Journal of clinical and diagnostic research

Management of Traumatic Fibroma in a Patient with Cerebral Palsy Using 810nm Diode Laser

There are several treatment options for hyperplastic gingival lesions. Among these, diode lasers have the advantages of less bleeding, which is an important characteristic in mucosal lesions, a shorter procedure time, better healing, and less complications. We present the case of a 48-year-old male patient with a history of cerebral palsy and a presumptive diagnosis of traumatic fibroma. The entire lesion was removed in one session with no complications. No recurrence was observed at 3 months follow up. This procedure can be considered a good modality especially for physically challenged patients.

Intrascrotal Muscular Myxoma - A Case Report

Myxomas are gelatinous tumours that commonly appear as circumscribed masses situated within muscles. It can occur at various sites. However, mostly found in cardiac muscles and skeletal muscles of extremities. Published cases of intrascrotal myxoma are rare in literature. A 28-year-old male was admitted to our General Surgery Department with a history of a gradually enlarging mass in the scrotum and scrotal discomfort since two years. After cytological and imaging investigations, a scrotal exploration was performed with plexiform neurofibroma as the preoperative diagnosis. Histopathological examination of the specimen revealed features of intramuscular myxoma. Although a relatively rare diagnosis, intramuscular myxoma should be considered as a differential diagnosis of testicular and paratesticular tumours.

Mullerian Agenesis Associated with Turner’s Syndrome

Turner’s syndrome is a chromosomal disorder with 45 X0 due to absence of a set of gene from the short arm of X chromosome. The incidence of Turner’s syndrome is 1 in 2500 live births. Primary amenorrhea is well known in Turner’s syndrome, the reason being streak ovaries; but mullerian agenesis as a cause of primary amenorrhea in Turner’s syndrome is a very rare entity. The incidence of Turner’s syndrome associated with mullerian agenesis is extremely rare as there is only a hand full of cases reported in literature. We report a rare case of adolescent female who presented with primary amenorrhea and found to have Turner’s syndrome with mullerian agenesis.

Intraosseous Neurofibroma of the Mandible: A Case Report and Review of Literature

Neurofibroma (NF) is a benign tumor of the peripheral nervous system. Head and neck NF are generally located in the soft tissue. The tumour is rarely seen intraosseously and most commonly such tumours are seen as solitary lesions, rather than part of neurofibromatosis. The following report describes a case of an intraosseous neurofibroma in a 45-year-old male located in the left posterior mandible. The diagnosis was made based on the clinical findings, radio graphical features, histopathology, and immunohistochemistry. A literature review has been done on intraosseuos neurofibromas located in the jaws, with a discussion on the possible differential diagnosis.

Absence of Posterior Triangle: Clinical and Embryological Perspective

Shikha Singh, Puja Chauhan, Hitendra Kumar Loh, Vandana Mehta, Rajesh Kumar Suri

Sternocleidomastoid (SCM) and Trapezius (TM) muscle present in the cervical region serves as an important landmark in forming boundaries of posterior triangle of neck. This case reports a continuous muscle sheet obscuring the left posterior triangle in the neck of a 60-year-old Indian male cadaver. An unfamiliar oval gap was observed in its posterosuperior portion. Description of such a variant in anatomical literature is rare and is scarcely reported. An attempt has been made to portray its embryological and phylogenetic basis. In addition authors have endeavoured to discuss its clinical implications. Awareness of such anatomical variations is relevant for the operating surgeons in their endeavour to perform various reconstruction surgeries of head and neck, radiologists while concluding various levels in Computed Tomography (CT) and Magnetic Resonance Images (MRI) of the region and to the anaesthetists in their search for nerves and vessels while attempting various anaesthetic procedures.

Misoprostol Induced Convulsion- A Rare Side Effect of Misoprostol

Nalini Sharma, Rituparna Das, Santa singh Ahanthem, Kalyani Reddy

Misoprostol, a synthetic prostaglandin E1 has wider application in obstetrics gynaecology. It has been recommended in the prophylaxis and treatment of Post Partum Haemorrhage (PPH) by Federation of Obstetrics and Gynaecology (FIGO), World Health Organisation (WHO) and American College of Obstetrics and Gynaecology (ACOG). It is a very safe drug associated with transient side-effects like fever, chills, nausea, vomiting, diarrhoea and abdominal pain. In the present case report patient had an unusual side effect of hyperpyrexia and convulsion after use of misoprostol for prophylaxis against PPH.

Significant Haematogone Proliferation Mimicking Relapse in Acute Lymphoblastic Leukaemia on Therapy

Smeeta Gajendra, Ruchira Misra, Pranav Dorwal, Rashi Sharma, Ritesh Sachdev

Haematogones are benign B lymphoid precursors which may mimic neoplastic lymphoblasts and pose diagnostic difficulty especially when the percentage of haematogones exceeds 10% in the bone marrow. Flow cytometric analysis with combination of CD19/CD10/CD20/CD34/CD38/CD58 can be used to differentiate the two depending upon the difference in the fluorescence intensity between blasts and haematogones. We hereby present a case of CALLA positive ALL, in which patient presented with haematogone proliferation in bone marrow after 6 months of chemotherapy mimicking relapse. The distinction was made on flow cytometric immunophenotyping by using optimal antibody combination. Distinction of benign haematogones from neoplastic lymphoblasts is essential for disease management in cases of post chemotherapy or post marrow transplant, especially in patients of ALL. Flow cytometric immunophenotyping is reliable to distinguish haematogones from residual lymphoblasts in almost all cases when optimal antibody combinations are used.

A Fortuitous Turn of Evidence in an Elderly Female – A Case of Pulmonary Fusariosis

Saraswathy Sreeram, Flora Dorothy Lobo, Vishak Acharya, Vishwas Saralaya

Pulmonary mycosis is seen infrequently in our country. It is more common in the immunocompromised. The infections caused by less known species like Fusarium have been found to be increasing in incidence in other parts of the world. We hereby report its occurrence in a 79-year-old, non-immunocompromised female who presented with pyrexia of unknown origin. Her Alanine Phosphatase (ALP) and Lactate Dehydrogenase (LHD) levels were raised. CT scan showed interstitial thickening in subpleural aspect of lungs and multiple enlarged lymph nodes in mediastinum. Liver showed multiple hypodense lesions. Metastasis was suspected for which Fine Needle Aspiration Cytology (FNAC) of liver was done which showed foci of regenerative hepatocytes with desmoplastic stromal tissue fragments and negative for tumour. Her Alpha Fetoprotein (AFP) was normal. The bronchial tree cytology showed endobronchial cells, dust-laden macrophages and chronic inflammatory cells along with fungi on Pap smear studies. This was confirmed by culture that grew Fusarium species after one week of incubation. The acutely branching septate hyphae of Fusarium species are identical to those of Aspergillus species. In a patient who has a disseminated infection with a septate fungus, growth in culture is important to identify the specific organism and subsequently treatment with appropriate antifungals. In cases like ours, where the infection simulates malignancy, it is even more important to make the correct diagnosis to give the appropriate treatment.

Variation in the Branching Pattern of Third Part of Axillary Artery- A Case Report

Aritra Banerjee, Chiman Kumari, Saroj Kaler Jhajhria

Anatomical variation of the branching pattern of axillary artery is very common. The knowledge of this variation is often useful during different surgical and interventional procedures. Variations include typically of Lateral Thoracic Artery (LTA) and Posterior Circumflex Humeral Artery (PCHA). The present case has been reported to document the variation of LTA and PCHA. The axilla of a 65-year-old embalmed female cadaver was routinely dissected for educational purpose in the Department of Anatomy, AIIMS, New Delhi, India. Cunnighams Manual of Dissection was followed during the whole dissection procedure. We found that the third part of axillary artery gave rise to a common trunk which divided into PCHA and LTA. The PCHA curved backwards around the humeral neck and made anastomosis with the anterior circumflex humeral artery. The LTA supplied serratus anterior and the pectoral muscles and made anastomosis with intercostal arteries. The axillary nerve accompanied PCHA while the thoracodorsal nerve accompanied LTA. The rare anatomical variation of the branching pattern of axillary artery is assumed to be helpful in the surgical procedures and various therapeutic interventions of the upper limb.

Unusual Presentation of Prostate Carcinoma: A Case Report

Rohit Bhattar, Anuradha Maheshwari, Sher singh yadav, Vinay Tomar

Prostate cancer is a common cancer in elderly men and it frequently metastasizes to regional lymph nodes and sometimes to bone. Very rarely in some of the cases it also shows involvement of non-regional lymph nodes like supra-diaphragmatic lymph nodes. In our report, we present a 60-year-old male, initially misdiagnosed as Chronic Obstructive Pulmonary Disease (COPD) with cervical lymph node involvement may be due to infective region or inflammatory pathology, which was later found to have prostatic adenocarcinoma metastatic to supraclavicular lymph nodes. Very less case reports are present which have shown similar presentations. So we would like to highlight that prostatic carcinoma can be present in an atypical form also.

Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach

We describe a 77-year-old male who had right upper limb ischemic symptoms and history of unsuccessful right subclavian artery angioplasty. According to ultrasound findings, upper limb angiography was performed which confirmed stenosis of the left vertebral and right subclavian arteries. Percutaneous angioplasty and stenting of left vertebral and right subclavian arteries were performed in two separate sessions. Retrograde approach was scheduled for right subclavian artery angioplasty which is challenging due to potential risks to adjacent vertebral artery. This case reports underscores that percutaneous approaches may be preferential given their confirmed long-term efficacy and lower morbidity.

Sclerosing Pneumocytoma of the Lung: A Case Report

Pulmonary Sclerosing Pneumocytoma (PSP) is a rare tumour of the lung and is always benign. Diagnosis is made incidentally following chest X-ray or chest CT scan performed for other clinical conditions. We report a case of PSP in a seven-year-old girl who got admitted for evaluation of an anterior mediastinal mass. Clinically, thought of teratoma or other germ cell tumour the mass was excised and sent for histopathological examination. Grossly, we received a pneumonectomy specimen measuring 13x11x8 cm with a nodular firm grey white lesion in the medial aspect of lower and middle lobe measuring 7.5x5.5x5 cm. Macroscopically, pleura was involved and adherent to the lung. Microscopy showed, an ill-defined lesion in the lung with extensive fibrosis and lymphoplasmacytic infiltrate. The lesion was composed of round to oval cells with ill defined cell border, moderate eosinophilic cytoplasm and bland nuclei. A panel of Immunohistochemical (IHC) markers was performed and the lesional cells were positive for Epithelial Membrane Antigen (EMA) and Thyroid Transcription Factor-1 (TTF-1). The prognosis after surgical resection is good and the patient is doing well.

Paecilomyces Keratitis in Western India: A Case Report

Anmol Ulhas Naik, Shveta Bhimashankar Gadewar

Cases of ocular trauma with vegetative matter are commonly encountered in ophthalmic practice in India. Many of these present with keratitis/corneal ulceration, of which fungi have a predominant share. We report a case of fungal keratitis and graft infection with Paecilomyces lilacinus, which was successfully treated with topical and systemic Voriconazole. A farmer presented with corneal ulcer and hypopyon in left eye following vegetative trauma during farming. A provisional diagnosis of fungal corneal ulcer was made based on clinical features and topical anti-fungal therapy with Natamycin was initiated. After deterioration, Therapeutic Penetrating Keratoplasty (TPK) was performed to prevent corneal perforation. Postoperatively, the graft responded well to treatment initially. Signs of graft infection appeared on the second postoperative day with perforation within 72 hours. Culture report of recipient corneal button obtained after first TPK revealed growth of P.lilacinus. A second TPK was performed and patient was started on local and oral Voriconazole. After one month follow up, the graft was clear of infection. To our knowledge, this is a rare case reported from western India, at least in recent years. With no definite consensus existing regarding management in such a scenario, extensive research is needed in this direction.

