behaviours like smoking or alcohol consumption. Due to change in lifestyle a considerable number of social drinkers have shifted to heavy episodic drinking. Alcohol consumption plays a role in the development of obesity but the relationship between alcohol and weight is still unclear. Objectives: To find the association between pattern of drinking and Body Mass Index (BMI). Materials and Methods: A cross-sectional study was conducted among 395 students from five health Institutions in Bagalkot. A pre tested, semi structured questionnaire was used and BMI was noted. Results were tabulated using Microsoft excel 2007 and analysis were performed using OpenEpi, version 2.3.1.Chi square tests was used to find the association. Results: In the present study 68% were girls and 32% were boys. About one fifth (20.53%) were current alcohol drinkers. Alcohol quantity and frequency had inverse association with BMI. As quantity increases from 1 drink/drinking day to =4 drinks/drinking day, BMI increases from 20.49 (95%CL 14.66-26.33) to 22.66 (95%CL 12.62-32.70). As frequency increased from low to high quintiles of drinking days/year, BMI significantly decreases (p <0.003) from 21.44 (95% CI 20.31-22.58) to 20.38 (95% CI 13.05-27.72). Conclusion: Alcohol contributes to increase in body weight in certain types of drinking pattern while in others it was not associated.

Molecular Identification of Clinical Isolates of Mycobacterium fortuitum by Random Amplified Polymorphic DNA (RAPD) Polymerase Chain Reaction and ERIC PCR

Azar Dokht Khosravi, Rasa Sheini Mehrabzadeh, Abbas Farahani, Hooshang Jamali

Backgrounds: Non tuberculous mycobacteria (NTM) are of importance now-a-days due to their increasing virulence outbreaks and emerging antibiotic resistance. Since the most common NTM in Iran is reportedly Mycobacterium fortuitum, the present study was designed with the aim of molecular identification of clinical isolates of M. foruitum to analyse their heterogeneity. Materials and Methods: A total of 81 isolates of NTM isolated from various samples were collected. The clinical isolates were assigned to species M. fortuitum by using conventional and molecular methods. The DNA banding patterns of ERIC- PCR and RAPD- PCR were analysed by using Bionumeric 7.5 software. Results: Out of 81 tested NTM, 36 strains of M. fortuitum were identified. 33 isolates were selected for molecular typing in this study. Based on RAPD and ERIC analysis, M. fortuitum isolates were divided into 3 and 6 clusters, respectively. Most of the isolates were distributed into types of II RAPD (20 members/ 60.6 %) and V (14 members/ 42.4% with sub cluster I& II) of ERIC. In RAPD analysis, the major fragments were 300 bp, followed by fragment 1000. In ERIC analysis, the major fragments were 280 bp followed by fragment 1200 bp. Conclusion: In conclusion, though the results from this study represented higher discriminatory power of ERIC, however the combination of RAPD and ERIC analysis were able to sufficiently discriminate the genotypic diversity, infection control, and gain useful epidemiological information regarding M. fortuitum isolates.

Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients

Background: Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children. Aims and Objectives: The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective. Materials and Methods: A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham’s Picture Test (VPT), Venham’s Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter. Results: A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group. Conclusion: The conclusion derived from the present study was that audio distraction was effective in reducing anxiety and audio-stories were the most effective.

Implication of Bifurcation of Abdominal Aorta for Radiotherapy Planning for Cervical Cancers

Introduction: External Beam Radiotherapy plays a major role in the management of Carcinoma Cervix. The Radiotherapy treatment portals are designed to adequately cover the gross disease and areas of microscopic spread. The upper border of Radiotherapy field is traditionally placed at the level of L4-L5 intervertebral space to cover the common iliac nodal area. It is determined based on anatomical and surgical series which have shown that division of Abdominal aorta occurs at that level. Aim: To study the level of the division of abdominal aorta in relation to the lumbar vertebral levels. To propose the change in the upper border of Radiotherapy portals used in the treatment of Cervical Cancers. Materials and Methods: Patients who underwent Radiotherapy for Cervical Cancer from December 2010 to January 2012 formed the subjects of this prospective study. All the patients underwent aquaplast immobilization in supine position and contrast enhanced Computed Tomography (CT) simulation for Radiotherapy planning following bladder protocol. The Radiotherapy planning was done on commercial treatment planning system, Prowess version 4.71. The level of division of Abdominal Aorta into right and left Common Iliac arteries with respect to vertebral level was determined and studied. Results: The division of abdominal aorta into common iliac arteries occurred at the level of L3-L4 intervertebral space, in front of body of L4 vertebra and L4-L5 intervertebral space in 53.84%, 30.76% and 15.40% of the patients respectively. Conclusion: The division of abdominal aorta occurs at a higher level than L4-L5 intervertebral space in majority of patients. It is highly recommended to use CT scan based planning. However, in institutes where there are no facilities for CT based planning, it is advisable to shift the upper border of Radiotherapy treatment portal above the L3-L4 intervertebral space for delivering adequate doses to the common iliac lymphnodes.

Perception of Medical Students about Communication Skills Laboratory (CSL) in a Rural Medical College of Central India

Introduction: “The art of medicine is intricately tied to the art of communication.” In traditional medical curriculum, communication is not taught formally and this leads to a gap in reliability and consistency of the teaching. Few studies have shown that much litigation against doctors is due to lack of communication and not because of lack of clinical expertise. Considering the importance of training in communication skills, it was included in the curriculum of students of DMIMS (DU), which has got probably the first communication skills lab in a medical college in India. Aim: To study the perception of medical students about usefulness of communication skills lab. Materials and Methods: This observational study was carried out at Communication Skills Lab (CSL) of Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharasthra. Feedback was obtained with the help of a prevalidated questionnaire from 65 final MBBS students about their perception about utility of the module taught in the CSL including factors which helped and which hindered in learning. Descriptive statistics was used for the quantitative data and categorization for qualitative data. Results: A total of 78.46% students were of the idea that CSL posting is must for all medical undergraduates. A 93.83% perceive that the module taught was very relevant and useful and were satisfied with the duration of posting (81.47%). A 78.46% students experienced improvement in their communication skills. They opined that more emphasis should be given on communication between doctor and patient (61.53%). Conclusion: The students found communication skills lab very useful. They desired more emphasis on communication between doctor and patient and sought more interactivity, video demonstrations to be part of the module.

Phytomedicine in the Treatment of Cancer: A Health Technology Assessment

Introduction: Cancer is reported to cause about 0.4 million deaths annually. The cost of diagnosis and treatment of cancer in India is enormous. Aim: This Health Technology Assessment (HTA) aims to understand the role, effect on mortality and adverse event occurrence, and cost effectiveness of phytomedicine in cancer treatment. Materials and Methods: Health technology assessment by systematic review of published literature. An electronic literature search was performed in Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, PubMed, Science Direct, SCOPUS, EMBASE, LANCET, and Google Scholar databases for randomized controlled trial, observational analytical studies, case control and cohort studies pertaining to phytomedicine and herbal medicine in cancer treatment published from 1987 till 2nd Novemeber 2014. Overall outcome measures collected included changes in mortality and adverse event profile. Cochrane Review Manager’s Risk of Bias Table was used to assess the risk of bias. Results: Out of 76 studies which were screened, 14 studies involving a total of 1965 participants (817 received various forms of phytomedicine or herbal medicine in addition to conventional therapy, and 1148 received conventional therapy only) suffering from various cancers (including cancers of the breast, prostate, nasopharynx, pancreas, stomach, ovary, non-small cell lung cancer and osteosarcoma), were included in this review. In comparison with conventional therapy, phytomedicine resulted in a significant reduction in mortality: Risk Ratio (RR) 0.67 (95% Confidence Interval (CI) 0.51 to 0.90). The combination of phytomedicine with conventional therapy resulted in a significant reduction in adverse drug reactions: RR 0.62 (95% CI 0.54 to 0.71). Addition of phytomedicine to chemotherapy resulted in an increase in the annual cost of treatment by INR 1.241 Billion (US$ 19.64 Million) and prevented 25,217 deaths: the cost-effectiveness of phytomedicine is INR 49,237/death averted (US$ 779/death averted). Conclusion: When taken with conventional cancer treatment, phytomedicine shows clinical and cost effectiveness. Domestic manufacturing and practice of phytomedicine should be encouraged.

Relationship Between the Parenting Styles and Students’ Educational Performance Among Iranian Girl High School Students, A Cross- Sectional Study

Introduction: Parenting styles are effective in the educational performance of their child. The present study aimed to investigate the relationship between the parenting styles and students’ educational performance among Iranian girl high school students. Materials and Methods: In a cross–sectional survey, female students in high schools of Ilam (Iran) evaluated during the academic year 2014-15. Multistage cluster random sampling was used to select the participants. Data were collected by two demographic and Baumrind's parenting styles questionnaire. The Cronbach’s alpha coefficient was measured as an index of internal identicalness of the questionnaire to verify its reliability. Results: A total 400 students were studied. The Mean±SD of the students’ age were 14±1.08. The students’ school grades were the first year of high school to pre-university course. The Mean±SD of parenting styles were 35.37±5.8, 34.69±6.34 and 19.17±6.64 for permissive parenting style, authoritarian parenting style and authoritative parenting styles, respectively. There was a significant relationship between the score of permissive parenting style (p= 0.001, r= 0.151), authoritarian parenting style (p= 0.001, r= 0.343) and authoritative parenting style (p=0. 001, r= 0.261) with the students' average score for studying. Conclusion: The results of this study demonstrate that parental influence plays an important role in students’ educational performance.

Evaluation of Endothelial and Platelet Derived Microparticles in Patients with Acute Coronary Syndrome

Background: Microparticles (MP) are a nuclear fragments of membrane released by the damaged cell during stress. Elevated levels of MP have been found in patients with acute coronary syndrome (ACS) owing to the damage in the endothelium. Aim: To determine if the levels of endothelial and platelet microparticles (EMP & PMP) in patients with ACS influenced the severity of the disease. Materials and Methods: This was a prospective cohort study performed in 63 ACS patients (ST elevation myocardial infarction- STEMI-28, non ST elevation myocardial infarction -NSTEMI-35). After obtaining consent, blood samples were collected from the patients and processed by flow cytometry. Results: The NSTEMI group had higher levels of EMP {792.11(327.59-1661.49) vs 300.35 (176.3-550.46), p=0.001} and PMP {218.87(86.65-439.77) vs 114.45(50.34-196.75), p= 0.007} as compared to the STEMI group. However, it was found that the EMP (r=-0.438, p=0.001) and PMP (r= -0.316, p=0.024) negatively correlated with Global Registry of Acute Coronary Events score (GRACE in-hospital score) for the entire cohort. Conclusion: The levels of microparticles are elevated in ACS patients and may reflect a protective effect in patients with acute coronary syndrome.

Thrombocytopenia in Paediatric ICU: Incidence, Transfusion Requirement and Role as Prognostic Indicator

Introduction: Thrombocytopenia is defined as platelet count less than 150×109/L, it has a greater incidence in Intensive Care Units (ICUs) compared to wards and its most common cause is increased platelet consumption. Aims: To investigate incidence of thrombocytopenia, platelet transfusions requirement, associated diseases and relationship between thrombocytopenia and mortality. Materials and Methods: Eleven months hospital records between October 2013 and August 2014 of the PICU in a tertiary care teaching hospital was investigated retrospectively and 275 critically ill children formed the sample. S tatistical analysis: Odds ratio with 95% confidence interval was used. Probability value (p-value) of less than 0.05 was considered statistically significant. Results were confirmed using ?2 test. Results: Out of 275 patients {168 males (61.09%) and 107 females (38.91%)}, 89 patients had thrombocytopenia. Out of these 89 patients, 43 patients (48.31%) had severe, 24 patients (27.91%) had moderate and 22 patients (24.72%) had mild thrombocytopenia. The 43 patients having severe thrombocytopenia received platelet transfusion and out of these 43 patients 24 (55.81%) received more than one transfusion and 18 (41.86%) of the transfused patients expired. Among thrombocytopaenic patients, Sepsis (25.84%) was the most common diagnosis followed by Pneumonia (19.10%), Meningitis (13.48%), Diabetic Ketoacidosis (5.62%), Enteric fever (7.86%), Tubercular Meningitis (3.37%), Infantile Tremor Syndrome (2.25%), Congenital heart disease (5.62%), Burns (3.37%), Brain Haemorrhage (2.25%%), Hepatic abscess (1.12%), Chronic Renal Failure (3.37%), Malaria (2.25%) and Hepatitis (4.49%). There is a statistically significant association between thrombocytopenia and mortality. A significant association was established between mortality in thrombocytopenic patients of sepsis. Conclusion: Thrombocytopenia is commonly associated with sepsis. Mortality rate is higher in thrombocytopenic patients.

Fibrinogen Degradation Products and Periodontitis: Deciphering the Connection

Shweta Dikshit

Introduction: Fibrinogen degradation products (e.g. D-dimer) arise from digested fibrin clots and fibrinogen. Elevated concentrations accompany activation of coagulation and fibrinolysis and indicate chronic inflammatory diseases. D-Dimer tests are a quick, noninvasive method to rule out abnormal clotting. Periodontitis strongly affects the haemostatic system and evokes a procoagulant state. Correlation of chronic periodontitis with early indicators of disease (biomarkers) might be useful. Aim: The aim of the study was to examine whether the plasma D-dimer concentration reflects the progression of chronic periodontitis and the beneficial effect of periodontal therapy. Materials and Methods: Forty randomly selected subjects were divided into four groups, Group I: 10 healthy subjects, Group II: 10 with mild periodontitis, Group III: 10 with moderate periodontitis, Group IV: 10 with severe periodontitis. After thorough dental and periodontal examination, 3 mL of venous blood was collected for measurement of fibrinogen degradation products. Results: The patients with moderate and chronic periodontitis exhibited high concentrations of D-dimer (mean value 434.98–535.52 mcg/mL), whereas subjects with mild or no periodontitis exhibited values of 329.78–211.29 mcg/mL. Concentrations of D-dimer were significantly reduced after therapy of all classes of periodontitis. Conclusion: Periodontal treatment can reduce amount of D-dimer in the plasma. A higher than normal concentration is observed in chronic periodontitis.

Study of Effectiveness and Safety of Percutaneous Balloon Mitral Valvulotomy for Treatment of Pregnant Patients with Severe Mitral Stenosis

Introduction: In pregnant women mitral stenosis is the commonest cardiac valvular lesion. When it is present in majorly severe condition it leads to maternal and fetal morbidity and mortality. In mitral stenosis pregnancy can lead to development of heart failure. Aim: To evaluate the safety and efficacy of balloon mitral valvulotomy (BMV) in pregnant females with severe mitral stenosis. Materials and Methods: A total of 30 pregnant patients who underwent BMV were included in the study from July 2011 to November 2013. Clinical follow-up during pregnancy was done every 3 months until delivery and after delivery. The mean follow up time after BMV was 6.72±0.56 months. Results: From the 30 pregnant females 14 (46.67%) and 16 (53.3%) patients underwent BMV during the third and second trimester of pregnancy respectively. The mean mitral valve area was 0.85+0.16 cm2 before BMV that increased to 1.60+0.27 cm2 (p<0.0001) immediately after BMV. Peak and mean diastolic gradients had decreased significantly within 48 hours after the procedure (p<0.001) but remained very much unchanged at 6.72 month period of follow-up. Two patients had an increase in mitral regurgitation by 2 grades. Conclusion: During pregnancy BMV technique is safe and effective in patients with severe mitral stenosis. This results in marked symptomatic relief along with long term maternal and fetal outcomes.

Osseous Metastases in Gynaecological Epithelial Malignancies: A Retrospective Institutional Study and Review of Literature

Saptarshi Ghosh, Pamidimukkala Bramhananda Rao

Introduction: Osseous metastasis in gynaecological epithelial tumours is an extremely rare phenomenon occurring in less than 1% of these cancers. Aim: To analyse the clinical characteristics and prognosis in patients with gynaecological epithelial cancers with bone metastases. Materials and Methods: This was a single institutional retrospective study done with the data available from January 2008 to January 2015. Out of 1686 patients with epithelial gynaecological malignancies there were a total 18 (1.07%) patients with osseous metastasis. Clinico-pathologic characteristics were tabulated in Microsoft Excel 2013 and data were analysed using SPSS software Version 21. A p-value< 0.05 was taken to be statistically significant. Survival analysis was done by using Kaplan-Meier method and log-rank test was used to find out the difference in survivals. Results: Out of the 18 gynaecological epithelial cancer patients with bone metastases, 12 had cervical cancer, three had ovarian cancer, two had endometrial carcinoma and one patient had vulvar malignancy. Twelve patients had squamous cell histology, while the rest had adenocarcinoma. The mean interval from primary diagnosis of cancer to the detection of bone metastases was 31.9 months (range, 1 – 60 months). Solitary bone lesion was present in seven patients. The most common site of bone metastasis was lumbar vertebra. Extra-osseous metastasis was present in 12 patients. The mean follow-up period was 8.3 months. During the follow-up period 12 out of the 18 patients died. There was significant difference in survival (p = 0.005) between patients with solitary bone metastasis and patients with multiple osseous metastases. Near significant survival difference (p = 0.056) was also noted in patients with extra-osseous metastases when compared to the patients without. Improved survival was also found in patients with controlled local disease (p = 0.003) when compared to patients with local failure. Conclusion: Bone metastasis in gynaecological epithelial malignancies is a rare phenomenon, but with grave prognosis. Multiple sites of bone involvement, recurrence at the primary tumour site and presence of other non-osseous metastases are poor prognostic indicators. Treatment in these patients should be tailored according to the patient’s need.

Morbidity and Mortality Pattern in Late Preterm Infants at a Tertiary Care Hospital in Jammu & Kashmir, Northern India

Introduction: The morbidity and mortality pattern in late preterm infants is higher than term infants (gestational age = 37weeks).The main reason behind that is the relative physiologic and metabolic immaturity, though there is no significant difference in the weight or the size of the two groups. Aim: The present study was undertaken to study the incidence, early neonatal morbidity and mortality (within first 7 days of life) in late preterm infants (34 – 36 6/7 weeks). Materials and Methods: It was a hospital based prospective study conducted from April 2012 to March 2013. The study was conducted in the Department of Paediatrics and Neonatology at G.B. Pant General Hospital and Department of Gynaecology and Obstetrics L.D hospital and G.B. pant general hospital, (associated hospitals of Government Medical College, Srinagar). Results: A total of 4100 neonates were included in the study. Incidence of late preterm neonates was 11.58 %. Three hundred sixty five (76.8%) of late preterm and 965 (28.3%) of term infants had at least one of the predefined neonatal conditions. Late preterm infants were at significantly higher risk for overall morbidity due to any cause (p<0.0001), respiratory morbidity (p<0.0001), mechanical ventilation (p=0.0002), jaundice (p<0.0001), hypoglycaemia (p<0.0001), and sepsis (p<0.0001) Perinatal asphyxia (p= 0.186). Early neonatal mortality in late preterm neonates was 2.5% or 25/1000 live births. Conclusion: Compared with term infants, late preterm infants are at high risk for overall morbidity, respiratory morbidity, and need of mechanical ventilation, jaundice, hypoglycaemia & sepsis. They also have a higher mortality as compared to term neonates.

Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries

Zia Arshad, Ravi Prakash, Shefali Gautam, Sanjeev Kumar

Introduction: Opioid is generally regarded as an important part of multimodal, perioperative analgesia, especially for moderate to severe pain. Amongst the various modes of delivery transdermal route has several potential benefits over oral and parentral administration. These include noninvasive dosing, better absorption and lack of first-pass metabolism. A transdermal drug delivery system provides steady and continuous drug delivery resulting in steady plasma concentration. Bolus dosing of systemic analgesic results in supra and sub therapeutic plasma resulting in toxic and sub analgesic plasma drug concentration. It also improves patient compliance. Materials and Methods: Sixty patients undergoing major abdominal surgery under GA were randomly divided in two groups (n=30). Group A received buprenorphine 10 mcg/h TDS and group B received 25 mcg/h fentanyl TDS, 6 hours prior to surgery. Patients were followed for three days for postoperative pain relief and adverse effects. Results: Baseline and demographic variables are comparable in both groups. The mean level of VAS was significantly lower in group B as compared to group A at Day 1, 2 and 3. The mean level of sedation score was significantly lower in Group B than Group A. Haemodynamic variables in both groups (SBP, DBP and HR), shows comparable values in both groups and no significant difference was observed. Five out of 30 (16.7%) patients in group A required single dose of rescue analgesic while 0 out of 30 patients (0.00%) in group B required rescue analgesic. This difference in rescue analgesic requirement in not quiet statistically significant (p-value 0.0522). Twenty percent patient in fentanyl group and 16.7% patients in buprenorphine group experienced some adverse effects. Nausea and vomiting were main side effects of the drugs. The incidence of nausea and vomiting were 6.7% and 10% in buprenorphine and fentanyl group respectively. Conclusion: Fentanyl and buprenorphine TDS were effective and safe in controlling postoperative pain. Fentanyl is better than buprenorphine in this respect.

Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim: To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods: This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results: Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection.

Evaluation of Coronal Leakage Following Different Obturation Techniques and in-vitro Evalution Using Methylene Blue Dye Preparation

Introduction: Coronal and apical leakage still remains one of the most important cause for endodontic failure in spite of the presence of advanced endodontic materials. The cause may attribute to different filling techniques, physical and chemical properties of sealers and presence or absence of smear layer assessment of coronal or apical leakage is used as a research method to compare the sealing ability of different techniques and endodontic materials. Aim: To compare the coronal bacterial leakage using methylene blue in four different obturation techniques after protaper hand instrumentation. Materials and Methods: Ninety extracted single-rooted teeth were instrumented to an apical preparation size F3 Protaper hand files. Twenty teeth were randomly obturated with lateral compaction, 20 with vertical compaction, 20 with combination of vertical and lateral compaction and 20 with Thermafil. Ten teeth were used for positive and negative controls (five teeth in each group). Teeth were kept in 100% humidity for 90 days, and then subjected coronally to Proteus vulgaris for 21 days to assess bacterial leakage. After bacterial challenge, methylene blue was placed coronally for another 21 days, and then scoring was done according to depth of dye leakage. Chi-square test was done for statistical analysis. Results: Leakage as observed with combination of vertical and lateral compaction was significantly less than vertical compaction, lateral compaction and thermafil carriers during bacterial challenge. However, when dye was used it also showed statistically significant results with thermafil carriers showing the least leakage in comparison to vertical condensation, lateral condensation and combined groups. Conclusion: The study concludes that two different methods i.e. bacterial and dye leakage revealed considerable variation on the same substrate Thus, due to the presence of variability among the results obtained by two different analytical methods used in the present study, the study emphasizes the need for standardization of methods as the lack of standardization hinders the comparison of different endodontic filling techniques.

Intrathyroid Injection of Steroid in Benign Thyroid Swellings

Santosh U P, Prashanth K B, Manjunatha H A, Sumanth K R, Triveni K M

Introduction: Benign thyroid swelling disorders are common conditions, frequently encountered in clinical practice. Though medical management has been useful in treating the hormonal variations, it has not been very significant in reducing the size of the swelling. Objective: To study the efficacy of intra thyroid injection of triamcinolone in benign thyroid swelling disorders. Materials and Methods: A total of 20 patients were selected for this study. All the patients with thyroid swellings, were evaluated with history and clinical examination followed by routine blood investigations, thyroid function tests (T3,T4,TSH), Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) of the neck. The treatment adopted in this study was intrathyroid injection of triamcinolone acetonide. Results: In this study there were 20 patients, all were females in the age group of 17- 55 years. Four patients did not come for regular follow up, and hence were excluded. Sixteen patients were followed up regularly. Thirteen (81.25 %) patients showed excellent results with no visible swelling, confirmed sonologically. Two patients (12.5%) showed fair results with residual swellings, and one patient did not show any reduction in size of the swelling. Conclusion: Intrathyroid injection of triamcinolone acetonide is a safe, minimally invasive technique in reducing the size of benign thyroid swellings with minimal or no side effects.

Double Tension Band Osteosynthesis in Inter-Condylar Humeral Fractures

Introduction: Intercondylar humerus fractures are uncommon in orthopaedic practice. The treatment for the same has been described in the literature and include paragonal and orthogonal fixation by using plates. Tension band wiring as a treatment for the same is sparsely described in the literature. Aim: To evaluate the effectiveness of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and compare the results with studies involving treatment with locked plates. Materials and Methods: Twenty patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring were retrospectively evaluated over a period of three years. Fractures were classified according to Jupiter classification of distal humeral fractures. There were 5 high T fractures, 13 low T fractures and 2 Y fractures. According to AO classification, all were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 13 males and 07 females. Results: Out of 20 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes with minimum of 50 minutes and maximum of 120 minutes. Radiological union was achieved at an average of 10.8 weeks (8-14weeks). Average range of motion was 104.5 degrees with maximum range of motion 120 degrees (10-130) and minimum of 70 degrees (30-100). Excellent or good results were obtained in 80% of the patients in our study. Conclusion: Double tension band is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus.

Is Video Podcast Supplementation as a Learning Aid Beneficial to Dental Students?

Shivananda Kalludi, Dhiren Punja, Raghavendra Rao, Murali Dhar

Introduction: Podcasting has recently emerged as an important information technology tool for health professionals. Podcasts can be viewed online or downloaded to a user computer or a handheld multimedia device like a portable MP3 player, smart phone and tablet device. The principal advantage of the podcast is that the presentation of information need not be linked with any particular time or location. Since students are familiar with newer technology tools and may be using it on a regular basis, video podcast could serve as a convenient tool for students to help remember both conceptual and factual information. Aim: The purpose of this study was to assess the attitude of first year dental students towards video podcast supplementation and to assess the efficacy of video podcast as a teaching aid in comparison to text book reading. Materials and Methods: First year dental students were recruited for this study. A didactic lecture class was conducted for the students (n=100). The students were then randomly divided into two groups. Students present in group A (n=46) underwent a video podcast session followed by a multiple choice question test. This was followed by student feedback to assess the usefulness of video podcast. Students belonging to group B (n=54) had a study session for 20 minutes followed by the MCQ test. Students then underwent the video podcast session followed by feedback to assess the utility of video podcast. Mann-Whitney U test was applied to compare the difference in the median MCQ score between the two groups. Results: The findings revealed a significant gain in the median MCQ score in the intervention group (group A) when compared to control group (Group B). In the feedback form, 89% of students agreed that the video podcast might be useful as it would enable them to view slides and hear the lectures repeatedly. Conclusion: Students who underwent the video podcast session performed significantly better in the MCQ test compared to students who underwent text book reading alone. This demonstrates an advantage of video podcasts over text book reading. Majority of students accepted the benefits of video podcast supplementation.

Fosfomycin: An Alternative Therapy for the Treatment of UTI Amidst Escalating Antimicrobial Resistance

Ekadashi Rajni Sabharwal, Rajni Sharma

Introduction: Urinary tract infections (UTIs) are the most commonly encountered infectious diseases. The current study was undertaken with a dual purpose, to provide an insight into the current scenario of the microorganisms causing UTI, their antimicrobial sensitivity patterns and also try and evaluate the activity of fosfomycin against E. coli, both ESBL producers as well as non-producers. Materials and Methods: The study was conducted prospectively in the Department of Microbiology of a tertiary care hospital from January to June 2014. A total of 358 isolates from the urinary samples of the patients with a diagnosis of urinary tract infection were included in the study. Antibiotic sensitivity testing and extended spectrum beta lactamase (ESBL) production testing was done as per CLSI guidelines. Results: These represented 297 (82.9%) gram-negative isolates and 61 (17%) gram-positive isolates. The 297 gram-negative isolates represented 265 (89.2%) members of the Enterobacteriaceae, 185 (69.8%) of which were Escherichia coli, 66 (24.9%) Klebsiella spp. and 14 (5.28%) Proteus spp. Non-fermentative Pseudomonas spp were isolated from 8.9% cases. Amongst the Gram negative isolates tested, 78 (21.8%) formed extended spectrum beta-lactamases. Of the total 358 isolates tested, 338 (94.4%) were found to be susceptible to fosfomycin. Conclusion: Fosfomycin showed good activity against both ESBL-producing and ESBL-negative E. coli isolates. The main finding of our study is that fosfomycin exhibits excellent antimicrobial activity even against the isolates with relatively high levels of antimicrobial resistance and hence can be a useful drug in our armamentarium.

Hepatitis C Virus (HCV) Infection among Seronegative Patients undergoing Haemodialysis in a Remotely Located Tertiary Care Hospital of Northern India: Value of HCV-RNA and Genotypes

Background: Haemodialysis (HD) patients are at an increased risk of Hepatitis C virus (HCV) infection, which is significantly associated with increased morbidity and mortality. Aim: The aim of this study was to find the prevalence of HCV infection in anti-HCV antibody negative haemodialysis patients by Real-time PCR (RT-PCR) and value of HCV-RNA among seronegative patients undergoing haemodialysis in a remotely located tertiary care hospital. Materials and Methods: A total of 100 chronic renal failure patients on haemodialysis were studied. All the patients were screened for anti-HCV antibodies by ELISA test and for HCV-RNA by RT-PCR. Results: The overall prevalence of HCV infection was 32%. Antibody positivity was 30% and HCV-RNA by RT-PCR was detected in 20%. HCV-RNA in seronegative patients was detected in 2.8%. Conclusion: Serological assays (30%) are quite reliable for detecting HCV infection in patients undergoing haemodialysis in our tertiary care hospital. Only a small proportion of them (2.8%) require the documentation of viral genome for current infection.

Another Scale for the Assessment of Facial Paralysis? ADS Scale: Our Proposition, How to Use It

Arianna DI Stadio

Introduction: Several authors in the years propose different methods to evaluate areas and specific movement’s disease in patient affected by facial palsy. Despite these efforts the House Brackmann is anyway the most used assessment in medical community. Aim: The aims of our study is the proposition and assessing a new rating Arianna Disease Scale (ADS) for the clinical evaluation of facial paralysis. Materials and Methods: Sixty patients affected by unilateral facial Bell paralysis were enrolled in a prospective study from 2012 to 2014. Their facial nerve function was evaluated with our assessment analysing facial district divided in upper, middle and lower third. We analysed different facial expressions. Each movement corresponded to the action of different muscles. The action of each muscle was scored from 0 to 1, with 0 corresponding from complete flaccid paralysis to muscle’s normal function ending with a score of 1. Synkinesis was considered and evaluated also in the scale with a fixed 0.5 score. Our results considered ease and speed of evaluation of the assessment, the accuracy of muscle deficit and the ability to calculate synkinesis using a score. Results: All the three observers agreed 100% in the highest degree of deficit. We found some discrepancies in intermediate score with 92% agreement in upper face, 87% in middle and 80% in lower face, where there were more muscles involved in movements. Conclusion: Our scale had some limitations linked to the small group of patients evaluated and we had a little difficulty understanding the intermediate score of 0.3 and 0.7. However, this was an accurate tool to quickly evaluate facial nerve function. This has potential as an alternative scale to and to diagnose facial nerve disorders.

Perceptions of Interns and General Medicine Examiners Regarding Cardiovascular Case Presentation in Practical Exams of General Medicine in Final MBBS Summative Examinations

Introduction: Assessment of cardiovascular cases in practical exit exam is limited to simple history taking and physical examination. Standards of assessment are not uniform. This makes assessment less valid and reliable. Aim: To explore the perceptions of Internees and General Medicine Examiners about current practices in Cardio Vascular system (CVS) case presentation in final MBBS exit exams and the necessity to change some of the practices. Materials and Methods: A set questions pertaining to the preparation for exams, validity, reliability, feasibility and educational impact were prepared to guide in obtaining the perceptions of internees and internal medicine examiners. Focus group discussions were conducted. Data Analysis was done by immersion-crystallization process. Results: Most of the internees admitted to feeling concerned because of difficulty in diagnosing murmurs by auscultation. Most of the examiners felt concerned about the logistics involved in arranging practical exams. Both admitted to the lack of uniform standards in assessment. Both agreed that the present system thrived as it was relatively feasible. Some internees suggested that the exam may be conducted in two parts by splitting the syllabus instead of once. Some internees suggested incorporating a student-doctor program to improve practical skills just like the on-going student nurse program. Conclusion: There is a need for overhauling the assessment of cardiovascular system in final MBBS summative exams towards one aligned to the competencies as required in an Indian Medical Graduate. Blueprinting of practical assessment with due weightage assigned to epidemiologically important topics is the need of the hour.

Clinical, Biochemical and Outcome Profile of Biotinidase Deficient Patients from Tertiary Centre in Northern India

Ankur Singh, Avinash Lomash, Sanjeev Pandey, Seema Kapoor

Introduction: Biotinidase deficiency is an inherited metabolic disorder with estimated birth incidence of 1 in 61,000 for profound and partial deficiency. Estimated incidence of profound and partial biotinidase deficiency is 1 in 1, 37,000 and 1 in 1, 10,000 respectively. The carrier frequency in general population is 1 in 120. We attempt to study clinical, biochemical and outcome from 10 Biotinidase deficient patients. Materials and Methods: A retrospective case record study was conducted to record Clinical, biochemical and outcome profile from genetic records. Biotinidase level was measured using spectrophotometric method. Results: Study group comprised of 8 males and 2 females with median age of presentation 6 (2-45.75) months. Median (interquartile range) Biotinidase level in study group 0.3 (0.08—1.5) nmol/ml/min. Study group was further divided in to early onset group (< 12 months, n-6) and late onset group (> 12 months, n-4). Seizure, alopecia and hearing loss were predominant phenotypes in study group. The other rare presentations were: hypotonia, ataxia, skin rash, seborrhoea. The most common seizure type was focal seizure. Control of seizure activity was important immediate outcome measured in study group. Median duration (interquartile range) of seizure control in early onset group was 3 (2-4)days against 13.5 (12.25-14.75) days in late onset group. Conclusion: This study highlights the need of early diagnosis for favourable outcome for a potentially treatable inherited metabolic disorder.

Evaluation of Skin Penetration of Diclofenac from a Novel Topical Non Aqueous Solution: A Comparative Bioavailability Study

Manish Nivsarkar, Sanjaykumar H. Maroo, Ketan R. Patel, Dixit D. Patel

Introduction: Different topical formulations of diclofenac have varying skin penetration profile. Recent advances in science and technology has led to the development of many new formulations of drugs for topical drug delivery. One such technological development has led to the innovation of Dynapar QPS, a novel, non-aqueous, quick penetrating solution (QPS) of diclofenac diethylamine. Aim: This study was aimed to measure the total exposure from the drug penetrating the skin in healthy human subjects and comparing the relative systemic bioavailability of Dynapar QPS® with diclofenac emulgel. Materials and Methods: A 200 mg of diclofenac from either Dynapar QPS® (5 ml) or emulgel (20 g) was applied on back of subject as per the randomisation schedule. Blood samples were collected up to 16 hours post drug application. Plasma concentration of diclofenac was measured by pre-validated HPLC method. Pharmacokinetic (PK) parameters like Cmax, Tmax, t1/2, AUC0-t, AUC0-8, and Kel, of diclofenac were determined for both the formulations. Results: Mean Cmax after administration of Dynapar QPS® and diclofenac emulgel were 175.93 and 40.04 ng/ml, respectively. Tmax of diclofenac was almost half with QPS compared to emulgel (5.24 hrs versus 9.53 hrs respectively). The mean AUC0–t and AUC0-8 after administration of Dynapar QPS® was higher as compared to diclofenac emulgel (AUC0–t: 1224.19 versus 289.78 ng.h/ml, respectively; AUC0-8: 1718.21 versus 513.83 ng.h/ml, respectively). None of the subject experienced any adverse event during the study. Conclusion: The results indicate an enhanced penetration and subsequent absorption of diclofenac from Dynapar QPS® as compared to diclofenac emulgel. Higher penetration is likely to translate into better pain relief in patients.

