Journal of clinical and diagnostic research

A Review of Literature to Understand the Complexity of Equity, Ethics and Management for Achieving Public Health Goals in India

Pankaj Garg, Jitender Nagpal

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradox ically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG). We systematically reviewed the evidence base regarding regulation of private hospitals, applicability of private-public mix, state of health insurance and effective policy development for India, while seeking lessons on regulation of private health systems, from South African (a developing country) and Australian (a developed country) health care systems.

Morphometric Study of Left Coronary Artery Trunk in Adult Human Cadavers: A Study on the Eastern Region Population

Sanchita Roy, Avanish Gupta, Baljit Kaur Nanrah, Minakshi Verma, Ritaban Saha

Introduction: The left coronary artery shows a wide range of morphological variations which has great clinical importance. Difficulties may occur during performance of diagnostic procedures, especially in patients who undergo evaluation of percutaneous coronary interventions or during coronary artery surgeries or prosthetic valve replacements. Even, it has been found that short length of main left coronary artery was one of the congenital factors which predisposed to the development of coronary artery disease. The aim of this work was to determine the variations in the origin, length and divisions of the left coronary artery trunk in the eastern region population of India. Materials and Methods: The present study was carried out on 100 heart samples which were collected from a mixed race population group from West Bengal, India, after preserving them in 10% formalin solution. While carefully maintaining all standard precautions, scientifically well-planned cadaveric dissections were done and variations were noted. Results: It was found that in all specimens, left coronary artery arose from single ostia at the left posterior aortic sinus. In about 65% cases, ostia was below or at the sinotubular junction (STJ) and in a significant number (35%) of cases, it is above the level of STJ. The mean length of the left coronary artery trunk was found to be 11.42 ± 4.98 mm. LMCA were bifurcated in 56% cases, they were trifurcated in 40% cases and they were tetrafurcated in 2% cases. The results were compared with those of other studies, which showed considerable variations. Conclusion: Thus, this morphometric study done on left coronary artery trunk in the eastern Indian population will be helpful for interventional cardiologists and radiologists for avoiding inadvertent vascular trauma during diagnostic and therapeutic procedures.

Variations in the Pulmonary Venous Ostium in the Left Atrium and Its Clinical Importance

Prasanna L.C., Praveena R., A.S. D’souza, Kumar M.R. Bhat

Introduction: During early embryonic development, absorption of pulmonary venous network by the left primitive atrial chamber results in opening of four pulmonary veins which drain independently into its chamber. The extent of absorption and hence, the number of pulmonary veins which open into the left atrium, may vary. As only few studies have been done, which have shown such variations, the present study was done to evaluate the possible variations in the pulmonary veins which opened into the left atrium. Materials and Methods: Fifty formalin fixed adult cadaveric hearts were studied for variations in the opening of the pulmonary veins into left atrium. Results: Our results showed that 68% of the hearts which were studied, showed usual pattern of 2 pulmonary veins on either side, while remaining 32% hearts showed variations in the number of pulmonary veins which opened. Twelve percent of the hearts showed 2 left and 3 right pulmonary veins, 14% of hearts showed 2 left and 1 right veins, 4% hearts showed 1 left and 2 right veins and 2% hearts showed 1 left and 4 right pulmonary veins opening into the left atrium. Conclusion: Knowledge on such variations gains significance in isolation for radiofrequency ablation as a treatment for atrial fibrillation.

Association of Body Mass Index (BMI) with Lung Function Parameters in Non-asthmatics Identified by Spirometric Protocols

Introduction: Association between obesity and asthma has been reported widely, with disparity between males and females. Epidemiological data which indicate that obesity precedes development of asthma and increases the prevalence and incidence of asthma, raises the possibility of a causal association. Aim: To find out the association, including gender differences, between Body Mass Index (BMI) and lung functions in non-asthmatics identified by spirometric protocols. Methods: A retrospective analysis was conducted of the spirometry results obtained between October 2012 and March 2013 for six months. Participants were referred by a variety of medical specialties to the pulmonary function laboratory in Physiology department, R.G. Kar Medical College, Kolkata, India of the 590 test results recorded in the study database 424 non-asthmatic subjects were reviewed. Results: Significant differences in the spirometric parameters, measured as a percentage of predicted were evident between male and female. Among obese subjects significant correlation is found between BMI and pulmonary function values, FEV1(r = -0.531, p=0.009); FEF25-75% (r= -0.653, p=0.001); FEV1/FVC (r= - 0.603, p=0.002). Significant association was found between BMI and lung function in obese female but not in obese male. Conclusion: Association was found between indices of spirometry and BMI in non-asthmatic obese group along with a gender disparity.

Bimanual Coordination: Influence of Age and Gender

Ashwini K. Shetty, Vinutha Shankar M.S., Nachal Annamalai

Introduction: Association between obesity and asthma has been reported widely, with disparity between males and females. Epidemiological data which indicate that obesity precedes development of asthma and increases the prevalence and incidence of asthma, raises the possibility of a causal association. Aim: To find out the association, including gender differences, between body mass index and lung functions in non-asthmatics identified by spirometric protocols. Methods: A retrospective analysis was conducted of the spirometry results obtained between October 2012 and March 2013 for 6 months. Participants were referred by a variety of medical specialties to the pulmonary function laboratory in Physiology department, R.G. Kar Medical College, Kolkata,India of the 590 test results recorded in the study database 424 non-asthmatic subjects were reviewed. Results: Significant differences in the spirometric parameters, measured as a percentage of predicted were evident between male and female. Among obese subjects significant correlation is found between BMI and pulmonary function values, FEV1(r = -0.531, p=0.009); FEF25-75% (r= -0.653, p=0.001); FEV1/FVC (r= - 0.603, p=0.002). Significant association was found between BMI and lung function in obese female but not in obese male. Conclusion: Association was found between indices of spirometry and BMI in non-asthmatic obese group along with a gender disparity.

A Comparative Study to Evaluate the Effect of Crook Lying Position versus Sitting Position on Forced Vital Capacity (FVC) in Healthy Individuals

Dharampal Singh Sudan, Harvinder Singh

Aim: To prove the effect of body position on the Forced Vital Capacity (FVC) and to find out the better position amongst the sitting and crook lying position as both are considered to be the best respiratory positions as far as FVC is concerned, but no research work is done to find out the better amongst the two. Materials and Methods: We analyzed the FVC of the randomly selected 100 subjects (both males and females) in sitting and crook lying position respectively. Computerized Pulmonary Function Testing (PFT) apparatus was used for analysis where three readings of FVC were taken in each position from which best ones were taken for analysis. Results: Mean FVC in crook lying position was found out to be 88.83% as compared to 99.07% in sitting position showing a difference of 10.24 %. The values were analyzed by using standard t-test which gave t-value 18.4316 and p-value 0.0001 which is statistically significant. Conclusion: The results show that FVC was more in sitting position as compared to crook lying position.

Glycosylated Haemoglobin (HbA1c) - A Marker of Circulating Lipids in Type 2 Diabetic Patients

Prabhavathi K., Kirthana Kunikullaya U., Jaisri Goturu

Background: Diabetic patients with concomitant dyslipidemia are often soft targets for cardiovascular disease and deaths. An early intervention to normalize circulating lipids has been shown to reduce cardiovascular morbidity and mortality. Glycosylated hemoglobin (HbA1c) is routinely used as a marker to indicate long-term glycemic control. Aim: Our aim was to test whether HbA1c can serve as a marker of circulating lipids among Type 2 diabetic patients. Methods: The sera of 130 Type 2 diabetic patients was analyzed for fasting blood sugar (FBS), HbA1c and lipid profile consisting of total cholesterol (TC), triglycerides (TG), High-density Lipoprotein (HDL) cholesterol and LDL cholesterol. We divided the subjects based on their glycemic index into three groups; HbA1c< 6% as good, HbA1c>6% - <9% as poor and HbA1c>9% as worst glycemic control. One–way analysis of variance (ANOVA) and post-hoc Dunnett’s multiple comparison tests was used to examine the significance levels for various biochemical parameters in age-categorized groups. Results: The mean ± SD levels of HbA1c was significantly higher in females (8.598 ± 2.284 %) compared to males (7.323±2.18 %). Older patients had HbA1c, FBS and lipid profile levels similar to younger ones. HbA1c showed direct and significant correlations with cholesterol, TG and LDL. Univariate analysis showed that HbA1c was a good predictor of circulating lipid levels. Conclusion: The study indicates the usefulness of HbA1c as a marker for lipid profile for screening of diabetic patients at high risk of developing cardiovascular diseases.

Prevalence of Hypoparathyroidism (HPT) in Beta Thalassemia Major

Khalida Parveen Basha N, Beena Shetty, U V Shenoy

Aim: This study was to assess the parathyroid functions and bone mineral density (BMD) in patients with beta thalassemia and to correlate them with serum ferritin, calcium, phosphorus and alkaline phosphatase levels. Materials and Methods: This is a case control study which was done on 55 subjects (40 cases and 15 controls) in the age group of 2-18 years. The cases included were with confirmed diagnosis of beta thalassemia major, more than ten blood transfusions and serum ferritin levels >2000 µg/L irrespective of chelation therapy. Results: Significant Hypoparathyroidism (HPT) observed along with low BMD levels in beta thalassemia patients (p < 0.01). A significant decrease in serum calcium level was seen in cases when compared to controls, where as the levels of both serum phosphorus and alkaline phosphatase levels increased in cases when compared to controls. Conclusion: BMD and PTH levels are very useful tools for diagnosing HPT. As a routine, in beta thalassemia major, screening for vitamin D deficiency and hypocalcemia should be done in second decade of life and as a preventive measure they should be supplemented with calcium and vitamin D to prevent hypocalcemic tetany, to facilitate bone growth and to prevent fractures.

Effect of Smoking on Metalloproteinases (MMPs) Activity in Patients with Acute Myocardial Infarction (AMI)

Sreekanth K Sivaraman, Geevar Zachariah, PT Annamala

Introduction: Many risk factors are involved in the course and pathogenesis of Acute Myocardial Infarction (AMI). Smoking can significantly increase the AMI mortality and morbidity. Matrix metalloproteinases (MMPs), a class of Zn containing enzymes, are involved in the erosion of the fibrous cap and rupture of the plaque which leads to AMI. Aim: To evaluate the activity of MMP2 and MMP9 in AMI patients, with or without the habit of smoking. Materials and Methods: The study group consists of 300 AMI patients and 100 sex and age matched control subjects with and without the habit of smoking. MMP2 and MMP9 activities were measured in the blood samples of these patients and controls by sandwich enzyme immunoassay and the values were noted and compared. Results: Both MMP2 and MMP9 were found to be significantly elevated in all the AMI patients when compared to the normal controls subjects irrespective of the habit of smoking. However MMP9 showed a significant elevation when compared to MMP2 in patients with the habit of smoking. Conclusion: The results of the present study shows increased concentration of both MMPs in AMI patients. However, concentration of MMP9 was found to be more in patients with the habit of smoking when compared to MMP2, indicating that smoking can increase the activity of MMP9 in these patients. Hence apart from producing the free radicals, the smoke can increase the activities of matrix degrading enzymes which in turn contribute to the vulnerability of plaque.

Status of Homocysteine in Polycystic Ovary Syndrome (PCOS)

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of reproductive age and is estimated to affect 5-10 % of the population. Women with PCOS have a clustering of cardiovascular risk factors, such as obesity, dyslipidemia, impaired glucose tolerance and hypertension. Homocysteine has been recognized recently as a risk factor for cardiovascular diseases. Preliminary investigations suggest that high sensitivity C-reactive protein, homocysteine and adiponectin are abnormal in women with PCOS. The possible determinants of elevated homocysteine concentration are still debated among authors who found significant correlations between homocysteine and insulin resistance or hyperandrogenism. Aim: The purpose of this study is to evaluate homocysteine levels in the PCOS population compared with controls. Materials and Methods: Study group comprised of 142 women with PCOS and 65 healthy non-PCOS controls. Body mass index (BMI), Waist circumference and serum homocysteine were measured in PCOS subjects and age matched controls. Statastical Analysis: All values are expressed as mean ± SD. The results obtained are analysed statistically using the unpaired student t-test to evaluate the significance of differences between the mean values. Results: The mean BMI, Waist circumference and serum homocysteine values are significantly increased in PCOS subjects when compared with non PCOS controls. Conclusion: The present study has demonstrated increase in mean serum homocysteine concentrations in women with PCOS.

Apo B/Apo A-I Ratio is Statistically A Better Predictor of Cardiovascular Disease (CVD) than Conventional Lipid Profile: A Study from Kathmandu Valley, Nepal

Background: Apo B and Apo A-I, are structural and functional components of lipoprotein particles that serve as transporters of cholesterol. The apo B/apo A-I ratio reflects the cholesterol transport and has been shown to be strongly related to risk of Myocardial infarction, stroke and other Cardiovascular manifestations. Materials and Methods: Forty five participants with Cardiovascular Disease (CVD) and forty four healthy participants were included from different locations of Kathmandu valley, Nepal. Fasting blood samples were collected from ante-cubital vein and serum samples were used for lipid parameters, apo B and apo A-I levels measurement. Results: Statistically significant differences were found for apo B/apo A-I ratio, HDL-c and apo B between the groups. The other lipid parameters and lipid ratios such as total cholesterol, triglyceride, low density lipoprotein, TC/HDL-c, TG/HDL-c and LDL-c/HDL-c were not found to be significant. Conclusion: Apo B/apo A-I ratio seems to have better predictive value than that of classical lipid parameters in cardiovascular risk assessment.

Relationship between Lipoprotein(a) and Thyroid Hormones in Hypothyroid Patients

Background and Objective: Changes in plasma lipid concentrations are well known metabolic consequences of thyroid dysfunction. The alterations are most prominent in hypothyroidism which is typically associated with pronounced hypercholesterolaemia and frequently with moderate hypertriglyceridaemia. In cases of hypothyroidism, how the serum Lp(a) levels are influenced by thyroid hormone remains unknown and contradictory results on the effect of thyroid hormone on serum Lp(a) levels have been reported. There is substantial evidence to suggest that elevated serum Lp(a) levels contribute significantly to the development of CHD. The present study was designed to determine the lipoprotein(a) [Lp(a)], lipid profile and thyroid hormone levels in newly diagnosed hypothyroid patients and to find any correlation that existed between Lp(a) and other parameters. Materials and Methods: Untreated hypothyroid (n=50) patients were included in the study. We also included 40 normal healthy subjects as controls. Lipid profile, Lp(a) and thyroid profile were estimated by using autoanalyzers. Results: The results of this study showed that levels of HDL-cholesterol were significantly decreased (p<0.001), whereas those of other lipid parameters and Lp(a) levels were found to be significantly increased (p<0.001) in hypothyroid patients as compared to those in controls. Correlation study revealed a significant positive correlation between Lp(a) and TSH levels in hypothyroid patients. Conclusion: Our present findings indicated that hypothyroidism could be strongly associated with lipid abnormalities that enhanced the development of cardiovascular diseases. Also, Lp(a) and non-HDL-C should be estimated with other lipid parameters as a useful index for measuring the cardiac risk in hypothyroid patients. A recommended screening should be advised for any patient with thyroid dysfunction, especially hypothyroidism, to assess lipid abnormalities by using Lp(a) and non- HDL - C and he/she should treated at the earliest.

Progression of Coronary Artery Disease (CAD) from Stable Angina (SA) Towards Myocardial Infarction (MI): Role of Oxidative Stress

Neha Uppal, Vibha Uppal, Pankaj Uppal

Introduction: There is now a consensus that atherosclerosis represents a state of heightened oxidative stress which is characterized by lipid and protein oxidation in the vascular wall. Inspite of many efforts which were made to explain the role of oxidative stress in progression of CAD (Coronary Artery Disease), its predictive role is still not clear. In order to fill these lacunae and to establish the utility of antioxidant vitamins in delaying the progression of CAD from stable angina (SA) towards myocardial Infarction (MI), the present study was conducted. Materials and Methods: In this study, we compared the lipid profile and oxidant antioxidant status in 50 patients of CAD and 50 controls. The 50 patients of CAD were further grouped into those with SA, unstable angina (USA) and MI and the values of blood reduced glutathione (GSH) and lipid peroxidation marker Malonyldialdehyde (MDA) were studied and compared in these three subgroups of CAD. Results: The values of MDA were significantly increased in patients of CAD as compared to those in controls. Plasma MDA values of patients who presented with unstable angina and acute MI were significantly higher than those in patients who presented with SA and in controls, whereas there was no significant difference between values in those with unstable angina and non Q wave MI. The values of GSH showed a significant depletion in patients of CAD as compared to those in controls. A clearly significant depletion in GSH levels was observed in SA patients as compared to those in unstable angina and MI. But no such variations were observed between unstable angina and MI patients. Conclusion: From the present study, it was concluded that there was a significant negative correlation between blood glutathione and serum MDA. This may have occurred due to utilization of GSH in quenching free radicals and still persisting oxidative stress, which may have caused an increase in MDA levels due to increased lipid peroxidation. Further, the enhanced depletion of GSH and the increase in the levels of MDA in patients of USA and MI as compared to those in SA patients confirms the role of oxidative stress in progression of CAD from SA through USA to MI.

Profile of Yeasts Isolated from Urinary Tracts of Catheterized Patients

Meena Mishra, Seema Agrawal, Sharmila Raut, A. M. Kurhade, R. M. Powar

Purpose: Nosocomial fungal infections are important cause of morbidity and mortality in hospital patients. Urinary catheters have been held responsible to cause a large number of hospital acquired Urinary Tract Infections (UTIs). This study was undertaken to determine the incidence of nosocomial Candiduria associated with in dwelling urinary catheters, to characterize the species and assess their resistance to antifungal agents. Materials and Methods: Urine specimens from 510 catheterized patients were inoculated on Sabauraud Dextrose Agar; the species identification of Candida isolates was done by biochemical tests and antifungal susceptibility testing was done by disc diffusion method. Results: Candida was isolated in 112 (21.96%) specimens. Of these, Candida albicans was commonly isolated in 50.89% followed by C. tropicalis, C. glabrata, C. krusei, C. parapsilosis, C. guillermondi and C. pseudotropicalis. Fluconazole resistance was encountered in some isolates. All C. glabrata and C. krusei were uniformly resistant to fluconazole and 8 of 16 C. tropicalis were also resistant to it. But only 7 of 57 isolates of C. albicans were resistant to it. Resistance to Nystatin was seen in 34 isolates. Similarly, emergence of resistance was also seen to Ketoconazole and Itraconazole in 24 of 112 isolates. Amphoterecin B resistance was exhibited by 3 C. albicans, 2 C. tropicalis, 1 C. glabrata and 1 C. krusei strain. C. albicans is an important nosocomial pathogen causing UTI in catheterized patients, nevertheless role of other species of Candida as emergent pathogens and resistance to antifungal drugs needs to be emphasized.

Evaluation of Culture, Antigen Detection and Polymerase Chain Reaction for Detection of Vaginal Colonization of Group B Streptococcus (GBS) in Pregnant Women

Kavitha Paul Konikkara, Shrikala Baliga, Suchithra Shenoy, Bharati B.

Background and Objective: Group B Streptococcal infection is an important cause of neonatal morbidity and mortality. Early detection of perinatal vagino-rectal (VR) carriage of Group B Streptococcus (GBS) is important in the management of newborn infections. The objective of the study was to evaluate Culture, antigen detection and Polymerase chain reaction for detection of GBS in Pregnant women. Settings and Design: Observational descriptive study was done in a tertiary care hospital in Southern India. Materials and Methods: VR swabs were collected from 50 women at 35 to 37 weeks of gestation. Culture in a selective Lim enrichment broth with subsequent culture on 5% sheep blood agar, Conventional PCR assay and antigen detection method were performed. The performance of antigen detection and PCR methods were compared with culture. Statistical analysis: Statistical analysis was performed by Chi-Square test. Results: GBS cultures were positive for 16% of the specimen (8 out of 50). Considering culture as a gold standard, Sensitivity, Specificity, Positive predictive value and Negative predictive value of antigen detection was 100%, 92.86%, 72.73%, 100% and similarly for that of PCR was 100%, 45.23%, 25.80%, 100%, respectively. Conclusion: Antigen detection method was the rapid, sensitive and specific test for the detection of GBS colonizers during pregnancy.

Pneumococcal Infections at a Rural Tertiary Care Hospital: A Seven Year Study on Isolation Rate, Clinical Spectrum and Antibiogram

Background: Invasive pneumococcal infections such as pneumonia, bacteraemia and meningitis are severe and often fatal. In recent years, pneumococcal resistance to penicillin has been a problem in many countries. We, in this retrospective study analysed the case records of culture proven pneumococcal infections seen over a period of seven at a rural tertiary health care centre in Karnataka and studied the antibiotic resistance pattern of the isolates. Aims: To know the spectrum of illness caused by pneumococci, isolation rate from the specimens and the antibiogram of pneumococci isolated from patients admitted at a rural tertiary care centre. Methods: The laboratory records were searched for isolations of pneumococci from different samples from 2006-2012. The isolation rate from different specimens was calculated. The case records of the patients whose samples yielded pneumococci were analysed for demographic and clinical details. The antibiotic sensitivity pattern of the isolates was studied. Results: During the study period of seven years, pneumococci were isolated from 34 (0.092%) of the 37,070 samples processed. Samples of blood, pleural fluid, sputum and CSF obtained from patients with bacteraemia, community acquired pneumonia and meningitis accounted for 31(91.2%) of the 34 pneumococcal isolations. All the isolates (100%) were sensitive to penicillin; they were also sensitive to erythromycin, chloramphenicol, vancomycin and linezolid. The sensitivity to gentamicin, ciprofloxacin and tetracycline varied from 79.4% to 88.2%. Only 50% of the isolates were sensitive to cotrimoxazole. Among the patients who yielded pneumococci, 21(61.76%) were children. The patients were treated with a combination of ß-lactam and aminoglycoside antibiotics. Eighteen (90%) of the 20 patients, whose outcome was known, recovered completely. Conclusion: Majority of the isolations of pneumococci over a period of seven were made from samples obtained from patients with invasive pneumococcal diseases such as community acquired pneumonia, bacteraemia and meningitis. Children contributed 2/3rd of the pneumococcal isolations. All the isolates were sensitive to penicillin, erythromycin, chloramphenicol, vancomycin and linezolid, where as 50% of the isolates were resistant to cotrimoxazole. Ninety percent of the patients recovered completely after appropriate antibiotic therapy.

Treatment Outcome Among the Retreatment Tuberculosis (TB) Patients under RNTCP in Chandigarh, India

Sandeep Singh Sarpal, Naveen Krishan Goel, Dinesh Kumar, A.K. Janmeja

Background: ‘RETREATMENT’ for Tuberculosis (TB) has long been a neglected area in global TB control. While other components of the Stop TB Strategy have garnered appropriate focus and, increasingly, sufficient resources, issues related to the TB of patients previously treated for tuberculosis remain under examined and under-resourced. Methods: A longitudinal study was designed and the patients registered under Revised National Tuberculosis Control Programme (RNTCP) category II from June 2010 to December 2011.Out of total 607 patients registered during this period under category II of RNTCP in Chandigarh (India), 545 consented to participate in the study. These were followed up to September 2012 till the completion of treatment. Statistical Analysis: The analysis was done by using SPPS-18 statistical software package. Chi- square test was used for testing association of different characteristics. Results: Four Hundred Thirty (78.9%) of the patients had pulmonary TB and 115(21.1%) of the patients had extra pulmonary TB. In the study cohort of category II patients 264(48.4%) were relapse patients,167(30.6%) belonged to others category, 75(13.8%) were on treatment after default, 39(7.2%) were failure cases. The mean age of patients was 35.92±15.42 (p = 0.928). Maximum patients belonged to age group of 25-34 years (25.3%). Seventy Three (13.4%) were Illiterate. In treatment after default group only 65.3% patients were cured. Maximum deaths 8% were seen in treatment after default group of patients. The overall default in the study was 5.9%. Conclusion: The findings of this study suggest that it is essential to monitor re-treatment patients with same vigour to reduce default and improve their treatment outcome.

Role of Gender and Serum Immunoglobulin E (IGE) levels on Severity of Migraine

David Rosario, George Pinto

Aim: Migraine headache is a common disorders. Several studies have reported that migraine headache is more common in patients with allergy. Aim of this study is to determine if the allergic sensitization is associated with the prevalence, frequency, and disability of migraine headaches. Materials and Methods: The study was conducted during the period August 2013. During this period 100 patients of either gender who were diagnosed with migraine were selected and total serum Immunoglobulin E (IGE) levels were estimated. Prevalence of migraine headache and degree of allergic sensitization was estimated in these patients. Severity of migraine was assessed using the MIDAS score. Statistical Analysis: Descriptive tables were generated showing the demographic and clinical characteristics of participants stratified by age and sex. Differences between subject groups were assessed by chi-square test. Correlation between severity of migraine and IgE levels was calculated using Pearson correlation. Results: A total of 100 patients with migraine who presented to the outpatient department where studied. Prevalence of migraine was found to be higher in females compared to males. At the younger age group IgE levels were higher. Patients with higher levels of IgE had more severe headaches compared to those with lower levels of IgE. Patients with higher levels of IgE required a longer duration of treatment compared to those with lower levels of IgE. Conclusion: Prevalence of migraine is high among females. Younger age and female sex are other contributory factors as prevalence of migraine is higher in these groups. Degree of allergic sensitisation determines the severity and frequency of headaches in those whom allergic rhinitis is a risk factor as evidenced by higher levels of IgE.

To Study the Level of Awareness About Complications of Chronic Suppurative Otitis Media(CSOM)in CSOM Patients

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the most common diseases in clinical practice. It affects large number of people. Disease causes disability and mortality because of its ability to cause complications. Patients develop complications because of lack of awareness about the disease, scarce availability of qualified otologists at peripheral areas and economical constraints. This study was conducted to study the awareness about CSOM and its complications. Materials and Methods: Patients suffering from CSOM attending outpatient department of Ear, Nose and Throat Department were included in this study. After taking proper history and examination to confirm the diagnosis patients were given structured questionnaire to assess their knowledge about CSOM and its complications. Results tabulated and compared with literature. Results: Majority of our patients (77.6%) were from low socio-economic status group. Maximum number of patients was from 3rd and 4th decade of life. Only 29.5% patients understood perforation in Tympanic Membrane (TM) as a cause for continued discharge. 94% patients did not differentiate between safe and unsafe CSOM. 52.2% had knowledge about entry of water in ear as cause for recurrence of discharge in CSOM. 44.7% said CSOM can be cured by surgery. Only 7.4% said infection can spread to brain, 23.3% knew about collection of pus around ear, 11.9% said it can cause vertigo, but none of them recognized facial nerve palsy as complication of CSOM. 38.8% took self medication and 16.4% consulted qualified ear nose throat (ENT) doctor. Conclusion: Although CSOM is a major disease affecting large number of people, awareness regarding disease and its complications is still poor. Mass education programs aimed at educating people about CSOM are need of the hour.

Cardiovascular Disease and Menopause

Rupal Dosi, Nikita Bhatt, Priyanki Shah, Rushad Patell

Aim: The aim of the study was to study the abnormalities in the cardiovascular profile in postmenopausal Indian women and to compare the same with the cardiovascular profile of pre menopausal Indian women belonging to the same age group; taken as controls. The goal was to throw some light on the cardiovascular risk in postmenopausal women of the Indian population as this population is thought to be at higher risk than their western counterparts and significant studies of the same kind in this population have been few. Materials and Methods: A cross-sectional comparative study on 100 women who were either postmenopausal or premenopausal and were between the age group of 40 to 55 years was carried out over a period of ten months at our hospital. The variations in the cardiovascular profile between both groups were studied. All the women were subjected to a detailed history, thorough examination, investigations and imaging studies. Results: The evaluation revealed that Coronary Artery Disease (CAD), hypertension, abnormal Body Mass Index (BMI) and abnormal Waist Hip Ratio (WHR) were significantly higher in the postmenopausal group as compared to the premenopausal group. The post menopausal women had significantly higher prevalence of abnormal lipid profiles as compared to their premenopausal counterparts. The postmenopausal women with a normal lipid profile also had increased prevalence of CAD and SAHT, which emphasizes the non-lipid cardiovascular benefits of estrogen. Conclusion: Thus, we can conclude that cardiovascular disease was more common in postmenopausal women of age group 40-55 years as compared to those not yet achieved menopause in a population of western Indian women. And this risk was significantly associated with central obesity, an abnormal lipid profile and the postmenopausal state in itself.

Disparities in the Prevalence of Metabolic Syndrome (MS) and its Components Among University Employees by Age, Gender and Occupation

Maureen Jepkorir Cheserek, Gui-Rong Wu, Li-Ye Shen, Yong-Hui Shi, Guo-Wei Le

Background: Metabolic Syndrome (MS), a known risk factor for Cardiovascular Disease (CVD) and type II diabetes is an emerging epidemic in China. Studies carried out on the general population indicate a varied clustering of cardiovascular risks in many parts of the country. However, there is limited data on its prevalence in the working population. Workplace can serve as an important place for prevention, control and management of CVD risks. The aim of this study was to investigate the prevalence of MS and its components among University workers, and determine how the prevalence varied according to sex and occupation. Methods: This was a cross-sectional study of 2,428 University employees (22-60 years) who received an annual clinical examination at the University hospital. Anthropometric measurements, blood pressure, Fasting Plasma Glucose (FPG), and lipid profiles were measured. MS was defined according to the National Cholesterol Education Program Adult Treatment panel III modified criteria. Results: Overall prevalence of MS was 6.1%, higher in males (5.1%) than females (1.1%), and increased with age. The most prevalent MS components in all workers were hypertension (37.9%) and hypertryglyceridemia (20.8%), corresponding rates in males were 28.3% and 16.1% while females had a prevalence of 9.6% and 4.7%. After adjustment for age, administrative work was associated (p<0.05) with increased hypertension (odds ratio (OR) =1.474; 95% confidence interval (CI), 1.146-1.896) and hyperglycemia (OR=1.469; 95% CI, 1.082-1.993) in male workers, and with hypertension (OR=1.492; 95% CI, 1.071-2.080) in females. However, prevalence of hypertryglyceridemia was lower (OR=0.390; 95% CI, 0.204-0.746) in female administrators compared to those in academics. Obesity, MS and reduced High Density Lipoprotein (HDL) cholesterol prevalence was not different (p>0.05) between the two occupations in both sexes. Conclusions: Prevalence of MS and its components was higher in male workers than in females, increased with age, and were more common in administrative workers. The findings support the need for gender and occupation specific health interventions to prevent CVDs and type II diabetes in the workplace.

A Study of Autoimmune Polyglandular Syndrome (APS) in Patients with Type1 Diabetes Mellitus (T1DM) Followed Up at a Teritiary Care Hospital

Shaheen Banu Shaikh, Ismail M. Haji, Parveen Doddamani, Rahman M.

Background: Type1 diabetes mellitus (T1DM) results from auto- immune destruction of insulin-producing ß cells and is characterized by the presence of insulitis and ß-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome (APS). Presence of other autoimmune disorders in patients with T1DM has been associated with increased morbidity and mortality. Hypoglycemia resulting from concurrent hypothyroidism or adrenal crisis can be dangerous; starting replacement therapy for hypothyroidism may result in adrenal crisis if background hypocortisolism is not recognized. Early detection of antibodies and latent organ-specific dysfunction is advocated to alert physicians to take appropriate action in order to prevent full-blown disease. Aims: The objectives of this study were to assess the concurrence of various autoimmune disorders in patients with T1DM, to review the concept and detect the overt forms of Autoimmune Thyroid Disease (AITD), Addison’s Disease (AD), Vitamin B 12, vitiligo in T1DM and to find their correlation according to age and sex of the patients. Methods: It is a retrospective study where medical records between January 2007-June 2010 of all the patients diagnosed with T1DM, followed up at Department of Endocrinology were reviewed to find out the presence of (AD), AITD, vitiligo, Vitamin B12 deficiency and Primary Gonadal Failure, which were diagnosed clinically with available investigational procedures. Results: A total of 100 cases of T1DM were evaluated during the present study. The age group of patients ranged from 8 to 40 years, with the average being 21.56 years. 64% of the patients were males and the rest were females. 29 % of T1DM subjects had AITD (Hashimoto’s or Graves’disease), 5% were diagnosed with Vitamin B12 deficiency, 4% had AD, and 6% showed Vitiligo. 28 % had family history of autoimmune endocrinopathy. Conclusion: The commonest autoimmune disorder associated with T1DM found in our study was AITD. Because genetic/ autoantibodies testing is not a feasible option, it is important to screen them with best available laboratory facilities and clinical assessment in view of high prevalence of associated autoimmune conditions.

A Hospital Based Study on Estimation of Adenosine Deaminase Activity in Cerebrospinal Fluid in Various Types of Meningitis

Ashok Kumar Agarwal, Sonia Bansal, Vidya Nand

Objective: Tuberculosis kills 3.70 lakh patients in India every year,out of which 7-12 % are meningeal involvement. Delay in its diagnosis and initiation of treatment results in poor prognosis and squeal in up to 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective, and fairly specific test in differentiating tubercular aetiology from other causes of meningitis. In the present study we measured the adenosine deaminase activity (ADA) in Cerebrospinal Fluid (CSF) of Tubercular Meningitis (TBM) and non-TBM patients. Methods: Fifty six patients attending hospital with symptoms and signs of meningitis were selected and divided into three groups: tubercular, pyogenic, and aseptic meningitis, depending upon the accepted criteria. CSF was drawn and ADA estimated. Results: Out of 32 tubercular patients, 28 had CSF-ADA at or above the cut-off value while four had below. Out of 24 non-tuberculous patients (pyogenic and aseptic meningitis), two aseptic meningitis (AM) patient had ADA levels at or above the cut-off value while 22 had below this value. Results of our study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of TBM, CSF, and ADA level 10 U/L as a cut-off value with sensitivity 87.5% and specificity 83.33% and positive predictive value of the test was 87.5%.and 83.3% negative predictive value. Conclusion: It can be concluded that ADA estimation in CSF is not only simple, inexpensive and rapid but also fairly specific method for making a diagnosis of tuberculous aetiology in TBM, especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous ones. For this reason ADA estimation in TBM may find a place as a routine investigation.

A Study of Clinical Characteristics of Mediastinal Mass

Background: Mediastinal tumours are uncommon lesions encountered in clinical practice. There has been a significant increase in the incidence of malignant mediastinal tumours over the past four decades. The presentation varies from asymptomatic lesions detected incidentally on imaging to severe life threatening presentations. Aim and Objectives: The study was conducted to assess the clinical characteristics, types, treatment modalities and outcome of mediastinal masses. Materials and Methods: In this two year prospective study, a total of 35 cases with or without symptoms of mediastinal mass, confirmed by Computed Tomography (CT) imaging were included. The results were expressed as percentages or proportions. Results: Maximum numbers of patients (25.71%) were seen in the 3rd decade and majority (94.3%) was symptomatic at presentation. Malignant lesions (68.57%) were more common than benign (31.43%) and lymphoma was the commonest malignant tumour (50%). Mediastinal widening on chest X-ray was seen in 27 cases (77.14%), pleural effusion and lung mass in 5 cases each (14.29%). On CT imaging and sub-classification, anterior mediastinum was the commonest compartment involved (42.86%). Conclusion: Mediastinal masses are usually symptomatic at presentation. Majority of the masses were malignant lesions and the symptoms of mediastinal obstruction was significantly higher in malignant lesions and anterior mediastinal masses. Lymphoma was the most frequent primary mediastinal mass and thymoma constituted the commonest benign anterior mediastinal tumour.

Hospital Acquired Infections Among Patients Admitted in the Medical and Surgical Wards of a Non-Teaching Secondary Care Hospital in Northern India

Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumannii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient’s bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals.

Ultrasound Guided Direct Percutaneous Nephrostomy (PCN) Tube Placement: Stepwise Report of a New Technique with Its Safety and Efficacy Evaluation

Bijit Lodh, Sandeep Gupta, Akoijam Kaku Singh, Rajendra Singh Sinam

Aims: Ultrasound guided Percutaneous Nephrostomy (PCN) tube placement: evaluation, safety and efficacy review. Settings and Design: This was a quasi-experimental study conducted at Department of Urology, Regional Institute of Medical Sciences, Imphal. Materials and Methods: The total number of 176 patients with grade I-IV hydronephrosis requiring PCN tube placement were included in the study. Scientific, operational and accessory steps of the technique and its related safety and efficacy pre-procedural, intra-procedural and post-procedural parameters were carefully and meticulously recorded. Statistical Analysis: Statistical analyses was performed using the Statistical Package for the Social Sciences (SPSS 16.0) for Windows. Results: The average length of the procedure was 9.07±2.79 (6-15) minutes. Severe procedure related pain (VAS score 8-10) was observed only in 18 patients (10.23%). Nephrostomy tube placement was successful in 96.60% of cases and only 9.66% required more than a single attempt of puncture. In this study, impacted ureteric calculus was found to be most common indication of PCN tube placement. Conclusions: Ultrasound guided direct PCN tube placement is a reliable, easy and cost effective technique. This procedure is particularly suitable for developing countries like India, where the majority of the patients belongs to the low socio-economical status and health care system lacks adequate infrastructural facility at most places.

A Comparative Study between Modified Bassini’s Repair and Lichtenstein Mesh Repair (LMR) of Inguinal Hernias in Rural Population

Naveen N., Srinath R.

Background: Bassini’s repair and the Lichtenstein’s tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no unison as to which is the best technique. Our hospital being in a rural setup and catering to majority of poor patients who are daily wagers, open hernia repairs are commonly done. This study was undertaken to compare the technique and post-operative course so as to determine the best suitable of the two procedures for them. Materials and Methods: A comparative randomized study was conducted on a total of 70 patients with inguinal hernia and were operated upon by either of technique and followed up. Outcome of both the techniques were analyzed and compared with other similar studies. Results: Study involved 35 each of Modified Bassini’s Repair (MBR) and Lichtenstein’s Mesh Repair (LMR), over a period of 18 months. MBR took more operating time than LMR. Commonest complication in both the groups was seroma formation. There were two recurrences in the MBR group and none in LMR group. Conclusion: LMR was comparatively better than MBR due to its simplicity, less dissection and early ambulation in the post-operative period and with no recurrence, in our study.

Pain Management after Laparoscopic Cholecystectomy-A Randomized Prospective Trial of Low Pressure and Standard Pressure Pneumoperitoneum

Sanjeev Singla, Geeta Mittal, Raghav, Rajinder K Mittal

Background: Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient. Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum . We designed a study to compare the post operative pain after laparoscopic cholecystectomy at low pressure (7-8 mm of Hg) and standard pressure technique (12-14 mm of Hg). Aim: To compare the effect of low pressure and standard pressure pneumoperitoneum in post laparoscopic cholecystectomy pain . Further to study the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy. Settings and Design: A prospective randomised double blind study. Materials and Methods: A prospective randomised double blind study was done in 100 ASA grade I & II patients. They were divided into two groups -50 each. Group A patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum (7-8 mm Hg) while group B underwent laparoscopic cholecystectomy with standard pressure pneumoperitoneum (12-13 mm Hg). Both the groups were compared for pain intensity, analgesic requirement and complications. Statistical Analysis: Demographic data and intraoperative complications were analysed using chi-square test. Frequency of pain, intensity of pain and analgesics consumption was compared by applying ANOVA test. Results: Post-operative pain score was significantly less in low pressure group as compared to standard pressure group. Number of patients requiring rescue analgesic doses was more in standard pressure group. This was statistically significant. Also total analgesic consumption was more in standard pressure group. There was no difference in intraoperative complications. Conclusion: This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of post-operative pain and hence early recovery and better outcome.This study also shows that low pressure technique is safe with comparable rate of intraoperative complications.

Pan Endoscopic Approach “Hysterolaparoscopy” as an Initial Procedure in Selected Infertile Women

Keya Vaid, Sheila Mehra, Mita Verma, Sandhya Jain, Abha Sharma, Sruti Bhaskaran

Introduction: Tuboperitoneal pathology is responsible for 40-50% cases of infertility. Hysterosalpingography (HSG) & laparoscopy are the two classic methods available for evaluation of tubal pathology and are complementary to each other. Though pelvic sonography and HSG are good enough to exclude gross intrauterine pathology, but subtle changes in the form of small polyps, adhesions and seedling fibroid are better picked up on magnification with hysteroscopy. Combined hysterolaparoscopy may obviate need for HSG, as complete evaluation and treatment is possible in the same sitting. Aim: To assess the utility of Hysterolaparoscopy as one step procedure and compare it with HSG, in the subset of ovulatory infertile women with normal pelvic sonography / seminogram /hormonal assays. Materials and Method: In this analytical prospective study, 193 infertile women aged 19 to 42 years underwent HSG and Hysterolaparoscopy over a period of six months. They were confirmed to have ovulatory cycles and normal seminogram. Patient with active genital infection were excluded. Findings were categorized as normal/abnormal and therapeutic intervention done, if required. Statistical evaluation was carried out using Chi- square test. Result: On comparing HSG and Hysteroscopy, uterine findings matched in 66.3% patients. HSG failed to detect uterine pathology in 32.12% patients (62/193) with a sensitivity of 21.3% and specificity of 97.45%. Ninety three percent of intrauterine adhesions/polyps were missed on HSG. Hysteroscopic intervention was required in 23.83% cases, adhesiolysis being the commonest. On comparing tubal patency on HSG and laparoscopy, the sensitivity of HSG in detecting bilateral tubal block was 80.6% and specificity of 81.5%. With regard to unilateral tubal block, sensitivity was 34.6% and specificity 89.8%. The agreement between the two was 74%. Pathology such as adhesions, fimbrial agglutination and endometriosis were dealt surgically in 65.8% patients. As per HSG, 112/193 women had both tubes patent and 177 revealed normal uterine cavity. When these 112 women (58.03%) with normal HSG report were further subjected to hysterolaparoscopy, only 35/193 (18.13%) of them actually had normal tubes and uterus; rest 77 women (39.89%) were benefited by one step procedure of hysterolaparoscopic evaluation and intervention and further treatment done. Conclusion: Hysterolaparoscopy (Pan Endoscopic) approach is better than HSG and should be encouraged as first and final procedure in selected infertile women.

Pregnancy Outcome in Women with Previous One Cesarean Section

Lekshmi Balachandran, Pooja R Vaswani, Ramakone Mogotlane

Objective: The purpose of this study was to determine the outcome of pregnancy in women with previous one cesarean section in relation to vaginal delivery and maternal and perinatal complications. It also aimed at identifying the factors, which can influence the outcome of trial of scar (TOS). Materials and Methods: A retrospective analysis of medical records of 151 women with previous one cesarean section who delivered at the Mafraq Hospital, Abu Dhabi between January– August 2011was carried out. Those women with previous classical cesarean section and those with extreme prematurity were excluded. The collected data were analyzed using SPSS software version 20. Continuous and categorical data were presented in the form of mean, standard deviation and percentage, while proportions were analyzed using the chi-square test. A p-value =0.05 was considered statistically significant. Results: Of the 151 women, 115 were candidates for TOS. Of them, 96 (83.47%) had vaginal birth after cesarean (VBAC) and 19 (16.5%) had a repeat cesarean section. There were four cases of primary postpartum hemorrhage (PPH) and two cases of scar dehiscence in the study group. No significant perinatal morbidity was observed. VBAC rate was significantly more in women who had prior vaginal deliveries, especially in those with previous VBAC. Conclusion: In carefully selected cases, trial of labor (TOL) after a prior cesarean is safe and often successful. A prior vaginal delivery, particularly, a prior VBAC are associated with a higher rate of successful TOL.

Type of Conception and Outcomes in Women with Singleton Pregnancy

Manjula Pochiraju, Praveen Kumar Nirmalan

Background: An estimated 4.9 million women in India are infertile. If we add secondary infertility to these estimates, the number of infertile couples in India may rise to 17.9 million. Increased use of assisted conception services and information on outcomes after assisted conceptions are useful, to appropriately counsel women who utilize such services. Aim: To determine as to whether outcomes of pregnancy differ between assisted conceptions and natural conceptions in pregnant women with singleton foetuses. Settings and Design: A retrospective observational study done a single tertiary care centre in southern India. Materials and Methods: This study included pregnant women with singleton gestations, who delivered at the study institute in 2012. Assisted conception was considered to include all invasive and non-invasive methods like ovulation induction (OI), Intrauterine insemination (IUI), in vitro fertilization (IVF), intracytopalsmic sperm injection (ICSI). Outcomes of interest included gestational age at delivery, birth weight, small for gestational age babies, still births, neonatal deaths and caesarean sections. Point estimates and the 95% Confidence Intervals (CI) around point estimates of associations with assisted conceptions and outcomes were determined by using bivariate analysis and a multivariate logistic regression model. Results: This study included 6,712 women who were pregnant with a singleton foetus, including 460 (6.85%, 95% CI: 6.27, 7.48) women who conceived with assistance Women who conceived with assistance were more likely to be older (p<0.001), nulliparous (p<0.001), who had a higher prevalence of obesity (p<0.001), pre-gestational diabetes mellitus (p=0.009), gestational diabetes (p<0.001) and pre-pregnancy hypothyroidism (p<0.001) in this population. Assisted conceptions were not significantly associated with small for gestational age babies (p=0.09), still births (p=0.56), or neonatal deaths (p=0.89). Assisted conceptions were associated with a higher incidence of caesarean sections (adjusted OR: 1.37, 95%CI: 1.11-1.70) in a multivariate logistic regression model. Conclusion: After adjusting for differences in maternal characteristics, pregnant women with singleton foetuses, who conceived with assistance, had similar outcomes, except for higher caesarean section rates, as compared to women who conceived naturally.

Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study

Ashraf Direkvand-Moghadam, Kourosh Sayehmiri, Ali Delpisheh, Sattar Kaikhavandi

Background and Objectives: Premenstrual Syndrome (PMS) is a common health problem in women in reproductive age. The present study aimed to investigate the prevalence of PMS using meta-analysis method. Methods: This meta-analysis systematically reviewed the prevalence of PMS. A search was conducted using keywords Premenstrual Syndrome, PMS, prevalence PMS and symptom of PMS in reliable English articles. The initial search 53 articles were available. After review of full-text articles, 17 articles were selected for analysis. Data were combined using meta-analysis (random effects model). Data were analyzed using STATA software, Version 11.1. Results: Overall, 17 studies met our inclusion criteria. The pooled prevalence of PMS was 47.8% (95% CI: 32.6-62.9). The lowest and highest prevalence were reported in France 12% (95% CI: 11-13) and Iran 98% (95% CI: 97-100) respectively. However, meta-regression scatter plot showed an increasing trend in the prevalence of PMS during 1996-2011 but correlation between prevalence of PMS and year of study was not significance (p= 0.797). Interpretation and Conclusions: Considering that different tools have been used in studies and many studies have been designed based on a limited sample, therefore, future research needs to consider the prevalence of PMS in different countries of world.

Nested Multiplex (NMPCR) Detection of Human Papillomavirus (HPV) 16 and 18 in Pre-invasive Lesions and its Implication in Screening of Carcinoma Cervix (CaCx)

Introduction: Carcinoma cervix (CaCx) is a preventable disease and is caused by certain high risk Papillomaviruses. In the present study, our aim was to investigate the utility of Nested Multiplex Polymerase Chain Reaction (NMPCR) in detecting Human Papillomavirus (HPV) 16 and 18 in cervical scrapes/biopsy samples and to correlate with cervical cytology/ histopathology findings. Methods: A total of 119 females were subjected for Papanicolaou smear examination of cervical scrapes and/or histopathological examination of cervical tissues. These samples were also subjected to nested multiplex PCR targeting HPV 16/ 18 specific E6/7 gene sequences. Results: HPV 16/18 were detected in 33.6% (40/119) cases included in the study. The overall HPV 16/ 18 positivity among cases with Negative for Intraepithelial Lesion or Malignancy, Low grade Squamous Intraepithelial Lesion, and High grade Squamous Intraepithelial Lesion was observed to be 20.8%, 44%, and 66.7% respectively. Positivity for HPV 16 in cases with Squamous Cell Carcinoma (SCC) was found to be 80%. HPV positivity among subjects reported with reactive cellular changes, a sub category of Negative for Intraepithelial Lesion or Malignancy, was observed to be 26.6%. Conclusion: HPV 16 and 18 positivity in cases reported with different stages of pre invasive lesions of CaCx, particularly in the subcategory reactive cellular changes of Negative for Intraepithelial Lesion or Malignancy, indicates that NMPCR detection of HPV 16/ 18 may be used as a screening tool for CaCx in conjunction with Papanicolaou smear examination.

Comparison of Intrathecal Dexmedetomidine with Buprenorphine as Adjuvant to Bupivacaine in Spinal Asnaesthesia

Mahima Gupta, S. Shailaja, K. Sudhir Hegde

Background: The supplementation of local anaesthetics with adjuvants to improve the efficacy of subarachnoid block has been recognised since long. The most preferred drug has been opioids, but newer drugs like dexmedetomidine has also been introduced and investigated as an effective adjuvant. Aim: This study was conducted to evaluate and compare the characteristics of subarachnoid blockade, hemodynamic stability and adverse effects of intrathecal buprenorphine and intrathecal dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine for lower abdominal surgeries. Materials and Methods: The present study included 60 patients aged between 18-60 years classified as ASA-PS I/II scheduled for elective lower abdominal surgeries. The patients were randomly allotted to two groups to receive intrathecal 3ml of 0.5% bupivacine with 60µg of buprenorphine (Group B; n=30) or 3ml of 0.5% bupivacaine with 5µg of dexmedetomidine (Group D; n= 30). The onset time to peak sensory level, motor block, sedation, Haemodynamic variables, duration of motor block, analgesia and any adverse effects were noted. Results: There was no significant difference between groups regarding demographic characteristics and type of surgery. The motor, sensory blockade and time of rescue analgesia were significantly prolonged in Group D compared to Group B. The sedation level was higher in Group D compared to Group B. There was no significant difference in haemodynamic variables although Group B had lower heart rate than Group D. Conclusion: Intrathecal dexmedetomidine when compared to intrathecal buprenorphine causes prolonged anaesthesia and analgesia with reduced need for sedation and rescue analgesics.

Assessment of Nutritional Risk and Its Associated Factors among Elderly Women of Old Age Homes of South Suburban Kolkata, West Bengal, India

Santanu Saha, Ayan Basu, Santanu Ghosh, Arghya Kusum Saha, Upasana Banerjee

Background: Different physiological, social and psychological factors contribute to nutritional risk in elderly population. Elderly women residing at old age homes are particularly susceptible. Objectives: To find out psychological and financial factors, if any, associated with malnutrition and risk of malnutrition. Methods: A cross sectional descriptive study was conducted on 200 residents belonging to > 65 years age group of nine old age homes selected randomly among eighteen old age homes located at south suburban areas of Kolkata from September 2010 to April 2011 using a pre-designed, pilot tested schedule containing Mini Nutritional Assessment (MNA) Scale and Geriatric Depression Scale (GDS). Intergroup comparison was performed using chi-square test.The study was approved by Institutional Ethics Committee of All India Institute of Hygiene & Public Health, Kolkata,India. Written informed consent was taken from each study participant. Results: Among 158 ‘possibly malnourished’ women, 114 (57%) were ‘at risk of malnutrition’ and 44 (22%) were malnourished according to MNA. Psychological stress was present among 44% of ‘at risk of malnutrition’ and 56% ‘malnourished’ population (df=1, x2= 28.852, p<0.001). About 77% of women having moderate depression were ‘at risk of malnutrition’ whereas 52% of women having severe depression were ‘malnourished’ (df =2, x2= 23.769, p<0.001). Conclusion: High proportion of ‘at risk malnutrition’ and ‘malnutrition’ associated with presence of psychological stress and different grades of depression were the major areas of concern.

Management of Unstable Thoracolumbar Spinal Fractures by Pedicle Screws and Rods Fixation

MURALIDHAR BM, DURGAPRASAD HEGDE, PSB HUSSAIN

Background: The thoracolumbar junction is the most common area of injury to the axial skeleton. Forces along the long stiff kyphotic thoracic spine switch abruptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to obtain a painless, balanced, stable spine with optimum neurological function and maximum spine mobility. The present prospective study has evaluated the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures. Materials & Methodology: Thirty cases of fractures around the TL spine were operated with posterior pedicle screw fixation one or two level above and below the fracture. The cases were followed up for a mean of 9.5 months with radiological and neurological evaluation. Results: The average age groups of the patients studied were 21 to 53 yearinjury involving the T12 and L1 vertebral body. The unstable burst fractures the s majority were males, fall from height being the predominant mode of most common type of fracture, radiological parameters sagittal angle and index were recorded pre and post-operatively. The neurological grading was done using the ASIA score. Follow-up was done for a minimum of 5 months where sagittal angle reduction achieved was 10.75 at final follow-up from 23.5 pre-operative. The sagittal index achieved at final follow-up was 72% compared to the pre-operative mean of 53%. The neurological improvement was regarded to be fair enough for the type of injury sustained and fixation achieved. Conclusion: We found that the application of posterior instrumentation using pedicle screw and rod resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; the limiting factor being the small study group and short follow-up period.

Psychomotor Retardation, Attention Deficit and Executive Dysfunctional in Young Non-hospitalised Un-medicated Non-psychotic Unipolar Depression Patients

Kamini Ramdas Ilamkar

Background: Neuropsychological deficits have been reported in patients with major depressive disorder during an acute episode. The reaction time gives an idea about integrity and the processing ability of central nervous system. The simple reaction time task is an attention seeking task that focuses primarily on speed of processing (executive function). Psychomotor retardation (i.e. delay at the output which includes perceptual decision, planning, motor process) is a constant and probably central feature of depression. Aims: The purpose of present study was to evaluate the neuropsychological functioning in young non-hospitalised un-medicated non-psychotic unipolar depression by focusing on tasks related to prefrontal cortex functioning. Materials and Methods: Newly diagnosed young antidepressant-free, clinically depressed patients (20 males and 24 females, n=44)and healthy controls (24 males and 27 females, n=51) pair-wise matched on gender, age (mean age 25±4) were included in this study. All patients were diagnosed with major depressive episode according to DSM-5. Both the patients and healthy controls performed a simple reaction time task with components of alerting auditory and visual oriention of attention by an instrument response analyzer. Statistical Analysis : The performances were expressed in mean ± standard deviation of the reaction time by using the Student’s unpaired t-test. Results: Patients with unipolar depression relative to controls were impaired on tasks psychomotor performance and deficits in sustained attention remained significant. Conclusions: These findings suggest deficits in sustained attention as vulnerability marker for unipolar depression. With further methodologically sound research, the changes in neuropsychological function associated with treatment response may provide a means of evaluating different treatment strategies in major depression.

Acute Transfusion Reactions in Intensive Care Unit: A Retrospective Study

Rajesh Kumar, Manvi Gupta, Varun Gupta, Amarjit Kaur, Sonia Gupta

Background: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. Aim: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. Materials and Methods: This was a retrospective review conducted from 1st April 2011 till 31st March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. Results: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. Conclusions: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.

Right Double Inferior Vena Cava (IVC) with Preaortic Iliac Confluence – Case Report and Review of Literature

C.S.Ramesh Babu, Rekha Lalwani, Indra Kumar

Anomalies of the inferior vena cava (IVC) are uncommon and most of them remain asymptomatic. Though rare, anomalies of IVC can lead to severe hemorrhagic complications especially during aortoiliac surgery. Prior knowledge of these variations facilitates proper interpretation of radiological images and safe performance of interventional procedures and surgeries. During routine anatomical dissection of abdomen in a female cadaver we observed the presence of right sided duplication of IVC. Both IVCs were present on the right side of abdominal aorta, one ventral and the other more dorsal in position and named ventral right IVC and dorsal right IVC. The ventrally and medially placed IVC, which appeared to be the main IVC was formed by the union of two common iliac veins in front of the right common iliac artery (Preaortic iliac confluence-“Marsupial Cava”). The right external iliac vein continued as the more dorsally and laterally placed dorsal right IVC. The right internal iliac vein after receiving a transverse anastomotic vein from the external iliac continued as the right common iliac vein. This transverse anastomosis was present behind the right common iliac artery. The narrower dorsal right IVC joined the wider ventral right IVC just below the level of renal veins to form a single IVC. The abdominal aorta presented a convexity to the left.

Origin of Medial and Lateral Pectoral Nerves from the Supraclavicular Part of Brachial Plexus and its Clinical Importance – A Case Report

Knowledge of normal and anomalous formation of brachial plexus and its branches is of utmost importance to anatomists, clinicians, anesthesiologists and surgeons. Possibility of variations in the origin, course and distribution of branches of brachial plexus must be kept in mind during anesthetizing the brachial plexus, mastectomy and plastic surgery procedures. In the current case, the medial pectoral nerve arose directly from the middle trunk of the brachial plexus and the lateral pectoral nerve arose from the anterior division of the upper trunk of the brachial plexus. The lateral pectoral nerve supplied the pectoralis major and the medial pectoral nerve supplied pectoralis major and pectoralis minor muscles through two separate branches.

Bilateral Absence of Flexor Digitorum Superficialis (FDS) Tendon of the Little Finger: Clinical Significance

Amrita Gupta, Virendra Kumar

The flexor digitorum superficialis (FDS/sublimis) is a flexor of the digits of the hand and has been reported to have varying degrees of agenesis. During routine cadaveric dissection for undergraduates at SRMS-IMS Bareilly, India, we observed bilateral absence of the FDS tendon to little finger in the upper limbs of a 45-year-old male cadaver. The muscle was normally supplied by a branch of median nerve in the forearm. Variants of the FDS muscle of the little finger have been reported in the literature. Proper knowledge of muscular variations is essential not only for anatomists but also for orthosurgeons, plastic surgeons and neurologists especially when evaluating possible tendon laceration/dysfunction. The FDS has been used as a motor for a wide variety of tendon transfer operations in the hand.

A Rare Case of Primary Supraclavicular Lymphadenitis due to Cryptococcus Neoformans in an HIV Infected Patient

Anuradha Sood, Lata R Chandel, Smriti Chauhan, Kamlesh Thakur, S.C. Jaryal

Cryptococcosis caused by encapsulated yeast Cryptococcus neoformans most commonly presents as disease of the central nervous system. Cryptococcus is a non–mycelial budding yeast found in soil, pigeon droppings and their nesting places. The three ‘classic’ virulence factors of cryptococci are: polysaccharide capsule, melanin production and growth at 37°C. Here, we present a rare case of cryptococcosis affecting left supraclavicular lymph node in a Human Immunodeficiency virus (HIV) infected individual. Culture of fine needle aspirate of the lymph node yielded Cryptococcus neoformans which was identified by standard microbiological techniques. Meyer’s mucicarmine stain imparted a typical rose burgundy colour to the capsule. Unusual characteristics of the isolate included poorly developed capsule and the presence of yeast in chains resembling pseudo-hyphae. This case highlights the importance of microbiological techniques for diagnosis and prompt treatment of cryptococcosis.

Isolation of Aeromonas salmonicida from Human Blood Sample: A Case Report

Rachna Tewari, Mridu Dudeja, Shyamasree Nandy, Ayan Kumar Das

Aeromonas salmonicida belonging to the genus Aeromonas, is a common pathogen that causes furunculosis and septicaemia in variety of fishes. It infects cold blooded vertebrates living at low temperatures mainly salmonid fish hence named salmonicida. Untill recently Aeromanas salmonicida is considered to be a fish pathogen. A. salmonicida is considered to be non-pathogenic for humans as it cannot grow at 37º C. “However, In our laboratory culture plates and broths were incubated twice at 370 C and each time same type of colonies were isolated which were identified as A. samonicida by Vitek 2 compact system bioMerieux, Inc. (Durham,N.C)”. By far no report has been received regarding its isolation from humans biological sample.Here we present the first report of A. salmonicida isolated from the human blood.

Coexistence of Cutaneous Tuberculosis (Scrofuloderma) and Hanseniasis-A Rare Presentation

Cutaneous tuberculosis, pulmonary tuberculosis and hanseniasis are all caused by different spp. of Mycobacterium, an intracellular pathogen whose development depends on impaired cell mediated immunity. Scrofuloderma is the most common variant of cutaneous tuberculosis, which is characterized by a direct extension of the skin which overlies the infected lymph gland, bone or joint, that breaks down to form an undermined ulcer. We are reporting a rare association of Scrofuloderma (cutaneous tuberculosis) with Hanseniasis (leprosy) in an adult male whose immune status was controversial.

A Heart with Multiple Coronaries Anomalies: Myocardial Bridging, Left Dominance and High Takeoff of Ostia-An Autopsy Case

Lokesh Haswani, Harendra Kumar M.L., J. Kiran

Myocardial bridging is a segment of coronary artery that runs intramurally through the myocardium. Though it is commonly seen in the anterior interventricular artery and less commonly in right coronary artery, it can cause limitation in the blood flow, which leads to myocardial ischaemia. Left dominance increases cardiac mortality because of association with the congenital bicuspid aortic valve and myocardial infarction. An earlier study has shown the correlation of myocardial bridging with left coronary circulation and it is rare in relation with right coronary and left dominance. Manifestations of high takeoff of the coronary ostia are highly debatable, with varied opinions given by various authors. It has been believed that myocardial bridging is congenital and that it also causes limitation of blood flow to the myocardium. Cardiac muscles have a unique capability to adapt in response to decreased blood supply, which is in the form of coronary collateral circulation. So, is their any correlation between myocardial bridging and dominance? Herein, we are reporting an unusual autopsy case of myocardial bridging on its right main coronary artery, left coronary dominance and high take off of left main coronary artery in the same heart.

Prominent Intracytoplasmic Crystals in Alveolar Soft Part Sarcoma (ASPS): An Aid in Cytological Diagnosis

Alveolar soft part sarcoma (ASPS) is a rare neoplasm of unknown histogenesis with poor prognosis. Due to the epithelioid appearance of the neoplastic cells, ASPS may resemble many neoplastic conditions, such as metastatic epithelial cell tumours with clear cell change, metastatic renal cell carcinoma, granular cell tumour, epithelioid sarcoma, malignant melanoma and even paragangliomas. Presence of abundant, rod like crystals in the cytoplasm of tumour cells is an important finding characteristic of this tumour, which helps in differentiating it from the other entities. The case study highlights the importance of correlating cytological features that help in reaching the diagnosis such as the background, cell morphology and presence of characteristic rod shaped crystals as immunohistochemical studies are often non-conclusive. The case also is unique as it demonstrates presence of intra-cytoplamic crystals in such abundance.

Small Cell Neuroendocrine Carcinoma of the Cervix: A Rare Entity

Small cell carcinoma of the cervix is a rare and a very aggressive tumour. Once being considered to be a rare type of squamous cell carcinoma, evidence has proven that most of the tumours express one or more markers of neuroendocrine differentiation. The behaviour of this rare malignancy is different from that of squamous cell carcinomas, with a high propensity for nodal and distant metastases. Hence, there is a need to highlight this histopathological entity.

Sinonasal Carcinoma – A Report of Two Cases

Kalyani R., Aparna Narshimhan, Shiva Prakash

Sinonasal carcinomas are rare and account for 3% of all malignant tumours of head and neck. Squamous cell carcinoma is the commonest histological variant. We present a case of sinonasal squamous cell carcinoma in a 52-years-male and another rare case of intestinal type sinonasal adenocarcinoma in 50-years-male.

Primary Cavernous Haemangioma of the Thyroid - A Case Report

Anuja Dasgupta, S Teerthanath, Meera Jayakumar, Kiran HS , Mary Raju

Primary thyroid haemangioma is extremely rare, with only countable cases having been previously reported. We are reporting a case of 38-year-old male with history of diffuse thyroid swelling in front of the neck, which was firm to hard in consistency. Ultrasonography (USG) displayed an enlarged left thyroid with anechoic / isoechoic nodule and foci of coarse calcification. Preoperative clinical diagnosis of solitary thyroid nodule was made. Fine Needle Aspiration Cytology (FNAC) was inconclusive, due to bloody aspirate. Left hemi-thyroidectomy was performed. Haemangioma was diagnosed, based on histopathological examination findings. Surgical excision would be the treatment of choice, which provides a good prognosis.

Encysted Spermatic Cord Hydrocele in a 60-year-old, Mimicking Incarcerated Inguinal Hernia: A Case Report

Manimaran D, Karthikeyan T M, Dost Mohamed Khan

Hydrocele of spermatic cord is caused by defect in closure of the processus vaginalis, as the testicles descend into the scrotum during foetal development. It usually occurs in infancy and childhood. There are two types of hydrocele of spermatic cord. Encysted type is caused by defective closure at both proximal and distal ends of processus vaginalis and it does not communicate with the peritoneal cavity. Funicular type is caused by defective closure of only distal end of tunica vaginalis and it communicates with the peritoneal cavity. The encysted type can be confused clinically with incarcerated inguinal hernia, inguinal lymphadenopathy, undescended testis and primary tumours of cord like lipoma. We are presenting a case of encysted hydrocele of spermatic cord in a 60-year-old male, which clinically mimicked incarcerated inguinal hernia.

Neuroendocrine Carcinoma of the Stomach-A Case Report

Poorana Priya P., Hemalatha Ganapathy, Subhashree A.R.

Neuroendocrine carcinomas of stomach have been considered a rare neoplasm. The present case concerns with a 69 year old male, who presented with vague abdominal discomfort and history of malena. Upper alimentary tract endoscopy showed an ulcero-proliferative growth in the antrum. Computed tomography abdomen revealed thickening of the gastric antrum, a subtotal gastrectomy was performed after correction of anemia. Microscopic evaluation revealed a neuroendocrine neoplasm. Immunohistochemically positive for Chromogranin A and Synaptophysin.A diagnosis of Neuroendocrine carcinoma of the stomach was given based on recent WHO classification of Neuroendocrine carcinoma of the stomach and on mitotic index with reference to grading scale.

Primary Midgut Carcinoid, a Rare Cause of Paraneoplastic Limbic Encephalitis: A Case Report

Gautham Krishnamurthy, K. Chandramouleeswari, Jagadeesh Chandra Bose, Rajendran

A 60-year-old male presented with an unexplained seizure whose aetiology could not be demonstrated. After 8 weeks, patient on evaluation for abdominal pain was detected to have primary midgut carcinoid with nodal and hepatic metastasis. Patient underwent cytoreductive surgery and metastatectomy with successful outcome. The case is being presented for its rarity and the need to recognize the paraneoplastic neurological manifestations of these rare neuroendocrine tumors

Scalp Metastasis of Gastro-Esophageal Junction Adenocarcinoma: A Rare Occurrence

Asitava Deb Roy, Mingma Sherpa rpa, P.R.K. Prasad , Rachna Lam ichanet

Cutaneous metastasis is one of the many skin changes which are associated with internal malignancies. Breast, lung, and colon are the most common sources of internal primary malignancies. Gastro-esophageal junction adenocarcinoma is a rare cause of cutaneous metastasis to the scalp. Gastric adenocarcinoma usually metastasizes to the liver, peritoneal cavity and regional lymph nodes more often than to skin. We are presenting a case of cutaneous metastasis on the scalp of a 79-year-old man, who was diagnosed and operated for gastro-oesophageal junction adenocarcinoma one year back.

Juvenile Hyaline Fibromatosis (JHF): A Rare Case with Recurrence

Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease. Less than 70 cases of JHF have been reported worldwide and extremely few from India. We present a case of 4-year-old girl who presented with multiple painless nodular masses on the scalp. On fine needle aspiration cytology, a diagnosis of benign spindle cell lesion was provided, the scalp lesions were excised and on histopathology the diagnosis of JHF was made. Retrospectively, the cytology slides were reviewed and the features were consistent with the diagnosis. A diagnosis of JHF was made based on the classical clinical features, Fine Needle Aspiration Cytology (FNAC) findings and the characteristic histopathological features along with a supportive evidence based on special stains. However, the patient had a recurrence within two years. Hence, we present this rare case with recurrence.

Sirenomelia with Oesophageal Atresia: A Rare Association

We are reporting a rare case of sirenomelia with oesophageal atresia. Sirenomelia is a lethal sporadic defect of which lower gastrointestinal tract anomalies are characteristic findings. Respiratory and upper gastrointestinal tract malformations like oesophageal atresia occur in about 20-35% of cases. Though its occurrence has been described, it has been reported only rarely. This report aims at describing this uncommon association along with its histological features.

Paratesticular Liposarcoma-Masquerading as a Testicular Tumour

Kalaivani Vinayagam, Vijayakumar Hosamath, Sridhar Honnapp a, Aarathi Ranga Rau

Paratesticular liposarcomas are rare tumours which account for 12% of all liposarcomas. Probably there are about 186 cases which have been reported till date. They must be differentiated from tumours of testicular origin which have extension to the spermatic cord. We are reporting a case of a 50-year-old male who had presented with a painless swelling in the right hemiscrotum, which was of 20 years’ duration. Inititally, a clinical diagnosis of testicular tumour was made; however, CT of the scrotum revealed paratesticular tumour? liposarcoma and testis being normal and displaced postero-inferiorly. Metastatic work-up, which included CT of the abdomen and pelvis, thorax and whole body scan, did not reveal any distant metastasis. Patient underwent high orchidectomy, hemiscrotectomy. Histopathological studies confirmed the diagnosis of well-differentiated liposarcoma (atypical lipomatous tumour of sclerosing type).

Giant Epidermoid Cyst of External Ear – A Rare Case Report

g.Siva Prasad Reddy, N.V.S.Sekhar Reddy, G.V. Reddy, Sriharsha K.

Epidermoid cysts are developmental, benign, cutaneous cysts which are commonly found on face followed by trunk and neck. They account for approximately 80% of follicular cysts of the skin. They are slow growing lesions and remain asymptomatic until or unless secondarily infected. They occasionally have tendency to develop into a malignancy. We describe a case of giant epidermoid cyst of posterior part of external ear, a location where very few cases have been reported in the literature. Since cyst was attached to the external ear, esthetics was also one of the important concern apart from the cyst getting infected, as they cause disfigurement of the face. The cyst was excised surgically. Histopathology confirmed the presumptive diagnosis of Epidermoid cyst. Two-years after the resection there was no recurrence. Due to the possibility of the cyst to transform into a malignancy and for appropriate diagnosis, histopathological examination remains a gold standard for confirmatory diagnosis.

Post-traumatic Headache: An Uncommon but Treatable Entity

Devendra Mishra, Satnam Kaur

Post-traumatic headache is a recognized sequel of all types of head injuries and reported in up to 6.8% of children with head–injuries. Two varieties, acute (resolving within 3 months) and persistent have been described. We report three cases and discuss pertinent issues for the clinicians.

Tracheal Agenesis with Tracheo-oesophageal Fistula

Tracheal Agenesis (TA) presents with respiratory distress at birth. Diagnosis requires recognition of clinical signs in newborns like failure of endotracheal intubation, respiratory distress with absent air entry over both side of chest and inaudible cry. We describe a TA Floyd Type I with a Tracheo-Oesophageal Fistula (TOF) without other congenital malformations.

Abdominal Cocoon: An Unusual Presentation of Small Bowel Obstruction

R.G. Naniwadekar, S.R. Kulkarn i, P. Bane, S. Ag arwal, A. Garje

Abdominal cocoon is a rare condition. It presents as a thick whitish membrane which covers bowel loops. Because of this presentation, it is also called as sclerosing encapsulating peritonitis. It is usually diagnosed intra operatively. Treatment of this condition involves resection of the membrane and release of adhesions. Pre-operatively, patient is investigated for recurrent episodes of small bowel obstructions. However, preoperative diagnosis does not change the treatment and management. Investigations done preoperatively help in expediting the treatment with planned laparotomy.

Splenic Epidermoid Cyst - A Rare Entity

C Splenic epidermoid cysts are relatively uncommon. Most often, they are asymptomatic, but they may present with abdominal discomfort, predominantly at young ages. We are reporting a rare case of 12-years-old female child with history of dull intermittent pain, tender palpable mass in left hypochondrium on physical examination. Ultrasonography (USG) of abdomen showed large cyst in upper pole of spleen, and an X ray of chest revealed slightly raised left hemidiaphragm. Axial sections taken on computerized tomography of abdomen showed a large well defined cystic mass near upper pole of spleen, with a thin septum in it. On laparotomy, open total splenectomy was performed. Sections from cystic wall were processed and histopathological examination revealed fibrous tissue covered by stratified squamous epithelium. Although, now-a-days emphasis is being laid on minimal invasive operative procedures which preserve spleen. This case report favours total splenectomy, considering postoperative outcome. The final diagnosis always depends upon histopathological examination.

Metastatic Primary Signet Ring Cell Carcinoma of Rectum: A Case Report of 10-Year-old Male Child

Kumkum Singh, Amit Singh, Shyam Bhutra, Geeta Pachori, Mahesh Kumar Jangir

Signet ring cell carcinomas of the colon and rectum are well documented in the adult population, but the incidence is very low in the paediatric population. Signet ring cell carcinoma has more malignant potential, mostly present as advanced stage and carries very poor prognosis. We are describing a 10-year-old male patient who presented with acute intestinal obstruction; radiology revealed large bowel obstruction and was diagnosed metastatic primary signet ring cell carcinoma of rectum on biopsy. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, signet ring cell carcinoma of colorectum represents a special diagnostic and surgical challenge.

Self Mutilation of Genitalia-Using Teeth

UgurLoK, Umut Gulacti, Can Benlioglu , Hasan Buyukaslan, Nurettin Aktas

Genital self-mutilation (GSM) is an uncommon self-inflicted injury, and rarely do self-mutilations have a serious nature. GSM is not a single clinical entity, and it can occur in any psychiatric state or condition. The instruments that are used for self-mutilation can vary, and treatment of these injuries requires a detailed clinical evaluation and multi disciplinary approach. We report here a case report about a 22-year-old mentally retarded man who referred to our emergency service for bloody vomitting by his family members. To our knowledge this is the first such case reported in literature as of injury technique.

A Rare Case of A2+ve Blood Group in an Obstetric Emergency

Padmasri R., Urvashi Bhatara, Rupa S. Iyengar

We present a rare case of A2+ve blood group with Placenta praevia with Obstetric Haemorrhage in mild hypovolemic shock. An emergency request for blood transfusion confounded the blood bank officer as the patient’s blood was seemingly incompatible with all ABO blood groups. Further investigation revealed the patient’s blood group to be a rare subtype of the A group known as A2+ve. This article highlights the need to be aware of such rare subgroups, especially in tertiary referral centres like ours, where unbooked Obstetric emergencies are encountered on a regular basis, so life-saving measures can be appropriately taken.

Bilateral Pathological Subluxation of Hips Secondary to Tuberculosis in an Adult: A Rare Presentation

Atmananda Hegde, Rajan Babu, Abhishek Shetty

Clinical descriptions of tuberculosis date back to antiquity. Extra-pulmonary involvement is noted in approximately 14% of patients, with 1% to 8% having osseous disease. In literature, some cases of bilateral traumatic dislocations have been described, but reports on bilateral pathological subluxations or dislocations of hip joints, that too in adults, are extremely rare. Tuberculosis can present in myriad ways and it can mimic any disease. The sole purpose of writing this article was to report one of the extremely rare presentations of skeletal tuberculosis.

Synchronous Multicentric Giant Cell Tumour (GCT)-A Rare Case Report

Anshu Shekhar, Gururaj Murgod, Suresh Korlhalli

Giant Cell Tumours (GCT) of bone account for 5% of all primary bone tumours. Multicentric variety is a rare variant of this condition, accounting for less than 1% of all cases and can occur as synchronous or metachronous lesions. We report a 22-year-old male patient with 18 months history of painful progressive swellings around the right knee. Radiographs revealed expansile lytic lesions in the distal femur, proximal tibia and fibula and core needle biopsy was typical of GCT. Biochemical parameters were normal and radiological investigations did not reveal any metastasis. The patient was treated by above knee amputation due to the extensive nature of the tumours. The excised tissue from all sites had features of giant cell tumor with no atypia or malignant cells seen. The patient is free from recurrence or metastasis at three years follow up.

Doppler Sonography and 3D CT Angiography of Acquired Uterine Arteriovenous Malformations (AVMs): Report of Two Cases

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan

Uterine Arteriovenous Malformations (AVMs) are rare but life threatening causes of abnormal vaginal bleeding. Accurate clinical and radiological diagnosis is essential because uterine instrumentation that is often used for management of other sources of abnormal bleeding, can lead to massive hemorrhage. Timely diagnosis and early proper treatment can markedly reduce the associated disease mortality. Ultrasound with colour and spectral doppler is the initial imaging modality of choice. Three-dimensional computed tomography (CT) angiography can determine the actual extent of the vascular malformation and helps in pre-interventional planning noninvasively. Uterine AVM can be either congenital or acquired in nature with latter being more common. We hereby report two cases of acquired AVMs diagnosed by color doppler sonography and confirmed by three-dimensional CT angiography. Both the cases reported here had previous history of dilation and curettage for abortion. Clinically one patient presented with profuse uterine bleeding and another with meno-metrorrhagia and both cases underwent surgical removal of uterus.

Etiopathogebesis and Neurobiology of Narcolepsy: A Review

Swarup Kumar, Haritha Sagili

Narcolepsy is a chronic lifelong sleep disorder and it often leaves a debilitating effect on the quality of life of the sufferer. This disorder is characterized by a tetrad of excessive daytime sleepiness, cataplexy (brief loss of muscle tone following strong emotion), hypnogogic hallucinations and sleep paralysis. There are two distinct subgroups of Narcolepsy: Narcolepsy with cataplexy and Narcolepsy without cataplexy. For over 100 years, clinicians have recognised narcolepsy, but only in the last few decades have scientists been able to shed light on the true cause and pathogenesis of narcolepsy. Recent studies have shown that a loss of the hypothalamic neuropeptide Hypocretin/Orexincauses Narcolepsy with cataplexy and that an autoimmune mechanism may be responsible for this loss. Our understanding of the neurophysiologic aspect of narcolepsy has also significantly improved. The basic neural mechanisms behind sleepiness and cataplexy, the two defining symptoms of narcolepsy have started to become clearer. In this review, we have provided a detailed account of the key aspects of etiopathogenesis and neurobiology of narcolepsy, along with a critical appraisal of the more recent and interesting causal associations.We have also looked at the contributions of neuroimaging to the etiopathogenesis of Narcolepsy.

Effect of Obesity and Lifestyle on the Oral Health of Pre Adolescent Children

Nithya Anand , m.Suresh, S.C.Chandra Sekara N

Background: Worldwide estimates of childhood obesity are as high as 43 million, and rates continue to increase each year. Childhood obesity is a growing problem in the present era and it causes serious consequences in the later years. In today’s society, electronic media have been thoroughly integrated into the fabric of life, with television, video games, and computers being central to both work and play. While these media outlets can provide education and entertainment to children, many researches are concerned with the negative impact of electronic media on children. Objective: The current study aimed to evaluate the correlation, as to how oral hygiene and periodontal health were influenced by obesity and lifestyle factors, among pre-adolescents of ages of 9-12 years. Materials and Methods: This study was conducted in schools located around Velachery, Chennai, India. A total of 426 children of age group of 9-12 years were selected. Information on their socio-economic, dietary, oral health statuses and time spent in leisure activities were assessed by using a questionnaire, followed by BMI estimation and these variables were correlated with their oral hygiene statuses. Results: The prevalence of poor oral hygiene and poor dietary habits was observed in children who spent more time in watching television, playing videogames and using computer. Good oral hygiene was observed in children who had visited dentists in the past. Conclusion: There is a strong association of lifestyle factors with oral hygiene in pre-adolescent children. Sedentary lifestyle, with more leisure activities, has a negative impact on the oral health of children.

Choosing Public Health Dentistry as a Career: A Cross-Sectional Study

Objectives: The purpose of this study was to assess the attitude of dental students towards considering Public Health Dentistry as their future career. Materials and Methods: A questionnaire based, cross-sectional survey was conducted, which included dental students from different years of study. It consisted of 27 questions that were graded on five point Likert scale. Results: A total of 293 of the 320 registered undergraduate students participated in the study, with an overall response rate of 91.5%. Among the sample, 80 (27%) were males and 213 (73%) were females. Among the total sample which was studied, it was observed that only one third (35.4%) of them had high attitude towards selecting Public Health Dentistry as a future career, and nearly two thirds of them (58.02%) had an average attitude, with very few students having low attitude (6.48%). Conclusion: The present study concluded that there was an average attitude of 58% among dental students, which showed that they had a considerable amount of interest in pursuing post graduation in this speciality. Efforts should be intensified, both by dental council and by the dental colleges, to develop this speciality, keeping in mind the increasing attitude of dental undergraduates towards it. This also helps in increasing the number of dental personnel who are specialized in implementation of oral health policy, which does not exist in India.

Assessment of Position and Bilateral Symmetry of Occurrence of Mental Foramen in Dentate Asian Population

Sneha Ketan Gada, Suhasini J. Nagda

Introduction: The mental foramen shares its significance in various fields of dentistry. Being a strategically eminent landmark, an understanding of the variation of its position is important Aim: To radiographically evaluate frequently occurring position of mental foramen and its distance with reference to the lower premolars and the lower border of mandible on standardized panoramic radiographs. Methods: The inferior alveolar canal, upto the mental foramen, was traced over 300 orthopantomographs (OPGs) which were selected by using specific criteria. The mandibular plane and the long axis of the premolars were used as references to measure perpendicular distance of foramen. Results: The most common position was found to be between the two premolars (63% cases), which scaled approximately 15.46mm above the lower border of the mandible, with an average proximity to the 2nd premolar (5.51mm) than the 1st premolar (8.21mm). This was followed by position behind the second premolar, which scored 20.67%. Both the foramina were noted in the same vertical plane of reference, and they showed bilateral occurrence of the most common position of the mental foramen, with respect to 45.67% cases. Conclusion: The most common location was reported to be between the two premolars, with a definite bilateral symmetry on both left and right sides. No gender preferences were observed. An average distance of 15mm from the lower border of the mandible was calculated.

Quantitative Assessment of Apical Debris Extrusion and Intracanal Debris in the Apical Third, Using Hand Instrumentation and Three Rotary Instrumentation Systems

Sowmya H.K., Subhash T.S., Beena Rani Goel, Nandini T.N., Shilpa H. Bhandi

Introduction: Decreased apical extrusion of debris and apical one third debris have strong implications for decreased incidence of postoperative inflammation and pain. Thus, the aim of this study was to assess quantitatively the apical extrusion of debris and intracanal debris in the apical third during root canal instrumentation using hand and three different types of rotary instruments. Methodology: Sixty freshly extracted single rooted human teeth were randomly divided into four groups. Canal preparation was done using step-back with hand instrumentation, crown-down technique with respect to ProTaper and K3, and hybrid technique with LightSpeed LSX. Irrigation was done with NaOCl, EDTA, and normal saline and for final irrigation, EndoVac system was used. The apically extruded debris was collected on the pre-weighed Millipore plastic filter disk and weighed using microbalance. The teeth were submitted to the histological processing. Sections from the apical third were analyzed by a trinocular research microscope that was coupled to a computer where the images were captured and analyzed using image proplus V4.1.0.0 software. The mean weight of extruded debris for each group and intracanal debris in the root canal was statistically analyzed by a Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test. Results: The result showed that, hand instrumentation using K files showed the highest amount of debris extrusion apically when compared to ProTaper, K3 and LightSpeed LSX. The result also showed that there was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third. Conclusion: Based on the results, all instrumentation techniques produced debris extrusion. The engine driven Ni-Ti systems extruded significantly less apical debris than hand instrumentation. There was no statistically significant difference between the groups in relation to presence of intracanal debris in the apical one third.

Cyclic Fatigue Testing of Three Different Rotary Nickel Titanium Endodontic Instruments in Simulated Curved Canals - An in Vitro Sem Analysis

Pallavi Reddy .Y, Kavita S, C.V. SubbaRao

Introduction: Instrument separation is a serious concern in endodontics. Stainless steel instruments usually deform before they separate whereas Nickel Titanium instruments do not show any sign of deformation. Aim: of the present study was to compare the cyclic rotations needed to fracture three different rotary nickel titanium endodontic instruments namely Profile, K3 Endo, RaCe in simulated curved canals having 2 different radii of curvature i.e., 5mm &10mm with a constant angle of curvature of 450.The fractured surfaces were analysed using Scanning Electron Microscopy (SEM). Materials and Methods: Sixty rotary nickel titanium instruments were used for analysis in this study. The instruments were divided into three groups based on the different cross sections . Three groups were further divided into two sub groups based on radius of curvatures. Ten files were tested in each sub-group. Results: Group A (Profile) showed increased number of cycles to failure i.e., low incidence of fracture at both the radii of curvatures when compared to the other two groups. SEM analysis showed that in Group A the fractured surface of the files tested were characterized by the presence of smooth area on their edges associated with nucleation and slow fatigue crack propagation when compared to Group B and C. Therefore Group A (Profile) demonstrated least cyclic fatigue when compared to the other two groups.

Effect of Vital Bleaching on Disintegration Tendency of Glass Ionomer Restorations

Kusai Baroudi, Rasha Said Mahmoud , Bassel Tarakji , Mohammed Alsakran Altamimi

Introduction: This study was designed to assess the effect of two bleaching agents on the disintegration tendency of three types of glass ionomers. Materials and Methods: A total of 90 specimens were prepared by using a split Teflon ring with an internal diameter of 5mm and a thickness of 2mm. The tested materials were applied and bleached according to manufacturer’s instructions. Dissolution measurements were made by calculating weight loss through different periods of the test; (one week, one month and three months) and they were analyzed by using one-way analysis of variance (ANOVA), followed by Tukey’s post-hoc test. Results: All glass ionomer materials exhibited a degree of dissolution. Opalescence Xtra increased the dissolution of Photac Fil and F2000 significantly, while Opalescence Quick had no effect on dissolution of glass ionomer restoratives. ConclusionBleaching effect on dissolution of glass ionomers is material and time dependant. Care should be taken by clinicians When bleaching teeth that are restored by glass ionomer, because this dissolution may affect the physical properties of these restorations.

Efficacy of Low–Level Laser Therapy in Treatment of Recurrent Aphthous Ulcers – A Sham Controlled, Split Mouth Follow Up Study

Hersheal Aggarwal, Mohit Pal Singh, Prashant Nahar, Hemant Mathur, Sowmya GV

Introduction: Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness, and occasional bleeding from the affected area(s). The aims of treatment are to reduce pain and healing time. Aims: To assess clinically the efficacy of Low-level laser therapy (LLLT) on recurrent aphthous ulcers for reduction of pain, lesion size, and healing time and to compare the results with those of a sham control group. Settings and Design: A total of 30 patients who presented with two separate aphthous ulcers were included in the study. Each lesion was randomly allotted to either the active treatment group or the sham control group. Materials and Methods: Lesions which were included in the active group were treated with LLLT in a single sitting, which was divided into four sessions. Lesions in the sham control group were subjected to similar treatment without activating the LASER unit. Each patient was evaluated for pain, lesion size, and complete healing at the following intervals; immediately post LLLT and one day, two days, and three days follow up. Statistical Analysis : The Student’s t-test was used for statistical evaluation of the data. Results: Complete resolution of the ulcers in the active group was 3.05 ± 1.10 days as compared to 8.90 ± 2.45 days in the sham control group. Immediately, post the LLLT application, complete pain relief was observed in 28 of the 30 patients of the active group. Conclusion: LLLT was effective in relieving pain and reducing the healing time during the treatment of aphthous ulcers.

Transepithelial Brush Biopsy – Oral CDx® – A Noninvasive Method for the Early Detection of Precancerous and Cancerous Lesions

Casparis S., Borm J.M., Tomic M.A., Burkhardt A., Locher M.C.

Introduction: The Oral CDx® brush biopsy (BB) method is a computer-assisted sample analysis that detects abnormal cells in all cell layers of the epithelium of the oral mucosa. Method: We took 263 oral BBs from 200 patients with potentially malignant disorders. Results: We received 204 negative results and 39 atypical, 7 positive and 13 inadequate results. SBs were taken in 56 cases. Therefore, the sensitivity for the detection of abnormal cells was 90% and the specificity was 44.1%. The positive predictive value accounted for 47.2% and the NPV accounted for 88.2%. Discussion and Conclusion: For the results of sensitivity and specificity of the Oral CDx® BB, there is still space for improvement but they are already high. Additional methods like DNA-image cytometry may enhance the results. But it is a simple and noninvasive method which does not need a special effort either from the patient or from the clinicians.

Effectiveness of Mini Implants in Three-Dimensional Control during Retraction - A Clinical Study

Introduction: Three-dimensional control throughout the orthodontic treatment is essential for uncompromised results. Mini screws introduced for orthodontic anchorage has given the clinician an option of absolute three dimensional control. The purpose of this study was to compare and measure the vertical control and torque control of incisors and molar during enmass retraction with titanium microimplants and conventional molar anchorage. Material and Methods: Twenty patients were selected with extraction of all first premolars and bonded with 0.022” slot MBT system. After aligning and leveling, all subjects were placed with 0.019” X 0.025” posted SS wire with standardized torquing curve. The 20 subjects were randomly divided into 2 groups consisting of 10 each (Group A & Group B). Group A subjects, implants were placed and Group B formed the control group. Retraction was carried out using NiTi closed coil springs. The assessment of the vertical and torque control of incisors and tipping and vertical control of molars was done by radiographic method using lateral cephalogram taken before and after retraction. Results: The torque control of incisors, P11 value in group A and B indicated no significant difference. The molar tip, P12 value in group A indicated that there was distal tipping of molars while the P12 in group B indicated mesial tipping. On vertical plane P21, P22 and P23 values in Group A indicated that there was intrusion of incisors and molars while value in Group B indicated extrusion of incisors and molars. Conclusion: Three dimensional control is better in the implant group compared to the non implant group. Therefore the implant group definitely has citied advantages over conventional method.

Evaluation of Salivary Flow Rate, pH and Buffer in Pre, Post & Post Menopausal Women on HRT

Mahesh D.R., Komali G., Jayanthi K., Dinesh D., Saikavitha T.V., Preeti Dinesh

Background: Climateric is considered to be a natural phase of life which by definition is the period of life starting from decline in ovarian activity until after the end of ovarian function . It is accompanied by various health consequences that include the changes in saliva too. This study was carried out to evaluate the salivary flow rate, pH, buffering capacity in pre-menopausal, post-menopausal and post-menopausal women on HRT. Aims and objectives: (1) To evaluate the salivary flow rate, pH of resting saliva and stimulated saliva and buffer capacity of stimulated saliva in pre-menopausal, post-menopausal and post-menopausal women on Hormone Replacement Therapy (HRT). (2) To compare the above salivary findings between pre-menopausal, post-menopausal and post-menopausal women on HRT. Materials and Methods: The study was carried out on 60 patients. These patients were divided into three groups of 20 patients: Group 1: Pre-menopausal women (control), Group 2: post-menopausal women (case), Group 3: post-menopausal women on HRT (case). The control group consisted of 20 women volunteers, having regular ovulatory menstrual cycles with no known systemic illness and deleterious habits and Group 2 consists of 20 post-menopausal women and Group 3 will consist of 20 post-menopausal women on HRT. After clearing the mouth by swallowing, stimulated saliva was collected after chewing paraffin for 10 mins in to a glass centrifuge tube graded in 0.1 mL increments up to 10mL.in rare cases the collection time will be reduced or extended (5-15 min), salivary flow rate will be determined as ml/min, immediately after collection, pH was determined by dipping pH test paper directly into the sample of oral fluid, salivary buffer capacity was determined by using saliva check buffer kit (GC corporation). The data obtained was statistically evaluated using chi-square test, fisher exact test ANOVA analysis. Results: In our study we found salivary flow rate significantly lower in the post-menopausal women in comparison with the menstruating women and also there was improvement in the flow rate in individuals who were on HRT, it was also observed that salivary pH of the post-menopausal group was significantly lower than that of the control group , statistically significant difference in buffer capacity values was found between the groups however buffer capacity values were higher in the post-menopausal group than the control group. Conclusion: From the above study it is clear that post-menopausal women will present with oral discomfort, while HRT can improve the same. Hence our role as physicians and health care providers is to incorporate preventive dental health care in post-menopausal women and clearly inform patients about both the benefits and the limitations of HRT.

Alveolar Bone Expansion for Implant Placement in Compromised Aesthetic Zone – Case Series

Jumshad B. Mohamed, Md Nazish Alam, Gurudeep Singh, S. C. Chandrasekaran

Implant placement and restoration of compromised alveolar ridges in the aesthetic zone has always been a challenge to the oral implantologists. The use of bone expanders and bone condensers without the use of traditional drilling sequences in this scenario is becoming popular because of its predictable results. Xenograft along with Platelet-rich fibrin (PRF) used as scaffold also provides growth factors to accelerate both soft and hard tissue healing as well as regeneration. The paper highlights this combined approach in the placement of implants in compromised alveolar ridges with good results. All implants were successfully restored and followed up for one year.

Management of Large Radicular Cyst by Conservative Surgical Approach: A Case Report

Radicular cysts are the most common cystic lesions which affect the jaw. They are most common among all the jaw cysts and comprise about 52% to 68% of the entire cysts which affect the human jaw. They are generally symptomless and are diagnosed during routine radiologic investigations. The treatment of radicular cysts includes conventional nonsurgical root canal therapy when lesion is localized or surgical treatment like enucleation, marsupialization or decompression when lesion is large. This case report presents the successful surgical management of a large infected radicular cyst which was associated with maxillary central incisor with open apex.

Biological Dentin Post for Intra Radicular Rehabilitation of A Fractured Anterior Tooth

Ideal coronal reconstruction of endodontically treated tooth is still a challenge for restorative dentistry. Despite having varied types of commercially available posts, none of them meet all the ideal biological and mechanical properties. In this context a “Biological Post” serves as a homologous recipe for intraradicular rehabilitation of a fractured endodontically treated tooth by virtue of its biomimetic property.This case report addresses the esthetic and functional restoration of a fractured, endodontically treated maxillary lateral incisor in a young patient, through the preparation and adhesive cementation of a “Biological Post” made from a freshly extracted, intact human canine. The use of biological post can be considered as a novel alternative technique for the rehabilitation of an extensively damaged tooth.

A Novel Technique in Restoring Fractured Anterior Teeth

Trauma to the anterior teeth is a common phenomenon in young children and in adolescents. Uncomplicated crown fracture to the permanent teeth has an intense effect not only on the patient’s appearance, but also on function and speech. This case report describes a novel technique in restoring an uncomplicated fractured maxillary anterior tooth in a young patient with direct composite, which is economical and requires less chair side time.

Residual Cyst Associated with Calcifications in an Elderly Patient

A residual cyst, as the name implies, is a radicular, lateral periodotal, dentigerous or any other cyst that has persisted after it’s associated tooth has been lost. Residual cysts show more predilection in males and they commonly affect the maxillary region. Usually, residual cysts are asymptomatic and calcifications occurring in the residual cysts are quite rare. We are reporting a case of symptomatic residual cyst, associated with calcifications involving the anterior region of the body of the mandible in a 60-year-old male patient. The pathogenesis, clinical, radiological features and differential diagnosis have been discussed.

Pediatric Odontogenic Tumor of the Jaw – A Case Report

Central jaw tumors (intra osseous) in children occur infrequently and few oral pathologists have had the opportunity or experience in diagnosing these lesions and predicting their biological behavior. Some children are not diagnosed correctly at the initial stages as having a neoplasm and are wrongly treated for infections by antibiotic administration. Subsequent to an unresponsive antibiotic therapy radiographs are taken to reveal a radiolucent or radio dense lesion in the jaws. Finally a tissue diagnosis becomes necessary in order to diagnose and initiate proper therapy. One among the central jaw tumors that occur infrequently in children is Ameloblastoma. It is often aggressive and destructive, with the capacity to attain great size, erode bone and invade adjacent structures. Ameloblastoma not only accounts for 1% of all tumors of maxilla and mandible but also 11% of all odontogenic tumors. It has a high percentage of local recurrence rate and possible malignant development when treated inadequately. Here we present a central jaw tumor in an 8-year-old child which was a case of unusually large plexiform ameloblastoma involving entire ramus up to the condyle, and part of body of the mandible.

Re-treatment of a Two-rooted Maxillary Central Incisor - A Case Report

This case report is on endodontic retreatment of a maxillary central incisor with two roots. A twenty-year-old male patient presented with pain in maxillary left central incisor. Radiographic examination showed an incompletely filled canal and an additional palatal root with periapical radiolucent lesion. Conventional cleaning and shaping of both the roots i.e., buccal and additional palatal root canals was performed and obturation was done. After one year recall examination, the tooth was asymptomatic and periapical lesion had healed.

Solitary Nodular Lesion of Tongue- A Rare Entity

P. sarada, CH. Sampath Reddy, Patil A.K, Saritha Kurra

The solitary, nodular lesions of the oral mucosa present a diagnostic dilemma to the dentist with their analogous presentation. The lesions that appear on the tongue, a soft muscular organ are distinct and even rarer with varied manifestations. Oral mucosa presents lesions of the tongue in all age groups that may range from a small nodular swelling and ulcer formation in an infant of a few days old to an ulcer or a lesion in a 70-year-old. The reason for the appearance of an ulcer may be trauma to the soft tissues in an infant may be due to the presence of natal teeth to the presence of a sharp tooth in the older individuals. These lesions have to be clinically and histologically correlated for the final outcome of the diagnosis, so that there is no chance of any recurrence. We present a unique case of a solitary nodular lesion on the ventral surface of tongue On a 6 year female, where there was a recurrence after surgical excision and after an unusual therapy of non surgical resolution, no recurrence was observed.

Evidence Based Dental Care:Integrating Clinical Expertise With Systematic Research

Clinical dentistry is becoming increasingly complex and our patients more knowledgeable. Evidence-based care is now regarded as the “gold standard” in health care delivery worldwide. The basis of evidence based dentistry is the published reports of research projects. They are, brought together and analyzed systematically in meta analysis, the source for evidence based decisions. Activities in the field of evidence-based dentistry has increased tremendously in the 21st century, more and more practitioners are joining the train, more education on the subject is being provided to elucidate the knotty areas and there is increasing advocacy for the emergence of the field into a specialty discipline. Evidence-based dentistry (EBD), if endorsed by the dental profession, including the research community, may well- influence the extent to which society values dental research. Hence, dental researchers should understand the precepts of EBD, and should also recognize the challenges it presents to the research community to strengthen the available evidence and improve the processes of summarizing the evidence and translating it into practice This paper examines the concept of evidence-based dentistry (EBD), including some of the barriers and will discuss about clinical practice guidelines.

Hyperbaric Oxygen Therapy – Can It Be the New Era in Dentistry?

Divya Devaraj, d Srisakthi

Hyperbaric oxygen therapy is a rapidly developing treatment modality in various fields of dentistry. It is the administration of 100% oxygen to the patient for a specified time period, to increase the oxygen tension in the tissues and also its dissolution in the blood. This review aims to briefly discuss the history, mode of action, indications, contraindications, complications and the applications of hyperbaric oxygen therapy in dentistry.

Histogenetic Concepts, Terminology and Categorization of Biphasic Tumours of the Oral and Maxillofacial Region

Arvind Babu R.S., Ramana Reddy B.V., Anuradha C.H.

A biphasic tumour is a truly histological term that refers to neoplastic tissue which is characterized by two different cellular elements. Several histogenetic theories have been proposed for the aetiogenesis of the biphasic tumours. Literatures have been published on the individual lesions, which have described their biphasic nature but, biphasic tumours have not been categorized singly . Categorizing biphasic tumours is not likely to highlight diagnostic standards, but it may sensitize the therapeutic planning and post operative monitoring. This review article focuses on the histogenetic concepts of biphasic tumours, and the histopathological description of the lesions that are suggested to be biphasic tumours.

Health Hazards of Xylene: A Literature Review

Sharada.T.Rajan, N.Malathi

Xylene, an aromatic hydrocarbon is widely used in industry and medical laboratory as a solvent. It is a flammable liquid that requires utmost care during its usage. On exposure the vapours are rapidly absorbed through the lungs and the slowly through the skin. Prolonged exposure to xylene leads to significant amount of solvent accumulation in the adipose and muscle tissue. This article reviews the various acute and chronic health effects of xylene through various routes of exposure.

Autism Disorder (AD): An Updated Review for Paediatric Dentists

Udhya J., Varadharaja M.m, Parthiban J., Ila Srinivasan

Over the past two decades, there has been an explosion of interest in Autism Disorder (AD). Knowledge and awareness on the condition has grown exponentially at all levels among the general public, parents, health professionals, the research community and more recently, at parliamentary level. The world has begun to recognize the scope of this problem and act internationally and locally to improve the lives of the growing number of individuals and families affected by this devastating disorder. This article reviews the dental literature since 1969 and it summarizes characteristics of patients with AD, oral health status and dental management of patients with AD.

Doctor and Healing Touch

Parul Kodan, Amit Hooda, Pallavi Kodan

Toxic Thyroid Adenoma in McCune-Albright Syndrome

Sahana Shetty, Ron Thomas Varghese, Nylla Shanthly , Thomas V. Paul

Quackery: A Major Loophole in Dental Practice in India

Manoj Kumar Hans, Rinki Hans , Ajay Nagpal