An Uncommon Presentation of Brucella Endocarditis Masquerading as Neurobrucellosis

Brucella endocarditis is a rare but a severe complication of brucellosis, observed in less than 2% of cases. It is the main cause responsible for up to 80% of deaths in brucellosis. Herein, we present a case of brucella endocarditis that developed on a native aortic valve, but presented to us with fever for several months and acute neurological symptoms. This case report signifies the importance of considering brucella endocarditis as one of the differentials in patients presenting with Pyrexia of Unknown Origin (PUO) and Central Nervous System (CNS) manifestations.

Primary Ewing Sarcoma of Sphenoid Bone with Intracranial Extension: A Common Tumour at an Uncommon Location

Guddi Rani Singh, Vijayanand Choudhary, Rawi Agrawal

Primary Ewing Sarcoma of the cranial bone is rare, contributing to only 1% of all Ewing Sarcomas. Primary cranial Ewing Sarcoma occurs most commonly in temporal bone followed by parietal and occipital bones. Sphenoid bone is less commonly involved. We report a case of Ewing Sarcoma of the sphenoid bone with intra-cranial extension in a 20-month-old boy. On CT scan a provisional diagnosis of rhabdomyosarcoma was made. Fine Needle Aspiration Cytology (FNAC) and histopathological examination of core needle biopsy showed small round cell tumour. On Immunohistochemistry (IHC), CD99 (MIC2) and FLI 1 were strongly positive and final diagnosis of Ewing Sarcoma was made. Considering the rarity of this unusual site, we report a case of primary Ewing Sarcoma arising in the sphenoid bone with erosion of adjacent bones and intra-cranial extension.

Cytohistological Features of Spindle Cell Lipoma- A Case Report with Differential Diagnosis

Yasmeen Khatib, Archana L Khade, Vinaya B Shah, Manisha S Khare

Spindle Cell Lipoma (SCL) is an uncommon benign tumour of adipose tissue that is usually superficially located in the neck, back and shoulder region. Although it has characteristic histological features it can pose a diagnostic dilemma on cytology. It presents with a mixture of spindle cells, adipocytes, collagen fibres and a myxoid matrix in varying proportions sometimes with mild pleomorphism. Hence, it can be mistaken for other spindle cell, adipose and myxoid tumours which can be benign or malignant. We present a case of SCL of the back in a 47-year-old male, who presented with a slow growing lesion. Fine Needle Aspiration Cytology (FNAC) showed the characteristic cytological features described above and a diagnosis could be given after clinical correlation. We report this case as the cytology of this uncommon tumour has been described in relatively few cases and a correct pre-operative diagnosis will aid in proper management of this tumour.

Paraneoplastic Hypoglycaemia: A Rare Manifestation of Pelvic Gastrointestinal Stromal Tumour

Ashish Singhal, Rahat Hadi, Kiranpreet Mehrotra, Shivani Rastogi, Shakeel Masood

Non-Islet Cell Tumour Induced Hypoglycaemia (NICTH), presenting with recurrent fasting hypoglycaemia is a very rare paraneoplastic syndrome. It usually presents with large metastatic mesenchymal tumours. NICTH secondary to Gastrointestinal Stromal Tumour (GIST) is even rarer. Diagnosis of NICTH is based on the low serum insulin level, low serum concentrations of IGF-I and IGF binding protein- III (IGFBP-III) in combination with elevated concentrations of pro-IGF-II. Various Immunohistochemical (IHC) markers are integral to diagnosis of GIST namely 2-deoxyglucose-6-phosphate phosphatase -1(DOG-1), Cluster Differentiation 34 (CD 34), Cluster Differentiation 117 (CD117). The management requires prompt intravenous hydration and glucose infusions followed by surgical resection. We hereby, report a rare case of a 65-year-old female with intractable fasting hypoglycaemia due to overproduction of "big" insulin-like growth factor II diagnosed to have pelvic GIST and managed by Steroids and Imatinib.

Familial Schwannomatosis: A Diagnostic Challenge

Schwannomatosis is a disease characterized by the development of multiple benign tumours originating from Schwann cells. Schwannomatosis is a member of the family of diseases known as Neurofibromatosis (NF). Patients with Schwannomatosis develop multiple Schwannomas on cranial, spinal and peripheral nerves. We report a rare case of a 60-year-old female who presented with a painful swelling on the ulnar aspect of her distal forearm. She underwent an excisional biopsy for it; which was suggestive of a Schwannoma. Following ulnar swelling surgery, she developed acute low back pain, which was burning in nature with radiation along both lower limbs without any neurovascular deficit. She was treated conservatively, failing which an MRI was performed which suggested abnormal lesions in the intradural extra medullary compartment of the spinal canal. She had multiple swellings over the entire body with a positive family history of similar swellings in her sister and nephew. The painful lumbar swellings were excised which on histopathological examination revealed to be Schwannomas. No neurological deficit was observed postoperatively. There were no neurocutaneous markers, axillary freckling, visual or auditory disturbances seen in the patient or her relatives. Any patient with multiple painful progressive swellings in the body without the characteristic features of NF-1 and NF-2 should raise the suspicion of Schwannomatosis.

Intramuscular Capillary Hemangioma of the Temporalis Muscle: A Rare Case with A Review of the Literature

Nikhil Arora, Eishaan Kamtata Bhargava, Arif Kavungal Nambillatath, Ravi Meher

An Intramuscular Haemangioma (IMH) is a benign mesenchymal tumour of the endothelial cells that accounts for less than 1% of all haemangiomas. Here we report the case of a capillary type intramuscular haemangioma in a five-year-old boy, only the fourth such case reported in literature, along with a relevant review of the literature. The lesion was surgically managed, with no recurrence in the follow up period till date.

Renal Primitive Neuroectodermal Tumour: Case Report of a Rare Entity

The peripheral Primitive Neuroectodermal Tumour (PNET) is a member of the family of small round cell tumours. PNET is more aggressive in kidney when compared to the other sites. It usually presents in childhood or adolescence. It has an aggressive clinical course and may process towards metastatic disease culminating in death. A 24-year-old female presented with left sided abdominal swelling. Abdominal ultrasound confirmed a heterogeneous left renal mass. Consequently the patient underwent nephrectomy of left kidney and left oophorectomy. Grossly, the tumour involved almost entire kidney, showed multi-lobular, grey, glistening appearance with focal haemorrhagic areas. Histologically, the tumour cells were arranged in diffuse infiltrating sheets, cohesive lobules, Homer-Wright rosettes and perivascular pseudo-rosettes. Individual tumour cells were small round cells with scant cytoplasm and round nuclei having dispersed chromatin. Features were suggestive of PNET. Immunohistochemistry showed tumour cells displaying strong membrane positivity for MIC 2. Renal PNET needs to be differentiated from other primary and metastatic renal round-cell tumours. Most of the cases of renal PNET have poor response to standard treatment of combined surgical resection, post-operative irradiation, and chemotherapy. PNET is a rare primary tumour in the kidney. Histopathological diagnosis has to be confirmed by immunophenotyping of the tumour cells.

Unusual Aetiology of Pasteurella canis Biovar 2 Causing Dacryocystitis in HIV Patient: A Case Report and Review of Literature

Sanjay Singh Negi, Rupa Mehta, Neeta Gade

Pasteurella species are zoonotic bacterial pathogens implicated very infrequently in various human infections following animal bites or licks usually of dogs and cats. This case report described a rare clinical presentation of dacryocystitis caused by P.canis in a Human Immunodeficiency Virus (HIV) positive young male patient involved in caring of cattle. It advocates the utmost need of recognizing the wide clinical manifestation spectrum of P.canis even without prior penetrating injury. P.canis associated clinical infection is more extensive than had been thought previously especially in immunocompromised patient. Early accurate identification and evidence based anti-microbial therapy may prove crucial in preventing further potential complications.

A Rare Collision Tumour of Uterus- Squamous Cell Carcinoma and Endometrial Stromal Sarcoma

Nadeem Tanveer, Bindiya Gupta, Abhishek Pathre, Shalini Rajaram, Neerja Goyal

Collision tumours are defined by co-existence of two tumours in the same or adjacent organs which are topographically and histologically distinct with minimal or no histological admixture. Collision tumours have been described in many organs notably thyroid, brain, adrenal gland, stomach and rarely uterus. Most of the collision tumours reported in uterus have two components; an adenocarcinoma and a sarcoma. We report a case of a 60-year-old lady who presented with complaints of post-menopausal bleeding. A cervical biopsy was performed which showed a non-keratinizing squamous cell carcinoma of cervix. Intra-operatively the uterus was bulky with a 6 cm x 5 cm polypoidal mass in the endometrial canal along with a 2 cm friable cervical growth. The fleshy uterine cavity mass was a spindle cell tumour with moderate pleomorphism and frequent mitosis. It was immunopositive for CD10 and negative for smooth muscle actin and cytokeratin 5/6. The other growth showed non-keratinizing squamous cell carcinoma which was positive for cytokeratin 5/6. Based on the distinct topographical location and limited areas of tumour admixture of the two tumours, a diagnosis of collision tumour of uterus comprising of endometrial stromal sarcoma (high grade) uterus and squamous cell carcinoma cervix was made.

Neonatal Airway Compromise by a Giant Cervicothoracic Venous Haemangioma

Janardhan Shenoy, Anita Coutinho, Sowmini P Kamath, Suresh Pai, Santosh PV Rai

Haemangiomas are most common non-malignant vascular tumours of infancy. Here, we describe an antenatally detected mass over the neck causing compressive respiratory compromise at birth requiring resuscitative measures at birth. The mass showed increased vascularity on Contrast Enhanced Computed Tomography (CECT) with extension upto superior mediastinum. Surgical excision was required following failure to medical measures with steroids and propranolol. Histopathology confirmed it to be a venous haemangioma. This case highlights that these benign lesions may reach large sizes and antenatal detection may help in planning effective delivery and resuscitative measures.

Post Extubation Bronchospasm in an Undiagnosed Case of Ascariasis: Anaesthetic Challenges

One of the most prevalent parasitic infestation is ascariasis which poses a great challenge to both the person being infested with and the treating medical team. We present here a case of round worm (Ascaris lumbricoides) infestation. A 40-year-old male, weighing 60 kg, diagnosed as perforation peritonitis, was scheduled for emergency exploratory laparotomy. The round worm was crawling out from duodenal perforation vent during laparotomy confirming the infestation. Patient later developed bronchospasm in post-extubation period and was managed accordingly. Surprisingly the patient expelled an adult worm in the next morning. This report highlights the importance of anticipating complications (i.e., airway obstruction, bronchospasm, etc.,) in an undiagnosed case of round worm infestation, especially if routine investigations were within normal limits.

Massive Ascites and Pleural Effusion in Preeclampsia

Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation and complicates approximately 2-8% of all pregnancies. Release of vasoconstrictive agents, endothelial damage, hyperpermeability of the capillaries and microangiopathic haemolysis involves the basic pathophysiology. It has variable clinical presentation. Here, we report a case of severe preeclampsia who developed postpartum massive ascites and pleural effusion. Primigravid patient was admitted to our clinic at 35 weeks of gestation with very high blood pressure. In biochemical analysis, Alanin aminotransferase (ALT) was 401 U/L, Aspartate aminotransferase (AST) was 292 U/L. An emergency caesarean section was performed because of fetal distress. On the 2nd post-operative day, abdominal distension and severe abdominal pain occurred. On the 3rd post-operative day, her abdominal distension increased and Ultrasonography (USG) revealed massive ascites. Abdominal drainage was performed and albumin infusion was administered. On postoperative day 4, she still had abdominal distension and concomitant respiratory distress. Computed Tomography (CT) showed ascites and bilateral pleural effusion. Her complaint regressed on the following days.

Azygous Vein Aneurysm (AVA): A Case Report

Charles Albert Tujo, Robert A. Jesinger

Azygous Vein Aneurysm (AVAs) is an uncommon cause of mediastinal mass. They are typically asymptomatic and do not commonly require treatment. They may mimic mediastinal adenopathy on chest radiographs. We present a case of AVAs found during evaluation of chest pain in a patient who was also found to have pulmonary thromboembolism. The mass was worked up with cross-sectional imaging techniques using both Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) and ultimately Positron Emission Tomography (PET). Due to recurrent symptomatology, the aneurysm was coiled.

Dasatinib Induced Cardiac Tamponade- A Rare Association

Drug induced cardiac tamponade is rare. Therapy for imatinib resistant Chronic Myeloid Leukaemia (CML) is an emerging challenge in clinical haematology. For such cases treatment with second line tyrosine kinase inhibitors like dasatinib has resulted in improved outcomes. Dasatinib is a second line BCR-ABL tyrosine kinase inhibitor used in the treatment of Imatinib resistant or Imatinib intolerant CML. Dasatinib has been reported to cause severe pericardial effusions in 1% of all patients in clinical studies. We report here a case of Dasatinib induced cardiac tamponade in whom all other causes of pericardial effusion were excluded and whose clinical symptoms as well as effusion showed no recurrence one month after the drug was stopped.

Dissimilar Pain of Primary Epiploic Appendagitis and Malabsorption

Primary Epiploic Appendagitis (PEA) is a rare cause of acute or subacute abdominal complaints and non-migratory pain. Usually the diagnosis of PEA is made when Computed Tomography (CT) reveals characteristic figures. Nonspecific abdominal complaints including diffuse abdominal pain may be caused by carbohydrate and/or protein malabsorption. We report a case of a patient with PEA who recovered without medication or surgical treatment within a few days. Eight months later, he was diagnosed with lactose- and histamine malabsorption and Helicobacter pylori infection. The malabsorption was treated successfully with an individually-tailored diet free of culprit triggers and the Helicobacter pylori infection was eradicated. A localized non-migratory abdominal pain caused by PEA needs to be differentiated from nonspecific abdominal complaints due to malabsorption and Helicobacter pylori infection.

A Rare Case of Unilateral Acute Idiopathic Maculopathy in Young Male

Atul Kumar Singh, Vikas Sharma

Unilateral Acute Idiopathic Maculopathy (UAIM) is a rare disorder of Retinal Pigmentary Epithelium (RPE) that mainly affects the young healthy male. The variability of this disease can masquerade different entity, so diagnosis becomes cumbersome. We are reporting a case of young healthy male, who has reported to us with gross diminution of vision from right eye. Right eye examination showed a grayish yellow lesion with fluffy margins on the macula. Based on Optical Coherence Tomography (OCT) and Fundus Fluorescein Angiography (FFA) findings, he was diagnosed as a case of UAIM. He was started on topical anti-inflammatory eye drops with subsequent improvement of his vision.

Proliferative Fasciitis in Childhood: A Review of Clinical Data Apropos of a Case

Proliferative Fasciitis (PF) is a benign lesion with histologic and clinical features overlapping with those of malignant soft tissue tumours. Its occurrence in children is considered very rare. We present a case of PF appearing as a painful, red, gradually increasing in size lesion, during a period of a few weeks, on the finger of a five-year-old boy compromising the dermis and subcutaneous tissue. We were able to locate literature on 20 paediatric PF cases, which we review. Only five of these focus on the clinical data, the rest describing mainly histological findings. It is the first reported paediatric case appearing on the finger.

A Crime Scene Fabricated as Suicide

RRG Sriyantha Amararatne, Muditha Vidanapathirana

When ascertaining the manner of death, the forensic pathologist should be careful, because in some instances, attempts are made by the criminals to conceal homicides as suicides. The case under discussion highlights the contribution of the forensic pathologist in the ascertainment of the manner in firearm deaths. The deceased was a poacher and his dead body was found in a cashew land with his shotgun lying over him. The shirt had a roughly circular defect with muzzle mark, and burnt and blackened margin. Beneath that, on front of the left upper chest a 2cm diameter circular, perforated laceration, with muzzle imprint and, burnt and blackened margin was found. Shelving was found at the upper margin. Chest X-ray showed the downward pellet distribution. Cause of death was chest injuries due to pellets discharged from a smooth bore weapon. Length of the upper arm reach was 65cm (25 inches) and the length from the muzzle to the trigger was 79cm (31 inches). In conclusion, it was found to be a fabricated suicide scene and the manner of death was ascertained as homicide. This reiterates that the postmortem investigation of firearm deaths should be performed or conducted under direct supervision of forensic specialist to deliver justice.

Primary Tuberculosis of Nose Causing Bilateral Nasal Obstruction and Halitosis in a 25-Year-Old Woman

Leena Rajam, M Hari Kumar, Sabitha Hari Kumar

Primary or secondary nasal tuberculosis is rare and usually, it is considered as an extra pulmonary form of tuberculosis. Nasal tuberculosis infection may spread to maxillary palatal region by contagious or haematogenous route causing palatal perforation. In some instance, it may cause septal perforation with nasal obstruction which may give rise to halitosis. We report a case where, there was bilateral nasal mucosal involvement leading to severe nasal obstruction. This rare manifestation should be considered in areas where the disease is prevalent as delay in diagnosis and treatment could lead to serious and life threatening complications due to local spread from the nose to the para nasal sinuses and brain.

Anaesthetic Management in Brugada Syndrome - A Case Report

Sulochana Dash, Shanmugam Pragathee

Brugada Syndrome (BS) is a rare congenital cardiac disorder involving cardiac sodium channels, sometimes presenting with ventricular arrhythmia and sudden cardiac death. Here, we are reporting a case of BS who presented for laparotomy due to obstructed inguinal hernia which was managed satisfactorily with combined epidural and general anaesthesia without any complications.

SLE and Tuberculosis: A Case Series and Review of Literature

Prasanta Kumar Bhattacharya, Md Jamil, Aakash Roy, Kishore Kumar Talukdar

Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

Primary Management and Outcome – Open Laryngotracheal Trauma

Acute external injury to the larynx is both life threatening and a potential long term management challenge. As Otorhinolaryngologist we must be prepared and well versed to manage these patients. In our study seven patients of open laryngeal traumas were managed by primary closure. In five patients nature of injury was known in other two patients exact nature of injury was not known. After primary closure five patients with known injury survived and two patients with unknown injury died. As per our experience, we recommend primary closure, if the exact nature of injury is known as the outcome is definitely favourable.

Giant Inguinal Herniae Managed by Primary Repair: A Case Series

Madhur Anand, Ranendra Hajong, Narang Naku, Debobratta Hajong, K Lenish Singh

Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications.

Ways and Means to Utilize Private Practitioners for Tuberculosis Care in India

Janmejaya Samal

The growing interest of utilizing the private practitioners in improving the outreach of public health services including Tuberculosis (TB) control programme stemmed out of people’s preference for private health facilities in situations where public health facilities fail to meet the expectations. In different parts of India, many models of Public Private Partnership have been tried and tested and proved successful in providing quality TB care in the concerned community. In this paper, several ways and means have been proposed to effectively utilize private practitioners for TB care in India. These strategies are discussed under different headings: (1) identification of potential private practitioners: (2) orientation of private practitioners: (3) networking of private practitioners with patients and Directly Observed Treatment Short course (DOTS) provider: (4) follow-up and sensitization of patients by private practitioners: (5) let the word of mouth work: and (6) evaluation of the involvement of private practitioners in TB care. However the following points must be addressed before utilizing the private practitioners for TB care: time constraints in notifying the disease, adherence to DOTS regime/alternative to DOTS regime, referral of patients to public health facilities for diagnosis and treatment, follow-up and sensitization of the patients and behaviour change communication and awareness in the community by the private practitioners. Few of these are mandatory for the private practitioners; most are practicable. With the effective utilization of private practitioners many problems can be sorted out that are currently plaguing the system such as irrational and excessive use of certain drugs, over reliance on chest X-ray for diagnosis, under use of sputum microscopy, lack of knowledge regarding standard treatment protocols and varied prescription practices.

A Study to Assess the Therapeutic Effect of Enalapril on Olanzapine Induced Metabolic Syndrome in Wistar Rats

Introduction: Metabolic Syndrome (MS) is a complex of risk factors for the development of cardiovascular complications and Type 2 Diabetes Mellitus (DM). Pharmacological management of the condition is complex, as multiple drug groups have to be used, as the syndrome itself is multi faceted. Angiotensin Converting Enzyme Inhibitors (ACEIs) are chiefly used to manage the hypertensive component of the syndrome. However, recent studies have shown that these drugs may have a role in the non hypertensive aspects of the syndrome as well. Aim: To evaluate the therapeutic effect of enalapril on total body weight, random blood glucose and serum lipid profile in a rodent model of olanzapine induced metabolic syndrome. Materials and Methods: Three different dosages (1 mg/kg/day, 10 mg/kg/day and 20 mg/kg/day) of oral enalapril were administered (for three weeks) in albino wistar rats, which received prior intra peritoneal olanzapine (for three weeks), and compared against control (normal saline) and standard (olanzapine only and enalapril only) groups. Parameters like total body weight, random blood glucose and serum lipid profile were measured at baseline, at three weeks and at six weeks. Results: Enalapril at 20 mg/kg/day was found to be effective in reversing the weight gain, hyperglycaemia and hypercholesterolaemia, without any changes in triglycerides, High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL). 10 mg/kg/day of enalapril prevented any further rise in body weight, blood glucose, total cholesterol and serum triglycerides, after olanzapine was stopped. 1 mg/kg/day of enalapril was ineffective. Conclusion: High dose of enalapril may be considered as a component of therapeutic regimens to combat weight gain, hyperglycaemia and dyslipidaemia seen in metabolic syndrome, in addition to its antihypertensive utility. Further rodent and clinical studies may be required to ascertain the same.

Patient with Three Fallopian Tubes at Right Adnexa

Mustafa Gazi Uçar, Tolgay Tuyan Ilhan, Ayhan Gül, Candan Korkutan, Çetin Çelik

A Rare Case of Adenomatoid Odontogenic Tumour with Unicystic Ameloblastoma

Acute Total Lung Collapse in a Woman with Acute Stroke and Atrial Fibrillation

Karanam Gowrinath, Gangapatnam Vamsidhar Reddy

Sturge-Weber Syndrome

Where is the Air?

Jonathan Ryan Schroeder, James Benjamin Gleason, Bruno Bastos, Jinesh P Mehta

“Zebra Stripe” Sign and “Bone in Bone” Sign in Cyclical Bisphosphonate Therapy

Partha Pratim Chakraborty, Sugata Narayan Biswas, Shinjan Patra, Gouranga Santra

Metastasis of Synovial Sarcoma of Thigh to Lung Presenting as Whole Lung Mass

Gourahari Pradhan, Nibedita Sahoo, Tapan Kumar Sahoo, Mamita Nayak

Familial Ankyloglossia -A Rare Report of three Cases in a Family

Ashwin Devasya, Mythri Sarpangala

A Novel Technique to Overcome Treatment Delay Between Facemask Therapy and Comprehensive Orthodontic Correction

Jalis Fatima, Subrata Saha, Subir Sarkar

Bronchiolitis: Comparative Study between Respiratory Synctial Virus (RSV) and Non RSV Aetiology

Anirban Mandal, Amitabh Singh, Puneet Kaur Sahi, Bhavika Rishi

A Case Report on Extraskeletal Osteosarcoma

Vivek Verma, Ashish Gulia, Ajay Puri

Letter to the Editor: “Umbilical Pilonidal Sinus: A Report of Two Cases and Recent Update of Literature”

Mehmet Kaplan, Elif Tugce Kaplan, Tugba Kaplan, Fatma Cigdem Kaplan

Comparative Evaluation of Fosfomycin Activity with other Antimicrobial Agents against E.coli Isolates from Urinary Tract Infections

Introduction: Fosfomycin is a broad spectrum anti-microbial agent with activity against various bacterial agents. It is a bactericidal antibiotic which interferes with cell wall synthesis. Fosfomycin is rapidly absorbed orally and majority of the drug is excreted unchanged in urine with very high concentration levels achieved in urine after a single oral dose. Urine levels remain high for prolonged period which makes it a suitable drug in the treatment of Urinary Tract Infections (UTI). E.coli is the most common organism causing the UTI. With the inappropriate and inadvertent use of higher antibiotics, these bacterial isolates have acquired multidrug resistance for which treatment options are limited. Aim: To evaluate the in-vitro activity of fosfomycin against uropathogenic E.coli and to compare its activity with the other anti-microbial agents. Materials and Methods:This was a prospective study done in the Department of Microbiology SVS Medical College, Mahbubnagar from Jan 2016 to Mar 2016. The study was approved and ethical clearance was obtained by the Institutional Ethics Committee. A total of 564 urine samples study period out of which 170 E.coli were isolated. Identification of the organisms were done by routine biochemical testing and antibiotic sensitivity testing was done by Kirby-Bauer disc diffusion testing according to the CLSI guidelines (M100-S23). Results: A total of 170 E.coli isolates were tested for antibiotic susceptibility. Out of 170 isolates 60 (35.30%) were isolated from males and 110 (64.70%) from females with male to female ratio of 1:1.83. Majority of the isolates were obtained from the age group of 21-30 years (25.8%). Antibiotics like fosfomycin, imipenem and methenamine mandelate showed the highest sensitivity with all the isolates (100%) being susceptible to these drugs. Whereas, least sensitivity was observed for amoxyclav (15.2%) followed by cefixime (16.4%) and norfloxacin (21%). Fosfomycin has shown very good in-vitro activity against all the tested isolates when compared with many other antibiotics. Conclusion: In view of emergence of multidrug resistant pathogens, testing for old and forgotten antibiotics like fosfomycin is gaining importance. Because of its unique mechanism of action and low incidence of resistance it can be a potential therapeutic alternative in the treatment of UTI.

Significance of Blood Eosinophil Count in Patients with Chronic Rhinosinusitis with Nasal Polyposis

Introduction: Chronic Rhino Sinusitis (CRS) is one of the most prevalent chronic illnesses across the globe, affecting persons of all ages. It is an inflammatory process that involves the paranasal sinuses with symptoms lasting longer than 12 weeks. Aim: To establish the significance of blood eosinophil (count) levels in CRS with nasal polyps and to compare blood eosinophil count with eosinophil count in the histopathology specimens of the polyps. Materials and Methods: This was a retrospective study done to review the medical records of 63 patients who underwent endoscopic sinus surgery for CRS with Nasal polyps. The patients were divided into two groups, 1 and 2 based on the number of patients suffering from non eosinophilic rhino sinusitis (Group 1) and those from eosinophlic rhino sinusitis (Group 2). The clinical examination findings, nasal endoscopy observations and MDCT-Paranasal sinuses were notified. Also, the mean Eosinophil Count (EC), Absolute Eosinophil Count (AEC), and Histopathology Eosinophil Count (HPE) was compared between two groups. This was aided by CT Scan Lund Mackay Scores (LMS). Results: Among the patients from Group 1, the male to female ratio was found to be 1.14:1 with 53.3% males and in Group 2 the same were noted as 1.75:1 and 63.6% respectively and found a male preponderance. With regard to symptomatology, significantly higher number of patients in the Group 2 suffered from nasal block (97% vs. 46.7%; p<0.001), nasal obstruction (90.9% vs. 46.7%; p<0.001), nasal discharge (81.8% vs. 56.7%; p=0.030), hyposmia (97% vs. 30%; p<0.001) and asthma (69.7% vs. 3.3%; p<0.001). However, facial pain (66.7% vs. 81.8%; p=0.168) and para nasal sinus tenderness (53.3% vs. 54.6%; p=0.923) were comparable in Groups 1 and 2. Mean EC, AEC and HPE were significantly high in Group 2 compared to Group 1. Conclusion: The study demonstrated that there was a significant correlation between tissue and blood eosinophil counts with increased severity of symptoms in patients with Eosinophilic CRS with nasal polyps in the Indian population.

Study of Dickkopf-1 (DKK-1) Gene Expression in Hepatocellular Carcinoma Patients

Mona Watany, Rehab Badawi, Walaa Elkhalawany, Sherief Abd-Elsalam

Introduction: Hepatocellular Carcinoma (HCC) is the sixth most common cancer in the world. Dickkopf -1 (DKK-1) protein is a new biomarker used in conjunction with Alpha Fetoprotein (AFP) to differentiate HCC from "non-malignant" liver disease. DKK-1 is an inhibitor of Wnt/ß-catenin signaling pathway which is involved in embryogenesis and has been implicated in tumorigenesis in many tissues. Aim: To investigate the level of DKK-1 gene expression in the peripheral blood of patients with HCC who had a history of Hepatitis C Virus (HCV) and schistosomal infections. Materials and Methods: This "cross-sectional" study was carried out in the Tropical Medicine Department of Tanta University Hospital on 50 patients with HCC and 10 healthy volunteers served as control. All patients were tested for HCV antibodies and "anti-schistosomal" antibodies. All groups were tested for DKK-1 gene expression which was measured with quantitative real-time PCR. Results: DKK-1 gene was over-expressed in HCC patients than in the control group with mean 3.269±4.762 versus 1.00 in controls (p< 0.005). "Over- expression" of DKK-1 was found in: 8/20 of patients with negative serology for both infections (40%; p<0.001), 7/18 of patients with positive anti-HCV antibodies (38.89%; p<0.001) and 11/12 of patients with positive anti-schistosomal antibodies (91.66%; p<0.001). There was no statistically significant correlation between DKK-1 expression and HCV infection (p=0.139) but there was significant correlation between the gene expression and schistosomal infection (p<0.001). Conclusion: These data suggest the role of DKK-1 over-expression in HCC development in patients with combined HCV and schistosomal infections and that induction of the Wnt pathway or using DKK-1 antagonist may represent a key advance in the area of genetic prevention of HCC in these "high-risk" patients.

Association Study of Vitamin D Receptor (VDR) - Related Genetic Polymorphisms and their Haplotypes with Chronic Periodontitis in Colombian Population

Sergio Iván Tobón-Arroyave, Diana María Isaza-Guzmán, Nicolás Pineda -Trujillo

Introduction: There is strong evidence that both genetic and environmental factors may affect the periodontal clinical status. However, epidemiological evidence on the association between Vitamin D Receptor (VDR) polymorphisms and Chronic Periodontitis (CP) has been inconsistent. Aim: The focus of this study was to identify if a possible association between VDR Single-Nucleotide Polymorphisms (SNPs) may be implicated in the aetiopathogenesis of CP in Colombian population. Materials and Methods: One hundred and ten CP patients and 50 Healthy Controls (HC) were recruited. Periodontal status was assessed based on probing depth, clinical attachment level, extent, and severity of periodontal breakdown. The polymerase chain reaction-restriction fragment length polymorphism method was used to identify the VDR rs7975232, rs1544410, rs2228570, and rs731236 SNPs from saliva samples. Odds Ratios (ORs) along with their 95% Confidence Intervals (CIs) were computed to compare the distribution of genotypes/alleles between HC and CP patients, alongside with analysis of Linkage Disequilibrium (LD) and haplotype associations between SNPs. Also, an analysis of the interaction between genetic findings and those significant demographic factors was performed for all SNPs. Results: There was no association neither between the different genotypes/allele frequencies nor haplotypes and CP. Similarly, no significant differences in extent or severity amongst genotype/allele groups were observed. Even so, interaction analysis revealed significant synergistic interactions between each SNP and age associated with the disease status. Conclusion: Although these results do not support that VDR SNPs could be identified as independent risk predictor variables for CP in the Colombian population, synergistic biological interactive effects of all these SNPs related to age might play a significant role in the pathogenic pathways of CP.

Inverse Association between Serum Bilirubin Levels and Retinopathy in Patients with Type 2 Diabetes Mellitus

Introduction: Oxidative stress plays a central role in the pathogenesis of Diabetic Retinopathy (DR) and serum bilirubin has been shown to have antioxidant properties. Aim: To investigate the association between serum bilirubin concentration and DR in patients with Type 2 Diabetes Mellitus (DM). Materials and Methods: This was a hospital based, cross- sectional study where in 86 patients with Type 2 DM and 30 controls were recruited. The study was conducted at a tertiary care centre in Southern India between January 2014 and December 2014. The presence and the severity of DR were determined by fundus examination and grading of colour fundus photographs using the international clinical disease severity scale for DR. Serum total, direct and indirect bilirubin levels were determined in all subjects and the association between bilirubin levels and severity of DR was studied. Results: Among the 86 diabetics, 24 had no retinopathy and 62 had DR of varying grades. The mean total bilirubin level among diabetic subjects (0.52±0.17) and controls (0.51±0.19) were found to be similar. The mean total as well as direct bilirubin levels were found to be lower in patients with retinopathy as compared to no retinopathy group (p<0.001). The severity of DR was inversely proportional to the serum bilirubin levels (p=0.010). Serum total bilirubin was found to have a negative association with glycosylated haemoglobin and served as an independent determinant of DR even after adjusting for risk factors known to be associated with DR (p=0.001). Conclusion: Low serum bilirubin levels are significantly associated with increased risk of DR independent of classic risk factors. Serum bilirubin can serve as a useful biomarker in identifying patients at risk for developing proliferative DR.

Efficacy of Green Tea Extract for Treatment of Dry Eye and Meibomian Gland Dysfunction; A Double-blind Randomized Controlled Clinical Trial Study

Mahmood Nejabat, Salehi Ali Reza, Mehdi Zadmehr, Masoud Yasemi, Zahra Sobhani

Introduction: With an incidence rate of 9%, dry eye is a common problem of the ocular surface, especially in patients more than 40-year-old. Green tea extract has anti-oxidative, anti-bacterial, anti-androgen, and immunomodulatory properties. Aim: To evaluate the efficacy of green tea extract for treatment of patients with dry eye and Meibomian Gland Dysfunction (MGD). Materials and Methods: In a double-blind randomized controlled clinical trial, 60 patients were selected within the age range of 30 to 70 years, and divided into two groups by blocked randomization method. Standard treatment included artificial tear eye drops, three times a day for a month for all patients. Topical green tea extract was prescribed three times a day for one month in one of the groups. All patients were evaluated at the beginning and end of the study for clinical symptoms based on the Ocular Surface Disease Index (OSDI) score, Schirmer’s test, Tear Breakup Time (TBUT), corneal and conjunctival staining and meibum score. Results: The mean age of participants in the green tea and control group was 61 and 64 years respectively. In the green tea group, the mean score of clinical symptoms was 9±0.86 that improved to 4.86±0.55 after one month (p=0.002). Scores suggesting improvement of TBUTs and the health of meibomian glands were significantly higher in the green tea group (p=0.002). Furthermore, no side effects of the treatment were observed. Conclusion: Green tea extract is an effective, safe, and well-tolerated topical treatment for mild and moderate evaporative dry eyes and MGD.

Effect of Atorvastatin on Glycaemic Parameters in Normoglycaemic and Prediabetic Subjects: A Prospective, Panel Study.

Sansita Parida, Trupti Rekha Swain, Satya Narayan Routray, Rituparna Maiti

Introduction: Type 2 diabetes is associated with obesity and dyslipidemia, which are risk factor for cardiovascular disease. With recent FDA approved indications for statins being widened because of its lipid lowering and pleiotropic effects, statins are currently amongst the most widely used drugs in patients with or without diabetes. Although cardiovascular risk is reduced by statin therapy, its association with the development of diabetes is disputed. Aim: This study was conducted to evaluate the effect of Atorvastatin on glycaemic status of normoglycaemic and prediabetic individuals. Materials and Methods: An observational, prospective panel study was conducted on 75 subjects who were on Atorvastatin therapy. After baseline data collection and investigations, subjects were recruited depending on their glycaemic status into three groups: normoglycaemic, Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) group. Atorvastatin therapy was continued and the subjects were followed every 6 months up to 18 months. At every follow-up all glycaemic parameters were evaluated and subjects were assessed for continuation of statin therapy, dosing schedule and possible adverse drug reactions. Result: All three groups as a whole, irrespective of dose of Atrovastatin therapy, showed a statistically significant (p<0.0001) increase in all glycaemic parameters. In normoglycaemic group with low dose Atorvastatin, there was no significant change in 2-hour Post Prandial Blood Sugar (PPBS) but change in HbA1c% (p=0.0004) and FBS (p<0.0001) was significant, whereas, with high dose, changes in 2-hr PPBS and HbA1c % were significant from 6 months onwards. In IFG group, both with low and high dose of Atorvastatin, there was significant change in all glycaemic parameters from 12 months onwards. In case of IGT, especially with high dose Atorvastatin, significant changes were evident from 6 months onwards. Conclusion: Atorvastatin therapy especially with higher dose was found to be associated with glucose intolerance in normoglycaemics and also caused progression towards diabetes in prediabetic individuals.

A Study to Find Out the Full Immunization Coverage of 12 to 23-month old Children and Areas of Under-Performance using LQAS Technique in a Rural Area of Tripura

Anjan Datta, Subrata Baidya, Srabani Datta, Chanda Mog, Shampa Das

Introduction: It is very important to analyze the factors which acts as obstacle in achieving 100% immunization among children. Lot Quality Assurance Sampling (LQAS) is one of the effective method to assess such barriers. Aim: To assess the full immunization coverage among 12 to 23-month old children of rural field practice area under Department of Community Medicine, Agartala Government Medical College and identify the factors for failure of full immunization. Materials and Methods: A community based cross-sectional study was conducted from November 2013 to October 2014 on children aged 12 to 23 months old of area under Mohanpur Community health centre. Using LQAS technique 330 samples were selected with multi-stage sampling, each sub-centre being one lot and two calculated to be the decision value. Data was collected using pre-designed pre-tested questionnaire during home visit and verifying immunization card and analysed by computer software SPSS version 21.0. Results: The full immunization coverage among 12 to 23 months old children of Mohanpur area was found as 91.67%. Out of all the 22 sub-centres, 36.36% was found under performing as per pre-fixed criteria and the main reasons for failure of full immunization in those areas are unawareness of need of subsequent doses of vaccines and illness of the children. Conclusion: LQAS is an effective method to identify areas of under-performance even though overall full immunization coverage is high.

Effectiveness of Video Demonstration over Conventional Methods in Teaching Osteology in Anatomy

Angela A Viswasom, Abraham Jobby

Introduction: Technology and its applications are the most happening things in the world. So, is it in the field of medical education. This study was an evaluation of whether the conventional methods can compete with the test of technology. Aim: A comparative study of traditional method of teaching osteology in human anatomy with an innovative visual aided method Material and Method: The study was conducted on 94 students admitted to MBBS 2014 to 2015 batch of Travancore Medical College. The students were divided into two academically validated groups. They were taught using conventional and video demonstrational techniques in a systematic manner. Post evaluation tests were conducted. Results: Analysis of the mark pattern revealed that the group taught using traditional method scored better when compared to the visual aided method. Feedback analysis showed that, the students were able to identify bony features better with clear visualisation and three dimensional view when taught using the video demonstration method. The students identified visual aided method as the more interesting one for learning which helped them in applying the knowledge gained. In most of the questions asked, the two methods of teaching were found to be comparable on the same scale. Conclusion: As the study ends, we discover that, no new technique can be substituted for time tested techniques of teaching and learning. The ideal method would be incorporating newer multimedia techniques into traditional classes.

Cost Effective Printing of Laboratory Reports: Biochemist’s and Physician’s debate and Institutions Dilemma

Arun Kumar Harith, Anil Kumar AVS, Sangeetha Sampath

Introduction: Laboratory investigations account for significant percentage of healthcare expenses. Every hospital and laboratory especially in the government sector wants to cut down the expenses on reports and offer inferior printouts of reports. The debate of printing attractive reports (clientele aspiration) Vs costs cutting (managerial issues) continues. It becomes the moral responsibility of doctors to guide the management into implementing an effective and economical option of report transcription. Cutting cost is always good but it should be achieved in an effective way keeping in mind the expectation of all the stake holders and ensuring that quality is not significantly compromised. The data regarding economics of printing available on the Internet may be market driven and not a true reflection of printing cost. The present study was undertaken to generate data on the economics of printing reports on various platforms to enable managers to make informed decision on choice of optimal printing option. Aim: To provide practical data on economics of printing reports using various printing options available in the country. Materials and Methods: Four printing devices (laser printer, inkjet printer, dotmatrix printer and thermal printer) were connected to the laboratory information system and the reports printed from them were critically evaluated for the following parameters - cost of stationary, printing cost, time of printing and clientele satisfaction. Results: The cost of printing a single report on laser printer, inkjet printer, dotmatrix printer and thermal printers was Rs 0.75, Rs 0.65, Rs 0.20 and Rs 0.93 respectively. The time taken to print 30 reports were 162 sec, 193 sec, 210 and 60 sec respectively. Clientele satisfaction scores were best with Laser and Inkjet printed reports. Conclusion: The most economical mode of printing is Dot Matrix printer using DOS output for printing. However, when the workload of a laboratory is high, then the use of laser printer is not prohibitively expensive option and can be resorted to. Use of thermal printer was found to be unsatisfactory.

Assessment of Autonomic Dysfunction in Acute Stroke Patients at a Tertiary Care Hospital

Introduction: In patients who present with acute cerebro-vascular disease, autonomic function testing is usually not given its due importance. This is because of the complex nature of the autonomic function tests and the relative technical difficulty faced in administering the tests to the patients. A simple and non-invasive method to assess the autonomic dysfunction is measurement of resting Heart Rate Variability (HRV). Aim: To study the pattern of autonomic dysfunction among patients admitted with acute stroke and to study the relationship between autonomic dysfunction and the morbidity and mortality associated with acute stroke. Materials and Methods: The study was carried out on 97 patients who were admitted with diagnosis of acute stroke. Patients with conduction abnormalities on ECG were excluded from the study. Resting ECG tracings were obtained for a period of 5 minutes. The frequency domain analysis of HRV was performed by a Fast Fourier transform of the RR intervals. The High Frequency (HF) was representative of the parasympathetic activity while low frequency is representative of baroreceptor mediated parasympathetic and sympathetic activity and Low Frequency (LF)/HF ratio was a measure of the sympathovagal balance. Statistical analysis was carried out with student’s t-test and chi-square test and p-value = 0.05 was taken to be statistically significant. Results: The mean age of the patients was 60.84±14.12 years. A total of 41 patients were females and 77 patients had ischemic stroke. Out of the total 97, 60 patients had evidence suggestive of increased sympathetic activity with a mean LF/HF ratio of 2.03±0.88. These patients had significantly higher mean systolic BP, diastolic BP and National Institute of Health Stroke Scale (NIHSS) values when compared to patients with reduced LF/HF ratio (166.33±24.81 vs 148.54±19.42, p=0.0003, 100.33±18.73 vs 88.76±12.66, p=0.0013, 15.77±8.22 vs 11.49±6.63, p=0.0088 respectively). These patients also had a higher mortality rate. Conclusion: This study highlights the problem of autonomic dysfunction among patients with stroke. Patients with autonomic dysfunction had higher morbidity and mortality in the acute phase of stroke in this study and also had higher blood pressure readings. This is a small scale study whose findings need to be validated further by larger population studies.

Radioprotective Effect of Beta D-Glucan and Vitamin E on Gamma Irradiated Mouse

Faraj Tabeie, Seyed Mehdi Tabatabaei, Ali Mahmoud-Pashazadeh, Majid Assadi

Introduction: It is shown that beta-D-glucan is an immunologic system booster with radioprotectory effects. Radioprotectors are chemical components that can alleviate biological damage produced by ionizing radiation. Aim: This study was designed to investigate the synergistic radioprotectory effects of beta-D-glucan and vitamin E on irradiated mice with 60Co source. Materials and Methods: A total of 240 female mice were arranged in four, equal population groups of control group (C), treated group with beta D-glucan (G), treated group with vitamin E (E), and treated group with both beta D-glucan and vitamin E (G+E). Each group was divided into three equal population groups of D6, D7 and D8 exposed to 60Co radiation with prescribed total body dose of 6, 7 and 8 Gray (Gy), respectively. After the exposure, the number of survived animals was counted by time, then Lethal Dose50/30 (LD50/30), Lethal Dose50/60 (LD50/60) and Dose Reduction Factor (DRF) were calculated in all groups and corresponding groups. Results: Based on the results of current study, treatment of the animals with vitamin E did not change values of LD50/30 and LD50/60, in comparison to control group. LD50/30 and LD50/60 of treated groups with beta D-glucan and beta D-glucan + vitamin E showed significant difference with those of control group (p<0.01). The DRF values in groups E, G and G + E, were calculated respectively as 1, 1.25 and 1.375 based on LD50/30, and respectively as 1, 1.17 and 1.33 based on LD50/60. While values of DRF in groups G and G + E showed significant difference in comparison to that of control group (p<0.01), but the difference between DRF of groups G and G + E was not significant (p=0.395). Conclusion: The findings of study obviously showed that, presence of beta D-glucan in the body of mice, during exposure to ionizing radiation, leads to DRF of higher than one, proving the radioprotectory effect of this agent. Also, we demonstrated that, while vitamin E had no radioprotectory effect on irradiated mice, beta D-glucan in combination with vitamin E increased resistance of mice against ionizing radiation.

A Study on Gender Preference and Awareness Regarding Prenatal Sex Determination among Antenatal Women in a Rural Area of Darjeeling District, West Bengal, India

Archak Roy, Romy Biswas

Introduction: Sex ratio is one of the major indicators to find the gender preferences in the community. Change in sex ratio reflects underlying socioeconomic, cultural patterns of a society. Aim: The present study was conducted with the aim to find out the knowledge of antenatal women regarding the prenatal sex determination and the Pre Natal Diagnostic Techniques (PNDT) Act in a rural area along with assessing the gender preference in family among the study population. Materials and Methods: A community based, descriptive, cross-sectional study was undertaken in the villages of Matigara Block of Darjeeling district of West Bengal, which serves as a field practice area of North Bengal Medical College & Hospital for two months. A total of 116 pregnant women were included and a pre designed pre tested questionnaire was used to collect the socio demographic details. The data were analysed by SPSS 20.0 software for proportions with chi-square tests. Results: Knowledge of sex determination and the PNDT Act were found to be 44.82% and 18.10% among antenatal women. Knowledge regarding assessment of gender preference showed 52.58% expect a boy in this pregnancy. It was found that the determinants for gender preference were caste, sex of the last pregnancy and current gender composition. It was found that the determinants for knowledge of sex determination are age of the mother and the gravida of the mother. It was also found that the factor for the knowledge regarding the PNDT Act is age of the mother. These associations are statistically significant. Conclusion: This situation calls for a strategy which includes community based awareness campaigns, women employment, education, and empowerment and by ensuring effective implementation of PNDT Act by the government so that families find it difficult to undertake sex determination.

The Impact of Eating and Exercise Frequency on Weight Gain - A Cross- Sectional Study on Medical Undergraduate Students

Introduction: Diverse factors influence an individual’s ability to successfully achieve and maintain energy balance consistent with a healthy body weight. Eating frequency is one among the varied feature that thought to have a direct impact on the body weight gain. Aim: The present cross-sectional study has been carried out with the intention of awareness of food habit that specifically emphasize the frequency of eating and its effect on weight gain of an individual. Materials and Methods: This cross-sectional study involved 265 medical undergraduate students. Faculty validated close ended questionnaire was distributed to the students and the responses given by them were then analysed. Statistical evaluation of data with Spearman correlation coefficient (r) was done. Results: Among the total 265 participants, 177 (66.8%) were noted to have normal Body Mass Index (BMI 18.5-24.9). Out of them, 113 (64%) found to have eating frequency 3-4 meals/day, 44 (25%) with 1-2 meals/day, 18 (10%) with 5-6 meals/day and 2 (1%) with more than 6 meals/day. Low positive correlation (r=0.09) between mean frequency of eating and the number of subjects with normal BMI was observed. Conclusion: An increase in the eating frequency can also be correlated with an increased prevalence of normal BMI individuals provided adequate physical exercise.

Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography

Introduction: Sarcoidosis is a disease of unknown aetiology that primarily affects the lungs. Clinical and radiological findings with demonstration of non caseating granulomas on pathology is utilised for diagnosing the disease. Aim: To assess and evaluate the features of thoracic sarcoidosis on High Resolution Computed Tomography (HRCT) chest. Materials and Methods: A total of 40 (31 males and 9 females) cases of pulmonary sarcoidosis in a period of three years were included in this study. Patients underwent detailed clinical evaluation, imaging, Pulmonary Function Tests (PFT) and pathological confirmation of disease. Chest radiograph was obtained in all patients. HRCT was done on 16 slice Computed Tomography (CT) using 1 mm slice thickness and high spatial frequency algorithm for image re-construction. Images were viewed and evaluated using appropriate lung and mediastinal windows. The lymph nodes were classified as hilar and mediastinal with Maximum Short Axis Diameter (MSAD) more than 10 mm taken as cut-off for enlargement. Pulmonary opacities were classified as nodules (micronodules 1-4 mm and macronodules >5 mm), reticular opacities, fibrotic lesions, ground glass opacities and consolidations. Nodule distribution classified as perilymphatic centrilobular and random. Repeat scanning done on follow up or as clinically indicated. Results: A total of five patients had Stage I disease, 24 patients had Stage II disease, eight patients had Stage III disease and three patients had stage IV disease. Mediastinal lymphdenopathy present in 29 patients. Bilateral hilar adenopathy was the predominant pattern seen in 22 patients. Lung parenchymal lesions excluding end stage disease noted in 32 patients. The characteristic HRCT lung parenchymal involvement of micronodules with a perilymphatic distribution was seen in 26 patients. HRCT features of predominant upper and middle lobe distribution seen in majority of patients. Documented atypical lesions and the characteristic features of end stage lung disease on HRCT noted in a small subset of patients. HRCT was superior to chest radiography for evaluating the features, pattern and distribution of the parenchymal lesions and mediastinal lymph nodes, for assessing the stage and activity of the disease and in aiding detection of subtle parenchymal lesions which are liable to be missed on conventional imaging. Conclusion: Thoracic sarcoidosis can have varied presentations. HRCT is superior to conventional CT for the detection and characterisation of the lung parenchymal lesions.

Application of Curved MPR Algorithm to High Resolution 3 Dimensional T2 Weighted CISS Images for Virtual Uncoiling of Membranous Cochlea as an Aid for Cochlear Morphometry

Joish Upendra Kumar, Y Kavitha

Introduction: With the use of various surgical techniques, types of implants, the preoperative assessment of cochlear dimensions is becoming increasingly relevant prior to cochlear implantation. High resolution CISS protocol MRI gives a better assessment of membranous cochlea, cochlear nerve, and membranous labyrinth. Curved Multiplanar (MPR) reconstruction algorithm provides better images that can be used for measuring dimensions of membranous cochlea. Aim: To ascertain the value of curved multiplanar reconstruction algorithm in high resolution 3-Dimensional T2 Weighted Gradient Echo Constructive Interference Steady State (3D T2W GRE CISS) imaging for accurate morphometry of membranous cochlea. Materials and Methods: Fourteen children underwent MRI for inner ear assessment. High resolution 3D T2W GRE CISS sequence was used to obtain images of cochlea. Curved MPR reconstruction algorithm was used to virtually uncoil the membranous cochlea on the volume images and cochlear measurements were done. Result: Virtually uncoiled images of membranous cochlea of appropriate resolution were obtained from the volume data obtained from the high resolution 3D T2W GRE CISS images, after using curved MPR reconstruction algorithm mean membranous cochlear length in the children was 27.52 mm. Maximum apical turn diameter of membranous cochlea was 1.13 mm, mid turn diameter was 1.38 mm, basal turn diameter was 1.81 mm. Conclusion: Curved MPR reconstruction algorithm applied to CISS protocol images facilitates in getting appropriate quality images of membranous cochlea for accurate measurements.

Human Epidermal Growth Factor Receptor-3 mRNA Expression as a Prognostic Marker for Invasive Duct Carcinoma not Otherwise Specified

Introduction: Breast cancer is the most common cancer in women and the Erythroblastosis Oncogene B(ErbB) receptor family holds crucial role in its pathogenesis. Human Epidermal Growth Factor Receptor 3 (HER-3) gene over expression in breast tissue has been associated with aggressive clinical behaviour and bad prognosis. Aim: To evaluate HER-3 mRNA expression level as a prognostic marker for breast cancer and to correlate its level with other established prognostic parameters. Materials and Methods: This study was carried out on specimens of 100 cases that were divided into 40 patients presented with fibroadenoma and 60 patients presented with Invasive Ductal Carcinoma (IDC) not otherwise specified and underwent modified radical mastectomy. All specimens were investigated for HER-2/neu, ER and PR expression by Immunohistochemistry (IHC) and quantitative assay of HER-3 mRNA expression using real time PCR technique. Results: There was a significant high HER3 mRNA level in carcinoma cases compared to fibroadenoma. In malignant cases, HER3 mRNA level was significantly associated with advanced T stage, advanced N stage, number of positive lymph nodes, large tumour size and cases associated with an adjacent in situ component. Moreover, HER-3 mRNA level was of highest values in Her-2/neu positive group followed by triple negative cases with the lowest level in luminal group (p<0.05). Conclusion: HER-3 gene is upregulated in IDC especially those carrying poor prognostic features. HER-3 mRNA level may identify a subset of patients with a poor prognosis, and who could undergo further evaluation for the efficacy of HER3 targeted anticancer therapy.

Comparative Study of Surgical Management of Fracture Neck of Femur with Cemented Versus Uncemented Bipolar Hemiarthroplasty

YS Prashanth, M Niranjan

Introduction: There is evidence for use of cemented hemiarthroplasty resulting in greater anchoring and lesser peri prosthetic fracture. However, this procedure results in more haemodynamic instability and cardiopulmonary complications termed as ‘cement reaction’ or bone cement implantation syndrome. There has been a heightened interest among surgeons to compare cemented and uncemented hemiarthroplasty for fracture neck of femur. Aim: To compare cemented and uncemented hemiarthroplasty in terms of blood loss during the procedure, post-operative complications, mortality, functional recovery and long term clinical outcome. Materials and Methods: In a prospective study spanning 8 years from January 2006 to January 2014 in a tertiary care hospital, 52 cases of fracture of neck were selected. Twenty four patients underwent cemented and 28 patients underwent uncemented hemiarthroplasty. Mean follow up duration was 59.3 months. Harris Hip Score evaluation was done at each follow up. Radiological evaluation was done at each follow up for calcar length and periprosthetic fractures. Results: Mean age of patients was 70 years. Harris Hip scores at 3, 6 and 12 months did not show statistically significant differences. Periprosthetic osteolysis or loosening was not seen in the present study. No complications noted in uncemented hemiarthroplasty. Four patients who had cemented hemiarthroplasty had infections. No mortality occurred during admission and within 12 months after surgery. Conclusion: No significant difference was noted between the cemented and uncemented hemiarthroplasty procedures on long term follow up in terms of functionality. No re-operations and no mortality reported. Cemented hemiarthroplasty had more blood loss and minimal post-operative complications.

Does Iron Deficiency Anaemia and its Severity Influence HbA1C Level in Non Diabetics? An Analysis of 150 Cases

Introduction: Anaemia has a high prevalence having great impact worldwide and potentially contributing to the pathogenesis of various chronic diseases. Approximately 1/3rd of patients with anaemia have iron deficiency. American Diabetes Association (ADA) has affirmed Glycated Haemoglobin (HbA1C) = 6.5% as a diagnostic criterion for Diabetes Mellitus (DM). Variation of HbA1C in Iron Deficiency Anaemia (IDA) has clashing results. Aim: To decide the impact of IDA on HbA1C levels among non diabetics. To assess and analyse the variation of HbA1C according to the degree of anaemia (mild, moderate and severe). Materials and Methods: This cross-sectional study was carried out in SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu from February 2016 to October 2016 and approved by our Institutional Ethical Committee. Totally 150 non diabetics (75 with IDA and 75 without IDA) were included in this study. Medical history was recorded and HbA1C, Haemoglobin (Hb), Haematocrit (Hct), red cell indices, serum iron, ferritin and Fasting Plasma Glucose (FPG) were tested. Results: The IDA patients in this study had a mean HbA1C (6.84±0.07%) which was higher than the non anaemic group (5.12±0.04%) and this difference was statistically significant (p< 0.05). HbA1C level was increased when severity of anaemia worsened. Also, noteworthy statistical significance was observed between no anaemia, mild, moderate and severe anaemia (p< 0.05). Conclusion: In this study, we observed a positive correlation between IDA and elevated HbA1C level in non-diabetic population.

Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques

Introduction: The management of displaced and comminuted radial head fractures has been a matter of debate amongst surgeons for many years. Radial head excision formed the mainstay of surgical management of these injuries. Over the years, there have been improvements in the surgical techniques and availability of better implants and instrumentation techniques, hence, open reduction and internal fixation of these fractures is gaining popularity. Aim: To compare the outcome of elbow function between radial head excision and open reduction and internal fixation of the radial head with mini screws of Mason Type II and Type III radial head fractures and to assess the complications that occur in both techniques. Materials and Methods: A prospective study was conducted in the Department of Orthopaedic Surgery of Justice K.S.Hegde Charitable hospital. A total of 40 patients between the age group of 30-50 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. Group I consisted of 20 patients who underwent radial head excision and Group II consisted of 20 patients who underwent open reduction and internal fixation with mini screws. Patients were reviewed at postoperative week 3, 6 and 24. Radiographs were taken and functional outcome assessment of the elbow was done during all the follow ups. Elbow physiotherapy was started on postoperative week three. Scoring of elbow function was done as per the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. Results were tabulated, compared and analysed statistically using the ‘chi-square test’. Results: At the end of six months, the patients of the open reduction and internal fixation group had lower DASH scores (4.82±2.73 points) than the radial head excision group (14.23±5.60 points). This inferred that patients who underwent open reduction and internal fixation had better functional outcomes than the excision group. Complications of proximal radial migration was noted in three patients, elbow osteoarthritis was noted in two and periarticular ossification was noted in six patients who underwent radial head excision. Conclusion: Open reduction and internal fixation of Mason Type II and Type III radial head fractures is a better management technique as compared to radial head excision for management of Mason Type II and III radial head fractures.

Irritable Bowel Syndrome and Bronchial Asthma: Are They Associated in Indian Population?

Salahuddin Siddiqui, Sri Prakash Misra, Manisha Dwivedi, Sanjay Pant

Introduction: Irritable Bowel Syndrome (IBS), a common gastrointestinal (GI) disorder has been linked with asthma implying a clue to its pathophysiology as being some form of allergic response. Previous studies from other parts of the world have shown both the presence as well as an absence of an association between them. Aim: We conducted a cross-sectional study to find an association between IBS and asthma, in an Indian cohort. Materials and Methods: Seventy patients of IBS diagnosed by exclusion and ROME III criteria with a matched control group were questioned for GI, respiratory symptoms along with their spirometry analysis. Those having reversible bronchoconstriction were categorized as asthmatic. Results: The prevalence of asthma in the IBS group of 16 females and 54 males was 12 (17.14%) as compared to 14 (20%) in control group. Chi-square test revealed the Odds Ratio (OR) for prevalence of asthma in IBS as 0.828 with 95% Confidence Interval (CI) between 0.320 and 2.121 (p=0.664) which was non-significant (p>0.05). Conclusion: This study denies the presence of association between IBS and asthma among Indian cohorts and suggests that regional variations are present in the above association.

Correlates and Predictors of Resilience among Baccalaureate Nursing Students

Monali Devaraj Mathad, Balaram Pradhan, Sasidharan K Rajesh

Introduction: A growing body of literature recognizes the importance of resilience in the nursing profession. Both mindfulness and resilience aid in handling stress, stress increases the risk of rumination and/or worry especially in females and they are more empathetic than other healthcare students. Aim: To identify correlates and predictors of the resilience among nursing students. Materials and Methods: This is a descriptive correlation study and we have recruited 194 participants (1-4th year B.Sc Nursing) from Government College of Nursing and NIMHANS College of Nursing in Bangalore, India. The following instruments were used to collect the data, Freiburg Mindfulness Inventory (FMI), Toronto Empathy Questionnaire (TEQ), Perseverative Thinking Questionnaire (PTQ) and Connor–Davidson Resilience Scale (CD-RISC). Data was analysed using Pearson’s correlation test and multiple regression analysis. Results: Resilience is significantly correlated with mindfulness, perseverative thinking and empathy in nursing students. Based on regression analysis this model accounted for almost 33% of variance in resilience. This result is of interest as mindfulness alone explained 23% of the variance and unproductive Repeated Negative Thinking (RNT) and RNT consuming mental capacity predicted 8% and 2% respectively. Conclusion: These results support the importance of resilience and mindfulness in nursing students. Hence, resilience and/or mindfulness enhancing interventions should be inculcated in nursing education.

Correlation between Visible Length of the Iris and the Length of the Maxillary Central Incisor Using Digital Image Analysis- A Pilot Study

Rohini, Hemalatha, Gopi Naveen Chander, Kuttae Viswanathan Anitha

Introduction: Complete denture therapy is one such modality where science and art goes hand in hand. Selection of artificial teeth for completely edentulous patients is not easy in the absence of pre extraction records, because till date concrete guidelines do not exist. Aim: The purpose of this study was to determine if a correlation existed between the visible length of the iris and the length of the maxillary central incisor to potentially provide a guide for teeth selection. Materials and Methods: A total of 20 Indian dental students consented to participate in the pilot study. Standardized digital images of the face revealing the eyes and component of teeth on smiling was captured using a digital camera. The digital measurements of the visible iris length (medial aperture height, tangential to iris) and the length of the maxillary central incisor from the zenith to the incisal edge were analysed using Adobe Photoshop creative cloud software. The data was statistically evaluated and results were tabulated. Karl Pearson’s Coefficient of Correlation was utilized to detect if any association existed between the two variables. Results: The mean value of length of central incisor was 10.39 mm and the mean value of the visible length of iris was found to be 12.9 mm. A Pearson correlation analysis revealed an r-value <0.3 indicating minimal association between the two variables with a p-value >0.01 (.322). Conclusion: On inference, the correlation between the visible iris length and that of maxillary central incisor were unable to produce a strong positive statistical association. However, an association factor between the two has been obtained. Deduction of 2.5 mm from the dimension of visible iris length will help in attaining the length of artificial maxillary central incisor tooth.

Anti Bacterial Efficacy of Terminalia Chebula, Terminalia Bellirica, Embilica Officinalis and Triphala on Salivary Streptococcus Mutans Count – A Linear Randomized Cross Over Trial

Smariti Saxena, Nagesh Lakshminarayan, Shanmukha Gudli, Manish Kumar

Introduction: From the oral health perspective, it is well established that microorganisms have an important role in caries aetiology. From the dawn of civilization, herbal plants have served an array of roles. Triphala a tradtional herbal Ayurvedic formula consists of three native fruits of india including Terminalia Chebula (T. chebula), Terminalia Bellirica (T. bellirica) and Embilica Officinalis (E. officinalis). As per Ayurvedic Formulary of India (AFI) Triphala is prepared by combining a 1:1:1 mixture of ground dry fruits called myrobalans. Till date, an inadequate number of clinical researches on herb based mouth rinses have been reported in Asia, especially in India and other Southeast Asian countries (where these products are most accepted and widely used). The present study was planned to assess the effectiveness of Triphala with its three constituents. Aim: The objective of this study was to determine the effect of Triphala, T. chebula, T. bellirica and E. officinalis aqueous extract rinses separately on Streptococcus mutans count at various time intervals. Materials and Methods: This is a double-blind, linear cross over, within group experimental trial conducted among subjects visiting the Department of Public Health Dentistry aged 15 to 40 years. In this design, subjects received all of the treatments sequentially in time. The independent variables to be assessed in this study were all the four interventions of herbal preparations used and the dependent variable assessed is anti bacterial efficacy. Each subject receives two or more different treatments. All the subjects were exposed to all four interventions: 1) T. chebula; 2) T. bellirica; 3) E. officinalis; and 4) Triphala and were provided 15 ml of the freshly prepared 10% rinse. The subjects were instructed not to eat or drink between salivary samples collection. Post rinse unstimulated salivary samples were collected at five minutes and 60 minutes intervals. All the salivary samples were transferred immediately to microbiological laboratory in sterile containers within one hour for microbiological analysis. Results: The mean Colony Forming Units (CFUs) of S. mutans with Triphala when compared to other three intervention was significantly reduced at 5 minutes and 60 minutes (p=0.001). E. officinalis showed least reduction of mean CFUs when compared to other three groups. Conclusion: It can be concluded that all four rinses were effective in reducing S. mutans CFUs, but 10% Triphala has greater efficacy than its other constituents.

Haemostasis with the FISH Vascular Closure Device after 6 French Transfemoral Accesses in Interventional Radiology: Clinical Results

Introduction: Endovascular procedures have increased for different indications over the recent years. To achieve a safe haemostasis after arterial puncture and for more comfort for the patients different vascular closure devices have been developed. Aim: To evaluate the effectiveness and safety of a percutaneous closure system based on a matrix patch for achieving haemostasis. Materials and Methods: In this study from 2014 to 2015 a percutaneous vascular closure system Femoral Introducer Sheath and Haemostasis (FISH) was used in 54 patients (mean age 69.0±10.7 years), in an antegrade and retrograde technique within the context of an angiographic intervention. The system was used in conjunction with transfemoral approaches with a sheath size of 6F. Postinterventionally (on the following day and after 6 weeks), follow-up was conducted clinically and using colour coded ultrasound. Results: Immediate haemostasis was achieved in 50/54 patients (92.6 %). In 4 cases, an immediate haemostasis was not achieved. In these cases, manual compression was successful. There was one major complication, a retroperitoneal bleeding requiring transfusion. Minor complications were not observed. Conclusion: Safe and effective haemostasis is possible with the percutaneous FISH closure system at puncture sizes of 6 F. An immediate re-puncture after using FISH is possible.

Ear, Nose and Throat Foreign Bodies Removed under General Anaesthesia: A Retrospective Study

Introduction: For Otorhinolaryngologist, removal of Foreign Bodies (FB) from the ear, nose and throat is one of the common emergency procedures done. Most of the cases especially of the ear and nose can be managed without General Anaesthesia (GA). But in some cases GA may be needed. There are very few studies that address the scenario of ear, nose and throat foreign body that required GA for its removal and the complications associated with it. Aim: This study was conducted with the aim to study the patient’s profile, types and distribution of FB removed under GA, and the associated complications. Materials and Methods: The present study is a hospital based retrospective, cross-sectional study conducted in the Department of Otorhinolaryngology in association with Department of Anaesthesiology and Critical Care in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India from year 2009 to 2014. Information was collected from indoor patient file and operation record book. Those patients where foreign body was not found after examination under GA were excluded. Results: A total of 112 cases of foreign body in ear, nose and throat removed under GA were selected. There was variation of age from youngest case being 11 months to 74 years with a slight male predominance. Two third of the patients belonged to paediatric age group. Most of the FB were inanimate with high number of inorganic type found in majority. Foreign body in food passage was found in most cases. Coin and meat bone were the common FB in children and adults respectively. We found no complications related to removal of foreign body from the food passage and nose. But some complications were seen in foreign body of ear and tracheo-bronchial tree. Conclusion: Ear, nose and throat FB that required GA were seen in all age groups. FB of food passage constitute the majority. Type of foreign body varies between children and adults. In children most common types were related to toys and their part and food materials. In adults, food materials were most common.

Unusual Presentation of Porencephalic Cyst in an Adult

Porencephalic cyst is quite a rare entity in adults with only a few cases reported so far. It is usually congenital and seen in neonates. Here, we report a 28-year-old female who presented with post-ictal confusion following a new onset of focal seizures with secondary generalisation. She was diagnosed to have porencephalic cyst in left posterior parietal lobe on brain imaging. She was started on anti-epileptic drugs and is on follow up.

Accuracy and Predictability of PANC-3 Scoring System over APACHE II in Acute Pancreatitis: A Prospective Study

Introduction: Acute Pancreatitis (AP) is one of the common conditions encountered in the emergency room. The course of the disease ranges from mild form to severe acute form. Most of these episodes are mild and spontaneously subsiding within 3 to 5 days. In contrast, Severe Acute Pancreatitis (SAP) occurring in around 15-20% of all cases, mortality can range between 10 to 85% across various centres and countries. In such a situation we need an indicator which can predict the outcome of an attack, as severe or mild, as early as possible and such an indicator should be sensitive and specific enough to trust upon. PANC-3 scoring is such a scoring system in predicting the outcome of an attack of AP. Aim: To assess the accuracy and predictability of PANC-3 scoring system over APACHE II in predicting severity in an attack of AP. Materials and Methods: This prospective study was conducted on 82 patients admitted with the diagnosis of pancreatitis. Investigations to evaluate PANC-3 and APACHE II were done on all the patients and the PANC-3 and APACHE II score was calculated. Results: PANC-3 score has a sensitivity of 82.6% and specificity of 77.9%, the test had a Positive Predictive Value (PPV) of 0.59 and Negative Predictive Value (NPV) of 0.92. Sensitivity of APACHE II in predicting SAP was 91.3% and specificity was 96.6% with PPV of 0.91, NPV was 0.96. Conclusion: Our study shows that PANC-3 can be used to predict the severity of pancreatitis as efficiently as APACHE II. The interpretation of PANC-3 does not need expertise and can be applied at the time of admission which is an advantage when compared to classical scoring systems.

Metabolic Syndrome in Psoriasis among Urban South Indians: A Case Control Study Using SAM-NCEP Criteria

Banavasi S Girisha, Neetha Thomas

Introduction: Psoriasis is a chronic inflammatory disease of the skin associated with increased cardiovascular morbidity. Metabolic syndrome is a significant forecaster of cardiovascular events. Aim: To assess the association of metabolic syndrome and its components in patients with psoriasis and to compare it with the age and sex matched control group. Materials and Methods: We conducted a hospital based case-control study on 156 adult patients with chronic plaque psoriasis and 156 patients with skin diseases other than psoriasis. Height, weight, BMI, blood pressure and waist circumference were documented in all the subjects. Fasting levels of serum glucose, serum triglycerides and serum HDL were estimated by automated clinical chemistry analyzer. The South Asian modified NCEP ATP criterion was used for the diagnosis of metabolic syndrome. Statistical analysis of the data was done using statistical processing software (SPSS-17). Results: Metabolic syndrome was significantly more common in psoriatic patients than in controls (28.8% vs 16.7%, p=0.01). Hypertriglyceridemia was significantly more prevalent in cases than in controls (34% vs 20.5%, p=0.008). The reduced HDL levels also showed a significantly high occurrence among cases (27.6% vs 13.5%, p=0.002). Moderate increase of blood pressure was seen among cases as compared to controls but the difference was not statistically significant (p=0.1). Impaired blood glucose and abdominal obesity were similar in both groups. Smoking and alcoholism did not influence the association of metabolic syndrome with psoriasis. There was no correlation of metabolic syndrome with severity and duration of psoriasis. Conclusion: Our findings suggest that metabolic syndrome as well as dyslipidemia is common in psoriasis patients among urban South Indians. This study highlights the need for screening at diagnosis and regular follow up of the metabolic aspects of the disease along with the skin lesions.

Health-Related Quality of Life (HRQoL) in Young Adults with Strabismus in India

Surendra P Sah, Indra P Sharma, Monica Chaudhry, Mousumi Saikia

Introduction: Strabismus has negative psycho-social and functional effects in adults. The impact can be minimised with surgery. However, in a low-income setting, it is important to evaluate the level of impact and prioritise the target population for intervention. The Adult Strabismus (AS-20) questionnaire is a reliable tool for assessment of Health-Related Quality of Life (HRQoL) in strabismic adults. Aim: To assess the HRQoL in young adults with manifest strabismus through psychosocial and functional scores according to gender and direction of deviation using the AS-20 questionnaire. Materials and Methods: In this cross-sectional cohort study, 132 young adults who manifest horizontal strabismus were recruited and the AS-20 questionnaire was administered. Patient’s demographic profile and type of strabismus were noted and compared with the overall mean scores of psycho-social and functional subscales. Data was analyzed using SPSS 21 and p-value less than 0.05 was considered statistically significant. Results: The participants comprised of 70 (53.03%) males and 62 (46.97%) females with a mean age of 24.5±3.57 years (range 18 to 38 years). The overall mean AS-20 score of young adults with strabismus was 61.62±12.61. The overall mean score for male and female were 65.54±13.53 and 57.68±13.46, respectively. Similarly, the mean scores for esotropes was 57.03±11.66 and 66.19±15.30 for exotropes. The overall mean scores were statistically significantly reduced (decreased QoL) in females as compared to males (CI 95%; p=0.002) and in esotropes as compared to exotropes (CI 95%; p=0.001). However, there was no significant difference between the psychosocial and functional score for all types of strabismus and genders (for all, p>0.05). Conclusion: The Quality of Life (QoL) is affected through psychosocial and functional factors in adults with strabismus. Females and adults with esotropia faced greater difficulties in the QoL. We recommend clinicians to consider the impact on QoL while managing adult with strabismus.

Association of +62 G>A Polymorphism in the Resistin Gene with Type 2 Diabetes Mellitus among Thais: Case-Control Study

Introduction: Resistin gene (RETN) polymorphisms in humans may have a role in the pathogenesis of Type 2 Diabetes Mellitus (T2DM) and insulin resistance. There is still lack of evidence on association between +62 G>A polymorphism in the RETN and T2DM among Thais. Aim: To determine the effect of polymorphisms at +62 G>A of RETN on Thai T2DM. Materials and Methods: This matched case control study was conducted with a total of 360 samples from all regions of Thailand (180 Thai new T2DM cases and 180 non-T2DM Thais for control) were enrolled. The RETN +62G>A polymorphism were detected using the Polymerase Chain Reaction (PCR) method. Conditional logistic regression was performed to test the association between +62 G>A polymorphism and T2DM. Results: Among 360 samples that were enrolled, only 350 samples completed molecular analysis. It was found that GA+AA genotype frequencies in T2DM cases was higher than control by 16% (95% CI: 6.0%, 27.0%, p-value=0.002). After adjustments for possible confounders, multivariable analyses by conditional logistic regression showed that the RETN+62 G>A polymorphism was statistically associated with Thai T2DM (ORadjusted =1.84, 95% CI: 1.03, 3.31, p-value=0.04). Other factors such as; low educational attainment (ORadjusted=3.87, 95%CI: 1.60, 9.36), hypertension (ORadjusted=3.07, 95%CI: 1.56, 6.04), had both obese father and mother (ORadjusted=1.94, 95%CI: 1.06, 3.56) and triglyceride=150 (ORadjusted=2.18, 95% CI: 1.18, 4.02) were statistically associated with Thai T2DM (p-value<0.05). While regular consumption of glutinous rice was found to be a protective factor (ORadjusted=0.29, 95%CI: 0.13, 0.64). Conclusion: These findings suggest that RETN polymorphism at position +62 G>A may increase the susceptibility to T2DM in Thais.

A Randomized Controlled Clinical Trial to Determine the Effectiveness of Caudal Epidural Steroid Injection in Lumbosacral Sciatica

Jaydeep Nandi, Abhishek Chowdhery

Introduction: Caudal epidural steroid injection have been a part of nonsurgical management of lumbosacral sciatica since last half a century but various randomized controlled trials fail to provide convincing evidence in favour of its effectiveness. Aim: To assess the efficacy of caudal epidural steroid injection in patients of lumbosacral sciatica in comparison to placebo. Materials and Methods: The study consisted of patients of sciatica caused by lumbosacral disc prolapse (observed on Magnetic Resonance Imaging (MRI) scan). Caudal epidural injections of 80 mg methyl prednisolone were injected in 47 patients in one group. The other group consisted of 46 patients who were injected isotonic saline as placebo. Self-evaluation was the main judgment criterion at 4th week using a descriptive four item scale (recovery, marked improvement, slight improvement, or worse). Patients rating the improvement as “recovery” or “marked improvement” were considered as success. Patients rating the improvement as “slight improvement” or “worse” were considered as failure. Only paracetamol were authorized and patients requiring Non Steroidal Anti-inflammatory Drugs (NSAIDs) before 4th week were also considered as failure. Results: On analysis per protocol, at 4 weeks, the two groups differed significantly with respect to the primary outcome: among the 93 patients, 8/46 (17%) in the placebo group and 32/47 (68%) in the steroid group (p=0.000) were considered as success (difference 50.7%; 95% CI for the difference 33.4 to 67.99). But at the end of the study (week 12) there was no significant difference in primary outcome between the groups: 22/46 (48%) patients in the placebo group and 28/47 (60%) in the steroid group (p=0.25) were considered as success (difference 11.8%; 95% CI for the difference -8.38 to 31.9). Conclusion: Caudal epidural steroid injections provide no additional improvement over placebo in the long term natural history of lumbosacral sciatica. However, it can be an important component of short term management of painful sciatica.

Occurrence of Anxiety and Depression among Stable COPD Patients and its Impact on Functional Capability

Introduction: Anxiety and depression are important but often under-diagnosed co-morbid conditions in patients with Chronic Obstructive Pulmonary Disease (COPD) which may affect the functional capacity of the patients. Aim: To find out the proportion of depression and anxiety among stable COPD patients using a validated questionnaire suitable for use in clinic and the factors affecting their reduced functional capability as assessed by six-minute walk test. Materials and Methods: This was a descriptive cross-sectional study. Seventy five patients diagnosed with stable COPD in outpatient Department of Pulmonary Medicine in a tertiary care hospital, satisfying all inclusion criteria, were included in the study. They were examined clinically, categorized as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity assessment guideline and interviewed by designated interviewer using validated questionnaire for depression (Hamilton depression rating scale, HAM-D) and anxiety (State Trait Anxiety Inventory, STAI). The functional exercise capacity of the patient was assessed by six-minute walk test. Statistical analysis was performed using Minitab software (version16.1). Results: Among 75 stable COPD patients (68 male, 7 female), majority (32 out of 75) had both depression and anxiety, while only anxiety or depression was present in 9 each. The patients with depression had no significant difference in six-minute walk distance, change in heart rate and respiratory rate (p = 0.4186, 0.219 and 0.41 respectively) as compared to those without depression, but were found to be more dyspnoeic at the end of the test (p= 0.003). There was also no significant difference in walk distance in patients with high STAI score as compared to those with low STAI score (p= 0.276). Conclusion: Both anxiety and depression were present in majority of the stable COPD patients. The presence of these co-morbid conditions had no significant effect on the functional status of the patients in the form of reduced six-minute walk distance, though they were more symptomatic than those without these co-morbidities.

Combined Conventional and Endoscopic Microdebrider-Assisted Adenoidectomy: A Tertiary Centre Experience

Amal T. Das, S.B. Prakash, V. Priyadarshini

Introduction: Adenoidectomy is one of the most commonly performed surgical procedures in children. Conventional adenoidectomy is associated with incomplete adenoid tissue removal with persistence of symptoms. The advent of rigid nasal endoscopes, cold light source, fiber optics and powered instruments used in functional endoscopic sinus surgery helped in the development of endoscopic microdebrider-assisted adenoidectomy. Aim: To establish the safety and efficacy of combined conventional and endoscopic microdebrider-assisted adenoidectomy procedure. Materials and Methods: This is a prospective study of 60 child patients who underwent combined conventional and endoscopic microdebrider-assisted adenoidectomy. The study was conducted from September 2013 to September 2015. Only child patients with grade 3 and grade 4 Adenoid Hypertrophy (AH) was included in the study. At the end of conventional adenoidectomy and after combined procedure, the AH was graded again. Post-operative complications like neck pain, hypernasality and swallowing problems were noted. Their symptom score was reviewed before surgery and after one month and one year of surgery. The duration of surgery and amount of blood loss was recorded. Results: By this technique, complete clearance of adenoid tissue was obtained in all 60 (100%) cases. The mean pre-operative symptom score for AH was 3.7, which improved to 0 after one month of combined conventional and endoscopic microdebrider-assisted adenoidectomy. All child patients were symptom-free at the end of one month and one year. The duration of conventional adenoidectomy was 5 minutes 12 seconds while total duration of the combined conventional and endoscopic microdebrider-assisted adenoidectomy was 14 minutes 45 seconds. There was no significant blood loss (15±3 ml approximately). There were no major complications in this study. Conclusion: The combined approach of conventional curette along with endoscopic microdebrider-assisted adenoidectomy is a safe and effective method for complete and accurate removal of large adenoids

Efficacy of Deferasirox as an Oral Iron Chelator in Paediatric Thalassaemia Patients

Introduction: Thalassaemia Major patients require frequent blood transfusion leading to iron overload. Excessive iron gets deposited in vital organs and leads to dysfunction of the heart, liver, anterior pituitary, pancreas, and joints. Our body has limited mechanism to excrete iron, so patients with iron overload and its complications need safe and effective iron chelation therapy. Aim: To assess the efficacy of Deferasirox (DFX) as an iron chelator, with specific reference to reduction in serum ferritin level. Materials and Methods: This is a prospective; observational study done in 45 multitransfused Thalassaemia Major Children receiving DFX therapy at registered Thalassaemia society Raipur Chhattisgarh. DFX was given in an initial dose of 20 mg/kg/day and according to response increased to a maximum of 40 mg/kg/day. Serum ferritin level was estimated at time of registration and at every three monthly intervals (four times during study period). The primary end point of the study was change in serum ferritin level after 12 months of DFX therapy. Results: The mean serum ferritin before DFX therapy of all cases was 3727.02 ng/mL. After 12 months of mean dose of 38 mg/kg/day of DFX, the mean decline in serum ferritin was 1207.11 ng/mL (drop by 32.38%, p-value <0.001). Conclusion: DFX monotherapy has a good safety profile and effectively chelates total body iron in Thalassaemia major patients.

Molecular Characterization of Multidrug Resistant Strains of Acinetobacter baumannii Isolated from Intensive Care Units in West of Iran

Parviz Mohajeri, Abbas Farahani, Rasa Sheini Mehrabzadeh

Introduction: According to the results of various studies using phenotypic methods, the prevalence of Multidrug Resistant (MDR) Acinetobacter baumannii (A. baumannii) isolates has been increasing worldwide. Pulsed-Field Gel Electrophoresis (PFGE) technique is known as the gold standard method to determine clonal characterization of bacterial species, especially A. baumannii. Aim: To determine the clonal relatedness and investigate the prevalence of integron classes 1 and 2 and genes encoding OXA-23 and 24 in A.baumanii isolates. Materials and Methods: A cross-sectional study was conducted from November 2011 to January 2013. A total of 140 A.baumannii isolates collected from three hospitals of Kermanshah were considered out of which 75 ICU isolates were included in this study. Antibiotics susceptibility test was done by disk diffusion method. Polymerase Chain Reaction (PCR) was performed in order to detect class 1 and 2 integrons and blaOXA-23-like, blaOXA-24-like genes. Isolates identified as MDR from a total of 75 Intensive Care Units (ICU) strains were subjected to genotyping for clonal relatedness. Results: A total of 37 isolates among 75 ICU isolates were identified as MDR. The maximum drug resistance was observed against ceftriaxone, mezlocycline, cefotaxime, piperacilin, ciprofloxacin and imipenem. Frequency of Class 1 and Class 2 Integrons, blaOXA-23-like and blaOXA-24-like genes were 33(44%), 27(36%), 60(80%) and 14(18.6%) respectively. Four clusters with high level of similarity were obtained showing homogeneity among MDR isolates. Conclusion: Significant correlation between presence of integrons and resistance to different classes of antibiotic was observed in this study. Monitoring of drug resistance using gene integrase PCR and blaOXA gene by cluster analysis is very important to plan specific infection control measures due to MDR A. baumannii.

Comparative Analysis between Podography and Radiography in the Management of Idiopathic Clubfeet by Ponseti Technique

Vikas Trivedi, Sumit Badhwar, