Journal of clinical and diagnostic research

An Ayurvedic Protocol to Manage Proliferative Diabetic Retinopathy with Tractional Retinal Detachment

Proliferative Diabetic Retinopathy (PDR) occurs in 50% of cases of diabetic retinopathy after 25 years of onset of diabetes. Neovascularization associated with diabetic retinopathy stimulates scar formation, which leads to retinal detachment, the separation of the neuro-sensory retina proper from the retinal pigment epithelium. Management options, which include pars plana vitrectomy, anti-Vascular Endothelial Growth Factor (anti-VEGF) injections, and pan-retinal LASER photocoagulation, are not always effective. Here, the present authors report a case of 41-year-old male who presented with foreign-body sensation for 1 year, photophobia for 8 months, and distorted image perception for 6 months. The patient was diagnosed as having Kacha (diminished vision) according to Ayurveda. He was managed using oral medications, viz., Samirapancakam Kashaya, Cirivilvadi Kashaya, and Laksha Jala, and external therapy, which comprised of local therapies for both the eyes and head. Assessment at discharge by fundus photography demonstrated reduction in retinal haemorrhages, and optical coherence tomography showed reduction in macular oedema and vitreo-macular traction.

Looking Beyond Lupus in Lupus

Bhargavi Kumar, Saravanan Thangavelu

Haematological abnormalities are a common finding in Systemic Lupus Erythematosus (SLE) patients. The wide spectrum includes anaemia, cytopenias, thrombosis as well as bleeding. Among the bleeding disorders, qualitative coagulation defects can be rarely encountered because of clotting factor inhibitors. More uncommon is the occurrence of quantitative clotting factor deficiencies. Here, we describe a rare cause of abdominal pain in a patient with SLE who developed perinephric and colonic sub mucosal haematomas owing to a rare association with acquired factor XIII deficiency which was diagnosed on quantitative assays and effectively treated with cryoprecipitate and fresh frozen plasma.

Fluconazole induced Stevens-Johnson Syndrome Leading to the Diagnosis of HIV Infection

Prafulla Kumar Sharma, Soumya Sachdeva, Konchok Dorjay, Devika Choudhry

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse cutaneous drug reaction that has been associated with various drugs like antibiotics, anticonvulsant and non-steroidal anti-inflammatory agents. Fluconazole has rarely been associated with SJS and TEN. A 39-year-old male case of SJS due to Fluconazole, who was subsequently diagnosed to suffer from Acquired Immunodeficiency Syndrome (AIDS) is being reported. The low CD4+ T Cell count in this patient is a likely contributing factor for the precipitation of SJS due to Fluconazole. There is a paucity of reports of SJS due to fluconazole in HIV positive patients, though TEN has been described in few patients. This case highlights that Fluconazole causing SJS/TEN is more likely in a HIV positive patient. This patient’s HIV positive status was diagnosed subsequent to the diagnosis of SJS.

Apexification as a Clinical Strategy for the Management of an Immature Non-Vital Tooth with Buccal Bone Loss: A Case Report

Endodontic treatment of immature non-vital teeth poses a considerable challenge. Its goals should include the control of intracanal infection and the promotion of continuous root development. This case report describes an apexification as an alternative strategy for the maintenance of a tooth with incomplete root formation. An 11-year-old female presented with a history of pain and discomfort on the left side of the mandibular region. Intraoral examination revealed the presence of a draining sinus tract located in the buccal mucosa, next to tooth 35, for which a cold test was negative. Periapical radiographs revealed a single-rooted tooth with incomplete root formation and a periapical lesion. A diagnosis of periapical abscess with fistula was made, and a root canal treatment in conjunction with apexification was planned. Cone Beam Computed Tomography (CBCT) imaging was performed which revealed resorption on the buccal side of the root and the destruction of the buccal cortical bone. After six appointments, the intraoral sinus tract had healed, no purulent discharge was observed, and the root apex was closed. The root canal was filled, and the tooth was restored. The three years follow-up examination showed adequate bone repair and the absence of periapical lesion. Apexification shows favourable results for the management of immature non-vital teeth.

Leigh Syndrome: Case Report and Review of Literature

Pratiksha Yadav, Saroja Variar

Leigh’s syndrome or sub-acute necrotizing encephalopathy is a rare progressive neurodegenerative disorder of paediatric age group. It has variable clinical, imaging and pathological presentation. Typical MRI features lead to the diagnosis. It is usually of infantile or juvenile form, which presents in <5 years of age. Here, the present authors report an unusual case of 7-year-old male presented with complaints of frequent falls, slurring of speech, difficulty in walking and regression of the achieved milestone was noted. MRI brain study showed altered signal intensity in bilateral putamen, bilateral caudate nucleus, midbrain, substantia nigra, periaqueductal region and pons. Magnetic Resonance spectroscopy revealed high lactate levels in pontine lesions. MRI findings were suggestive of subacute necrotizing encephalopathy.

Milky Colour Ascitic Fluid in Idiopathic Nephrotic Syndrome: Pseudochylous Ascites

Parveen Kumar Antil, Bablu Kumar Gaur, Meenakshi Dadwal, Baljeet Maini

In normal conditions, ascitic fluid is clear to pale yellow. The causes of milky colour ascitic fluid in children includes spontaneous bacterial peritonitis, chylous ascites and pseudochylous ascites. Pseudochylous ascitis is an uncommon clinical entity in children. Nephrotic syndrome rarely causes pseudochylous ascites. Here the present authors report a case of 24-month-old child (male) who presented with clinical features of nephrotic syndrome. Diagnostic paracentesis was done which strikingly showed milky colour ascitic fluid. Physical appearance of ascitic fluid and laboratory findings were consistent with nephrotic syndrome associated with pseudochylous ascites. He was started on medical treatments and is under regular follow-up. Pseudochylous ascites should be considered in differential diagnosis of milky colour ascitic fluid in nephrotic syndrome.

Mycobacterium Tuberculosis and Mycobacterium Leprae Co-infection: A Case Report

Bimal K Agrawal, Saurabh Marwaha, Manu Mathew

Tuberculosis (TB) is one of the oldest diseases known to affect man caused by bacteria of the Mycobacterium tuberculosis complex. World Health Organisation (WHO) estimate shows that 10.4 million new cases of tuberculosis occurred worldwide in 2016. Likewise, leprosy is another age-old disease caused by Mycobacterium leprae. Leprosy is predominantly a disease seen in the developing world with a worldwide estimation of 0.6 to 8 million affected individuals. Both are chronic diseases, prevalent in various parts of the world and account for significant disease morbidity. Co-infection of the two Mycobacteria, although rare, has been reported to occur. Here the present authors discuss one such case of co-infection with both Mycobacteriae. A 24-year-old male was presented with fever, cutaneous lesion and cough. The clinical diagnosis of leprosy was made and chest X-ray was suggestive of tuberculosis. After confirming the diagnosis, the patient was treated with four antitubercular drugs as per the guidelines along with dapsone and clofazimine. The patient gradually improved and after six months treatment was continued only for leprosy.

Leg Ulcers Secondary to Antiphospholipid Syndrome in a Young Female

Aditya Dhanawat, Partisha Gupta, Prasanta Padhan, Lalatendu Mohanty

Eighty percent of leg ulcers have a vascular aetiology. These ulcers are often debilitating for the patients and difficult to treat owing to lack of clinical suspicion leading to significant morbidity and mortality. Here we report a case of bilateral leg ulcers in a young female with Anti Phospholipid Syndrome (APS). She also had associated Evans’ syndrome in the absence of lupus. She responded well with oral anticoagulant and immunosuppressives on follow-up after 6 weeks and 12 weeks. Thus, APS should be kept in mind while evaluating a case with leg ulcers in a young as in the present case.

Fabrication of Hollow Complete Denture with Althaea- A Case Report

KV Anitha, Gopi Naveen Chander, Srividya Devi, Sanjana Tharakan

Rehabilitation of extremely resorbed residual ridges present a threat to dental clinicians. Fabrication of dentures with excessive inter-ridge distance makes the prosthesis heavy. Fabricating light weight dentures is important to reduce the discomfort of patient. Several methods have been tried and till now there is no definitive and simple way to fabricate hollow removable dental prosthesis. This case report describes a new variant method for fabrication of hollow complete denture with edible Althaea candy. Althaea officinalis L is scientific name for marsh-mallow perennial plant with each part having health benefits. Roots are powdered and mixed with sugar and egg white to make it edible as candy. These candies were used as index spacers for hollowing removable dentures. Patient comfort, mastication and phonetics improved with wearing of light weight dental prosthesis.

Splenic Marginal Zone Lymphoma: A Case with Long History

Splenic Marginal Zone Lymphoma (SMZL) is a rare, indolent B-cell Non-Hodgkin Lymphoma (NHL) which may present with isolated splenomegaly. Herein, we report a case of SMZL in a 48 years old male with asymptomatic pancytopenia and insidious development of massive splenomegaly over a period of 11 years, where splenectomy not only revealed the diagnosis of SMZL after bone marrow biopsy was non-diagnostic, but also resulted in normalisation of blood counts without any further treatment.

Ovarian Tumour in a Child with Vaginal Bleeding: A Rare Case Report

Amit Kumar, Sambedna, Rashi, Amit Kumar Sinha, Bindey Kumar

Gynaecological malignancy account for 2% of all kinds of cancer in children and 60-70% of these lesions arise from ovaries. The clinical manifestations and histological types of ovarian tumours in paediatric population are different from those seen in adults. In pre menarche group usually ovarian tumours are of germ cell origin. These germ cell tumours in paediatric age group may present with features of precocious puberty. We report a case of ovarian tumour that presented with features of isosexual precocious puberty in the form of vaginal bleeding, in a four-year-old female child. She underwent surgical exploration and removal of the tumour with an attempt to preserve the reproductive function. She was relieved of the symptoms followed by the tumour removal as evidenced by the regular follow-ups.

Incidentally Detected Intranasal Supernumerary Tooth: A Case Report

S Aparna, Rishikant Sinha, Upasna Sinha, Prem Kumar

Intranasal tooth is a rare type of supernumerary teeth. Its aetiopathogenesis is uncertain but genetic predisposition, trauma and infection are described in previous literatures. It can be either symptomatic or asymptomatic. In our case report, it was asymptomatic which was diagnosed mainly by CT scan as a radiopaque lesion with morphology and attenuation same as that of intraoral tooth. We report a case of an incidental intranasal supernumerary tooth in a 45-year-old male who presented with history of road traffic accident and parasymphyseal fracture of left mandible. This case highlights the rarity of this entity.

A Rare Case of Actinomycotic Mycetoma of Wrist

Pratibha Shamanna, MS Nawaz Basha, KN Nagegowda, V Punith, KN Shwetha

Mycetoma is a chronic, slowly progressing granulomatous subcutaneous infection caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). The present case report is a rare case of Actinomycotic Mycetoma involving wrist due to Streptomyces species. A 53-year-old male presented with multiple swellings over the right wrist and forearm with sinuses discharging sero-purulent pus since 3 years. Patient underwent incision and drainage and appropriate antibiotic course after the complete diagnosis. This case report emphasises the role of meticulous clinical examination assisted by microbiological cultures and histopathological studies which are mandatory in the diagnosis, management and assessment of the prognosis of such unusual cases.

Passage of Gangrenous Small Bowel Per Rectum Following Superior Mesenteric Vessel Thrombosis

Meenakshi Eknath Yeola (Pate), Aditya Prabhalkarrao Borgaonkar

Mesenteric venous thrombosis is a rare cause of chronic pain in abdomen. Only in few cases with abdominal pain, bowel infarct has been reported. This report is that of a 42-year-old male with a history of chronic alcoholism, presented with continuous dull pain in abdomen for 1 year and vomiting for 1 month, typically after ingestion of food. At the time of admission, his vitals were stable. On examination of abdomen, the only finding was tenderness in left hypochondriac and left lumbar region without guarding or rigidity. His erect abdomen radiograph suggested no evidence of intestinal perforation or obstruction. Ultrasonography of abdomen suggested bowel loops with normal peristalsis, no evidence of any dilatation or oedema of wall or of free fluid in peritoneal cavity. CT angiography of abdomen was suggestive of Superior Mesenteric Artery (SMA) thrombosis. While on conservative management he passed almost 2 feet small bowel per rectum. Emergency diagnostic laparoscopy showed faecal matter in left paracolic gutter. Exploratory laparotomy was done and jejuno-ileal resection and anastomosis were done.

Bilateral Intralobar Pulmonary Sequestration in an Elderly Patient

Askin Gülsen, Berat Uslu

Pulmonary Sequestrations (PS) are congenital anomalies resulting from defective pulmonary development. PS consist of abnormal lung tissue that is not associated with the normal airway. They have their own abnormal vascular system consisting of arterial connections (usually from the aorta and its branches) and venous drainage through pulmonary venules. These lung lesions do not contribute to the exchange of oxygen and carbon dioxide. However, intralobar PS is usually seen in childhood, unilaterally in the left lower lobe of the lung. PS is rarely encountered bilaterally or in older patients. Herein, we describe a case of bilateral PS detected by computed tomography angiography in an elderly patient. The patient refused additional interventional examination and operation, so clinical follow-up was continued.

Bilateral Tortuous External Iliac Artery: An Unusual Variation

Rohini Motwani, Prajakta Kishve, Ratna Gosain

Bilateral tortuosity in the external iliac arteries is a rare finding in the cadavers. We report highly tortuous external iliac arteries of both the sides in a 60-year-old male cadaver noted during routine dissection. Left external iliac artery had a ‘U’ shaped loop and right external iliac artery had a ‘S’ shaped loop. The loops were found in the lesser pelvis in close relation to the obturator nerve and vessels which may get compressed by the artery. In addition the tortuous external iliac artery was also compressing the internal iliac vessels on both sides. Mild tortuosity is usually asymptomatic, moderate to severe tortuosity can lead to ischaemia of the organs or structures supplied by them or even ischaemia of the lower limb, as external iliac artery continues as femoral artery. Mild dilatation of the right common iliac artery was also present. Tortuosity of the arteries may be due to abnormal development or vascular disease, but exact mechanism is not known clearly till now. Anatomical knowledge of the tortuosity, aneurysm or kinking of iliac arteries is of utmost importance to the urologists, gynaecologists and orthopaedic surgeons so that they can correlate their findings and can take great care while doing surgeries on the pelvic region.

Haemodialysis Permcath-associated Superior Vena Cava Syndrome

Sukanto K Das, Subodh K Das, Jajati K Padhi

Superior Vena Cava (SVC) syndrome can arise due to obstruction of blood flow in the SVC. Haemodialysis (HD) catheter is very commonly inserted into the SVC, and can lead to thrombotic complications, thereby resulting in signs and symptoms of SVC syndrome. We hereby report a case of a 59-year-old male patient from Western Orissa (India) who was diagnosed with end-stage renal disease and was maintained on regular haemodialysis via right jugular vein dual lumen cuffed tunnelled (Permcath) catheter for five months and presented with signs and symptoms suggestive of SVC obstruction. His symptoms worsened, for which, he was taken for percutaneous transluminal angioplasty to SVC followed by stenting of right brachiocephalic vein and SVC. The SVC syndrome can be a potential consequence of HD catheter-related thrombosis. In view of frequency of HD catheter placement, nephrologists should be aware of these potential complications in any patient with HD catheter-related thrombosis and appropriate therapeutic intervention including stenting when required.

Why is the Oral Cholera Vaccine Underused in India?

Kaushik Bharati

Antimicrobial Efficacy of Various Concentrations of Chlorhexidine Against Enterococcus Faecalis Bacteria

Sari Dewiyani, Boy Muchlis Bachtiar, Endang Winiati Bachtiar, Narlan Sumawinata

Introduction: Enterococcus faecalis bacteria is well-known for causing a persistent root canal infection, nevertheless its phenotypic characteristics are not widely known. Aim: To evaluate the antimicrobial efficacy of various concentrations of chlorhexidine against E. faecalis bacteria in the endodontically treated root canals. Materials and Methods: The present in-vitro study was done using E. faecalis isolates from 30 endodotic patients. Samples were taken from patients at the start of the endodontic treatment (pre-treatment) and with repeated treatment (post-treatment) after satisfying the inclusion criteria. E. faecalis samples were isolated from patient’s teeth which were then cultured followed by exposure to different concentrations of chlorhexidine of 0.1%, 0.2% and 2% with an incubation period of half hour, one hour and three hours respectively. Viability of E. faecalis samples were calculated with MTT assay using a standardised formula. Results: As the chlorhexidine concentration increased, the viability of E. faecalis isolates is reduced, although statistically it is not significant. With increase in incubation time from half hour to one hour, Chlorhexidine (CHX) effectiveness increased, although this trend was decreased after three hours of incubation time. Conclusion: Chlorhexidine 0.1% resulted in the largest decrease in E. faecalis viability and an incubation time of 30 minutes was effective to significantly reduce the viability of E. faecalis.

Response to Infliximab Biosimilar in a Case of Reactive Arthritis: Our Experience

Correspondence: Curious Case of Myocardial Infarction Caused by Lung Abscess- From the Viewpoint of Type 2 Myocardial Infarction by Chest Trauma

Takahiko Nagamine

Is Episodic Short Course of Montelukast Effective in Preschool Wheezing?

Prawin Kumar, Jagdish Prasad Goyal

Intravenous Iron Sucrose versus Packed Cell Volume for Treatment of Severe Iron Deficiency Anaemia in Pregnancy: A Randomization Clinical Trial

Girija Wagh

Introduction: Severe Iron Deficiency Anaemia (IDA) in pregnancy is usually treated with whole blood or Packed Cell Volume (PCV) transfusion to maintain feto-placental perfusion and replete the haemodynamic mechanisms before delivery. Administration of whole blood or PCV may not always be feasible and therefore Intravenous Iron Sucrose (IVIS) is proposed to be therapeutically better approach to treat severe IDA during pregnancy. Aim: To compare the efficacy and safety of IVIS to PCV for the treatment of severe IDA in pregnancy. Materials and Methods: This was prospective, randomised, open label study which included 30 pregnant women with severe IDA. Patients were randomised to receive either PCV or IVIS calculated as per the haemoglobin deficit. The deficit was divided as per the iron sucrose dose of 100/200 mg in 100 mL Normal Saline (NS) infused over a period of 20 minutes per day. The number of PCVs was decided based on the fact that 1 PCV raises the haemoglobin level by 1 g/dL. Adverse drug reactions were noted in both the groups. Haemoglobin level, MCV, reticulocyte count was done on day 8, 15, 30 and at delivery in both the groups while serum ferritin levels were done on day 30 and at delivery. Results: Both modalities were efficacious in producing significant rise in haemoglobin. Immediate 8th day follow-up showed significant rise of haemoglobin in both the groups. Comparison of successive follow-up values with baseline showed that the group receiving PCV showed significant rise in haemoglobin on day 8 and day 15 (p<0.05). The subjects which were administered IVIS showed progressive rise in haemoglobin which was significant on the day of delivery as compared to the ones receiving PCV (p<0.05). Adverse reactions for both the groups were documented. Conclusion: IVIS showed sustained haemoglobin rise and better restoration of iron stores as compared to PCV for treatment of severe IDA in pregnancy. A larger study group would help in establishing this fact better.

Oxidised LDL Cholesterol (Ox-LDL-C) and Ox-LDL-C/HDL Cholesterol (HDL-C) Ratio in Acute Coronary Syndrome Patients versus Chronic Coronary Artery Disease Patients on Statin Treatment

Introduction: Oxidised Low Density Lipoprotein Cholesterol (Ox-LDL-C) and High Density Lipoprotein Cholesterol (HDL-C) have antagonistic action in the development of atherosclerotic cardiovascular disease. Use of statins reduces cardiovascular risk by reducing LDL-C levels and also by increasing HDL-C. No systematic studies were carried out to study the role of HDL-C as an antioxidant and its effect in decreasing Ox-LDL-C. Aim: To compare the values of Ox-LDL-C/HDL-C in patients with chronic Coronary Artery Disease (CAD) and patients with Acute Coronary Syndrome (ACS) and to evaluate the levels of Ox-LDL-C and Ox LDL-C/HDL-C ratio in patients treated with the two different statins. Materials and Methods: In this cross-sectional study 30 patients with ACS and 30 patients with chronic CAD on rosuvastatin or atorvastatin were included in the study. Apparently normal 27 age and sex-matched controls without CAD was included in the study. Lipid profile was estimated using fully auto analyser and Ox-LDL-C was estimated using ELISA kits. Statistical analysis was done using SPSS version 16 software. A p-value of <0.05 was considered as statistically significant. Results: Hypertension and diabetes were found to be significantly associated with CAD (p-value 0.03). There was significant correlation between total cholesterol, triglycerides, with CAD. The levels of triglycerides, Ox-LDL-C and Ox-LDL-C/HDL-C were significantly higher (p<0.05) in ACS patients compared to chronic CAD and normal. Total cholesterol and LDL-C were lower in chronic CAD patients on atorvastatin treatment compared to patients on rosuvastatin treatment. Conclusion: Ox-LDL-C/HDL-C ratio is a better predictor of acute coronary events. In addition to lipid lowering action, statins have pleiotropic benefits including prevention of LDL oxidation.

Assessing Social Skills of Children Diagnosed with Autism Spectrum Disorders in India: A Pilot Study

Reema Gupta, Rajni Sahni

Introduction: The prevalence of Autism is increasing now-a-days in India so there is an evident need to develop early intervention programs targeting social-communication and behavioural skills of children with Autism Spectrum Disorders (ASD) that are applicable in the Indian setting. However, a lack of adequate measurement of social skills, hampers the evaluation of effectiveness of such programs. Aim: To evaluate the correlation between Social Skills Rating Scale (SSRS) and Indian Scale for Assessment of Autism (ISAA) and to find out the validity of SSRS in Indian children. Materials and Methods:The present study was an observational study. Fifty children diagnosed with ASD between 3-6 years as per the DSM-V criteria were recruited from March 2016 to Febuary 2017. Social Skills were assessed on SSRS and severity of autism was assessed on ISAA. Pearson correlation coefficient were calculated between seven subdomains of SSRS and total score of ISAA to evaluate the validity of SSRS. Results: A significant negative correlation was found between Social Skills and total score of ISAA (r=-0.61, p<0.01) and positive correlation between problem behaviours and ISAA total score (r=0.60, p<0.01). Conclusion: The study concluded that SSRS may be used to assess the social skills of children with ASD in Indian setting.

Health Belief Model and Behavioural Usage of Respiratory Protective Equipment among Sugarcane Workers in Northeast of Thailand: A Cross-sectional Analytical Study

Wipada Panakobkit, Pornpun Sakunkoo, Pall Chamroen

Introduction: Workers in developing countries face as many difficulties particularly occupational health hazards as their counterparts in industrialised nations. The Health Belief Model (HBM) encourage workers to use Respiratory Protective Equipment (RPE) that could protect them from risks of environmental health and work-safety caused by bagasse dust. Aim: To investigate the relationship between HBM and behavioural usage of RPE among Sugarcane Factory Workers (SFW) in Thailand. Materials and Methods: A Cross-sectional analytical study was conducted among 588 SFW in Northeast, Thailand by using multistage sampling to select the sample size. The structured questionnaire was comprised of perceived susceptibility, perceived severity, perceived benefits and perceived barriers. The content validity of questionnaire was tested by 3 experts and had a Cronbach’s alpha coefficient of 0.86. The data were presented as proportions, mean±standard deviation or median and range as in descriptive statistics. In addition, associated factors with behaviour using RPE were analysed by multiple logistic regression showing 95% CI and p<0.05 was statistically significant. Results: Most workers had good level of behavioural usage of RPE (64.80%, 95%CI: 60.92-68.67). The common types of RPE usage were cotton masks (94.56%). The sources of information on RPE usage as provided by safety officers were 77.89%, by supervisors (70.41%) and by knowledge boards in factories (37.24%) respectively. Additionally, workers who had good level of HBM in perceived benefits were 2.67 times more likely to have good behaviour in usage of RPE when compared with those who had poor level of HBM in perceived benefits (Adjusted OR=2.66, 95% CI=1.53 to 4.62, p=0.001). Conclusion: More than half of SFW had good level of usage of RPE. HBM in perceived benefits had influenced on good level of usage of RPE of workers. Therefore encouraging workers to use RPE can prevent work related respiratory diseases by strict regulation and enforcement of occupational laws.

Comparison of Bilirubin Induced Neurologic Dysfunction Score with Brainstem Auditory Evoked Response in Detecting Acute Bilirubin Encephalopathy in Term Neonates

Fatima Usman, Zubaida Ladan Farouk, Abdulaziz Ahmed, Muutassim Ibrahim

Introduction: Brainstem Auditory Evoked Response (BAER) is an effective and objective hearing screening method in new-borns, especially those with Bilirubin Encephalopathy (BE). The most common and earliest manifestation of bilirubin neurotoxicity is involvement of the auditory nerve. This, often ‘silent’ sequel is sometimes missed, but can be detected early using BAER. The Bilirubin Induced Neurologic Dysfunction (BIND) score has been proposed to facilitate the clinical diagnosis of this disorder. Aim: To determine the effectiveness of BAER and BIND score in detecting Acute Bilirubin Encephalopathy (ABE) amongst neonates with hyperbilirubinaemia. Materials and Methods: A cross-sectional study involving 132 consecutive term neonates (66 neonates with Total Serum Bilirubin (TSB) =10.0 mg/dL and 66 age and sex matched controls) was conducted. Eligible neonates were subjected to BAER immediately after sample for bilirubin was taken and BIND scoring was done. The data was analysed with SPSS version 21. The mean, standard deviation and t-test was calculated for continuous data, while percentages and Chi-square test or fisher’s-exact test (where applicable) were computed for categorical variables. The sensitivity, specificity, predictive values of the BIND score relative to BAER and Receiver Operator Characteristic (ROC) curve analysis were also calculated. The level of statistical significance was set at p=0.05. Results: The mean gestational age at birth of cases was 39.1±0.8 weeks, and 39.1±0.7 weeks for healthy controls. The age range of the neonates at presentation was between 24 hours to 15 days, with the mean age of neonates with hyperbilirubinaemia was 5.17±2.1 days while that of the healthy controls was 5.98±2.8. Thirty-six (54.5%) males and 30 (45.5%) females with hyperbilirubinaemia were enrolled (M:F 1.2:1), similar to 35 (53%) females and 31 (47%) males amongst the control group (M:F=1:1.1). The sensitivity and specificity of the BIND score relative to BAER was 93.8% and 90% respectively, with an area of 0.96 by ROC analysis. The BIND score had a positive predictive value of 75%, negative predictive value of 97.8% and an overall diagnostic accuracy of 90.9%. Conclusion: BAER audiometry and BIND score are useful diagnostic tools in detecting ABE. The BIND score is a reliable surrogate where BAER is not available to detect ABE.

An Evaluation of Factors Influencing Alcohol Dependence to Identify the Need for Designing Suitable Interventions: A Step towards Harm Reduction

K Lohit, Chanda Kulkarni

Introduction: Alcohol dependence is well known for its harmful effects and is considered as the ‘gate way’ drug of abuse across the globe. There has been a progressive increase in its abuse with a serious impact on health contributing to high morbidity and mortality. Aim: To evaluate the extent and pattern of alcohol consumption, reasons for and factors influencing its consumption. Materials and Methods: This was a cross-sectional study conducted in a tertiary Hospital. All in-patients admitted in psychiatry ward with diagnosis of alcohol dependence were included for the study. A pilot study was done to assess the feasibility of Case Record Form (CRF). Data collected from all alcohol dependent in-patients in psychiatry ward for a year on socio-demographic profile, patterns and types of alcohol use, the age at onset and duration of consumption/dependence along with treatment details was evaluated for in-patients reporting at a tertiary care hospital. Results: In this cross-sectional study, 102 subjects were assessed, among them 35.30% from upper lower and middle socioeconomic category and 24.50% skilled worker group. The mean age of study population was 41.17±9.80 years with 81% in the productive age group. The mean age at onset of regular alcohol consumption was 24 years in 68.62% and 18 years in 27.45% of hospital admissions. The average number of years for first hospital admission after initiation of regular alcohol consumption was 19.92 years. The number of patients who consumed spirits was 96% and those consumed more than 3 units/day was 73.6%. The hospital admissions for alcohol related illnesses were 58.80% and those reported to seek medical help on their own was 52.9%. Conclusion: The findings indicate that alcohol dependence is common among adolescents and young adults who are the in the productive age group. The upper lower and middle socioeconomic groups are at higher risk of dependence. There is a need for stringent policies, programs, early identification, treatment and preventive measures using age specific, feasible and efficient interventional tools to achieve ‘harm reduction’ due to alcohol dependence.

The Effect of Ramelteon on Postoperative Delirium in Elderly Patients: A Randomised Double-Blind Study

Prabhat Kumar Gupta, Reetu Verma, Monica Kohli, Nidhi Shukla, Shashank Kannaujia

Introduction: Delirium is known as an acute mental disturbance characterised by confused thinking and disrupted attention that is usually accompanied by disordered speech and hallucination. Delirium often is seen in patients post-surgery. Use of Melatonin pre-operatively decreases the incidence of postoperative delirium. Ramelteon is an agonist of melatonin having longer half-life than melatonin. Aim: To evaluate the efficacy of Ramelteon for the prevention of postoperative delirium in elderly patients. Materials and Methods: In this randomised controlled double-blind (all places) study 50 patients with ASA I and II were selected and randomly assigned to each group. Group I received one tablet of Ramelteon (8 mg) 12 hours before surgery and 1 tablet of Ramelteon (8 mg) 1 hour before surgery and Group II received placebo one tablet 12 hours before surgery and 1 tablet 1 hour before surgery. Incidence of delirium was assessed by Confusion Assessment Method (CAM) at 1^st, 2^nd and 3^rd day. The SPSS Version 21.0 was used for the statistical analyses and p-value <0.05 was considered as significant. The Chi-square test was used to compare the categorical variables between the groups. Unpaired t-test was used to compare the continuous variables between the groups. Results: Only two patients developed delirium in Ramelteon group, one patient at Day 2 and one patient at Day 3; but in control group, six patients develop delirium, three patients at day two and three patients at Day 3. The incidence of delirium in Ramelteon group was lower in comparison with placebo group but it was not statistically significant. Conclusion: Thus, it was observed that Ramelteon administration in preoperative period decreases (non significantly) the incidence of postoperative delirium with higher sedation scores. So Ramelteon can be recommended in patients having high risk of developing postoperative delirium.

Evaluation of Nexus of Dental Erosion and Gastro-esophageal Reflux Disease: A Hospital-based Cross-sectional Study

Manoj Mahadeo Ramugade, Abrar Sayed, Kishor Dattatray Sapkale, Sapna Sonkurla

Introduction: Oral Squamous Cell Carcinoma (OSCC) accounts for approximately 90% of all the oral malignancies and a major cause of morbidity and mortality worldwide. The study utilises the Anneroth’s multifactorial grading system with Argyrophilic Nucleolar Organiser Region (AgNOR) score and the p53 expression as adjuncts; emphasising on the enhanced efficiency rendered by nuclear proliferative indices is the gold standard method of histomorphological grading of OSCC. Aim: To analyse the relationship between the histomorphological grading (Anneroth’s grading) and the nuclear proliferative markers that is AgNOR and p53 protein in OSCC. Materials and Methods: Total 98 cases of OSCC were investigated from July 2017 to July 2019. The histomorphological grading was done according to the Anneroth’s system. The AgNOR score was quantified by counting the mean number of AgNORs per cell. The p53 expression was graded as score 0 to 3 according to the percent of cells showing positive p53 immunostaining. Results: An increasing trend in the mean AgNOR count and p53 expression was observed with progressing histological grade of OSCC. Conclusion: The nuclear proliferative indices (AgNORs and p53) serve as reliable predictive markers and can be used as an adjunct to the gold standard Anneroth’s histomorphological grading system of OSCC.

Validation of the Gujarati Version of Center for Epidemiological Studies Depression Scale for Children (CES-DC) and Prevalence of Depressive Symptoms amongst School Going Adolescents in Gujarat, India

Introduction: Adolescents are at-risk for mental health issues especially depression. Center for Epidemiological Studies Depression scale for Children (CES-DC) is a validated scale to screen for depressive symptoms in population-based samples of children and adolescents. There is a need to validate available screening tools in local language to screen adolescents for depressive symptoms. Aim: To validate CES-DC in Gujarati and to assess prevalence of depressive symptoms and its associated socio-demographic factors among school going adolescents. Materials and Methods: A cross-sectional study was conducted among students studying in 8th to 12th standards (13 years to 17 years) from five Gujarati medium schools in Gujarat. CES-DC, Patient Health Questionnaire-9 and Rosenberg self-esteem scale were used for validation part of the study. Socio-demographic data was collected using a semi-structured questionnaire. Validity of the Gujarati version of CES-DC was assessed by checking for semantic, content equivalence, convergent and discriminant validity. The validated CES-DC scale, was used in a larger sample to assess prevalence of depressive symptoms. Descriptive analysis was done to assess prevalence of depressive symptoms among students and associations and were compared using chi-square test. Results: Validation study was conducted among 300 participants. Gujarati translation of CES-DC scale was found to have acceptable semantic equivalence, content validity index, convergent, divergent validity and reliability. A total of 1000 students from urban and rural schools were surveyed, 53.2% students had a high CES-DC score. Prevalence of self-reported depressive symptoms increased with increase in class. Girls from 11th and 12th classes had more depressive symptoms. Conclusion:The newly-translated scale can be used as self-reporting tool in detecting depressive symptoms of Gujarati children studying in 8th to 12th standard of school. Significant proportion of school going adolescents had depressive symptoms.

Long Term Clinicoepidemiological Study of Leprosy: A Retrospective Study from Bangladesh

Alvin Saha, Moynal Hossain, Junaid Mahmud Khan, Fazle Rabbi, Mohammad Safi Ullah

Introduction: Leprosy is a chronic granulomatous infection but least pathogenic disease caused by Mycobacterium leprae that affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes, testes and certain other tissues. Prevalence Rate (PR) of leprosy should be determined to achieve WHO elimination target. Aim: To study the clinic-epidemiological trend of leprosy in 5 years in a tertiary care hospital in Bangladesh. Materials and Methods: This was a retrospective analysis of 161 leprosy patients of both sexes, between 8 to 65 years of age, registered at the leprosy clinic of a tertiary care Hospital (CMCH), from January 2014 to December 2018. The number of skin lesions, neuritis, lepra reaction episode (Type I and Type II), deformity status (Grade-1 and Grade-2) in each patient was recorded. Results: The majority of patients, 67 (41.61%), were between 26-40 years of age with a male preponderance. A total of 11 (6.83%) were children. Slit skin smear was positive in 67 (41.61%) patients, 127 (78.88%) patients were classified as Multibacillary (MB) and 34 (21.12%) as Paucibacillary (PB) disease by National Leprosy Elimination Program (NLEP) criteria. Lepra reaction was observed in 87 (54.03%), Type I in 48 (29.81%) cases and Type II in 39 (24.22%), and Neuritis 28 (17.39%). Deformities occurred in 54 (33.54%) patients, Grade I deformity in 31 (19.25%) cases and Grade II in 23 (14.29%). Despite the statistical elimination of leprosy at national level, leprosy cases continue to be present in significant numbers. Conclusion: This study revealed that among the multibacillary diseased (127), the complications of lepra reactions and deformities remain higher. Early detection, treatment with MDT (Multi Drug Therapy) and contact tracing may be important in reducing the burden of leprosy in the community.

Thalassaemia Carrier Detection during Antenatal Period: Single Centre Experience from Eastern India

Introduction: Haemoglobinopathies include thalassaemias and structural variants of haemoglobin affecting nearly 3 to 4 lac of newborns per year. Identification of the disorders as well as carrier stages is of utmost importance. Detection of spectrum of the diseases and also its prevention by population screening at an incipient stage is important to reduce the global burden. Aim: To evaluate the epidemiology and early detection of carrier stages of haemoglobinopathies among antenatal mothers undergoing routine screening. Materials and Methods: This single centered, prospective, cross-sectional study was conducted from January 2015 to December 2017, amongst the antenatal mothers visiting the Thalassaemia Control Unit of Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India for a duration of three years, on a total of 7340 study population. The database was collected using a Linux Based Thalamon Software. Results: Out of a total number of 7340 subjects, on HPLC study, 91.7% were diagnosed as normal, 3.9% were diagnosed as ß thalassaemia carriers, 3.8% as HbE carrier and 3.8% were diagnosed among others as HbD carriers, HbS carrier and Hereditary Persistent Foetal Haemoglobin (HPFH) traits. HbA2 levels were found to be higher among the carrier stages in comparison to the normal individuals. Among the different haematological parameters assessed, MCV showed maximum variation. Conclusion: To reduce the global disease burden of thalassemia, identification of the carriers becomes essential, especially in the antenatal mothers. Cation-Exchange High-Performance Liquid Chromatography (CE-HPLC) serves as an appropriate tool for identification and quantification of normal Hb and its abnormal variants at its earliest. An effort is to create a mass awareness for detection of carrier states among antenatal mothers and further follow-up is indispensable to reduce the immense disease burden of haemoglobinopathies.

Utility of Carba NP test (Inhouse/RAPIDEC Commercial Kit) in the Identification of Carbapenemase Producing Clinical Isolates in a Tertiary Care Hospital

K Sreeja Vamsi, S Ramamoorthy, TS Murali, Manisha Singh, Vasanti Kabra

Introduction: Carbapenems are the drugs of choice for the treatment of many multidrug resistant hospital acquired infections. Resistance to carbapenems also is not uncommon and is increasingly being reported now-a-days. Though various tests like modified hodge test are available for the detection of carbapenemases, they lack sensitivity and specificity. Recently, the Carba NP test has been introduced for carbapenemase detection which has been approved and included in CLSI guidelines. Aim: To identify the prevalence of carbapenemase producing isolates and the utility of Carba NP in house as well as commercial RAPIDEC Carba NP test in the identification of these carbapenemases. Materials and Methods: All the carbapenem resistant organisms isolated during the study period from July 2018 to December 2018 were included in the study. A total of 91 isolates were identified during the study period which were further tested for carbapenemase production by both in House Carba NP test as well as commercially available RAPIDEC Carba NP (Biomerieux) as per the existing protocols. Twenty five carbapenem sensitive isolates were also tested. Klebsiella pneumoniae BAA ATCC-1705 and BAA ATCC-1706 were used as controls. Results: Out of 91, carbapenem resistant strains tested, 72 were identified as carbapenemase producers. Out of them, Klebsiella pneumonia accounted for 59.7% of the total carbapenemase producing organisms followed by Pseudomonas aeruginosa (25%) and E.coli (6.9%) followed by Acinetobacter and Enterobacter which constituted less than 5%. Among enterobacteriaceae, 43 out of 59 carbapenem resistant Klebsiella were carbapenemase producers whereas all the 5 carbapenem resistant E.coli were positive for Carba NP test. Among Pseudomonas 18 out of 21 were carbapenemase producers. All the positive isolates by in-house Carba NP test were also positive by commercial RAPIDEC test and vice-versa and none of the 25 carbapenem sensitive strains tested were positive for Carba NP test by either method indicating 100% correlation between the two methods studied. Conclusion: Carba NP in house as well as commercial RAPIDEC Carba NP test were equally effective in the identification of the carbapenemase producing gram negative bacilli. Wide adaptability of these tests by various laboratories will help in the early identification of these potentially spreading carbapenemase producers, which in association with appropriate treatment and infection control practices will prevent the emergence of these strains and will decrease the mortality and morbidity.

To Compare the Changes in the Corneal Endothelium Post Phacoemulsification Surgery with Balanced Salt Solution vs. Viscoelastic Device

Sachin Daigavane, Prarthana Patkar

Introduction: The corneal endothelial layer cannot regenerate. During phacoemulsification, it is exposed to damage. It is necessary to determine the causes of endothelial damage and replace them with less damaging alternatives. Aim: To compare the endothelial cell density and morphology in patients undergoing phacoemulsification with and without the use of viscoelastic device. Materials and Methods: This was a hospital based prospective interventional study. Fifty patients with cataract were included, who underwent cataract extraction by phacoemulsification. Among 25 patients viscoelastic device (Group I) was used. In the other 25 (Group II) the Anterior Chamber (AC) was maintained using continuous infusion of Balanced Salt Solution (BSS). Specular microscopy was done preoperatively and on 14^th postoperative day. Student’s paired and Unpaired t-test was done. SPSS 24.0 version was the software used and p<0.05 was considered as level of significance. Results: The endothelial cell density reduced from 2346.16±237.04 cells/mm² to 2327.88±234.93 cells/mm² in Group I and from 2347.96±215.55 cells/mm² to 2320.28±220.82 cells/mm² in Group II on 14^th postoperative day. The percentage of hexagonal cells reduced by 8.33% in Group I and 8.37% in Group II on the 14^th postoperative day. Conclusion: Implantation of IOL using BSS infusion seems to be a faster alternative to use of viscoelastic device in experienced hands without higher endothelial cell loss rates since there was no significant difference in corneal density or morphology between the two groups on the 14^th postoperative day.

Premenstrual Syndrome and Associated Factors among Health Care Professionals: A Cross-sectional Study

Poonam Bharti, Anshu Mittal, Anshu Gupta, Parul Gupta, Neha Jain

Introduction: Premenstrual Syndrome (PMS) is the combination of physical, emotional, physiological and psychological symptoms felt by females after ovulation of each menstrual cycle which may affect the quality of life of the professionals. Aim: To assess the quality of life among Health Care Professionals (HCP) during PMS. Materials and Methods: This was a cross sectional descriptive study conducted at MMIMSR, Mullana to assess the quality of life among HCPs during premenstrual period. Total 493 subjects were enrolled out of 520 after excluding those who didn’t participate in the study. Subjects were assessed on three scales- Socio demographic Performa, Premenstrual Symptoms Scale (PMSS), Quality of Life (QoL-10). The results were computed with descriptive statistical methods (frequency tables, ANOVA) using SPSS 20 version (IBM Inc Chicago) software. Results: Out of 493 subjects 253 had PMS. The parameters which showed significant association with QoL were age (<0.001), occupation (<0.001), marital status (<0.001), regularity of cycles (0.02), as well as with the severity (<0.001) of PMS. Conclusion: The study outcome showed that QoL is directly affected in Healthcare Professional (HCP) with increase in the severity score on PMS symptoms scale. The QoL is also affected with other related socio demographic variables. Proper actions shall be taken to increase the awareness among the women regarding the quality of life during PMS. Proper pharmacological and psychological treatment should be taken which will improve their quality of life.

Dipstick Screening for Urinary Tract Infection in Adolescent School Girls: Evaluation of Self Screening Ability

Swetha Ramesh, Bukanakere Sangappa Sumana

Introduction: Urinary Tract Infection (UTI) is a significant health problem in young women and adolescent females. Microscopic analysis and/or urine culture are costly, labour intensive laboratory-based tests. For many individuals, access and affordability for such care can be difficult specially in India rural settings have limited resources for this. The concept of self-screening for UTI by urine dipstick bedside method and benefits of adopting it as a regular school health programme is relatively new in our country. Aim: To evaluate the ability of self screening for UTI by urine dipstick method in the adolescent school girls. Materials and Methods: In this cross-sectional study the ability to self screen for UTI in 374 participants, including 184 girls from a rural school and 190 girls together from two urban schools was evaluated. At each school, the participants were educated about UTI and the objectives and methodology of the study. The participants reported to the school (to the investigators) within one hour of collecting first-morning, clean-voided, midstream urine sample in a sterile labelled container. The ability to self-interpret for UTI by the participants using dipstick method was evaluated. The interpretation by the investigator was considered the gold standard. Sensitivity, specificity and predictive values were calculated to assess the ability to self screen for UTI. The association between UTI and contributory factors was calculated using Chi-square tests. Results: The overall self screening ability of the participants for UTI was found to have sensitivity, specificity, positive and negative predictive values of 81.82%, 96.7%, 42.86% and 99.43%, respectively. The UTI was significantly associated with water intake (?²=11.196, p<0.01), habit of holding urine (?²=5.92, p<0.05) and method of perineal cleaning (?²=16.591, p<0.01). The prevalence of UTI among urban and rural adolescent school girls was 2.1% and 3.8% respectively with an overall prevalence of 2.9%. Conclusion: The results show that regular self screening of school girls for asymptomatic bacteriuria is feasible on a large scale at low cost.

To Compare Propofol and Sevoflurane for Maintenance of Anaesthesia on Recovery Characteristics and Cognitive Functions: A Randomised Control Trial

Tripat Kaur Bindra, Hardeep Bariar, Parmod Kumar, Nikita Gupta

Introduction: Laparoscopic Cholecystectomy is one of the most commonly performed surgery. Though cognitive dysfunction is less commonly seen, it is one of the most distressing post-operative complication. Aim: To compare the effects of sevoflurane and propofol infusion for maintenance of anaesthesia on recovery characteristics and cognitive functions in patients undergoing laparoscopic cholecystectomy. Materials and Methods: After approval from ethical committee, 80 patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly divided into two groups to receive either intravenous infusion of propofol (group A) or sevoflurane inhalation (group B) for maintenance of anaesthesia. Time to spontaneous breathing, eye opening, response to commands, time to extubation, time to achieve aldrete score >9 were recorded. Cognitive functions were recorded by using Rivermead behavioural memory test, California verbal learning test and by asking the name of surgeon and anaesthesiologist, both preoperatively and postoperatively. Descriptive statistics were done for all data and suitable statistical tests of comparison were done. Continuous variables were analysed with unpaired t-test and Mann Whitney U-test. Categorical variables were analysed with Chi-square test. Results: Haemodynamic parameters like Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) were comparable in both the groups. Though there were slight variations in HR and MAP at some time intervals but patients in both the groups were haemodynamically stable throughout the surgery. Emergence and recovery was significantly faster after maintenance with sevoflurane than propofol. Cognition was better in sevoflurane group than propofol group two hours postoperatively. Conclusion: Sevoflurane might be considered as a useful alternative to propofol in providing anaesthesia in laparoscopic cholecystectomies, especially in patients where rapid emergence and recovery of cognitive function are very much desired.

Influence of Geriatric Depression on Oral Health-related Quality of Life in the Urban Elderly Population: A Study from Southern Indian

Deepa Ponnaiyan, Harinath Parthasarathy, Dhayanand John Victor

Introduction: Depression causes a lot of Problems which leads to decreased quality of life and increased mortality in elderly. It is necessary to assess the relationship between geriatric depression and its impact on Oral Health-Related Quality of Life (OHRQoL). Aim: To determine the association between geriatric depression and OHRQoL in older adult southern Indian population. Materials and Methods: Two hundred and thirty subjects aged 60 years and older, attending outpatient department of SRM Dental College, Chennai, Tamil Nadu, India were recruited for the study. Geriatric Depression Scale (GDS) -15 and Oral Health Impact Profile (OHIP) -14 was recorded. Decayed Missing Filled Teeth (DMFT) index was used to ascertain the dental treatment needs of subjects. Data were collected using self or interviewer-administered questionnaires. Data were analysed using descriptive statistics. To compare proportions between GDS score groups Chi-Square test was applied. Uni variate and multi variate logistic regression analysis was done to estimate the Odds ratios of the factors associated with Geriatric depression. Results: The prevalence of depression according to GDS-15 was 56.5% (130) out of which 47.4% (109) were suffering from mild depression (GDS 5-9) and 9.1% had severe depression (GDS 10-15). The oral health impact profile was significantly associated with depression (p<0.001). Socio-demographic characteristics like presence of systemic diseases (p=0.002), smoking and alcohol consumption (p<0.001), marital status (p=0.001), education (p=0.024), family circumstances (p=0.001) were also significantly associated with depression. Subjects with poor oral hygiene had odds ratio of 1.79 when correlated with GDS score >5. Conclusion: These present results indicate that there is a strong correlation between GDS and OHIP-14. The presence of geriatric depression affects the overall oral health related quality of life. Intervention programs of oral health promotion and routine screening for detecting early signs of depression are essential in urban elderly population.

Effect of Maternal HIV Infection on Treatment with HAART on Neonatal Birth Weight and Other Anthropometry: A Cohort Study of HIV Sero-Positive Women in Enugu, South-East Nigeria

Introduction: Low Birth Weight (LBW) is associated with poor health conditions during neonatal period, infancy and in adult life. It is possible that some form of fetal growth restriction occurs in babies of HIV sero-positive women. Aim: To determine the effect of maternal HIV infection on neonatal birth weight and other neonatal anthropometric indices. Materials and Methods: The study was prospective cohort in design. Neonatal birth weight, head circumference, and crown-heel length of babies of 87 consecutive consenting HAART experienced HIV sero-positive pregnant women on HAART (study group) were compared with those of 92 matched HIV sero-negative women (control group). Data analyses were both descriptive and inferential at 95% confidence level. Results: The incidence of low birth weight was 25.3% (22/87) among the HIV sero-positive group and 14.1% (13/92) among the control group (p=0.060, R.R=1.8, 95% CI: 0.96-3.33). The mean neonatal head circumference in the study and control groups were 33.7±2.93 cm and 34.5±2.31 cm respectively, p=0.036 while the mean crown-heel length was 47.9±4.59 cm versus 48.7±4.02 cm, p=0.217. Conclusion: Maternal HIV treatment with Highly Active Antiretroviral Therapy (HAART) was not associated with high incidence LBW in Enugu, Nigeria. However, the head circumference was reduced. Careful measurement of the head circumferences of neonates of HIV sero-positive mothers, during routine new-born examination, is encouraged, so that any disproportionate growth would receive further appropriate assessment.

Assessment of Atherogenic Indices in Type 2 Diabetes Mellitus

Yogita Suresh Phapale, Zunjarrao G Badade, Shibban K Kaul, Sandeep Rai

Introduction: Worldwide, Diabetes mellitus is the most common chronic disorder and risk factor for Coronary Artery Disease (CAD). The atherogenic indices including atherogenic index of plasma is a novel indicator of diabetic dyslipidemia, which is equivalent to the risk predictor of CAD. Aim: To compare the atherogenic indices including atherogenic index of plasma, cardiac risk ratio and atherogenic coefficient in individuals with Type 2 diabetes mellitus and in control group. Materials and Methods: The present study included 280 participants; of which 70 were healthy age and sex matched controls and 210 were known cases of Type 2 diabetes mellitus (30-60 years). Lipid profile was assessed by enzymatic assay and atherogenic indices including, atherogenic index of plasma, cardiac risk ratio and atherogenic coefficient were calculated. Patients with chronic liver/kidney disease and on lipid lowering drugs were excluded. Statistical analysis was done with SPSS version 20.0 and chi-square and one sample t-test was applied, p<0.05 were considered as statistically significant. Results: Duration of diabetes was 6 to 10 years, the average BMI was 26.09 kg/m². Among 210 diabetic patients 73 (34.76%) were of normal weight, 128 (60.95%) overweight and 09 (4.29%) obese; 87% had diabetic dyslipidemia. High level of HbA1c (8.8±1.5%) was associated with increase in duration of diabetes, the average duration of Type 2 diabetes in study population was 9.8±4.4 years. Significantly increased levels of cholesterol (188.3±31.9), triglyceride (161.3±19.4) and LDL-C (114.9±30.9) and decreased HDL-C (41.17±3.19) in diabetic patients as compared to control (165.5±35.5, 114.5±9.28, 94.4±34.4 and 48.17±3.4 respectively) (p<0.001) was noted. The atherogenic indices showed significantly increased levels of Atherogenic Index of Plasma (AIP) {(0.22±0.07) vs (0.04±0.01)} (p<0.001); Cardiac Risk Ratio (CRR) {(4.60±0.81) vs (2.44±0.71)} and Atherogenic Coefficient (AC) {(3.60±0.81) vs (2.44±0.71)} (p<0.001) in Type 2 diabetic patients vs control group. Conclusion: All diabetic patients having at least one kind of dyslipidemia, assessment of atherogenic indices, especially atherogenic index of plasma gives valuable information about future risk of abnormal cardiac event. Thus, it could be a better marker and predictor for increased risk of CAD in Type 2 diabetes.

Tunica Vaginalis Flap Repair for Urethrocutaneous Fistulae

Suersh Bhat, Chandrasenan Nair, Suyog Shetty, Fredrick Paul

Introduction: Hypospadias is a common condition which needs to be repaired within the first few years of life. However, the surgery is usually associated with several complications of which Urethrocutaneous Fistula (UCF) is the most common. Several surgical techniques have been described to correct these UCF. Use of a vascularized flap to repair this fistula is the current standard. Aim: To assess the feasibility of using tunica vaginalis flap in repair of UCFs. Materials and Methods: The present study was an observational study where 32 patients with UCF resulting from a previous failed hypospadias repair were subjected to tunica vaginalis flap repair. These patients were followed-up to a mean duration of 18 months to look for recurrence of fistula and other fresh complications. Results: The study included 32 patients of whom 19 had a fistula after primary surgery, 9 had undergone 2 failed surgeries and 4 had undergone 3 previous attempts at hypospadias repair. Majority (29 patients) had a single UCF. No scrotal haematoma or testicular complications were noted. Penile cosmesis was satisfactory as determined by HOSE scoring system. Erection seemed to be unaffected but could be a spurious result as majority of the patients were of pre-pubertal age. After median follow-up of 18 months, two cases had recurrence of fistula; both occurred within 1 month of the surgery. Conclusion: Tunica vaginalis interposition flap repair of urethrocutneous fistula has good outcome.

Influence of Cola-Based Soft Drinks on the Microhardness of Nanohybrid and Bulk Fill Composites

Introduction: Bulk fill composites have been introduced in the past few years and appear to solve some of the disadvantages of conventional composites such as polymerisation contraction and the consequent marginal microinfiltration. Aim: To evaluate the surface microhardness of the Z350 and the Bulk fill composites when immersed in distilled water, for 24 hours, and immersed in Coca-Cola™, along with distilled water, for 30 days. Materials and Methods: Seventy two specimens from each composite were evaluated, being divided into two groups and kept in distilled water at 37°C, for 24 hours and, subsequently, submitted to the Knoop microhardness analysis. After performing the reading, 12 specimens from each composite were individually stored in distilled water and in Coca-Cola Classic™ at 37°C, for 30 days and, then, the Knoop Hardness Number (KHN) value analysis was performed again. Data were submitted to the statistical analysis applying the Kruskal-Wallis test and the Dunn’s post-test (p<0.05). Results: Immersion after 30 days in Coca-Cola™ and distilled water similarly changed KHN values for Z350 and Bulk Fill composites. The analysis between the composites showed statistically significant changes for the group immersed in distilled water, in 24 hours, as well as for the group immersed in Coca-Cola™, with higher KHN for the Z350 composite (57.69±4.15), (p<0.0001). Conclusion: The bulk fill composite presented lower microhardness values than the Z350 composite after immersion in distilled water, for 24 hours, and immersion in Coca-Cola™. However, the immersion in distilled water, for 30 days, did not show differences between the two evaluated composites.

Comparative Evaluation of Uroflowmetric Parameters in Patients with Benign Prostatic Hyperplasia Undergoing Transurethral Resection of the Prostate

JB Narendra, N Sathishkumar, GV Ravikumar

Introduction: Benign Prostatic Hyperplasia (BPH) is a common disorder affecting elderly men which substantially impacts Quality of Life (QoL) mainly due to Lower Urinary Tract Symptoms (LUTS). Aim: This study assessed the role of uroflowmetry in LUTS evaluation due to BPH and use of uroflowmetry before and after Transurethral Resection of the Prostate (TURP). Materials and Methods: This was a prospective single centre study conducted between November 2016 and May 2018. Patients aged more than 40 years who presented with LUTS due to BPH and were recommended to undergo TURP were eligible for participation. International Prostate Symptomatic Score (IPSS) and uroflowmetric data was collected pre and postoperatively (Day 7, 30 and 90). Chi-Square, crosstabs, paired-t, repeated measure ANOVA, and Pearson’s correlation coefficient tests were used. Results: A total of 50 patients were included in the study. The mean (SD) age was 67.62 (8.63) years and a total of 20 (40%) patients were aged between 61 to 70 years. Postoperatively, significant (p<0.0001) improvement was observed in the IPSS score with 3 (6%) patients having values <8, 47 (94%) patients having values between 9-19 and none had >20. Postoperatively, maximum flow rate (Q_max), average flow rate (Q_avg), and time taken for voiding maximum volume/second (T_max) improved significantly (p<0.0001). Among IPSS QoL parameters the greatest improvement was found for incomplete emptying, intermittency, weak stream, and straining. Conclusion: Uroflowmetry parameters can be used to assess the symptoms as well as to predict the outcome of TURP. The IPSS is valuable in assessing the symptom complex of LUTS with BPH.

Taste Detection and Recognition Thresholds among Young Adults of Different Blood Groups: A Pilot Study

Avinash Eknath Thakare, Pooja Suresh Salkar, Nushrat Fatima, Santosh Wakode

Introduction: Individuals differ, sometimes extremely in their ability to perceive and enjoy the different qualities of taste and flavor. Present study tried to explore the relationship between different blood groups (ABO blood groups) and taste thresholds for five basic taste sensations. Aim: To compare taste detection and recognition thresholds for basic taste sensations among individuals of different blood groups. Materials and Methods: An observational cross-sectional pilot study was conducted in which total 100 young adults (males and females) in age group of 19-25 years were tested for taste Detection Threshold (DT) and Recognition Threshold (RT) for five basic taste sensations (sweet, sour, salty, bitter and umami). ABO and Rh blood groups of the subjects were determined and taste detection and RTs for basic taste sensations were compared among individuals of different blood groups. Data was analysed using SPSS V16 software and two-way ANOVA test was used. Results: AB blood group subjects have low mean RT (0.0218±0.0085 Molar) for sweet taste and B blood group subjects have shown low mean DT value (0.0120±0.0079 Molar) for sweet taste. AB blood group subjects have low mean DT value (0.0078±0.0047 M) for salty taste. Low mean RT (0.0027±0.0017 Molar) for sour taste was seen for Blood group O. Bitter taste has lowest mean RT (0.0000117±0.0000039 Molar) for blood group A. Blood group O was found to have lowest values for both RT (0.037364±0.018087 Molar) and DT (0.011549±0.005707 Molar) for umami taste sensation. However, all the observed detection and RT were statistically non-significant. Conclusion: Blood group alone cannot explain taste sensitivity as well as variations for particular taste sensation.

Comparing the Efficacy of First Rib Maitland Mobilisation and Muscle Energy Technique on Pain, Disability and Head Position Sense in Patients with Chronic Mechanical Neck Pain

Shail Sachdeva, Joginder Yadav, Mohit Gulati

Introduction: Mechanical neck pain is the most common musculoskeletal disorders. Muscle Energy Technique (MET) and Maitland mobilisation may provide a useful intervention for treating such disorder. Aim: To compare the effect of MET with Maitland mobilisation on pain, functional disability and head position sense in people with chronic mechanical neck pain. Materials and Methods: An experimental comparative study including 40 patients with mechanical neck pain of age group 25-40 years were undertaken from March 2018 to June 2018. Patients were randomly allocated to either the MET group or mobilisation group with 20 patients in each group. The former group received MET (group A) which is a form of active stretching techniques used as manipulative treatments and the latter (group B) received Maitland mobilisation manual therapy intervention, a type of passive movement of a skeletal joint. Both groups received conventional therapy in the form of proprioceptive training and hot fomentation. Treatment was given three times per week for four weeks. A Mc Gill pain questionnaire was used to measure the intensity of pain, functional disability was assessed using the Neck Disability Index (NDI) and head position sense was assessed by using cervical joint position error device using laser tracker immediately before treatment at 2nd week and again on the last day of 4th week intervention, ANOVA and student’s t-test was used to compare the intergroup analysis for all variables at baseline, 2nd and 4th week of intervention. Results: Both groups improved significantly at the end of 4th week but group A showed highly significant difference for pain, disability and head position sense in comparison to group B (p<0.005). Conclusion: MET has shown better improvement than Maitland mobilisation on pain, functional disability and head position sense in patients with chronic mechanical neck pain.

Efficacy of 4% Articaine and 2% Mepivacaine without Palatal Injection in Assessing Pain during Maxillary Teeth Extraction: A Randomised Clinical Trial

Introduction: Local anaesthesia is used to reduce pain while performing the extraction of teeth. But local anaesthesia injection itself causes pain while administration, especially palatal injections. Many patients avoid dental extractions due to the same reason, which can lead to life threatening situations. In the present-day dental practice, providing treatment with least amount of pain and discomfort is the key. Aim: The study was done to compare the efficacy of 4% articaine and 2% mepivacaine without palatal injection for assessment of pain during maxillary teeth extraction. Materials and Methods: A double blinded pilot randomised clinical trial was performed on 54 patients which required extraction of anterior and posterior maxillary teeth. Single buccal infiltration of 1 mL of 4% Articaine hydrochloride with adrenaline 1:200000 solution was given to 27 patients in study group A and 1 mL of 2% Mepivacaine with adrenaline 1:200000 was given to 27 patients in control group B. Objective signs of palatal anaesthesia was checked and pain was assessed by VAS scale. Mann-Whitney U test was used to compare the pain at different stages of extraction between group A and group B. Chi-square test was used to compare palatal injection needed between groups. The statistical analysis was performed with the SPSS version 15. Results: The subjects who required re-anaesthesia is significantly higher percentage (70.4%) in the Mepivacaine group than compared to Articaine group (29.6%) (p=0.003). Hence, patients in the group where 4% articaine was administered showed significant reduction of pain without palatal anaesthesia. Conclusion: Articaine 4% was superior in comparison to 2% Mepivacaine in its characteristics of bony diffusion and there was no absolute requirement to use palatal infiltration for the extraction of maxillary teeth.

Evaluation of Soluble Fms-like Tyrosine Kinase-1 in First Trimester of Pregnancy: A Cross-sectional Study

Sathya Selvarajan, Jothimalar Ramalingam, Jaya Vijayaraghavan, Zachariah Bobby

Introduction: Soluble fms-like tyrosine kinase-1 (sFLT-1) is the form of the Vascular Endothelial Growth Factor (VEGF) receptor-1. It is an anti-angiogenic protein tyrosine-kinase receptor that binds to the VEGF. In pregnancy, the overexpression of receptor in placenta inhibits the formation of new blood vessels in uterus, and has been implicated in abnormal embryonic and placental development, and other complications of pregnancy like preeclampsia. Aim: To determine the levels of soluble fms-like tyrosine kinase-1 (sFLT-1) in sera of apparently healthy pregnant women in the gestational age group of 4 to 10 weeks. Materials and Methods: A cross-sectional study conducted at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. Serum sFLT-1 levels of 140 pregnant women (in first trimester of their pregnancy) were measured by Enzyme-Linked Immuno Sorbent Assay (ELISA). Correlation of gestational age with sFLT-1 values was performed by using Karl Pearson’s correlation coefficient. Results: The mean value of sFLT-1 in pregnancy was found to be 1043±435 pg/mL. A significant positive correlation was observed between gestational age and sFLT-1 in early pregnancy. Linear regression equation for predicting the sFLT-1 level based on the gestational age=282.57+94.23* (gestational age in weeks). Conclusion: sFLT-1 levels were observed to be directly correlated to the gestational age, and increased with gestational age. Determining the level of sFLT-1 in early first trimester of pregnancy and establishing its reference interval based on gestational age can help in differentiating normal pregnancy from a non-viable pregnancy in the early stages.

Pattern of Renal Histopathological Findings in Children: A Single Center Study

Lipsa Priyadarshini, Subal Kumar Pradhan

Introduction: A well-known diagnostic tool for determining kidney diseases in paediatrics is renal biopsy. It aids in selection of precise therapeutic approaches for several renal diseases. Aim: To explore the indications and histopathological patterns of renal diseases in children in a tertiary care center in Odisha, India. Materials and Methods: A retrospective study involving renal biopsies were performed on children aged ≤14 years between January 2010 and July 2018. All renal biopsies were studied under light and immunofluorescent microscopy. The clinical characteristics and histological diagnosis pertaining to each case during the study period were retrieved from medical records and analysed. Results: A total of 443 biopsies were considered for analysis. The mean age was 5.94 years (range 4 months-14 years) with a predominance of boys (62.97%). The most common indication for renal biopsy was Nephrotic Syndrome (NS) (79.9%) followed by lupus nephritis (5.19%), Acute Kidney Injury (AKI) (3.16%) and haematuria (2.25%). Steroid Dependent Nephrotic Syndrome (SDNS) was the most frequent indication among all NS children. Minimal Change Disease (MCD) was the most common histopathological finding in NS which constituted 47.63% followed by Focal Segmental Glomerulosclerosis (FSGS) 22.12%. The biopsy report of the children with lupus nephritis showed the disease progression to stage IV. Most common primary glomerulonephritis was MCD while secondary glomerulonephritis was lupus nephritis. Conclusion: MCD was the most common histological finding. The present study provides largest data on Biopsy Proven Renal Disease (BPRD) in children from eastern India published till date.

Allelic Distribution of A1298C and C677T Polymorphisms of MTHFR in Central India

Suprava Patel, Rachita Nanda, Eli Mohapatra

Introduction: A 5,10-Methylene Tetra Hydrofolate Reductase (MTHFR) is known for its metabolic implications involved in biosynthesis of various active metabolites involved in gene expression and modulating protein functions. The variants, A1298C and C677T, have been studied globally for its association with various disorders. The prevalence for the polymorphisms of the two variants has not been much studied in Central region, especially in children. Aim: To know the prevalence of MTHFR variants in children in central region. Materials and Methods: The cross-sectional study was conducted on 375 children aged 5-15 years. All children in the study population, irrespective of their health status, were recruited from Outpatient Department (OPD) and Inpatient Department (IPD) of the institute during the sampling period of three months. The collected samples were analysed for MTHFR C677 (rs1801133) and A1298 (rs1801131) polymorphism by RT-PCR using TaqMan SNP genotyping assay. Percentage calculation for allele and genotype frequency, Hardy-Weinberg Equilibrium (HWE) and Linkage Disequilibrium (LD) were calculated using Microsoft Excel. Results: The wild type CC677 (72.3%) was the most commonly occurring genotype in the study group. The frequency of wild type alleles for A1298C and C677T was 0.59 and 0.86, respectively and the minor allele (homozygous mutant variant) frequency was 0.41 and 0.14, respectively in the study population. High prevalence of mutant C´ allele (41%) of A1298C and high prevalence of combined genotype CC/AC´ (35.2%) together contribute to higher frequency of heterozygous (46.9%) and homozygous mutant (17.9%) forms of A1298C as compared to the variants of C677T. The allelic frequencies did not follow HWE and exhibited significant but low LD (D’=0.12, p=0.04). Conclusion: The mutant allele of A1298C was more frequently occurring. Fresh incorporation of the mutant allele into the population might be responsible for disrupting the HWE and low LD.

Corrosion of Orthodontic Brackets Immersed in Spices and Salt Solution: A Pilot Study

Introduction: Various studies on corrosion of Orthodontic appliances and numerous factors aggravating this process have been discussed in the past. The diverse environment of the oral cavity favours the degradation of the metal alloys which is of concern to an Orthodontist due to the prolonged duration of these appliances in the mouth. Of the various factors affecting the biodegradation of the metals one of the factors is the diet and the dietary spices. Inspite of being an integral part of daily cuisine, the literature explaining their role in corrosion of the Orthodontic appliances is scarce. Aim: To assess and compare in vitro corrosion of Orthodontic metal brackets immersed in solutions of different spices and salt in artificial saliva. Materials and Methods: A total of 20 metal orthodontic brackets (AO) were divided into 10 groups containing artificial saliva, coriander (coriandrum sativum), turmeric (curcuma longa), black pepper (piper nigrum), red chilli (capsicum annuum) and Salt (sodium chloride). Electrochemical corrosion of the orthodontic brackets was carried out in corrosion cell. The corrosion current density (Icorr), corrosion potential (Ecorr) and pitting potential (Epit) rates were calculated using Tafel analysis and potentiodynamic data. Photographic images were captured from the metallurgical microscope. Results: The present study demonstrated that turmeric and coriander showed reduced corrosion whereas salt, red chilli and black pepper have been found to enhance it. Increased corrosion was seen in all groups containing salt. Surface analysis under metallurgical microscope showed increased pitting in red chilli solution group while less in coriander solution group. Conclusion: Different spices affect corrosion of metal brackets. Turmeric and coriander showed reduced corrosion whereas salt, red chillies and black pepper have been found to enhance it. Increased corrosion was seen with solutions containing salt.

Burden and Impact of Multidrug Resistance Infection on Outcome of the Patients with Decompensated Liver Disease in a Tertiary Care Institute

Introduction: Cirrhosis-Associated Immune Dysfunction (CAID) increases the risk of development of infection which progresses to sepsis and death. Most common infection associated with liver cirrhosis patients are Spontaneous Bacterial Peritonitis (SBP) and Urinary Tract Infections (UTI), together they make up about two thirds of these infections, while the remainder belongs to infections of the skin and soft tissue, bacteremia and other infections. There are increasing numbers of Multidrug Resistant Strains (MDRs) emerging especially in the hospital setting. Aim: To assess the prevalence of bacterial infection, MDR pattern among the isolates, infection status in correlation with Child-Turcotte-Pugh (CTP) score, survival rate and mortality rate. Materials and Methods: This retrospective study includes 359 consecutive hospitalised cirrhotic patients from August 2017-July 2018. Based on the clinical examination, laboratory findings and culture positivity, the bacterial infections were diagnosed accordingly. Results: The prevalence of bacterial infection was 29.80%. The most common infections were UTI (51.56%) followed by Blood Stream Infection (BSI) (24.21%), SBP (14.06%) and Skin and soft tissue infections (7.03%). The most common isolates were Escherichia coli, Staphylococcus spp, Klebsiella spp, Enterococus spp, and among Fungi were Candida spp. Among bacterial isolates 55.9% turned out to be MDR. The mortality rate was high (61.1%) among the patients with infection and patients with CTP-C (=10 points) with multiple infections which showed significantly higher mortality rate. Based on the source and development of infection, majority were under community-acquired infections (39.84%) followed by nosocomial (38.29%) and healthcare associated (21.87%). A higher MDR (68.18%) among nosocomial infections were observed. Conclusion: Increased trend of MDR in nosocomial and healthcare associated infections, shows increased failure rates of empirical antibiotic treatment and necessitates the implementation of Antibiotic stewardship programs. Infections acts as precipitating factor for liver function deterioration thereby increases the chance of mortality. So, the patients with cirrhosis should be carefully monitored for infections.

An Audit of Andrological Needs in Traumatic Paraplegic Male Patients: Five Year Assessment in a Single Paraplegic Centre

Introduction: Management of andrological needs of paraplegic patients is challenging and has to be individualised. Aim: To analyse demographic profile and treatment responses with respect to the andrological needs in Traumatic Spinal Cord Injury (TSI) patients over five years in a single paraplegic centre. Materials and Methods: Records of 110 patients admitted for TSI over a period of five years were studied. Demographic parameters considered were age, marital and fertility status, mode of trauma, socioeconomic status. Patients were assessed by American Spinal Injury Association Impairment Scale (AIS) and International Index of Erectile Function score (IIEF5). Erectile Dysfunction (ED) and Ejaculatory Dysfunctions (EJD) were primarily targeted for interventions. Treatment options included were Phosphodiesterase-5 inhibitors (PDE-5i), Intracavernosal Injections of Vasoactive Drugs (ICIVAD) and Vacuum Erection Devices (VED) for ED; Penile Vibrator Stimulation (PVS) and Electroejaculation (EEJ) for EJD. All the interventions were also accompanied by psychosexual counseling.The proportion of patients responding to each therapy was noted. Paired t-test was used to compare the IIEF score in patients with ED before and after therapy. Results: Seventy four patients were addressed for ED. The mean age was 31.3±7.8 years; 58 of 74 patients were compliant for PDE-5 inhibitors; 42 patients out of these were satisfied with oral PDE-5i therapy. Out of 12 patients who opted for ICIVAD, 10 were satisfied with the outcome. Out of 16 patients treated by VED, 5 deemed their erections as satisfactory. The mean IIEF-5 score before therapy was 8. The mean IIEF-5 score as a result of the combined therapy was 12.3 (p<0.01). Total 16 patients had EJD, out of which 5 had successful ejaculation after PVS. One patient underwent successful Electro-ejaculation. Conclusion: A step-by-step approach of oral PDE-5i therapy, ICIVAD and VED is adequate to manage ED in a majority of patients with SCI. Similarly, PVS and EEJ can be used for management of EJD in these patients.

Nasogastric Tube Insertion in Anaesthetised, Intubated Paediatric Patients: A Comparison between Conventional Blind Method and ‘Throat Pack In-situ’ Technique

Ratul Chowdhury, Mohanchandra Mandal, Moushumi Khanra, Abhijit Mukherjee

Introduction: Nasogastric Tube (NGT) insertion may become difficult in anaesthetised and intubated children similar to adults. In paediatrics, often anaesthesiologists are compelled to use uncuffed Endotracheal Tubes (ETT) owing to resource problem. Conventionally, NGT is inserted prior to throat pack application with the fear of difficulty later on. Aim: To compare the ‘throat pack in-situ’ method with the conventional blind insertion of NGT with respect to success rates, procedure times and adverse events. Materials and Methods: A total of 140 anaesthetised and intubated children aged 3-12 years were evaluated for insertion of NGT either before (‘conventional blind technique’, group A, n=70,) or after (‘throat pack in-situ’ method, group B, n=70) pharyngeal pack application. Success rate was the primary outcome. Student’s t-test was used for analysing numerical/ continuous data such as NGT placement time, throat pack application time and duration of fresh gas flow leak, etc. Pearson Chi-square test was utilised for categorical data such as number (proportion) of successful placement of NGT, gender distribution, ASA-PS class of patients, etc. Results: Both the groups achieved a high (>90%), comparable success rate but group B had a favourable profile regarding adverse event. Duration of fresh gas flow leak was lesser in group B owing to early pack application before NGT insertion. (p<0.001). Conclusion: Considering the comparable success rate and lesser adverse events, the ‘throat pack in-situ’ technique appears better alternative to the conventional blind method in paediatric population where the use of uncuffed ETT with throat pack application is still common. Moreover, the duration of fresh gas leak was found to be considerably less with the use of throat-pack in-situ technique.

Sensitive Serological Testing and Universal Precautions Prevent Blood Borne Viral Infections in Patients Undergoing Haemodialysis

Veena Shenoy, Ramanathan Thambiran, Anil Kumar, Zachariah Paul, George Kurian

Introduction: Lawn tennis is one of the most admired racquet sports world wide which is played either individually or in doubles. Circuit training is a simple method of giving a player a variety of exercises that will improve the three main functions relating to performance on the field. These are speed, strength and agility. Plyometric training involves lengthening of muscle followed by quick shortening contraction that enhances capability of muscle to produce large amount of force. Aim: To compare the effectiveness of circuit training and plyometric training on speed, strength and agility in aspiring state level Lawn tennis players. Materials and Methods: The present study had an experimental study design. Forty male lawn tennis players in the age group of 18-25 years were included in this comparative study and randomly divided into two groups: Circuit training (Group A) and Plyometric training (Group B) with 20 players in each group. All players were evaluated for lower limb strength, upper limb strength, agility, running speed with Vertical Jump Test, Chest press test, agility-T-Test and 50 meter Dash test. Circuit training group performed 5 minutes warm up, 5 minutes sports specific training, Circuit training 28 to 42 minutes and cool down 5 minutes. Plyometric group performed warm up 5 minutes, Plyometric training 30 to 60 minutes, 5 minutes sports specific training, cool down 5 minutes. Paired t-test was used to compare the differences within the group and unpaired t-test was used to compare the difference between groups. Data was collected for all variables at baseline, 4th and end of 8th week. Results: Both groups improved significantly after 8th week but circuit training group showed highly significant difference for upper limb strength, lower limb strength, running speed and agility compared to plyometric training group (p<0.05). Conclusion: Circuit training is an important method for improving upper limb and lower limb strength, running speed and agility in lawn tennis players.

A Comparative Study of Circuit Training and Plyometric Training on Strength, Speed and Agility in State Level Lawn Tennis Players

Nirjhar Mohanta, Sheetal Kalra, Sonia Pawaria

Hydatid disease is a zoonotic infestation caused by the genus Echinococcus. It is still widespread in agricultural communities. It is common in temperate and sheep raising countries of the world where it causes a significant public health problem. It is a chronic disease and cyst can be presented in different organs. In humans, hydatid cyst develops most often in the liver (65%) and lungs (25%). Other organs affected occasionally include the brain, muscle, kidney, heart, pancreas, adrenal, and thyroid gland. Involvement of the thyroid gland by hydatid cyst is rare. It is most often asymptomatic or present with anterior neck swelling or rarely dysphagia or dyspnoea. This case report explains our experience with a patient suffering from hydatid cyst in the thyroid.

Comparative Study of Two Different Intravenous Doses of Tranexamic Acid with Placebo on Surgical Field Quality in Functional Endoscopic Sinus Surgery- A Randomised Clinical Trial

Tamil Anbu Pannerselvam, Kodali V Rajesh Kumar, Ranjith B Karthekeyan

Introduction: Intraoperative haemorrhage, which disrupts surgical patency, is a major obstacle for surgeons, especially in endoscopic sinus surgeries. Tranexamic acid is synthetic antifibrinolytic agent that binds competitively at lysine binding site on plasminogen prevents fibrinolysis, improves blood clot formation and reduces bleeding. The role of tranexamic acid by topical adminstration during Functional Endoscopic Sinus Surgeries (FESS) had contrasting reports and limited number of studies are available with systemic adminstration of tranexamic acid in FESS surgeries. Aim: To compare two different intravenous doses of tranexamic acid with placebo on surgical field quality, surgical time and blood loss in FESS surgeries. Materials and Methods: Eighty four ASA physical status I and II patients from January 2013 to December 2013 aged 18-60 years, who underwent FESS surgery, were included in the study. Patients were randomised to Group A receiving 15 mg.kg^-1 tranexamic acid Group B receiving 5 mg.kg^-1 tranexamic acid and Group C as placebo receiving normal saline. Heart rate, systolic, diastolic blood pressure, oxygen saturation, blood loss and surgical site quality were recorded. Statistical analysis between treatment groups was performed using repeated measures of ANOVA and intergroup analysis was performed where appropriate. The primary outcome was surgical field quality; secondary outcome was blood loss and surgical time. Results: Intravenous administration of tranexamic acid was found to reduce the total blood loss in FESS surgery by 64% in group A (15 mg.kg^-1) and 31% in group B (5 mg.kg^-1) compared to placebo (p=0.0001). Reduction in bleeding by administration of tranexamic acid also led to an improved surgical field quality. There was partial surgical field clearance at a low dose of tranexamic acid while 15 mg.kg^-1 of the drug achieved about 100% surgical site clearance as measured with Wormald Grading Scale of surgical field quality (p=0.0001). This was also validated by a surgeon satisfaction score after FESS procedure using Likert scale and the fraction of patients for whom surgery was affected by bleeding. The surgical field improvement by use of tranexamic acid has also been found to have a prominent reduction in the total time taken to complete the surgery. Administration of 5 mg.kg^-1 drug led to a 7% reduction and 15 mg.kg^-1 of tranexamic acid led to about 15% reduction in time taken for FESS surgery (p=0.0001). Conclusion: Tranexamic acid 15 mg/kg dose effectively reduces blood loss, improves surgical field quality and reduces surgical time.

Expression of DNA Gyrase at mRNA Levels and Antibacterial Effect of Fluoroquinolone-Derived Compounds on Two Antibiotic Resistant Bacteria; Staphylococcus aureus and Enterococcus faecalis

Introduction: Fluoroquinolones are a form of antibiotics capable of influencing DNA Gyrase of bacteria. Any alteration in the structure of current fluoroquinolone antibacterials may provide a better effect on the growth inhibition of bacteria. Aim: To assess the probable anti-bacterial activity of two fluoroquinolone derivatives on Staphylococcus aureus (S.aureus) and Enterococcus faecalis (E. faecalis). Materials and Methods: The inhibitory effect of two synthetic derivatives of fluoroquinolones, N-4-methyl (phenyl) -2,2,2-trifluoroacetimidoyl ciprofloxacin (C1), and N-4-methyl (phenyl) -2,2,2-trifluoroacetimidoyl norfloxacin (C2), was measured by Minimum Inhibitory Concentration (MIC) using Broth Microdilution (BMD) and disc diffusion methods. Also, by using real-time PCR technique, the influence of C1/C2 was evaluated on DNA gyrase gene expression of S.aureus and E. faecalis and all compared with vancomycin as a control antibiotic. Collected data were analysed by SPSS 18.0 software. One-way ANOVA and Tukey’s multiple comparisons test were used for it. Results: The findings showed that vancomycin (MIC, 16 µg/mL) has higher antimicrobial activity, especially on E. faecalis, compared to C1 (MIC, 256 µg/mL). The anti-bacterial effect of C2 (MIC, 128 µg/mL) was higher on E. faecalis but no significant effect on S. aureus. (p<0.05). In addition, the results of gene expression alterations showed that the C1 reduced the gene expression of DNA gyrase in tested bacteria, but not significant in comparison to control (p<0.05). C2 reduced the gene expression of DNA gyrase in both bacteria and it was significant for E. faecalis (p<0.01). Conclusion: Because of bacterial growth inhibition characteristic, C2 possibly may be used as an alternative antibiotic to control infection caused by E. faecalis.

Self-perception Regarding Oral Health Status in Relation with Socioeconomic Determinants: A Study from Hail, Saudi Arabia

Introduction: Achieving satisfactory oral health is a subjective state; despite improvement and advances in health, disparities in oral health still occurs. Identification of determinant of health is an initial step to know insights of certain locality. Aim: To determine the perception of oral health status amongst respondent of Hail region based on gender, age, level of education and income. Materials and Methods: It was a cross-sectional study conducted from June 2019 to August 2019. The sample (n=412) was selected through non-probability convenient sampling technique. Components of oral health survey questionnaire designed by World Health Organisation, was used as study tool to measure the perception of respondent’s. Data were displayed as number and percentage. Chi square test was used to measured the association of different oral health determinants. p-value <0.05 was considered significant. Results: Females {84 (62%)} perceived a good oral health status than males {52 (38%)} with p=0.013. The perception of 18-28 years old participants was 33%, and 49 years old and more was 12%, i.e., with increasing age, perception toward oral health status was decreasing. University level of education participants (46%) perceived an excellent oral health. Majority of participants 163 (39%) with high income group perceived a good oral health. The education level and amount of income were also found to be statistically associated in determining respondent’s perception towards their oral health status. Conclusion:Perception of oral health found to be associated with the age, gender, level of education and income. Female gender, higher level of education and good income contributes to good oral health perception while increasing age inversely affects the oral health perception.

Socioeconomic Disparity and Musculoskeletal Disorders: The National Socioeconomics Survey, 2010 and 2012

Introduction: Musculoskeletal Disorders (MSDs) is one of the leading public health problems in Thailand especially among the working age and elderly population. MSDs is the disease that can be affected by many factors such as working environment, abnormal body structure and age related degenerative conditions. Aim: To explore the prevalence and association between Socioeconomic Status factors (SES) and MSDs in Thai population. Materials and Methods: A cross-sectional study was performed by using the data from the National Socioeconomics Survey conducted by the National Statistical Office (NSO) in 2010 and 2012. A total of 17,040 and 16,905 participants who met the inclusion criteria of this study were recruited in 2010 and 2012 respectively. The required information was collected by face-to-face interview with structured questionnaires. Multilevel mixed-effects logistic regression analysis was performed to determine potential socioeconomic factors associated with MSDs. Results: The prevalence of MSDs in 2010 and 2012 was 3.90% (95%CI: 3.61 to 4.19) and 2.96% (95%CI: 2.70 to 3.21) respectively. The multilevel mixed-effects logistic regression observed that odds of having MSDs were significantly higher among those who had low education attainment (ORadj=1.52: 95% CI: 1.18 to 1.95), were agriculturist (ORadj=1.69; 95% CI: 1.32 to 2.18), aged 40 year old or greater (ORadj=9.10; 95% CI: 7.02 to 11.80) and were female (ORadj=1.22; 95%CI: 1.04 to 1.44). In addition, the factors that were associated with MSDs in 2012 data were respondents residing in the North region (ORadj=2.25; 95% CI: 1.36 to 3.70), were agriculturist (ORadj=1.72; 95% CI: 1.28 to 2.32), had low education attainment (ORadj=1.51; 95% CI: 1.14 to 1.99) and aged 40 year old or greater (ORadj=11.28; 95% CI: 7.96 to 15.98). Conclusion: The study indicated that socioeconomic status was associated with musculoskeletal disorders. Those who were female, agriculturalist and had low educational attainment were vulnerable to MSDs in Thai population.

Seroprevalence of Anti-Chikungunya IgG Antibodies among Rheumatoid Arthritis (RA) Patients

Introduction: Chikungunya infection is an acute disabling illness characterised by high fever and severe arthralgia. Most of the patients recover completely; however few may develop post-Chikungunya Chronic Inflammatory Rheumatism (CHIK-CIR). Aim: To detect the seroprevalence of chikungunya among Rheumatoid Arthritis (RA) patients and to demonstrate association between them. Materials and Methods: This was a prospective study conducted from July 2018 to November 2018 at the Department of Microbiology, in a tertiary care hospital. Patients attending rheumatology clinic with complaints of arthritis and clinically suspected to have RA were included in the study. Samples were tested for Anti-Citrullinated Peptide Antibodies (ACPA), Anti-Chikungunya IgM and IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA) as per manufacturer’s instructions. Results: A total of 373 patients were included in the study. Of these serum samples 90 (24.12%) samples were positive for ACPA, with female predominance (n=66, 73.33%) and 29 (7.77%) patients’ serum samples tested positive for chikungunya IgM. Highest positivity for APCA was observed in the age group 40-60 years (n=47, 52.22%). IgG ELISA for chikungunya was positive in 58.89% (n=53), 60% (n=27) and 46.67% (n=21) of clinically suspected and ACPA positive, 45 clinically suspected but ACPA negative and 45 healthy individuals respectively. The difference was not statistically significant across the different groups. However, seroprevalence was higher among patients suffering with arthralgia as compared to that of healthy population group. Conclusion: Rheumatologist should always consider Chikungunya infection as one of the causes for arthralgia. In endemic countries like India it is difficult to ascertain whether chikungunya infection progresses to RA or not.

Electrocardiography and Echocardiography Correlation in Patients of Left Ventricular Hypertrophy

Sachin Agrawal, Sunil Kumar, Vaibhao Gabhane, Sourya Acharya, Anil Wanjari

Introduction: Electrocardiography (ECG) is the most common investigation for evaluation of Left Ventricular Hypertrophy (LVH), an important parameter of cardiovascular morbidity and mortality. This can also be evaluated by Echocardiography (Echo), which is superior to ECG but costlier, thus a major constraint in rural set ups. Aim: To correlate the relationship of ECG and Echocardiography for the diagnosis of left ventricular hypertrophy and to find out sensitivity and specificity of various electrocardiographic criteria. Materials and Methods: A total of 500 patients showing left ventricular hypertrophy by any of the mentioned ECG criteria, were enrolled in the study. Eight ECG criteria (Sokolow Lyon index, Romhilt Estes point score system, Talbot Criteria, Roberts’s criteria, Cornell Criteria, McPhie criteria, Casale criteria and Criteria of Koitos & Spodick) and Echocardiogram were taken into account for the diagnosis. The statistical tests were performed using SPSS version 10.0. Diagnostic validity tests such as sensitivity, specificity Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy were calculated. Results: Out of 500 patients, 270 (54%) had LVH on Echo which was the gold standard investigation for the diagnosis of LVH in this study. Sokolow Lyon criteria showed sensitivity of 77.78%, specificity of 60.87%, PPV of 70%, NPV of 70% and accuracy of 70%. Comparison of Combined or either one of Sokolow Lyon and Romhilt Estes point score system on ECG with Echo for LVH showed sensitivity of 100%, specificity 60.87%, PPV 75%, NPV 100% and diagnostic accuracy of 82%. Conclusion: Adding two, three or four criteria except Sokolow Lyon and Romhilt Estes point score system does not increase the diagnostic efficacy of the electrocardiography for left ventricular hypertrophy.

Auditory and Preverbal Skill Improvements between Early and Late Cochlear Implantees: Evidence from LittlEARS Questionnaire

KR Rahul, Deepika Jayachandran, Ranjith Rajeswaran, Abishek Umashankar

Introduction: Children with hearing loss are either fitted with hearing aid or implanted with Cochlear implants and Brainstem Implants. It is essential for these children to undergo intervention during the critical period, a lot of objective evidences such as Brainstem Evoked Response Audiometry, Late Latency Response and Mismatch Negativity have shown the benefit of early implantation, there is also a need to document subjective evidences to show the outcomes of early implantation. Aim: To compare the auditory performance in early and late Implantees using LittlEARS Auditory Questionnaire. Materials and Methods: A cross-sectional descriptive study was designed. Children with bilateral profound hearing loss, unilateral cochlear implant users and implant ages between six months to 24 months were considered for the study. A hundred random samples of parents of Congenital Hearing Impaired children participated. A Tamil translated version of LittlEARS Auditory Questionnaire was administered to the parents of cochlear implantees, the samples were grouped as early implantees and late implantees. Mean scores were analysed and compared between the groups using descriptive and inferential statistics. Results: Results reveal early Implantees had a better mean (28.52) score of auditory development than late implantees (27.69) and statistical significance (<0.005) was not obtained between the groups. This shows that the performance did not significantly differ between the groups, in terms of auditory behaviour and early preverbal skills. Conclusion: LittlEARS Auditory Questionnare is a better and promising tool to measure outcomes in cochlear implant and also provides us the evidence, the need for early implantation.

Effectiveness of Backward Walking in the Gait Performance of Stroke Patients

V Kalidasan, Kabilan , Diksha Sarma

Introduction: Stroke is one of the leading cause of long term disabilities. The most commonly affected activity is walking. Though conventional therapy is producing beneficial effects in the gait of stroke patients, Backward walking is proposed to be effective in improving the gait of stroke patients. Aim: To examine the effectiveness of backward walking training on gait performance of stroke patients. Materials and Methods: The study design was an experimental study. Thirty hemiplegic patients were selected by convenient sampling technique and divided into two groups. Subjects in both groups received 40 minutes of conventional training one session per day for two weeks. Subjects in the experimental group received additional backward training for 30 minutes. Gait performance was measured using Wisconsin gait scale. Gait parameters, cadence and walking speed were also measured before and after treatment. Statistical analysis was done using independent ‘t’ test and paired ‘t’ test for between the groups and within the groups respectively. Results: After four weeks of training period, subjects in the experimental group showed much improvement than those in control group for gait performance (score: 17.42±1.53 versus 22.47±1.52) (p<0.05), walking speed (score: 14.4±2.11 versus 20±0.5) (p<0.05), and cadence (score: 114.6±3.76 versus 97.06±1.61) (p<0.05), all the three variables showing statistical significance. Conclusion: Backward walking can also be supplemented along with conventional training in improving gait performance, walking speed and cadence of stroke patients.

Magnetic Resonance Imaging in Non-compressive Myelopathy

Abhijit D Pawar, Varsha P Rangankar, Prajakta R Jagtap

Abnormal hyperintense signal within the spinal cord is often encountered in radiological practice. Though clinical features may give a hint to the diagnosis, additional investigations and imaging are more often than not required to establish a diagnosis in these cases. An abnormal signal within the cord can be evaluated with respect to the length of the cord involved (short segment or long segment), the location of the signal on axial images (central, focal, diffuse), association with cord expansion or thinning, enhancement pattern, associated cysts and a few imaging features pathognomonic to certain clinical conditions. In this pictorial essay, we describe the imaging features of the vast spectrum of conditions producing an abnormal cord signal on Magnetic Resonance Imaging (MRI) with illustrative cases and also the implementation of a systematic approach to evaluate the abnormal signal in order to reach a diagnosis in each of these cases.

A Review of Polymer Crown Materials: Biomechanical and Material Science

Muhammad Syafiq Alauddin

The conventional full coverage crown comes with complications such as material biomechanical complication, non- aesthetic appearance and the unpredictable longevity intraorally. Technology such as 3-dimensional printing accelerates the development of the polymer such as PEEK (Polyetheretherketone) in dentistry. Stress distribution analysis, specifically Finite Element Analysis (FEA) is one of the assessment methods to determine the suitability of the material used intraorally. The present paper focuses on the history and current usage of polymer in dentistry, potential role of polymer in full coverage crown fabrication and relevant investigations including FEA as investigation for in vitro assessment.

Instrument Assisted Soft Tissue Mobilisation in the Management of Musculoskeletal Pain: A Literature Review with Implications for Clinical Practice Guidelines

Mallika Bitra, SG Sudhan

Musculoskeletal conditions are common and involve most of the tissue types. Soft tissue mobilisation is a type of manual therapy administered by hand or with a rigid device. Instrument Assisted Soft Tissue Mobilisation (IASTM) is a technique which uses instruments to remove scar tissues and helps to facilitate healing in soft tissue injuries. Several IASTM tools and techniques are available to provide the soft tissue mobilisation. The purpose of this review article is to appraise evidence and show insight on history, mechanism and effects of IASTM. A literature search was conducted from PubMed, Embase, PEDro and Science Direct database journals to identify potential articles. Forty articles were identified, 32 articles were considered for the review. Based on the available case studies and experimental studies, IASTM can help the scar tissue mobilisation, musculoskeletal injuries. Still more articles and research must emerge to provide more evidence on IASTM.

The Effect of Probiotic Administration in the Treatment of Peri-implant Diseases: A Systematic Review and Meta-analysis

Abdulaziz M Albaker

Introduction: According to the present evidence, there seems to be a variation with regards to the role of probiotics in the reduction of peri-implant inflammation and a systematic review is thought to be necessary to evaluate the clinical efficacy of probiotics compared with placebo in peri-implant disease. Aim: To evaluate the clinical efficacy of probiotics in the treatment of peri-implant diseases. Materials and Methods: Main electronic databases were explored until January 2019. Published articles measuring clinical efficacy of probiotics in any form with active intervention, placebo, or no treatment were considered. Probing Depth (PD), Bleeding on Probing (BOP) and Plaque Index (Pi) were selected as outcome variables. Meta-analysis reporting Weighted Mean Difference (WMD) and Odds Ratio (OR) of outcomes with 95% Confidence Intervals (CI). Results: Six clinical trials were included. Considering the overall effect of probiotics versus placebo in peri-implant mucositis, no significant differences were observed for PD (WMD=-0.11, 95% CI=-0.43;0.21, p=0.50), BOP (OR=1.03, 95% CI=0.40;2.62, p=0.94) and Pi (OR=0.80, 95% CI=0.29;2.18, p=0.66. In addition, the overall effect for PD (WMD=-0.25, 95% CI=-0.79;0.28, p=0.34), BOP (WMD=-0.44, 95% CI=-0.99;0.10, p=0.11) and Pi (WMD=-0.13, 95% CI=-0.67;0.40, p=0.62) in peri-implantitis was not statistically significant either. Conclusion: Based on the qualitative and quantitative results of this review, the efficacy of probiotics in the treatment of peri-implant diseases remains debatable.

Association of Arg72Pro Single Nucleotide Polymorphism of p53 Gene with Functional Outcome after Traumatic Brain Injury: A Meta-Analysis

Neha Martin Honnalli, Usha Sachidananda Adiga, Sriprajna Mayur Kanchan

Introduction: Traumatic Brain Injury (TBI) is one of the major causes of death and disability. The p53 gene, guardian of genomes has a key role in programmed cell death and repair mechanisms of damaged DNA. Single Nucleotide Polymorphism (SNP) of this gene may have a role in functional outcome after TBI, There is only limited research carried out on the SNP of Arg72Pro of p53 and there is no meta-analysis or systematic reviews carried out on this area to the best of our knowledge. Aim: The aim of the study was to find the association of Arg72Pro Polymorphism of p53 with the functional outcome after TBI by conducting a meta-analysis. Materials and Methods: Literature search was systematically carried out by browsing, PubMed, Google Scholar, and Scopus for original research articles with the keyword,’p53 Gene Polymorphism and TBI’. Out of 10 articles retrieved, only three were eligible as per the inclusion criteria. Studies which assessed Arg72Pro Polymorphism of p53 and functional outcome by Glasgow outcome scale at discharge after TBI were included. Results: Statistical analysis was carried out using Medcalc, Random effect models were used to calculate OR and CI. The significance of summary ORs was determined with a Z test. Heterogeneity assumption was checked by x2-based Q test. Forest plot was used to study the heterogeneity of the studies, the funnel plot was used to assess the publication bias. Results showed that Arg/Arg SNP of the p53 gene is associated with poor outcome, with a pooled OR of 2.636, with a 95% confidence interval of 1.376-5.048, p=0.003. No publication bias was observed. Conclusion: Single nucleotide polymorphism of p53, Arg72Arg is associated with poor outcome after TBI when assessed at discharge. However, there is a need for further primary research to confirm this association and also the study reflects that further gene loci which may influence the outcome can be explored.

Aged Care Ethical Values: A Content Analysis of the Literature

Ethical values have gained much interest in health care. They are the basis of the behaviour and performance of professional care staff. This article aimed to explain ethical values in aged care. In this content analysis, major databases including PubMed, Scopus, Ovid, ProQuest, Web of Science, Psych Info, and Google Scholar were searched from January 2000 to June 2018 using specific keywords, and a total of 43 articles were included considering the inclusion criteria of the study. The texts of the results of the articles were studied repeatedly and the data were coded and classified using the method presented by Graneheim and Lundman. Five main themes of ethical values including preserving dignity, preserving integrity, establishing human relationships, justice, and providing professional care, along with 19 subcategories, were identified. Ethical values in aged care include providing professional care, and paying more attention to human aspects of care. Providing ethical care requires better understanding of older adults, awareness of their needs, and efforts to solve their problems.

WhatsApp in University: Friend or Foe

Aksh Chahal, Rashid Ali Beg, Amr S Shalaby, Abdulraouf Ayoub, Abu Shaphe

Amid technological advancement, the global internet market has gone beyond 3G. Recent transformation of internet speed to 5G has driven the youth fanatical towards applications available on internet for mainly two purposes, entertainment and education. Winning the race of popularity among the commonly used communication applications, WhatsApp has been fulfilling the needs of many people in the community, including both social and educational purposes. It is utilised to send or share text messages, Portable Document Format (PDF), contacts, slideshows, picture images, status, video and voice calls, documents and user location. Being so much resourceful, youngsters have started using WhatsApp popularly for both entertainment as well as education. School, college and university students started making use of WhatsApp for communications between them and their instructors by forming WhatsApp group, with their focus on transferring and mediating data among the group members and to help explain things to those in need.