Association of Temporomandibular Joint Signs & Symptoms with Dental Fluorosis & Skeletal Manifestations in Endemic Fluoride Areas of Dungarpur District, Rajasthan, India

Introduction: Endemic fluorosis resulting from high fluoride concentration in groundwater is a major public health problem. India is among the numerous nations, where fluoride sullied groundwater is creating wellbeing issues. Safe drinking water in rural areas of India is predominantly rely on groundwater sources, which are exceptionally contaminated with fluoride. Aim: To investigate the association of temporomandibular joint Signs & Symptoms with Dental Fluorosis & Skeletal Manifestations among people living in Dad, Bokersal & Deotalab villages of Dungarpur District, Rajasthan, India. Materials and Methods: The study group consisted of 750 subjects who were born & brought up in Dad, Bokersal & Deotalab villages of Dungarpur District, Rajasthan. Temporomandibular joint & Dental fluorosis was assessed by performing type III clinical examination according to WHO guidelines (1997). For the assessment of skeletal manifestations, participants were asked to perform three diagnostic tests: (1)Touching the toes without bending the knees; (2) Touching the chest with the chin; (3) Stretching the arms sideways & folding the arms to touch the back of the head. Chi Square test & Multiple Logistic Regression were applied for statistical analysis. Results: Among the 750 (462 males & 288 females) who participated in the study, 53% had moderate grade of dental fluorosis. The most prominent symptom suggesting Temporomandibular Joint Disorder was the clicking sound affecting 21.4% population.(p>0.001). TMJ Signs & Symptoms were prominent in the age group of 45-54 years & males were highly affected than females. Conclusion: Clinical examination of TMJ in Dental Fluorosis & Skeletal Fluorosis subjects showed a significant association with Dental Fluorosis & Skeletal Fluorosis.

Morphometry As a Diagnostic Tool for Potentially Malignant Lesions

Introduction: Though we are in 21st century with nano technology & tissue printing, there still exist many lacunae in the field of diagnosis. Not much is known about prognostic markers till now from literature to assess potentially malignant lesions. Lesions so called potentially malignant can be termed only after clinical & malignant changes have been developed and there are no means of predicting with certainty the risk of cancerous transformation. Aim: Our present study was undertaken to establish the morphometric parameters of the parabasal and spinous cells of normal oral epithelium with the changes occurring in cells of Oral Leukoplakia (OL), Oral Verrucous Carcinoma (OVC) and Oral Squamous Cell Carcinoma (OSCC). Materials and Methods: Total 40 patients were divided into Group I which includes patients with normal oral mucosa, group II oral leukoplakia patients, group III oral verrucous carcinoma patients and group IV includes oral squamous cell carcinoma patients. Tissue sections were taken and morphometric analysis of cell area, cell diameter, nuclear area, nuclear diameter, nuclear cytoplasmic ratio was done for parabasal and spinous layer cells. Statistical analysis was done using one-way ANOVA and T-test. Results: Nuclear diameter, nuclear area, cell area, nuclear cytoplasmic ratio were significantly increased in OL, OVC, OSCC patients than normal oral mucosa, which was statistically significant. Cell diameter was decreased in OL, OVC, OSCC patients than with normal oral mucosa which was statistically significant. Conclusion: Cellular & nuclear parameters showed statistically significant changes in oral leukoplakia, oral verrucous carcinoma & oral squamous cell carcinoma in comparison with normal oral mucosa.

Study of Pattern of Change in Handwriting Class Characters with Different Grades of Myopia

Shruti Prabhat Hedge, Vijay Kautilya Dayanidhi, Sriram

Introduction: Handwriting is a visuo-motor skill highly dependent on visual skills. Any defect in the visual inputs could affect a change in the handwriting. Understanding the variation in handwriting characters caused by visual acuity change can help in identifying learning disabilities in children and also assess the disability in elderly. In our study we try to analyse and catalogue these changes in the handwriting of a person. Materials and Methods: The study was conducted among 100 subjects having normal visual acuity. They were asked to perform a set of writing tasks, after which the same tasks were repeated after inducing different grades of myopia. Changes in the handwriting class characters were analysed and compared in all grades of myopia. R esults: In the study it was found that the letter size, pastiosity, word omissions, inability to stay on line all increase with changes in visual acuity. However these finding are not proportional to the grade of myopia. Conclusion: From the findings of the study it can be concluded that myopia significantly influences the handwriting and any change in visual acuity would induce corresponding changes in handwriting. There is increase in letter size, pastiosity where as the ability to stay on line and space between the lines decrease in different grades of myopia. The changes are not linear and cannot be used to predict the grade of myopia but can be used as parameters suggestive of refractive error.

Comparative Evaluation of Frictional Properties, Load Deflection Rate and Surface Characteristics of Different Coloured TMA Archwires - An Invitro Study

Introduction: During tooth movement the success of sliding mechanics is dependent upon various factors which include frictional resistance at bracket-archwire interface, surface roughness of archwire materials and elastic properties of archwires. Ion implantation techniques reduce the frictional force and allow better tooth movement clinically. Aim: The main objective of this study was to evaluate and compare the frictional properties, load deflection rate and surface characteristics of Honey dew and Purple coloured (Ion implanted) TMA wires with uncoated TMA wires. Materials and Methods: Fifteen archwire samples were divided into three groups comprising of five samples in each group namely, Group I – Uncoated TMA wires (Control), Group II – Purple coloured TMA wires and Group III- Honey dew TMA wires. Friction and load deflection rate testing were performed with the Instron Universal testing machine and the surface characteristics of the wires were evaluated before and after sliding using Scanning Electron Microscope. Results: The mean frictional characteristics and surface roughness for Honey dew TMA wires was lesser than Purple coloured TMA wires which was statistically significant. Both the coloured TMA wires showed low frictional characteristics and less surface roughness than uncoated TMA wires (the control). The mean load deflection rate was low for both coloured ion implanted TMA wires when compared to uncoated TMA wires which was statistically significant. Conclusion: Coloured ion implanted TMA wires, especially Honey dew TMA wires have low friction, low load deflection rate and improved surface finish. Hence they can be used in frictionless as well as sliding mechanics, where uncoated TMA wires are inefficient.

A Clinico-Mycological Study on Suspected Cases of Chromoblastomycosis: Challenges in Diagnosis and Management

Introduction: Verrucous plaques mimicking chromoblastomycosis are frequently seen in dermatology outpatient departments (OPD). However, no scientific evaluation has been carried out till date from eastern India. So this present endeavour is aimed at a thorough study of those cases to readdress the challenges in diagnosis and management in chromoblastomycosis from this part of the country. Aim: The study is to observe the incidence of proved chromoblastomycosis cases from clinically mimicking conditions and to note therapeutic prospects by use of different antifungal agents. Materials and Methods: Twenty clinically suspected cases attending dermatology OPD were included in this study. Relevant histories were taken. Apart from routine hematological and biochemical investigations, scrapings from lesions were examined by direct microscopy with KOH wet mount, calcoflour white mount and fungal culture. Histopatholgical examination was also done. Any fungal growth was identified by growth characteristics and morphological features. Results: Sclerotic bodies were detected in five samples. Of them three were found to be culture positive. Two growths were identified as Fonsecaea pedrosoi and one as Cladosporium carrionii. Rest 12 cases were diagnosed as either lupus vulgaris (3 cases; 15%), atypical mycobacterial infections (3 cases, 15%), Hypertrophic lichen planus (2, 10%), Hypertrophic DLE plaque (2; 10%), Wart (1, 5%) or fixed cutaneous sporothricosis (1, 5%), zygomycosis (1, 5%). Three cases (15%) were lost in follow up. Cases of chromoblastomycosis were managed with prolonged use of antifungal alone or in combination with saturated solution of potassium iodide and/or debridement. They were followed up for at least six months post treatment. Conclusion: A database comprising diagnostic clues and effective therapeutic intervention have been proposed for these rare subcutaneous mycoses.

Periodontal Health Condition and Associated Factors among University Students, Yemen

Introduction: Studies on oral health status among Yemeni population are scarce. Aim: This study aimed to evaluate the periodontal health among advantaged section of Yemeni society, university students, in health and non-health fields. Materials and Methods: Periodontal health status of a sample of 360 students from dental, medical and literature faculties (120 each with equal gender distribution) at Sana`a University was evaluated by two calibrated examiners using CPI index. Data regarding tooth-brushing practices and smoking and khat chewing habits were obtained using a structured interview questionnaire. Results: Only 45 students (12.5%) had healthy periodontium, while 113 (31.4%), 186 (51.7%) and 16 (4.4%) had bleeding, calculus and shallow pocket, respectively, with no significant differences between faculties. Females revealed significantly better periodontal health compared to males, though their bleeding score was higher. Dental and medical students and female students in general were significantly more interested in tooth-brushing and significantly less interested in practicing the deleterious habits such as smoking and khat chewing. Conclusion: The overall periodontal health of Sana`a University students is still unsatisfactory even among students in health field. Females and students in health field revealed better periodontal health and oral health practices (tooth-brushing) in comparison to male students and those in non-health field. The negative effects of the highly prevalent smoking and khat chewing habits deserve further reliable researches and proper educational programs at the national level.

The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of Kerman: A Cross-Sectional Study

Abbas Balouchi, Hosein Shahdadi, Sudabeh Ahmadidarrehsima, Hosein Rafiemanesh

Introduction: The needlestick injuries can cause the transmission of infectious diseases. Compared to other members of the community of health care nurses are at great risk of needle stick injury because of their frequent performance with vein punctures and taking care of patients suffering from different infectious diseases. Aim: The main aim of this study was to assess Prevalence, causes and preventive of Needle Sticks injuries among nurses in Kerman (south of Iran). Materials and Methods: This cross-sectional study was conducted from December 2014 to March 2015 on 240 nurses employed in two hospitals of Kerman. Sampling was performed through simple random sampling. Data gathered through a researcher made questioner. Data analysed by use descriptive analytical testes. Results: From the nurses’ perspective the main physical and human causes of needlestick injuries were syringe needles (82) and crowded wards (74). The majority of the nurses believed the most effective method to prevent needlestick were training (82). Conclusion: Due to the high prevalence of injuries caused by sharp objects in nurses, needlestick injuries are suggested to be recorded in special forms and their causes to be checked by the Infection Control Committee. Since syringe needle heads and angiocatheter are the main causes of needlestick injuries, providing safe medical equipment should also be emphasized.

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip

Introduction: Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. Aim: To study pre and post core decompression MRI changes in avascular necrosis of hip. Materials and Methods: This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. Results: Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. Conclusion: Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

The Knowledge of Radiation and the Attitude Towards Radio-Protection among Urology Residents in India

Tarun Jindal

Introduction: Exposure to radiation is a hazard and precautions are necessary to limit it. This study was done to assess the knowledge of radiation and the attitude towards radio-protection among urology residents in India. Materials and Methods: A questionnaire was administered to assess the knowledge and attitude of urology residents who came from all over the country to attend a clinical meeting at Apollo Gleneagles Hospital, Kolkata, India. Results: All the respondents agreed to being exposed to radiation, with 78.2% using radiation in more than five cases a week. Only 65.2% always took some steps for radio-protection. Lead aprons and thyroid shields were the most common radiation protection devices used. None of the residents ever used lead gloves or protective eye glasses or dosimeters. An 82.6% felt that they did not have adequate knowledge, 85.4% of residents did not receive any formal classes regarding the risk of radiation, 21.7% either rarely or never moved out of the operating room when the radiation was being used, 42.4% did not know that the SI unit of the equivalent absorbed dose of radiation & 52.1% did not know about the amount of radiation delivered to an adult during a contrast enhanced CT scan of the abdomen. Conclusion: Results of the present study reveal that the urology residents of India lack knowledge about the risks of radiation exposure. Majority of them did not take necessary precautions to limit their exposure to radiation.

Diagnostic and Surgical Approach of Thyroglossal Duct Cyst in Children: Ten Years Data Review

Introduction: Thyroglossal duct cysts are the most common congenital midline neck swelling in children. Aim: To evaluate the clinical features, treatment, incidence of complications and outcomes in children with congenital midline neck lesions and more specifically with thyroglossal duct cyst, treated in our department the last ten years. It is a retrospective study. Materials and Methods: The aggregated data revealed 59 patients with congenital midline neck lesions, of which 33 patients were with thyroglossal duct cyst (TDC). The diagnosis of TDC was made by physical examination, ultrasound (US) in all cases, and for complicated cases a magnetic resonance imaging (MRI) was performed. In all cases followed histopathological conformation of thyroglossal duct cyst. Results: Fifty nine patients were admitted with midline cystic neck mass and the histopathological evaluation revealed, 33 cases (55.9%) of thyroglossal duct cyst, 14 cases (23.7%) of dermoid cysts, 3 cases (5.1%) of second branchial anomalies, 4 cases (6.7%) of inflammation of unknown cause, 4 cases (6.7%) of lymph nodes and 1 case (1.7%) of capillary skin haemangioma. More specifically, 38 patients were admitted with preoperative diagnosis of thyroglossal duct cyst, but in 5 patients pathological investigation demonstrated the presence of dermoid cyst. The mean age of the 33 patients with TDC at the time of surgery was 6.125 years, ranging between 9 months and 13 years with 10 patients younger than 3 years. Of the 38 patients with initial diagnosis of thyroglossal duct cyst, only four patients (10.5%) had a simple cyst excision and complication rate was 25% (1 case with recurrence). In these patients, the histopathological examination showed that three of them had a dermoid cyst and one had thyroglossal duct cyst. The other 34 patients (89.4%) were treated by Sistrunk’s procedure, with two cases (5.9%) were proven on histology to be non TDC. In this group the complication rate was 3.03% (1 case with wound infection). Conclusion: The inappropriate surgical approach due to misdiagnosis or the incomplete surgical procedure remains the impact factor for recurrence. The modification of Sistrunk’s procedure remains the main surgical technique that can provides good results with low rate of complication (3.03%) and recurrence (0%) as shown of our collecting data.

Functional Neonatal Echocardiography: Indian Experience

Introduction: Functional echocardiography, as opposed to echocardiography as performed by the cardiologist, is the bedside utilization of cardiac ultrasound to take after functional and haemodynamic changes longitudinally. Information reflecting cardiovascular capacity and systemic and pulmonary blood flow in sick preterm and term neonates can be observed utilizing this strategy. Information is lacking on its use in neonatal units in India. Aim: To characterize the impact of Functional neonatal echocardiography (FnECHO) programme on decision making in a tertiary care centre in India by evaluating its frequency of use, patient characteristics, and indications. Materials and Methods: Prospective observational study of neonates in a tertiary Neonatal Intensive Care Unit (NICU) in Pune (India) from February 2014 to January 2015. All the neonates undergoing FnECHO during this 12 month period based on clinical findings were included in the study. Data extracted from the review of the clinical notes included gestational age, birth-weight, mode of delivery, Apgar scores, details of respiratory and cardiovascular support, timing of FnECHO and any other clinical diagnosis. The findings of echocardiography were recorded and correlated with the clinical and other laboratory or X-ray findings. If these findings indicated a change in management, it was instituted. Results: A total of 348 echocardiographic studies were performed in 187 neonates (mean 1.86; SD 2.02). The most frequent indication was Patent Ductus Arteriosus (PDA) assessment (n= 174, 50%), followed by haemodynamic instability (n=43, 12.36%). The results of FnECHO modified treatment in 148 cases (42.50%) in the form of addition and/or change in the treatment or avoidance of unnecessary intervention. Conclusion: FnECHO is frequently used in the NICU setting and may be a useful tool to guide treatment. PDA assessment and haemodynamic instability are the most frequent indications. To validate its usefulness, well co-ordinated large prospective studies are needed.

Metronidazole-Induced Bullous Pemphigoid: A Case Report

Saibal Moitra, Sukanta Sen, Indranil Banerjee, Ayan Sikder, Prasanta Das

Bullous pemphigoid is an autoimmune cutaneous blistering disorder, the exact pathogenesis of which is still not fully elucidated. Drug-induced bullous pemphigoid eruptions are rare but have been reported earlier with the use of frusemide, psoralens, ibuprofen, galantamine hydrobromide, ACE inhibitors like captopril, spironolactone, penicillin, ampicillin, levofloxacin, penicillamine. We hereby report a case of metronidazole induced bullous pemphigoid (BP) in a 52-year-old male patient suffering from liver abscess following 4 days of drug administration. The skin biopsy findings obtained from the patient were consistent with the diagnosis of bullous pemphigoid (BP). Metronidazole was discontinued and symptomatic treatment was offered to the patient. Following withdrawal of metronidazole, the bullae subsided in the next 7-10 days without any significant residual scarring. The causality assessment performed as per the Naranjo algorithm revealed the case to be probable (Naranjo score 7).

Effect of Abstinence on Audio-Visual Reaction Time in Chronic Smokers Pursuing a Professional Course

Aditya Lal Vallath, Anuradha Rajiv Joshi, Savita Madhukar Vaidya

Introduction: It has now been proven that tobacco abuse is the leading cause for various carcinomas such as oral, lung and oesophageal. It also leads to atherosclerosis of major vessels, development of hypertension, autoimmune disorders, COPD, bronchitis, asthma, bronchiectasis, etc. Most smokers are dependent on nicotine and abstinence from smoking results in tobacco withdrawal and craving. It also affects cognitive skills and reaction time. Many students in professional college have the habit of smoking. In spite of awareness programmes carried out in schools, colleges and having ban on smoking, prevalence of smoking is rising in India. Aim: To observe the effect of abstinence on audiovisual reaction time and to note the cause for reverting to smoking by the students pursing professional course. Materials and Methods: Sixty male volunteers in the age group of 18-25 years participated in the study. The volunteers were divided in to two groups (control group and study group). Cigarette smokers consuming at least 10-19 cigarettes per day for more than 2-3 years were included as subjects in study group. The study was conducted using a audiovisual reaction time apparatus in a quiet and bright lit room. All volunteers were subjected to baseline readings after demonstrating working of the apparatus. Auditory (high pitched and low pitched sound) and visual (red light and green light) reaction time was recorded. Thirty students in study group were subjected to these tests immediately after smoking and after 12 hours of abstinence. After all the individuals were tested, the recorded values were compared by Student’s t-test. Results: Statistically significant difference was recorded in auditory and visual reaction time in study group subjects immediately after smoking and after 12 hours of abstinence as compared to base line readings. Conclusion: It was observed that auditory and visual reaction time was prolonged in chronic smokers after 12 hours of abstinence.

Fluconazole Resistant Candida Oesophagitis in Immunocompetent Patients: Is Empirical Therapy Justifiable?

Barnali Kakati, Aarti Kotwal, Debasis Biswas, Shantanu Sahu

Introduction: C. albicans (Candida albicans) is the foremost cause of fungal oesophagitis, however other species such as Candida tropicalis, Candida krusei and Candida stellatoidea have also been implicated to cause this condition. Although, numerous studies have identified risk factors for C. albicans oesophagitis, data for non- C. albicans species is still sparse. Aim: To determine the aetiology of Candida oesophagitis in our medical centre over a two year period. Additionally, to investigate predisposing conditions for oesophageal candidiasis caused by different Candida species. Material and Methods: All consecutive patients posted for upper gastrointestinal endoscopy at the endoscopy unit of a tertiary care hospital in north India with findings consistent with oesophagitis were screened for the presence of Candida oesophagitis by performing KOH (potassium hydroxide) examination and culture on SDA (Sabouraud’s dextrose agar). Antifungal susceptibility testing as per CLSI guidelines was performed for fluconazole, a most common empirically prescribed antifungal for the condition. Results: A total of 1868 patients with no known immune-compromised condition underwent upper gastroscopy at our centre during the study period. The prevalence of Candida oesophagitis was 8.7% (n = 163). C. albicans was recovered from majority of infections (52.1%), followed by C. tropicalis (24%), C. parapsilosis (13.4%), C. glabrata (6.9%) and C. krusei (3.6%). Alarmingly, among the C. albicans isolates 8.6% were resistant to fluconazole. Conclusion: With rising reports of antifungal drug resistance among the isolates of Candida species, an increasing prevalence of this organism could have an impact on the treatment of Candidal oesophagitis and it should be approached with caution by the clinician.

Prevalence of Nosocomial Diarrhea Due to Adenoviruses 40 and 41 in a Paediatric Ward in Iran

Abolfazl Khoshdel, Neda Parvin, Abbas Doosti, Fatemeh Famouri

Background: Enteric adenoviruses 40 (Ad40) and adenovirus 41 (Ad41) have been shown to be a significant cause of paediatric gastroenteritis worldwide, but no data are available for nosocomial diarrhea due to adenovirus in Iran. Aim: The present study was performed to determine the incidence of Ad40 and Ad41 in children less than five years with nosocomial diarrhea in Shahrekord, southwest Iran. Materials and Methods: Adenovirus was detected by polymerase chain reaction (PCR) in stool samples collected during one year (2010-2011) from children less than five years with nosocomial diarrhea admitted to a paediatric center in Shahrekord, Iran. Nosocomial diarrhea was defined as those occurring more than 72 hours after admission to hospital for non-diarrheal causes. PCR technique was used for investigation of Ad40 and Ad41. Results: In total of 100 samples, Ad40 and Ad41 DNA was found to be positive in 14/100 (14%), and 8/100 (8%) of diarrheic patients less than five years, respectively. Conclusion: Ad40 and Ad41 are important causes of nosocomial diarrhea in less than five-year, hospitalized Iranian children.

Non Diphtheritic Corynebacteria: An Emerging Nosocomial Pathogen in Skin and Soft Tissue Infection

Introduction: Non-diphtheritic corynebacteria are normal inhabitants of skin and mucous membrane. When isolated from clinical specimens they are often considered as contaminants. Recent reports suggest their role as emerging nosocomial pathogens. Aim: To speciate non-diphtheritic corynebacteria isolated from wound specimens, to correlate their clinical significance and to determine their invitro antimicrobial susceptibilities to 9 antimicrobial agents. Materials and Methods: Twenty five non-diphtheritic corynebacteria from skin and soft tissue infections were selected for study. Isolates were identified by battery of tests and minimum inhibitory concentration (MIC) was detected by Clinical & Laboratory Standards Institute (CLSI) described broth microdilution method. MIC was interpreted according CLSI and British Society for Antimicrobial Chemotherapy (BSAC) guidelines. Results: C. amycolatum was the predominant species (20%) followed by C. striatum (16%). Penicillin was least effective invitro followed by clindamycin and ciprofloxacin. Excellent activities were shown by vancomycin, linezolid and imipenem. Multidrug resistance was found in all the species. Conclusion: Non-diphtheritic corynebacteria are potential nosocomial pathogens among acute/chronic complicated skin and soft tissue infection. Vancomycin or linezolid can be used empirically to treat such infections until the invitro susceptibility results are available.

Evaluation of Anti Cancer Effects of DPP -4 Inhibitors in Colon Cancer- An Invitro Study

C.A Amritha, Punnagai Kumaravelu, D. Darling Chellathai

Introduction: Among the oral anti-diabetic drugs, Dipeptidyl peptidase - 4(DPP-4) inhibitor is an emerging class of drugs. Inhibitors of DPP-4 enzyme like Sitagliptin and Vildagliptin have shown Anti-oxidant properties in many studies, both invivo and invitro. It has also been characterized as an apoptotic agent on pancreatic cancer cells. In the following study, Anticancer effect of DPP 4 inhibitors on colon cell lines (HT-29) using MTT assay— {3 -4, 5-dimethyl (thiazol – 2 -yl) -3, 5- dimethyl tetrazolium bromide} assay was elucidated. Aim: To elucidate and compare the anticancer potential of two DPP 4 inhibitors using in-vitro MTT assay on colorectal cell lines (HT-29). Materials and Methods: We treated HT-29 cell lines with two DPP 4 inhibitors. HT-29 cells were incubated at 370C and drug samples were added in various concentrations and incubated for 24 hours. MTT dye was added to the sample and it was incubated for 4 hours. One ml of DMSO was added Using an Ultraviolet-Spectrophotometer, measurement of absorbance was done at 570nm following which the half maximal inhibitory concentration was graphically estimated in relation to the percentage of viability of the cell and the sample concentration. Results: We found that both the drugs have shown anticancer activity starting from low to high concentrations when compared with the control using MTT assay. The IC 50 value of Sitagliptin is 31.2 mcg/ml and Vildagliptin is 125 mcg/ml. Conclusion: From this study, we found that the drugs have significant Anti-Cancer property, which would probably play a role as cytotoxic agent in tumour cells. Sitagliptin was found to be more potent than Vildagliptin in colon cancer cell lines.

Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

Piyush Kumar, Namrata, Shabi Ahmad

Introduction: Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim: This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods: This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results: Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion: Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin excoriation. However, role of Gum Acacia was found to be good with inflamed, excoriated and ulcerative skin in comparison to Aluminum Paint and as efficacious as Karaya Gum but at much lower cost.

Exploring Health Situation of Indian Children with Autism Spectrum Disorder Using Autism Treatment Evaluation Checklist (ATEC) in an Urban Area of Odisha: A Case Study

Introduction: Autism or Autism Spectrum Disorder (ASD) is a complex behavioural disorder in children with uncertain aetiology. Gastrointestinal metabolites have direct impact on brain function with possible role in its causation. Data on burden of Autism in India is sparse. Aim: The aim of the study was to determine the extent of social, communication and behavioural impairment among children suffering from ASD patientsin Odisha. Materials and Methods: A cross-sectional study design was used to assess 20 children with ASD in Odisha using an autism treatment evaluation checklist to understand the extent of social, communication and behavioural impairment in them. Of these, 72% children were diagnosed with ASD within 2 to 2.5 years of age and 38.9% patients suffered from diarrhoea together with constipation at the time of the study. Result: There was moderate impairment in, subclasses I (Speech/language/ communication), II (sociability), III (sensory/ cognitive awareness) and overall score but mild impairment in subclass IV (i.e., health/ physical/behaviour). Possibly, the training programme of the school had positive impact on the behaviour and the health component. Severity of scores in subclasses was less in older children. There is need for training in order to improve the communication and social interaction domain of these children. Conclusion: This study has provided valuable insight into the health situation of children with ASD. The study has been carried out using ATEC checklist. It points towards the need for training in order to improve the communication and social interaction domain of these children. It also reinforces the necessity to carry out further studies to explore possible link of gastrointestinal metabolites in causing ASD and age related changes in ATEC score of these children.

Glaucoma Awareness and Self-Care Practices among the Health Professionals in a Medical College Hospital

Nimitha Nageeb, Uma D Kulkarni

Background: Awareness and self-care practices concerning glaucoma, the silent thief of sight, is poor. This study was conducted to assess the same among health professionals in a medical college. Materials and Methods: Institutional Ethics Committee Clearance was obtained and a descriptive semi-structured-questionnaire-based study was conducted. Informed written consent was taken from 114 (convenience sampling) health professionals (doctors/paramedicals) and a questionnaire were administered. Participants were questioned about the awareness of glaucoma, what are the features of glaucoma etc. Non-medical hospital workers were excluded. Data was analysed using Microsoft excel, descriptive statistics and chi-square test. Results: Respondents included clinicians, non-clinician-doctors and paramedicals (36:30:48) {mean age: 37 years, males:females::58:56}. Glaucoma awareness was statistically similar in the three study groups: high IOP (82.4%, p=0.55); optic nerve damage (32.4%, p=0.79); normal/low IOP (38.6%, p=0.2); irreversible blindness (47.1%, p=0.29); risk factors like corticosteroids (57%, p=0.11), family history of glaucoma (74.5%, p=0.17) and diabetes (77.1%, p=0.84). Over 13% thought that screening is done after 60 years. Few had undertaken screening for themselves (16.60%) and family members (21.05%). Few knew tests (41.2%, p=0.04) and treatment modalities (41.2%, p=0.0516). Conclusion: The study revealed unsatisfactory awareness and self-care practices concerning glaucoma among health professionals including clinicians despite studying ophthalmology, although it is presumed and predicted to be the contrary. This alarming revelation warrants the need for enrichment of glaucoma awareness programs.

Maternal Anaemia and Neonatal Outcome: A Prospective Study on Urban Pregnant Women

Manpreet Kaur, Aarti Chauhan, Md Dilshad Manzar, Mohammad Muntafa Rajput

Introduction: Maternal anaemia is a major contributor of adverse neonatal outcomes, particularly compromised birth weight and head circumference. Objective: To assess the relationship between maternal anaemia and neonatal measures in a sample of low-middle income group urban mothers. Materials and Methods: One hundred pregnant women with population representative prevalence of anaemia were enrolled. Socio-demographic, anthropometry, obstetric profile (parity, abortion history, food habits, gap period with last pregnancy etc), and systolic/diastolic blood pressure were documented. Neonatal outcomes (gestational age and type of delivery), and birth anthropometry (weight, length, and head circumference) were measured at delivery. Univariate and multivariate regression analysis for associating maternal haemoglobin levels and neonatal outcomes were performed. Results: The anaemic and non-anaemic pregnant women differed significantly in interval between previous & index pregnancy (p=0.031), parity (p=0.009), systolic blood pressure (p=0.026), diastolic blood pressure (p=0.042), maternal Hb (p<0.01). The mean gestational age (p<0.01), weight (p<0.01), length (p<0.01) and head circumference (p<0.01) of the neonates differed significantly between the two groups. On using maternal haemoglobin as a continuous variable, these anthropometric birth outcomes were positively correlated with maternal haemoglobin (p<0.05). Further, univariate linear regression showed similar associations between maternal haemoglobin (g/dL) and birth weight (p=0.004), length (p=0.010) and head circumference (p=0.003). Conclusion: Maternal haemoglobin has a positive relationship with the neonatal measures of weight, length and head circumference.

Perception of Medical Faculties towards Early Clinical Exposure and MCI Vision 2015 Documents in Western Maharashtra

Motilal Chandu Tayade, Ramchandra G Latti

Introduction: The Medical Council of India (MCI) has advocated early clinical exposure for students in medical colleges. In its ‘Vision-2015’ document for further reforms in undergraduate medical education, the MCI underlined the need for clinical teaching from first year onwards in medical colleges. Aim: Our aim was to collect and analyse perception of medical faculties towards early clinical exposure and MCI Vision 2015 and to study the awareness, depth and interest among medical faculties towards these changes. Materials and Methods: We used 10-item self developed survey questionnaires, which was validated from experts in medical education. 10–item questionnaire was based on awareness, depth and interest among medical faculties towards early clinical exposure and MCI Vision 2015 documents released by MCI in 2011. Qualitative data was assessed using percentage scale. We were approached to 182 preclinical medical faculties, however responses were received from 127 medical faculties from first year medical course subjects from six different college’s viz. two from Deemed University, two from Government sector and two from private sector but affiliated to Maharashtra University of Health sciences, Nasik, India. Results: A 94.48% faculty members were aware regarding MCI Vision 2015 documents released by MCI in 2011. Average 12% faculties could answer specific approach MCQs based on MCI Vision 2015 documents. However, 82.67% faculties agreed early clinical exposure will be definitely helpful if implemented in curriculum. Conclusion: The present work underlines need of special coaching and attention towards this important issue in medical education.

Knowledge, Attitude and Practice of Self-Medication Among Basic Science Undergraduate Medical Students in a Medical School in Western Nepal

Sudesh Gyawali, P Ravi Shankar, Phanindra Prasad Poudel, Archana Saha

Introduction: Studies have shown self-medication to be common among medical students. These studies are however, few in Nepal. The present study assessed knowledge, attitude, and practice of self-medication among second and fourth semesters’ undergraduate medical students and studied differences in knowledge and attitude (if any) among different subgroups of the respondents. Materials and Methods: A cross-sectional survey was conducted using a questionnaire among basic science medical students of Manipal College of Medical Sciences, Nepal. Semester of study, gender, age, nationality, and the profession of their parents were noted. Students’ knowledge and attitude about self-medication was studied by noting their degree of agreement with a set of 40 statements using a Likert-type scale. The average scores and frequency of occurrence of particular behaviors among different categories of respondents were compared using appropriate statistical tests. Results: Two hundred and seventy-six of the 295 (93.6%) students participated. The mean (SD) knowledge, attitude, and total scores were 74.54 (6.92), 67.18 (5.68), and 141.73 (10.76) with maximum possible scores 100, 100 and 200, respectively. There was no significant difference in scores according to respondents’ gender, age, and the profession of their parents. However, the mean knowledge, attitude and total scores were significantly different among students of different nationalities. Mean scores of fourth semester students were significantly higher compared to second semester students. There were differences in knowledge and total scores among students of different nationalities. Eighty two percent of respondents had self-medicated during the one year period preceding the study; 149 respondents (54%) shared that previous experience with the medicine was one of the information sources for self-medication. Prevalence of self-medication among respondents according to semester of study, gender, age, and profession of the parents was not significantly different. The use of self-medication was more common among Sri Lankan respondents compared to Nepalese. Painkillers (73.2%), antipyretics (68.8%), and antimicrobials (56.2%) were most commonly used for self-medication. Conclusion: Students’ knowledge and attitude about self-medication is good. The prevalence of self-medication among medical students was high.

Reduction of Complications of Local Anaesthesia in Dental Healthcare Setups by Application of the Six Sigma Methodology: A Statistical Quality Improvement Technique

Syed Akifuddin, FaFarheen Khatoon

Background: Health care faces challenges due to complications, inefficiencies and other concerns that threaten the safety of patients. Aim: The purpose of his study was to identify causes of complications encountered after administration of local anaesthesia for dental and oral surgical procedures and to reduce the incidence of complications by introduction of six sigma methodology. Materials and Methods: DMAIC (Define, Measure, Analyse, Improve and Control) process of Six Sigma was taken into consideration to reduce the incidence of complications encountered after administration of local anaesthesia injections for dental and oral surgical procedures using failure mode and effect analysis. Pareto analysis was taken into consideration to analyse the most recurring complications. Paired z-sample test using Minitab Statistical Inference and Fisher’s exact test was used to statistically analyse the obtained data. The p-value <0.05 was considered as significant value. Results: Total 54 systemic and 62 local complications occurred during three months of analyse and measure phase. Syncope, failure of anaesthesia, trismus, auto mordeduras and pain at injection site was found to be most recurring complications. Cumulative defective percentage was 7.99 in case of pre-improved data and decreased to 4.58 in the control phase. Estimate for difference was 0.0341228 and 95% lower bound for difference was 0.0193966. p-value was found to be highly significant with p= 0.000. Conclusion: The application of six sigma improvement methodology in healthcare tends to deliver consistently better results to the patients as well as hospitals and results in better patient compliance as well as satisfaction.

Aetiologies of Acute Undifferentiated Febrile illness in Adult Patients – an Experience from a Tertiary Care Hospital in Northern India

Introduction: Acute undifferentiated febrile illness (AUFI) is a common clinical entity in most of the hospitals. The fever can be potentially fatal if the aetiology is not recognized and appropriately treated early. Aim: To describe the aetiology of fever among patients in a tertiary care hospital in Northern India. Materials and Methods: A one-year retro-prospective, observational study was conducted in adults (age>18years) presenting with undifferentiated febrile illness (of duration 5-14 days). Diagnosis was confirmed by suitable laboratory tests after exhaustive clinical examination. Results: A total of 2547 patients with AUFI were evaluated. Of these, 1663 (65.3%) were males and 884 (34.7%) were females. Dengue (37.54%); enteric fever (16.5%); scrub typhus (14.42%); bacterial sepsis (10.3%); malaria (6.8%); hepatitis A (1.9%); hepatitis E (1.4%); leptospirosis (0.14%); were the main infections while no specific diagnosis could be delineated in 11%. Mixed infections were noted in 48 (1.9%) patients. Conclusion: A good clinical acumen supported by the basic investigations can help diagnose the cause of fever with reasonable certainty.

A Comparative Evaluation of the Effectiveness of Three Different Irrigating Solution on Microorganisms in the Root Canal: An Invivo Study

Introduction: An infected root canal system either due to caries exposure or trauma cannot be eliminated by the host defense mechanisms alone or in combination with systemic antibiotic therapy. It can be treated through professional endodontic intervention using both chemical and mechanical procedures. Aim: To suggest triple antibiotic solution containing tetracycline, ornidazole and ciprofloxacin as a new endodontic irrigant that may possess superior antibacterial activity in comparison with chlorhexidine solution. Materials and Methods: This study was carried out on 60 teeth from 40 children with anterior tooth fracture, asymptomatic, non-vital and necrotic in nature. Patients were randomly divided into three groups of 20 teeth each depending upon the type of irrigant. After access opening microbial samples were obtained: a) Pre- irrigation i.e. sample after pulp extirpation and before irrigation, b) Post-irrigation i.e. sample after irrigation, stored in sterile containers and immediately transferred to microbiological laboratory. After incubation of samples aerobically at 370C for 24 hours, the samples were streaked on blood agar culture media and incubated for 48 hours. After 48 hours, the colony forming units were counted using a colony counter. Statistical analysis was carried out using Kruskal-Wallis test, Wilcoxson signed rank test and Mann-Whitney test. Results: On intra group comparison, highly significant differences in the colony forming units were found between pre-irrigation and post-irrigation sample for all the three groups. On inter group comparison, statistical difference was found between saline and chlorhexidine (p = 0.001), saline and triple antibiotic paste (p< 0.001).The greatest percentage decrease was obtained in samples treated with Chlorhexidine solution (Group 2) i.e.73.91. The triple antibiotic irrigating solution group showed percentage decrease of 66.22 followed by Group 1 (Saline) 15.04. The difference found amongst the groups was statistically insignificant. Conclusion: It was concluded that triple antibiotic irrigating solution can be used as an irrigating solution. The antibacterial action of triple antibiotic irrigating solution is comparable with chlorhexidine. Although saline may not be effective in the antimicrobial action but its flushing action may be able to decrease some microbial load.

Vertical Alveolar Ridge Augmentation by Distraction Osteogenesis

Rajat Mohanty, N.Nanda Kumar, C.Ravindran

Introduction: Compromised alveolar ridge in vertical and horizontal dimension is a common finding in patients visiting practitioners for dental prosthesis. Various treatment modalities are available for correction of deficient ridges among which alveolar distraction osteogenesis is one. Aim: To study the efficacy of alveolar distraction osteogenesis in augmentation of alveolar ridges deficient in vertical dimension. Materials and Methods: Ten patients aged 16 to 46 years with deficient alveolar ridge underwent ridge augmentation in 11 alveolar segments using the distraction osteogenesis method. For each patient a custom made distraction device was fabricated. The device was indigenously manufactured with SS-316 (ISO 3506). Results: The vertical bone gain reached more than 10mm without the use of bone transplantation. Certain complications like incorrect vector of distraction, paresthesia, pain and loss of transport segment were encountered during the course of the study. Conclusion: Alveolar vertical distraction osteogenesis is a reliable and predictable technique for both hard and soft tissue genesis. Implant placement is feasible with primary stability in neogenerated bone at the level of the distracted areas.

Outcome of Capsular Tension Ring (CTR) Implant in Complicated Cataracts

Garima Rai, Anshu Sahai, Pukhrambam Ratan Kumar

Introduction: Surgery in the presence of zonular weakness or subluxated lens was a great surgical challenge and included intracapsular cataract extraction with anterior chamber IOL implantation or pars plana lensectomy and vitrectomy with a sutured (IOL). Modern surgical approache involves placement of endocapsular flexible PMMA ring that prevents iatrogenic loss of zonular support, minimizing vitreous loss and enables placement of in the bag IOL. Aim: To evaluate frequency and indications of capsular tension ring (CTR) implant and analyse the visual and anatomical outcome in various complicated cataract surgeries. Materials and Methods: Retrospective screening of database of 6000 consecutive cataract surgeries was done. BCVA, complete ocular examination with SLEx, intraocular pressure, direct ophthalmoscope, fundus examination with +78/+90D were noted. CTR was implanted in cases where Zonular dialysis of > 3 clock hours was present or capsular bag instability was detected during capsulorhexis or subsequent intraoperative maneuvers. In cases with capsulorrhexis extension, CTR was not implanted. Records were analysed for indication of CTR implant and clinical outcome on Day 1, 1 month and 6 month follow up. Results: In this series CTR implant was done in 45 cases. The indications were hypermature senile cataract in 9 cases, hypermature senile cataract with lens induced glaucoma in 9 cases, pseudoexfoliation syndrome in 9 cases, post blunt injury traumatic cataract in 6 cases, iridochoroidal coloboma in 6 cases, hypermature cataract with pseudoexfoliation and marfan syndrome in 3 cases respectively. Decision of CTR implant was intraoperative in 42 patients. At 6 month follow up, 39 patients had best corrected visual acuity =6/12. IOL decentration was detected in only 3 cases, but without any subjective visual complaints. Conclusion: As per the results CTR was used very infrequently (0.75%) but remains useful in cataract surgeries with difficult pre and intraoperative conditions. It gives good postoperative result and creates satisfied patients.

Evaluation of Crestal Bone Loss Around Implants Placed at Equicrestal and Subcrestal Levels Before Loading: A Prospective Clinical Study

Introduction: Depth of placement of implant shoulder in relation to the crestal bone positively influence bone remodelling and preservation but the role of placement depth on bone loss before loading is not very clear. Aim: To assess the effect of placement depth alone on the crestal bone loss around implant placed at subcrestal and equicrestal level before prosthetic loading. Materials and Methods: Patients reporting to the Department of Prosthodontics with the complaint of missing teeth were enrolled in the study after analysing inclusion and exclusion criteria. A total of 24 implants were planned to be placed into two groups as Group E (n=12) and Group S (n=12). Follow up radiographs after implant placement and after six months were analysed for the amount of bone loss. Results: On six months follow up crestal bone levels of Group E were apical to Group S. Bone loss comparison between groups after six months follow up, revealed almost same mean bone loss. Conclusion: The implants placed at subcrestal and equicrestal level did not show difference in crestal bone loss before prosthetic loading.

Serum Copper as a Marker of Disease Activity in Rheumatoid Arthritis

Montosh Chakraborty, Happy Chutia, Rita Changkakati

Introduction: Copper is an important trace element for normal growth and development of the body. It is also essential for maturation of collagen tissues. The purpose of the study was to estimate the serum copper levels in rheumatoid arthritis patients and to see its association with the various parameters of disease activity. Materials and Methods: The study was carried out among 50 diagnosed rheumatoid arthritis patients (25 each of active disease & remission patients) and 50 age and sex matched controls. Fasting blood sample was collected for estimation of serum copper, haemoglobin level and ESR in the subjects. Results: Mean serum copper level in the case group was found to be significantly higher than that of the control group (p-value<0.001). This increase of copper level was more in active disease than those with remission (p-value < 0.0001). A significant positive correlation was found between serum copper level and ESR, serum copper level and morning stiffness and a negative correlation was found between serum copper level and haemoglobin level in rheumatoid arthritis patients. Conclusion: In rheumatoid arthritis patients, serum copper level may be used as an additional biochemical marker for estimation of disease activity.

Impact of Video Based Learning on the Perfomance of Post Graduate Students in Biostatistics: A Retrospective Study

Karthikeyan Murthykumar, Deepak Nallaswamy Veeraiyan, Preetham Prasad

Introduction: Education, being a process of knowledge transfer always has advances which are generally on par with the discovery of newer technologies. Currently, most of the education process has shifted away from the conventional black board towards the usage of more student friendly technologies. This leads us to the aim of this study, which is to analyse the impact of video based learning on the performance of dental post graduate students in their biostatistics course. Materials and Methods: A new video based discussion method was followed to teach biostatistics to MDS postgraduate students in 2013 (test group, n=44). The performance of these students were compared to a historical cohort of scores obtained by students of the 2012 batch (control group, n=44) who underwent a traditional lecture based teaching for the same course. The scores obtained by the students in their undergraduate board exams were compared to test for difference in academic aptitude of the students in the two groups. Results: The mean exam score of the test group was significantly higher (66.60±8.92) when compared to the control group (53.48±8.38); (p < 0.001 Independent Sample t-test). There was no significant difference in the overall academic performance of the students from both groups (test group mean academic performance was 61.47±4.86 and control group was 63.19±4.69. Conclusion: The results of this study suggest that video based discussion based teaching is more effective in training postgraduate dental students in biostatistics.

Pulmonary Sequestration: A 29 Patient Case Series and Review

Introduction: Pulmonary sequestration also known as bronchopulmonary sequestration is a rare disease, with very few case series reviewed in literature. In this study, we review the demographics, presentation, imaging and treatment of pulmonary sequestration in 29 patients from our institution, and provide comparison data from previously published series with an overview of the disease history. Materials and Methods: Records reviewed for all patients evaluated and treated in our institution with a pathological proven diagnosis of pulmonary sequestration from January 2004 through December 2013. Collected data included demographics, clinical presentation, diagnostic imaging, location of the lesion, type of sequestration, and subsequent treatment. Results: Of the 29 patients reviewed 8 (28%) were children 0-2 years, 1 adolescent age 17, and 20 (69%) adults 21-70 years with a mean age of 42 among adults. Systemic arterial supply to the sequestered segment was demonstrated with computed tomographic angiography (CTA) in 25 patients (86%). In 19 patients (66%), the sequestered segment was located in the left lower lobe, and 16 (55%) were intralobar. Conclusion: Diagnostic delays of pulmonary sequestration were common among the adult population as the presenting symptoms often mimicked other common pulmonary diseases, such as pneumonia and asthma. These findings were consistent among previously published series. CTA was the preferred imaging modality for preoperative planning with high sensitivity and specificity in identifying the lesion.

Clinical Evaluation of Neurosensory Changes in the Infraorbital Nerve Following Surgical Management of Zygomatico-Maxillary Complex Fractures

Introduction: Zygomatico-orbital fractures are the second most common facial injuries. Trauma to mid-facial region can lead to an alteration or loss of sensation in the facial region which sometimes requires early surgical intervention to aid in an early recovery. Aim: To evaluate the different neurosensory changes in the infraorbital nerve function following common treatment modalities used in the management of zygomatico-maxillary complex fractures. Materials and Methods: Thirteen patients selected for the study had unilateral zygomatic complex fracture with altered sensation in the region of distribution of the infraorbital nerve. The fractures were managed either by reduction followed by internal fixation with mini-plates (Group A), reduction alone (Group B) or conservatively (Group C). Infraorbital nerve function tests were done by mechanical, heat and pain threshold detection. Evaluation was done on 1st, 3rd, 7th day, one month, three months and six months interval in a manner similar to that done at the beginning of the study (Day0). Results: A male predominance with male:female ratio of 5.5:1 and an age range of 21 to 50 years was found with the right side mostly affected. Road traffic accident was the most common aetiology. Most common clinical presentations were sub-conjunctival haemorrhage (84.61%), flattening of the malar prominence (69.23%) with deficit in neurosensory function of infra orbital nerve. Recovery in the infraorbital nerve function was relatively complete in 76.92% cases with partial recovery in 23.07% of the patients. Conclusion: Marked improvement in the neurosensory function of the infraorbital nerve was found when some form of treatment either in the form of Open Reduction and Internal Fixation (ORIF) or approach through Gillie’s temporal or Keen’s intraoral approach were applied as compared to when conservative treatment was provided. In zygomatic complex fractures, any form of treatment employed brought about decompression of the infraorbital nerve which aided in the recovery of the nerve within a span of 1-6 months, except when no treatment was applied.

An Infant with Chronic Diarrhoea and Failure to Thrive: Familial Hypobetalipoproteinemia

Ankur Singh, Rajniti Prasad, Om Prakash Mishra

Diarrhoea is a common clinical problem for treating clinicians in developing countries. Mostly, it is attributed to malnutrition and infection. We, as clinicians, tend to miss some of cases who have inherited enteropathies because of lack of suspicion and non availability of diagnostic facilities. Here, we report a case of homozygous hypobetalipoproteinaemia in a nine-month-old female patient presenting with chronic diarrhoea and failure to thrive. Simple parental screening of lipid parameters led to correct diagnosis and early intervention in present case.

Corynebacterium amycolatum: An Unexpected Pathogen in the Ear

Mallika Sengupta, P. Naina, V. Balaji, Shalini Anandan

Non-diphtheritic Corynebacteria are now being increasingly recognised as the causative agents of various infections. Among these organisms, Corynebacterium amycolatum is the most frequently isolated one. It has been isolated from urine, pus, catheter tips, blood, prostatic secretion, cerebrospinal fluid and sputum. However, to the best of our knowledge, there are no reports on its role in ear infections. Here, we present 12 cases of ear infection with C.amycolatum. A high index of suspicion is necessary for identification of these gram positive bacilli as they resemble other Corynebacterium species on gram stain. They have metachromatic granules which can be demonstrated by Albert’s stain and form characteristic dry, flat colonies on blood agar. These organisms are frequently resistant to ceftriaxone and imipenem. In our study, among the 12 isolates, eight isolates were resistant to ceftriaxone and four to imipenem and two were intermediately susceptible to ceftriaxone although all the 12 strains were uniformly susceptible to vancomycin. All the isolates were negative for toxA and toxB genes by PCR. Genomic sequencing of two isolates confirmed them as C.amycolatum. C.amycolatum is a relatively rare cause of pyogenic ear infections. As it demonstrates more antibiotic resistance than other similar organisms, careful identification with antibiotic susceptibility testing is required in managing these infections.

Malignant Melanoma of Nasal Cavity– A Case Report

Richa Bhartiya, K M Prasad

Malignant Melanoma of nasal cavity is an extremely rare tumour and is more aggressive than its cutaneous counterpart. Primary malignant melanoma of nasal cavity arise from melanocytes located in the mucous membrane. Only 0.5% of malignant melanoma arises in nasal cavity. We report a case of malignant melanoma of the nasal cavity in a 51-year-old male who presented with swelling of nose, nasal block and epistaxis. By brush cytology and CT scan imaging, the pre operative diagnosis of malignant melanoma was made which was later confirmed by histopathology examination along with immunohistochemistry by using S100 and HMB 45. Malignant melanoma of nose is rare tumour, with aggressive behavior and poor prognosis. Rarity of this lesion warrants its mention and emphasizes the importance of considering malignant melanoma among the differential diagnosis of tumours of nose and paranasal sinuses.

Concomitant Correction of a Soft-Tissue Fenestration with Keratinised Tissue Augmentation By Using A Rotated Double-Pedicle Flap During Second-Stage Implant Surgery- A Case Report

Soft tissue deficiencies and defects around dental implants have been observed frequently. Soft-tissue defects after implant procedures originate from the process of modelling of periimplant mucosa and often cause aesthetic disharmony, food debris accumulation and soft tissue shrinkage. Periimplant mucogingival surgery focuses on creating an optimum band of keratinized tissue resulting in soft tissue architecture similar to the gingiva around natural teeth. A 23-year-old male reported to the Department of Periodontology with a complaint of gum soreness, foul smell and food accumulation at a site where a 3.75 x 11.5mm implant was placed previously. On clinical examination, fenestration of tissue above the cover screw was observed and there appeared to be a keratinized tissue of 1mm surrounding the implant. The case was managed by use of a rotated double-pedicle flap during second-stage implant surgery to correct the soft-tissue fenestration defect and to obtain a keratinized periimplant soft tissue. A periosteal bed was prepared by giving a horizontal incision at the mucogingival junction to a depth of 4 mm. Two split-thickness keratinized pedicles were dissected from the mesial and distal interproximal tissues near the implant. After rotation, both the pedicles were sutured to each other mid-buccally and the pedicles were rigidly immobilized with sutures. At 1 month, there was a 3mm band of stable and firm keratinized tissue over the underlying tissues. The procedure resulted in an aesthetic improvement due to enhanced soft tissue architecture and optimum integration between the peri-implant soft tissue and the final prosthesis.

A Rare Combination of Ipsilateral Partial Talocalcaneal and Talonavicular Coalition

Raghavendra S Kembhavi, Boblee James

Tarsal coalitions refer to fibrous, cartilaginous or osseous fusion between two tarsal bones. Commonly seen are talocalcaneal coalitions and calcaneonavicular coalitions. Talonavicular, calcaneocuboid and cubonavicular coalition are very uncommonly seen. Talocalcaneal and calcaneonavicular coalitions are generally symptomatic whereas talonavicular coalitions are asymptomatic. Special view radiography, CT and MRI will be helpful in diagnosing coalitions depending on nature of coalitions. In this case report, we present 24-year-old male patient with rare combination of talocalcaneal and talonavicular coalition on ipsilateral side. Patient also showed talar beak sign and arthritic changes at subtalar joint. Considering first time presentation to hospital and milder symptoms, we treated patient conservatively with short leg cast and foot orthoses. With course of treatment, symptoms were relieved significantly.

Prenatal Diagnosis of Tectocerebellar Dysraphia with Occipital Encephalocele

Hakan Timur, Cem Y Sanhal, Aytekin Tokmak, Kamil H Müftüoglu, Nuri Danisman

Tectocerebellar dysraphia (TCD) is an extremely rare disorder and comprises the congenital abnormalities including occipital encephalocele, aplasia and/or hypoplasia of cerebellar vermis and deformity of tectum. Only few reported cases of this entity are there in the literature. However, the diagnosis in each of the previous cases had been made after birth. We herein describe the first reported case of prenatal diagnosis for TCD in a Turkish woman.

A Rare Constellation of Hürthle Cell Thyroid Carcinoma and Parathyroid Carcinoma

Mehrnoosh Zakerkish, Elham Rajaei, Mehrdad Dargahi, Mohammad Bahadoram

Separate occurrence of thyroid and parathyroid carcinoma in patients is extremely rare, and to the best of our knowledge, only 7 patients with documented parathyroid and papillary thyroid carcinomas have been described formerly in published reports. We report a patient with an extremely unusual clinical presentation of Hürthle cell carcinoma in thyroid and parathyroid carcinoma. The patient displayed a rare presentation of life-threatening hypercalcaemia after total para-thyroidectomy and failed to respond to standard therapy. Our review of available literature yielded insufficient evidence in managing such. When a patient with thyroid cancer is diagnosed, checking for serum calcium is advised. This is considered a useful method for detecting possible incidental parathyroid lesion and screening the probable concealed parathyroid pathology.

Proximal Interruption of the Pulmonary Artery: A Case Series

S.H. Anand, Anitha Jasper, Sunithi Elizabeth Mani, Elizabeth Joseph, John Mathai

We present a few cases of Proximal Interruption of the Pulmonary Artery, an uncommon developmental anomaly associated with congenital heart disease. The cases had varied clinical presentations. Chest radiograph showed a hypoplastic lung with an ipsilateral small hilum on the side of the interruption and hyperinflation of the contralateral lung. Contrast CT confirmed the diagnosis, demonstrating non-visualization of the left or right pulmonary artery, and other related findings.

A Case Series on Gossypiboma - Varied Clinical Presentations and Their Management

Seema Chopra, Vanita Suri, Pooja Sikka, Neelam Aggarwal

Retained surgical sponges in the peritoneal cavities are an infrequent operative/surgical complication and an error which is avoidable. The unfortunate situation of forgotten or missed foreign bodies after any surgical procedure may lead to medico legal problems. Though gossypiboma can be found at any operative site but intraperitoneal cavity is the most frequent site reported in literature. Over a period of three years, June 2009-2012, we conducted retrospective analysis of case summaries of eight patients who underwent re-laparotomy for retained surgical sponge at our institute. Pre operative diagnosis was made in 7out of 8 patients, 5 of whom underwent re-laparotomy and one had sponge removed through the caesarean incision, while in another it was removed per-vaginum through the open vault (post hysterectomy). In one patient, gossypiboma was an incidental finding on laparotomy done for adnexal mass. There was no mortality in any of the cases.

Management of Cyclosporine and Nifedipine-Induced Gingival Hyperplasia

Cüneyt Asim Aral, Erhan Dilber, Kübra Aral, Yagmur Sarica, Oya Nermin Sivrikoz

Gingival enlargements modified by medications are becoming more common because of the increased use of inducing drugs, and may create speech, mastication, tooth eruption, periodontal, and aesthetic problems. We hereby present a case of a 54-year-old man with 12-month history of generalized gingival enlargement in the keratinized gingiva was referred to our clinic. The patient had a history of kidney transplant and was under medication of cyclosporine and nifedipine. After medical consultation, cyclosporine was changed to tacrolimus and nifedipine was changed to captopril. Gingivectomy was performed using a diode laser, and scaling and root planning were performed. At five months postoperative, the gingival enlargements relapsed and diode laser-assisted surgery was repeated. The patient was followed-up on second postoperatively at 18 months and no relapse was seen. Diode laser-assisted gingivectomy was found to be useful for coagulation during surgery and decreased postoperative bleeding. Recurrence risk of cyclosporine and nifedipine-induced gingival overgrowth is high, thus, there is a great need for prolonged care of patients following treatment and prosthetic restoration.

HSV Encephalitis with Normal CSF — A Case Report with Review of Literature

Gautam Rawal, Sankalp Yadav, Umar Rasool Wani, Alok Kumar Ambastha

Herpes simplex virus encephalitis (HSVE) is one of the most potentially fatal infectious disease that should be detected as early as possible. The combination of clinical history and examination, brain computed tomography or magnetic resonance imaging (MRI) and lumbar puncture have been used to establish a diagnosis. The authors present a case of HSVE with normal CSF analysis, but typical MRI findings consistent with HSE and CSF PCR positive for Herpes simplex virus1 DNA, who responded to Acyclovir therapy with complete recovery.

Bilateral Multiple Variations in Carotid Arteries-A Case Report

The common carotid arteries are the largest bilateral arteries of the head and neck. The common carotid arteries may bifurcate higher or lower than the usual levels. A higher bifurcation is more common. Tortuous arteries if present may be asymptomatic if it is mild but may lead to ischaemia of the organs if severe. The cause could be genetic, or may be thickening of the arteries. During routine dissection of an adult male cadaver in the department of Anatomy, BLDEU’s Shri BM Patil Medical college, Vijaypur, we found the bilateral multiple variations in the carotid arteries regarding the bifurcation level of common carotid arteries, tortuous external and internal carotid arteries and the number of branches arising from external carotid arteries. The knowledge of such variations of carotid arteries is of great importance in radiological examinations especially per cutaneous carotid angiography. It is necessary to understand the anatomy of these vessels and its variations to carry out surgeries with minimum complications.

Herpes Zoster Duplex Bilateralis in Immuno-Competent Patients: Report of Two Cases

Atul Vijay, Gauravav Dalela

Herpes Zoster is a common viral disorder, occurs due to reactivation of latent Varicella Zoster Virus (VZV) usually in adults or elderly patients, usually confined to a single dermatome. Herpes zoster duplex is a rare but well established entity which is simultaneous, occurring of herpes zoster at two different non contiguous dermatomes, can be unilateralis or bilateralis. Here we are reporting two cases of herpes zoster duplex bilateralis, in case-1 lesions occurs in two different distant dermatomes while in case-2 it appeared in a single dermatome but both sides were involved. Both the patients were healthy immuno-competent male.

Giant Cell Tumour of Soft Tissue in Neck: An Uncommon Tumour in an Uncommon Location

Giant cell tumour of soft tissue is an extremely rare tumour. It is thought to be the soft tissue counterpart of giant cell tumours of the bone due to its histological and immunohistochemical resemblances. Almost 80% of these tumours occur in upper and lower extremities; neck is a very rare location. Here we describe a case of primary soft tissue giant cell tumour in right submandibular region. A 35-year-old male patient presented with a swelling in right submandibular area. FNAC suggested a benign soft tissue neoplasm, comprising of spindle cells and multinucleated giant cells. Histopathology of resected specimen showed spindle cell tumour with intricately mixed giant cells, consistent with a primary giant cell tumour of soft tissue. Giant cells were CD 68 positive. Giant cell tumour of soft tissue is benign tumour, though very rarely can show features of malignancy. We present this case for its rarity and morphological overlap with other soft tissue neoplasms containing giant cells.

Filippi Syndrome: Report of a Rare Case

Lata Goyal, Jagdish Prasad Goyal, Bhanu Kiran Bhakhri, Ashi Chug

Filippi syndrome is an autosomal recessive condition characterized by syndactyly of fingers and toes, microcephaly, growth retardation and abnormal facies. We are describing a boy who presented with syndactyly, mental retardation, microcephaly, depressed nasal bridge and growth retardation. In addition he had some dental abnormalities like missing bilateral lateral incisors and delayed eruption of teeth. We concluded it to be Filippi syndrome by studying pathognomic clinical features and reviewed the literature. This is the second case report from India.

Large Tubullo-villous Adenoma of Duodenum Presenting as Gastric Outlet Obstruction

Tubullo-villous adenoma of duodenum is a rare entity. These are potentially malignant tumours and therefore, complete excision is the treatment of choice. However, at times preoperative diagnosis could not be always achieved posing difficulty in choosing the optimal surgical method of excision. We report a 40-year-old male patient presented with vague upper abdominal pain and vomiting for last 6 months. His computed tomography and endoscopy demonstrated intraluminal polypoidal mass. Endoscopic biopsies were negative for malignancy. Local surgical excision with tumour free margin was performed and histology revealed tubullo-villous adenoma.

Nasal Septal Angiofibroma in a Post-Menopausal Woman: A Rare Entity

Sandie Ewe, Farah Dayana, Fazalina Mohd Fadzilah, Balwant Singh Gendeh

Juvenile angiofibromas (JAs) are well-characterised in literature, arising typically in the posterolateral wall of the nasal cavity of young males. Numerous theories have been proposed to explain the occurrence of this unique and rare tumour. Angiofibromas originating in other sites within the head and neck have been described but this is exceedingly rare, constituting less than 2% of all diagnosed cases. Extranasopharyngeal angiofibroma is a rare lesion, and more importantly, controversial. It is not known whether it is actually a relative of the well-known JA that is seen exclusively in adolescent males. We present the case of a post-menopausal woman with unilateral nasal obstruction who was unexpectedly diagnosed as nasal septal angiofibroma.

Osteochondroma of Upper Dorsal Spine Causing Spastic Paraparesis in Hereditary Multiple Exostosis: A Case Report

Osteochondroma of the spine is rare. It may present in solitary or multiple form (hereditary multiple exostoses). Herein, we report a case of an 18-year-old male who was diagnosed with thoracic osteochondroma, originating from the D4 vertebra with intraspinal extension and spinal cord compression in hereditary multiple exostosis. The patient was managed with surgery. Complete tumour excision was done to relieve cord compression and recurrence. Postoperatively the patient's symptoms were improved. At 2.5 year follow-up patient is doing well without any recurrence.

Robinow Syndrome: A Rare Diagnosis

Shubhankar Mishra, Sunil Kumar Agarwalla, Swayanprava Pradhan

Robinow syndrome is a rare entity characterized by short stature and abnormalities of the head, face and external genitalia. It is otherwise called ‘fetal face syndrome’ due to its resemblance with fetal face. We present an eight-year-old female child who came with mesomelic short stature, abnormal facial features, multiple sets of teeth (both deciduous and permanent), pectus excavatum, umbilical hernia, limb abnormalities like shortening of fore arm, simian crease, broad thumbs and other fingers, clinodactyly, abnormal carrying angle, absent labia minora, absent clitoris. Apart from physical appearance she was having diversification of recti and umbilical hernia. Due to the several physical presentation mild systemic involvement it was diagnosed as autosomal dominant robinow syndrome. She is now on follow up and planned for a cosmetic surgery to repair facial defects.

Fibroepithelial Polyp of the Tonsil: Report of a Rare Case

Ramesh Babu Telugu, Gaurav Ashish

Pedunculated polyps of the palatine tonsil are rare benign tumours of tonsil. Most of the cases have been reported in adults with varying presenting symptoms. We report a 12-year-old male child who presented with 6 months history of difficulty in swallowing. There was no history of breathing difficulty, change in voice or history of trauma. Clinical examination revealed a 2x1 cm small pedunculated polyp arising from the superior pole of right tonsil which was excised under general anaesthesia. Left tonsil was normal. A diagnosis of fibroepithelial polyp of right palatine tonsil was made based on histopathological findings. An unusual presentation of a rare condition in a paediatric patient has been discussed along with the clinical and histopathological features of this lesion.

Placenta Percreta Presenting with Delayed Haematuria

Vinayak Gorakhanath Wagaskar, Sudarshan Omprakash Daga, Sujata Kiran Patwardhan

Placenta percreta presents as life threatening complications with bladder invasion. A condition of placenta invading urinary bladder presented with differential diagnosis of gestational trophoblastic neoplasia on imaging and responded to chemotherapy. A 35-year-old primi-gravida presented at term with per vaginal bleeding. During caesarian section placental mass totally invading uterine myometrium was found. She was given single dose of Methotrexate. After 2 months she presented with gross haematuria with clot retention two times. Her MRI was suggestive of gestational trophoblastic neoplasia of size 19 X 10 X 13cm. Her beta-Human Chorionic Gonadotropin levels were 691.23 mIU/ml. She was given total four doses of methotrexate. At present size of mass was 1.6 X1.3X 1.1cm. Her beta Human Chorionic Gonadotropin level dropped down to 2mIU/ml. Patient was not willing for further intervention or for follow up.

Abridged Technique for Precise Implant Angulation

Enormous scientific knowledge with evidence and clinical dexterity impart definitive ground for success in implant dentistry. Nevertheless, the unfeasibility to access the inner bone tissue makes the situation altogether more demanding. Presently the advent of numerous imaging techniques and associated surgical guide templates are documented for evaluation of implant angulation. However, they are not cost effective and consume more time to plan and design the structure. This article describes a simple concise technique for precise implant angulation.

A Rare Occurrence of Enchondroma in Neck of Femur in an Adult Female: A Case Report

Partap Singh, Ujjwal Kejariwal, Ankush Chugh

Enchondroma is a solitary, benign, intramedullary cartilaginous tumour occurring most commonly in small bones of hands and feet. Distal femur and proximal humerus are other less common locations. Enchondroma consists of 3-10% of all bone tumours, while they constitute 12-24% of benign bone tumours. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Radiographs reveal a localized, radiolucent lytic bone defect usually with punctuate calcifications. Lesions are central or eccentric and metaphyseal involvement most commonly for long bones. MRI and histopathological examination can be used to confirm the diagnosis. Asymptomatic cases can be managed conservatively with serial radiological follow ups. Cases with symptoms are managed operatively. Recurrence rate is very low (<5%), it suggests malignancy. We here present a case of a 30-year-old female patient who presented with a history of pain in right hip since 7 months. Radiological examination showed the lesion to be enchondroma. The patient was managed by curettage with autogenous iliac bone graft & prophylactic 6.5 mm cannulated screws fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow up after 6 months, the patient was symptom free and there was no evidence of any recurrence. The current case report of enchondroma located in the neck of femur signifies the importance of early diagnosis, timely intervention and treatment. Also, this case report represents one of the very rare cases reported in literature.

Repositioning of Misplaced Central Venous Catheter with Saline Injection Under C-Arm Imaging

Parshotam Lal Gautam, Sandeep Kundra, Krishan Jain, Hitika Monga

Malposition of central venous catheter is a well known technical complication. Misplaced catheter often requires reinsertion for proper placement of the catheter in the superior vena cava (SVC) to support safe delivery of care and minimize complications. But reinsertion exposes the patient once again to risks of complications related to the procedure including potential of misplacement. Literature describes only a few techniques for repositioning a misplaced central venous catheter (CVC). We tried old simple method of saline injection with force under image intensifier using hydrostatic force of intravenous fluid to straighten the CVC. We could successfully reposition two misplaced CVC’s using this method.

Interstitial Lung Disease in Systemic Scleroderma, Complicated with Bilateral Pulmonary Aspergilloma: An Unusual Association

Saumen Nandi, Avradip Santra, Loknath Ghoshal, Soumya Kundu

Aspergilloma or mycetoma is a saprophytic fungal infection that colonizes pre-existing excavated lung lesion. However, its association with systemic sclerosis related interstitial lung disease is unusual and scarcely found in literature. We report a middle aged female with long standing systemic sclerosis, who was on immunosuppressive therapy for many years, presented with repeated haemoptysis. Although provisionally pulmonary tuberculosis was suspected, imaging investigations showed presence of bilateral masses inside bullous air spaces along with air-crescent sign suggestive of fungal ball. Subsequent Computed tomography guided needle aspiration from lung mass confirmed Aspergillus fumigatus as aetiologic agent on fungal culture. Patient was treated conservatively for haemoptysis and with oral antifungal drug as surgical removal of fungal ball was not an option due to poor pulmonary reserve. Although she had been treated with itraconazole for more than three years, she had recurrent haemoptysis during this period without any significant regression of size of the aspergilloma. Management of aspergilloma in a background of extensive interstitial lung disease remains poorly defined and complicated. Thereby, overall prognosis is unfavourable and depends on evolution of both underlying scleroderma as well as aspergilloma.

Multiple Compond Odontomas in the Jaws: A Rare Case Report

Pavan Kumar Gujjar, Priya Sahni, Treville Pereira, Jyoti Zingade

Odontomas are tumours of odontogenic origin. In these tumours both the epithelial and mesenchymal cells undergo differentiation to form enamel and dentin with variable amounts of cementum and pulp tissue. The odontomas represent a hamartoma rather than a neoplasm. When the enamel and dentin are laid down in an organized manner it is termed as a compound odontoma wherein the tumour forms a collection of small structures resembling teeth. On the other hand, an irregular mass with no similarity to teeth is termed as a complex odontoma. There are cases of extensive and multiple compound odontomas which have been identified in either of the jaws. The present case is rare with multiple compound odontomas involving both the jaws of 45-year-old male patient. A review of seven such cases reported so far has been presented.

Unusual Morphological Alteration in Sigmoid Notch: An Insight Through CBCT

The Temporomandibular Joint (TMJ) is a ginglymo-diarthrodial joint known to be the most complex joint in human body. Growth disturbances, owing to genetic influences or trauma during the intrauterine life or during early developmental age may lead to morphological and functional variations in the mandible resulting in developmental anomaly. We report a rare case of altered sigmoid notch morphology on the right side and condylar hypoplasia on the left side, not related to any clear pathological disorder. Cone Beam Computed Tomography (CBCT) was helpful in evaluating this case. This case of unknown aetiology was thoroughly examined; based on clinical and radiographic findings, we suggest that this case is of congenital origin.

Rare Co-existence of Squamous Cell Carcinoma with Infiltration of Renal Vein and Xanthogranulomatous Pyelonephritis

K.V. Kanodia, A.V. Vanikar, R.D. Patel, L. K. Nigam, H. L. Trivedi

Primary renal squamous cell carcinoma is a very rare malignancy of the upper urinary tract. Most patients have history of chronic urolithiasis, analgesics abuse, radiotherapy or infection. Co-existence of SCC with xanthogranulomatous pyelonephritis is exceedingly rare with only few reports in the literature. We report a case of a 60-year-old male presented with right flank pain and mild tenderness of abdomen. Computed tomography of the abdomen revealed gross hydronephrosis with parenchymal thinning and irregular thick enhancing wall of pelvicalyceal system with multiple calculi in right kidney. Right renal vein appeared distended, filled with hypo dense material. Right nephrectomy was performed and sent for pathological examination. Histological evaluation revealed keratinizing squamous cell carcinoma with infiltration of renal vein and xanthogranulomatous pyelonephritis.

Primary Extra-Gonadal Retroperitoneal Seminoma, Clinically Mimicking Sarcoma

Davsheen Bedi, Permeet Kaur Bagga, Amarjit Singh, Vaishali Verma

Extra-gonadal Germ cell tumours (EGCTs) are germ cell tumours that are found in locations other than the gonads. These tumours are seen in young males in the midline, mostly in the mediastinum followed by retroperitoneum, pineal gland, and sacrococcygeal area. While most of these are non-seminomatous, few are seminomatous. We present here a case report of a 25-year-old, mentally retarded male patient, with bilaterally normal testes, who presented with a huge mass in abdomen. The ultrasound and CECT (Contrast Enhanced Computerized Tomography) scan done showed two large retroperitoneal masses, which on FNAC (Fine Needle Aspiration Cytology) suggested germ cell tumour. Surgical resection was done and the subsequent histopathological examination provided the diagnosis of seminoma, which was further confirmed by PAS (Periodic Acid Schiff) staining and Immunohistochemistry for PLAP (Placental Alkaline Phosphatase). Retroperitoneum is a common site for sarcomas, which also present as huge, bulky masses. Thus, EGCTs should be considered in the differential diagnosis of a soft-tissue mass in abdomen, especially arising in the retroperitoneum.

Difficulties in Management of a Sessile Subglottic Polyp

H.T. Lathadevi, S.P. Guggarigoudar

Benign laryngeal polyps are usually managed with micro-laryngeal surgery. Occasionally surgery becomes challenging because of size of the polyp or its location. Maintaining the anaesthesia and the airway becomes difficult either during immediate management or during excision. Upper airway obstruction still remains the major indication for tracheostomy in many centers. Nowadays Laryngeal tumour has become the main indication of tracheostomy. Conditions like infections, trauma, benign lesions and prolonged intubation were leading indications previously. Otolaryngologist has to decide a method, often on the spot. Here we are presenting such a case where emergency tracheostomy was the only choice.

Mucoepidermoid Carcinoma of Floor of the Mouth – A Rarity

Mucoepidermoid Carcinoma (MEC) is one of the most commonly occurring malignant salivary gland neoplasm, and contributes 2.8%–15% of all salivary gland tumours. More than half of these cases involve the major salivary glands, primarily the parotid glands and minor salivary glands. Sublingual salivary glands neoplasms are very rare and constitute 0.5% and 1% of all epithelial salivary tumours and approximately 1.5% of the major salivary glands carcinomas. Here we describe a case report of low grade mucoepidermoid carcinoma in the floor of the mouth in a 70-year-old female patient that was mimicking like a ranula clinically.

Accelerated Phase of Chediak-Higashi Syndrome at Initial Presentation: A Case Report of an Uncommon Occurrence in a Rare Disorder

Pooja Jaiswal, Yogesh Kumar Yadav, Nilam Bhasker, Rashmi Kushwaha

Chediak-Higashi syndrome (CHS) is an uncommon and fatal congenital disorder. The characteristic features of CHS are partial oculocutaneous albinism, increased vulnerability to infections, presence of abnormal large granules in leukocytes and an accelerated lymphohistiocytic phase. Accelerated phase at initial presentation is rarely seen as it is usually preceded by repeated episodes of infections. Hence this interesting case of a four-month-old Indian child born to consanguineous parents in accelerated phase at initial presentation is described. The boy presented with fever, hepatosplenomegaly, and cleft lip. Clinical diagnosis was leukemia or a lysosomal storage disorder. Cytopaenias, lymphohistiocytic infiltration in bone marrow, and the characteristic large granules in leucocytes helped in the diagnosis, emphasizing the importance of bone marrow in diagnosis of unusual presentation of this rare disorder.

The Combined use of Diode LASER & Conscious Sedation in the Excision of Pyogenic Granuloma in A Nine-Year-Old Patient

This case report is to comprehensively review N2O/ O2 inhalational sedation in the context of conscious sedation for treating a nine-year-old patient with pyogenic granuloma. The excision was carried out by the use of diode laser. The six month postoperative follow up showed complete resolution of the lesion and increased patient acceptance for the future treatment. The use of laser minimizes the pain during the surgery and postoperatively and suturing was not required. Therefore this case report emphasizes the use of combined treatment modalities to increase patient comfort and to obtain a better function and aesthetics of the oral cavity.

Multifocal Bullous Fixed Drug Erruption Due To Phenytoin: A Lesson Learned!

Ankur Jain, Naresh Gupta

Antiepileptic drugs (AED) are a common culprit of cutaneous eruptions in clinical practice. Phenytoin, lamotrigine and carbamazepine are the commonest offenders. Maculopapular eruptions are the most frequently reported events. However, multifocal bullous fixed drug eruptions have rarely been described in association with AED use. The risk factors for skin rash including its association with the rate of drug administration are unclear in the literature. We report a case of a young alcoholic man, on long term phenytoin therapy since 3 years, who presented to our emergency department with a breakthrough seizure episode. Patient’s routine investigations including serum biochemistry, imaging and toxicology screen were normal. Patient was found to have sub-therapeutic serum phenytoin levels and was prescribed loading with intravenous phenytoin (15mg/kg body weight), which was mistakenly infused at a rapid rate (60mg/minute). Patient developed multifocal bullous lesions over muco-cutaneous regions after 6 hours of drug administration which healed after its discontinuation leaving behind residual hyperpigmentation. Patient was managed conservatively, switched to oral levetiracetam and discharged in a stable condition after one week of hospital stay. Present case highlights a yet uncommon reaction to a commonly used drug and tries to establish the relation between rate of drug infusion and the risk of skin reaction.

Bilateral Krukenberg Tumours Diagnosed Primarily by Transabdominal Sonography- A Case Report

Krukenberg tumour, also known as carcinoma mucocellulare, is a metastatic adenocarcinoma of ovaries from different primary tumour sites. Gastric carcinoma is most common primary tumour responsible for approximately 50% of Krukenberg tumours. Discrimination between primary ovarian cancer and metastatic tumours in the ovary is important, because their management is different. Here we present a case of female suffering from gastric carcinoma with bilateral Krukenberg tumours, diagnosed primarily by transabdominal sonography. The patient was referred to higher centre for further treatment and followed up.

The Diagnosis of Sigmoid Liposarcoma in a Young Male with Metabolic Syndrome

Cezary Rudnicki, Marek Romanowski, Marta ME¸drek-Socha, Krystyna Stec-Michalska

The clinical picture and risk factors are decisive in differential diagnosis. It was proved that patients with metabolic syndrome have increased incidence of malignant tumours. The visceral adipose tissue releases active proteins that promote oncogenesis. We are presenting a case of 34-year-old male with metabolic syndrome suffering from pain in left iliac fossa with accompanying variable stool pattern. At first, the sigmoid diverticulosis was suspected. Patient’s condition after the treatment has improved. The ambulatory, partial colonoscopy revealed a cauliflower-like, balloting, wide-base growth in the sigmoid that narrowed its lumen. The biopsy did not reveal atypical growth characteristics. Because of tumour type and enlarged regional lymph nodes seen in abdomen CT scan, the segmental colon resection and end-to-end anastomosis was performed in the area of sigmoid-rectal junction. Macroscopically, there were no visible metastases in the operation field. The surgery and postoperative period ran without any complications. On histopathological examination, the removed tumour was a well differentiated liposarcoma (WDL) stemming unusually from adipose tissue of colonic submucosa in an obese male. WDL is a hard to diagnose tumour, especially in early stages of its growth. In the presented case, the tumour was completely resected.

Disseminated Histoplasmosis in an Immunocompetent Patient Diagnosed on Bone Marrow Aspirate – A Rare Presentation from a Non–Endemic Area

Nidhya Ganesan, Reetika sharma, Manjiri Dilip Phansalkar, Renug boy Varghese

Histoplasmosis causing systemic fungal infection is commonly seen in endemic areas. In India, disease prevalence is more in eastern part of the country and there have been very few reports from southern part of India. The occurrence of disseminated histoplasmosis in immunocompetent individual is rare. We report a case of disseminated histoplasmosis in an immunocompetent individual with no underlying risk factors. The disease was not suspected clinically and was diagnosed by bone marrow aspirate incidentally.

Imaging in Rare and Atypical Sinonasal Masses: An Interesting Case Series

Shantiranjan Sanyal, Akhila Prasad, Deb Kumar Baruah, Umesh Chandra Garga

Sinonasal tumours present a myriad of radiographic findings. While many of these tumours have been well described with regard to their typical sites of origin, age group and radiological appearance we have come across lesions in our daily practice which are exceedingly rare with regard to site of origin in sinonasal cavity. The radiological appearances of 4 such rare and unusual tumours arising in sinonasal region evaluated by cross sectional imaging (CT/MRI) have been illustrated in this article with a purpose to review the radio-pathological correlation of these tumours and to explain the utility of cross-sectional imaging CT and MRI in exploring diagnostic clues. Morphological features and radiological patterns of each tumour have been graded into mild, moderate and severe based on the extent of tumoural involvement. This review is intended to acquaint radiologists with the appearance of atypical sinonasal masses and their radiological appearance on cross sectional imaging to make an early diagnosis.

Glandular Odontogenic Cyst of Mandible: A Rare Entity

Ankur Mittal, Vikram Narang, Gursheen Kaur, Neena Sood

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst. It is a slow growing and asymptomatic swelling, usually affecting middle aged men and has tendency to reoccur. Here, we report a case of GOC in the anterior portion of mandible diagnosed by histopathology.

Valproate Induced Hyperammonemic Delirium

Sodium valproate induced hyperammonaemic delirium with normal liver function tests is a relatively uncommon adverse effect. It may be mistaken for psychosis or worsening of mania leading to wrong diagnosis and improper management. Plasma ammonia levels should be monitored in all patients developing altered mental status after receiving valproate therapy. This is a case series of hyperammonaemic delirium due to valproate reported to the Department of Pharmacology from Department of Psychiatry over a period of one year.

Incidentally Detected Testicular Metastasis in a Case of Prostatic Adenocarcinoma

Adenocarcinoma of the prostate is one of the common cancers among elderly men worldwide. However, testicular metastasis detected incidentally after orchiectomy is a rare presentation as most commonly we encounter patients presenting with bone metastasis at the time of primary diagnosis. Here, we describe a recently diagnosed case of prostatic carcinoma that had metastasis in a single testis, incidentally detected in the orchiectomy histopathological specimen, performed for surgical castration and emphasize the importance of routine microscopical examination of the testicular specimens.

Primary Angiosarcoma of the Breast: An Uncommon Histopathological Subtype

Primary angiosarcoma of the breast is extremely rare malignant tumour of the breast. The cytological and radiological findings are often non specific for diagnosis. Histopathology plays an important role in diagnosis and grading of tumour. Herewith we present a case of 55-year-old postmenopausal woman having history of rapidly enlarging right breast lump with prominent vascularity and associated bluish discolouration of overlying skin. Mammography shows ill defined mass lesion. Fine needle aspiration cytology was done which showed haemorrhagic aspirate with few clusters of highly pleomorphic neoplastic cells. Patient underwent modified radical mastectomy. On histopathological evaluation it showed primary angiosarcoma of the breast, poorly differentiated, grade-III. We are presenting this extremely rare malignancy of breast for its clinical, cytological and histopathological findings.

Necrotizing Sialometaplasia of the Hard Palate: A Rare Entity of Dilemma on Cytology, Confirmatory on Histopatholog

Necrotizing sialometaplasia is a rare, benign reactive necrotizing lesion, involving sites where salivary gland tissue is usually present. The importance of this lesion is that it mimics malignancy clinically leading to treatments ranging from conservative excision to total maxillectomy. Cytologically and histologically also the lesion is often confused with neoplasms. We present a case of a lady with a hard palatal swelling, which was non – ulcerative unlike typical cases of necrotizing sialometaplsia. FNAC features made us strongly suspect a low grade mucoepidermiod carcinoma, following which the swelling was excised. Histopathology came to the rescue, on which the final diagnosis of necrotizing sialometaplasia of the hard palate was made. Necrotizing siaometaplasia is often misdiagnosed by the inexperienced cytologist, with histopathological examination being confirmatory. We also emphasize the fact that lesions like necrotizing sialometaplasia need a high degree of suspicion along with clinical co relation before subjecting the patient to unnecessary surgical procedures.

PET-CT with MR Fusion: Single Comprehensive Preoperative Metastatic Workup in Head and Neck Malignancy: A Case Report

Karan Gupta, Dushyant Mandlik, Purvi Patel, Tushar Desai, Kaustubh D. Patel

Head neck cancers (HNC) are the sixth most common cancer worldwide. In presence of the complex anatomy of this region, early diagnosis can sometimes be a challenge. At present for the TNM staging, contrast enhanced CT and MRI are the primary imaging modalities for evaluating T stage of HNSCC. Multiple studies suggest that PET/CT might be superior to conventional imaging (CT or MRI) in initial staging and may alter management and treatment especially when distant metastases are discovered. We present a case of a 35-year-old patient who presented to us with an ulcerative lesion on the left buccal mucosa, which was staged as cT2N0M0, using the conventional radiology. But on subsequent imaging by PET-CT with MR-fusion was upstaged to cT4bN0M0, thus completely changing the management of the patient. With the recent advances in technology leading to fusion of MRI images with PET-CT images have combined the benefits of all three imaging modalities and has led to increased sensitivity towards soft tissue and peri-neural invasion of tumours leading to upstaging of primary oral cavity malignancies, altering their management. Accuracy is increased when the information of multiple imaging modalities are analysed together and has the potential of changing the management plan of patients.

Successful Management of Live Cervical Ectopic Pregnancy: A Case Report

Sunita Samal, Seetesh Ghose, P Pallavee, P Porkkodi

Cervical pregnancy is a rare form of ectopic pregnancy with potential grave consequences occurring in approximately 1:9,000 deliveries. It is life-threatening as the pregnancy is implanted in the endocervical canal and the trophoblast can penetrate through the cervical wall and into the uterine blood supply resulting in catastrophic haemorrhage. Historically, the treatment had been hysterectomy because of the considerable risk of life-threatening haemorrhage, but in the recent past various conservative management modalities have been applied to preserve fertility. Here, we report a case of successful (both medical and surgical) management of cervical ectopic pregnancy in a young woman. A 29-year-old, gravid 2, para1 and living 1 with previous caesarean section had presented with mild bleeding per vagina for 5 days following 7 weeks of amenorrhoea. Past menstrual, medical, surgical and family history were unremarkable except the previous caesarean section. On examination vital signs were normal but pelvic examination revealed a distended cervix with bulky uterus, without anyadnexal mass or tenderness and no cervical motion tenderness. Further transvaginal sonography showed a live cervical gestation of 7 weeks and 4 days and serum beta-HCG value of 1,03,113mIU/ml. Patient received conservative approach with combination of intraamniotic potassium chloride and methotrexate and suction curettage. Due to conservative approach emergency hysterectomy and blood transfusion was avoided.

Tinea Capitis: Mixed or Consecutive Infection with White and Violet Strains of Trichophyton violaceum: A Diagnostic or Therapeutic Challenge

Rameshwari Thakur, Roma Goyal

Tinea capitis is a common dermatophyte infection affecting scalp and hair of pre-pubertal children. With introduction of Griseofulvin in 1958, there has been considerable improvement in the treatment of tinea capitis. A seven-year-old male child was brought to the dermatology clinic. He presented with diffuse white scaly patches of alopecia on scalp of one-year duration. The child was sent to the microbiology section of the National Health laboratory, Botswana for the collection of the samples. The samples consisted of scalp scrapings and few plucked hairs from the suspicious areas, which were collected by swab and scalpel blade methods. Potassium hydroxide (10% KOH) mounts were prepared for scales and hair samples. Scales were positive for fungal elements and endothrix type of perforation was seen in hair. Cultures on Sabouraud’s dextrose agar (SDA) and Derm agar were incubated at 25°C, which yielded white variant of Trichophyton violaceum after two weeks of incubation. T. vioaceum (white variant) grew in all the plates. After six weeks of treatment with griseofulvin, the repeat culture grew only T. violaceum (violet strain). The child showed a definite clinical improvement.

Umbilical Cord Haematoma Causing Still Birth- A Case Report

Anuja Abraham, Swati Rathore, Mayank Gupta, Santosh Joseph Benjamin

Still birth continues to be one of the many challenges that an obstetrician has to face. Still births that occur in the antenatal period are more difficult to explain than that which occurs intrapartum. The latter is most often due to intrapartum asphyxia, medical complications or infections; however a cause for antenatal still birth is difficult to ascertain. A thorough examination of the case along with necessary investigations might not necessarily reveal any cause and this leads to considerable anxiety for both the mother and the treating obstetrician. In the investigation of a case of still birth a detailed examination of the placenta and cord has to be emphasised as a considerable number of still births that are thought to be unexplained may be attributable to placental or cord pathologies. Here we present one such case where an umbilical cord haematoma resulted in intrauterine foetal death.

Multifocal Cutaneous Tuberculosis in Immunocompetent Individual

Malay Mehta, Gopikrishnan Anjaneyan, Kirti Rathod, Rita V Vora

Most common form of cutaneous tuberculosis (TB) is lupus vulgaris, which usually occurs in previously sensitized individuals who have a high degree of tuberculin sensitivity. Various forms including plaque, ulcerative, hypertrophic, vegetative, papular, and nodular forms have been described. We are reporting a case of a young female, who presented with 6 well defined erythematous scaly plaques involving both arms and a puckered scar on right forearm and right breast. Clinically, it was looking like lupus vulgaris with cold abscess, few lesions mimicking scrofuloderma, but skin biopsy from both the types of lesions revealed lupus vulgaris. Patient improved with Anti Tuberculous Therapy and surgical drainage of underlying cold abscess.

Osteoporosis: Its Prosthodontic Considerations - A Review

Osteoporosis is a disease of bone which is common in middle aged post-menopausal women. The osteoporotic bones will become weak and are prone to fractures. Osteoporosis means “porous bone” is a “silent disease”. Healthy bone microscopically appears like a honeycomb but, in osteoporotic patients the spaces are much bigger. The osteoporotic bone will have less density or mass and the structure of bone tissue is abnormal. As the bone becomes less dense, they become weaker and more likely to fracture. Women are four times more likely to develop osteoporosis than men. Oral health maintenance for adults with osteoporosis is important. Bone weakness and loss may also affect the ridges that hold dentures resulting in poor fitting dentures. The patients require new dentures more often than those who have strong, healthy bones. Best way to handle problems is avoid delaying or postponing the dental treatment. Regular dental visits and healthy lifestyle is necessary in strengthening and maintenance of good bone health. Well balanced diet with high amounts of vitamin-D & calcium with regular physical activity is recommended.

Disaster Management and the Role of Oral Maxillofacial Surgeons

“Disaster” the word itself suggests an event resulting in great loss and misfortune. In this developing world, India is becoming more powerful and is shining across the world. But we are still left to deal with various disasters, so that no harm comes to mankind. India has the occasional national disaster to which we have to promptly respond. Like the rest of the world, India has become a terror prone nation and recent attacks since the last decades affected not only the function but also it made citizens insecure. As we are in a large nation so, no matter how large a disaster it may be; we have to overcome it. The oral and maxillofacial region in a human body is very delicate with complicated anatomy, which decides the life of a human being. The management of disaster is a multitask approach, in which maxillofacial surgeon plays an important role. It is a very difficult task to operate in disaster zone. It is essential for a surgeon to make quick and important decisions under stressful conditions. Usually the surgeries are performed in a well-equipped hospital but, when it comes to disaster zone the surgeon have to treat the patient with a minimal armamentarium available within a fraction of time. The surgical competence in a disaster field is an alarming situation. Disaster management itself is not an alarming situation but the time management is important for better outcomes. A surgeon however should be trained, so that he should not miss injuries for better outcomes along with personal safety. The article discusses about disaster management strategy and guidelines for both oral maxillofacial surgeons and the statuary body to make maxillofacial surgeon as part of disaster management team for better outcomes.

Hirudotherapy in Medicine and Dentistry

Kunal Jha, Aarti Garg, Ridhi Narang, Sunanda Das

The concept of Unani medicine is based on balancing body humours, the imbalance of which causes diseases. The application of leech therapy in medical and dental science is well recognized. Although easy and non-invasive, complications also exist. The article aims to presents a brief review on the applications of leech therapy. The physiological effect, along with its therapeutic role in cancer, diabetes and dentistry have been underlined. Complications of leech therapy have also been dealt with.

Green Hospital and Climate Change: Their Interrelationship and the Way Forward

Vardeep Singh Dhillon, Dilpreet Kaur

Climate change is a reality, and the modern healthcare sector not just contributes towards this grave phenomenon but is itself being affected by it. The present review was thus conducted to understand the meaning of ‘Green Hospital’, to identify the many ways in which health sector is contributing towards climate change, to explore possibilities for countering this grave trend and last of all to look for institutions that are pioneering change. Data for the review was extracted from multiple online sources using the Google search engine. It was found that hospitals, being resource intensive establishments, consume vast amounts of electricity, water, food and construction materials to provide high quality care. It was also found that certain healthcare institutions, by employing simple, smart and sustainable measures can greatly reduce their environmental footprint. But constructing Green Hospitals can be a challenge considering the local conditions and growing customer expectations.

The Induction of Oxidative/Nitrosative Stress, Inflammation, and Apoptosis by a Ferric Carboxymaltose Copy Compared to Iron Sucrose in a Non-Clinical Model

Jorge E. Toblli, Gabriel Cao, Margarita Angerosa

Introduction: Ferric carboxymaltose is a next-generation polynuclear iron(III)-hydroxide carbohydrate complex for intravenous iron therapy belonging to the class of so-called non-biological complex drugs. The product characteristics and therapeutic performance of non-biological complex drugs are largely defined by the manufacturing process. A follow-on product, termed herein as ferric carboxymaltose similar, is available in India. Given that non-biological complex drugs may display differences in diverse product properties not characterisable by physico-chemical methods alone. Aim: The aim is to assess the effects of this ferric carboxymaltose similar in our non-clinical model in non-anaemic healthy rats. Materials and Methods: Non-anaemic rats were treated with intravenous ferric carboxymaltose similar or iron sucrose both at (40 mg iron/kg body weight), or with saline solution (control) for four weeks, after which the animals were sacrificed. Parameters for tissue iron distribution, oxidative stress, nitrosative stress, inflammation and apoptosis were assessed by immunohistomorphometry. Results: Ferric carboxymaltose similar resulted in deranged iron distribution versus iron sucrose originator as indicated by increased serum iron, transferrin saturation and tissue iron(III) deposits as well as decreased ferritin deposits in the liver, heart and kidneys versus iron sucrose originator. Ferric carboxymaltose similar also increased significantly oxidative/nitrosative stress, pro-inflammatory, and apoptosis markers in the liver, heart and kidneys versus iron sucrose originator. Conclusion: In our rat model, ferric carboxymaltose similar had a less favourable safety profile than iron sucrose originator, adversely affecting iron deposition, oxidative and nitrosative stress, inflammatory responses, with impaired liver and kidney function.

Dysregulation of Glucose Homeostasis Following Chronic Exogenous Administration of Leptin in Healthy Sprague-Dawley Rats

Introduction: Impaired glucose utilization is seen in chronic hyperleptinaemia associated conditions such as obesity and type 2 diabetes mellitus. It is unclear if this impaired glucose utilization is due to the effect of persistent hyperleptinaemia on insulin secretion from the beta cells of pancreas. Aim: To examine the effects of chronic leptin administration on plasma glucose regulation in rats. Materials and Methods: Glucose challenge curves were plotted for male Sprague-Dawley rats treated with either normal saline (Control; n=8) or subcutaneous leptin injection for 42 days (60 µg/kg body weight/day; n=8). Plasma glucose and plasma insulin levels were measured at 0, 5, 10, 15, 20 and 25 minutes after glucose challenege. Skeletal muscle tissue was collected at the end of a glucose challenge for glucose transporter-4 protein content, insulin receptor and glucose transporter-4 mRNA expression. Data were analysed using repeated measures and one-way ANOVA with post-hoc analysis. Results: Chronic leptin treatment caused significantly higher fasting insulin level. Post glucose challenge, there was a significant increase in blood glucose levels and insulin level in the leptin treated rats. There was no significant difference in the skeletal muscle glucose transporter-4 content. However, leptin treated rats showed decreased mRNA expression of Insulin Receptor and glucose transporter-4 in the skeletal muscle. Conclusion: Leptin administration for 42 days caused hyperinsulinaemia and decreased the expression of insulin receptors in insulin sensitive tissues leading to the development of an insulin resistance-like state in the rats.

Croton membranaceus Improves Some Biomarkers of Cardiovascular Disease and Diabetes in Genetic Animal Models

Introduction: Cardiovascular disease (CVD) accounts for 17.3 million deaths per year globally. In Ghana, CVD accounts for 22.2% of deaths. Croton membranaceus (CM) Mull. Arg. (Euphorbiaceae), a medicinal plant in Ghana is mainly used traditionally for the treatment of benign prostatic hyperplasia and measles. However, some hypoglycaemic and hypotensive effects have recently been reported but not scientifically examined. Aim: The study aimed at establishing whether Croton membranaceus (CM) used for prostatitis had any effect on CVD markers. Materials and Methods: In experiment 1, lipid profile changes were determined. Twenty four male Spontaneously Hypertensive Rats (SHR) were divided into 4 groups. Low (LD), intermediate (ID) and high dose (HD) groups received 25, 50 and 100 mg/kg b.wt. CM aqueous root extracts (CMARE) for 60 days, respectively, the controls received distilled water. In experiment 2, blood glucose levels (BGL) were determined. 21 db/db mice were divided into 3 groups of 7 mice each alongside db/+ mice (7) (negative control). Groups 1 and 2 received 250 mg/kg b.wt CMARE and metformin, respectively. Group 3 (positive control) and db/+ mice (negative control) received distilled water. Mice were monitored for 15 hours. Data collected were analysed using SPSS version 20. Results: Hypotriglyceridaemic effect was observed (p=0.005). High Density Lipoprotein cholesterol (HDL) and Low Density Lipoprotein cholesterol (LDL) showed significant increases (p=0.013) and decreases (p=0.003), respectively. A significant CRP reduction was observed for ID and HD groups (p = 0.010, p = 0.011, respectively). BGL was reduced in Metformin and Croton groups (p=0.000; p= 0.006, respectively) after 3 hours. Conclusion: In conclusion, CMARE has positive effects on some CVD biomarkers and a hypoglycaemic effect.

Diuretic Activity of Ethanolic Root Extract of Mimosa Pudica in Albino Rats

Introducation: Diuretics are the drugs which increase the urine output. This property is useful in various pathological conditions of fluid overload. The presently available diuretics have lot of adverse effects. Our study has evaluated the diuretic activity of ethanolic root extract of Mimosa pudica as an alternative/new drug which may induce diuresis. Aim: To evaluate the diuretic activity of ethanolic root extract of Mimosa pudicaa in albino rats. Materials and Methods: Ethanolic root extract of Mimosa pudica (EEMP) was prepared using soxhlet’s apparatus. Albino rats were divided into 5 groups of 6 rats each. Group-I (Control) received distilled water 25ml/kg orally. Group-II (Standard) received Furosemide 20mg/kg orally. Group-III received EEMP 100 mg/kg, Group-IV received EEMP 200 mg/kg and Group-V received EEMP 400 mg/kg. The urine samples were collected for all the groups upto 5 hours after dosing and urine volume was measured. Urine was analysed for electrolytes (Na+, K+ and Cl-). ANOVA, Dunnet’s test and p-values were measured and data was analysed. Results: EEMP exhibited significant diuretic activity by increasing urine volume and also by enhancing elimination of Sodium (Na+), Potassium (K+) and Chloride (Cl-) at doses of 100 and 200mg/kg. Conclusion: EEMP possesses significant diuretic activity and has a beneficial role in volume overload conditions.

Effects of Pomegranate Seed Oil on the Fertilization Potency of Rat’s Sperm

Mohsen Nikseresht, Ali Reza Fallahzadeh, Mehdi Akbartabar Toori, Reza Mahmoudi

Background: Pomegranate has been taken great scientific attention in recent years due to its health benefits. Pomegranate seed oil is a rich source of 9-cis, and 11-trans conjugate linolenic acid. The aim of this study was to evaluate the effect of dietary pomegranate seed oil on the fertilization potency of rat’s sperm. Materials and Methods: Twenty-four male Wistar rats were divided into four groups. The first group, which served as the control group, received 1 mL of corn oil for seven weeks. Groups II, III, IV served as the experimental groups received 200, 500 and 1000 mg/kg of pomegranate seed oil, for the same period of time respectively. After seven weeks, all of the rats were sacrificed, and their epididymis sperm was collected and added to IVF medium (T6) containing metaphase II oocytes. Almost 21 oocytes had been removed from every female rat oviduct. In this medium, oocyte fertilization, cleavage rates, and embryo development into blastocysts, were evaluated by inverted microscopy. Results: Levels of LD50 in the oral route in male rats were more than 5000 mg/kg body weight. Our data showed that the rates of fertilization, cleavage and embryo development into blastocysts were higher in the groups that had received 500 and 1000 mg/kg body weight of pomegranate seed oil. Conclusion: This study demonstrated that pomegranate seed oil had a positive effect on the fertilization potency of male rats. These beneficial effects may be useful in assisted reproductive technology.

Effects of Different Concentrations of Fluoride in Oral Mucosal Cells in Albino Rats

M.S.Sushma Susik, P.Ajay Prakash, T.Madhusudhan Rao

Introduction: Fluoride has been described to be physiologically essential for the normal development and growth of human beings. However, it is well known that excessive fluoride causes skeletal, nonskeletal and dental complications. Therefore, outlining the cytogenetic effects induced by fluorosis is necessary. Objectives: To evaluate the cytomorphology of exfoliated oral mucosal cells among various concentrations of fluoride. Study design: Study group comprised of 12 Albino Wistar rats, categorized into A,B and C groups (fed with 25 ppm,50 ppm and 100 ppm concentration of NaF), each group consisting of 4 rats, with 4 controls (fed with 1ppm concentration of NaF in distilled water). Each group was fed for a period of 42 days. Materials and Methods: Cytological smears were taken from the buccal mucosa of each group after 42 days of fluoride administration. The samples were stained with the papanicolaou method and assessed for Cytomorphometrical changes in maximum diameter of nucleus, minimum diameter of nucleus, perimeter of the nucleus, maximum diameter of the cell, minimum diameter of the cell and perimeter of the cell by image analysis software and the results were statistically analysed using SPSS software. Results: Mean values of maximum diameter, minimum diameter and perimeter of the nucleus increased in fluoride induced study groups when compared to controls and the results showed that p-value was statistically significant (p-value: 0.000, 0.001). Mean value of maximum diameter, minimum diameter and perimeter of the cell decreased in fluoride induced subjects when compared with controls which were statistically not significant (p-value: 0.791, 0.600& 0.719). A continuous increase in the nuclear size and decrease in the cell size was identified in fluoride induced groups as compared to controls. Conclusion: The observations of our present study revealed that cellular changes occur with severity of fluorosis. These cellular morphological changes may possibly eventuate into dysplastic alterations, which can progress to malignant changes.

Tubular Ectasia of Rete Testis with Spermatocele

Neeraj Jain, Udit Chauhan, Sonali Sethi, Vandana Goel, Sunil Kumar Puri

High Resolution Ultrasound in Disseminated Soft Tissue, Muscular and Glandular Cysticercosis

Rashmi M Nagaraju, Bhimarao

Mesenteric Panniculitis: An Unusual Cause of Epigastric Pain

Hichem Jerraya, Mehdi Khalfallah, Ramzi Nouira, Chadli Dziri

Primary Cavernous Haemangioma of the Frontal Bone: Computed Tomography Features

Mainak Dutta, Arijit Jotdar, Sohag Kundu, Subrata Mukhopadhyay

An Uncommon Cause for Polyuria

Mesenteric Lymphangioma Presenting as Ileal Volvulus

Bilateral Fusion of Primary Mandibular Incisors: A Rare Case Report

Teena Gupta, Naveen Manuja

The JAK2 V617F Mutation in Plasma Cell Neoplasms with Co-existing Erythrocytosis

Stephen E. Langabeer

Acute Respiratory and Renal Failure due to Hypermagnesemia, Induced by Counter Laxatives in an Elderly Man

Mahmut Alp Karahan, Ahmet Kucuk, Evren Buyukfirat, Funda Yalcin

Atypical Fibroxanthoma of Scalp: A Paradoxical Benign Tumour

Ritesh Sachdev, Ruchika K Goel, Smeeta Gajendra

Energy and Power Density: A Key Factor in Lasers Studies

Jacek Matys, Marzena Dominiak, Rafal Flieger

A Novel Technique of Defattening Large Full Thickness Skin Grafts

Kapil S Agrawal, Raghav Shrotriya, Manoj Bachhav, Mansi Pabari

Letter to the editor about Maculopapular Rash after Penicillin Injection in a Patient with Confirmed Infectious Mononucleosis

Mostafa Shahabi Nejad, Shayan Shahabi Nejad, Naser Shahabi Nejad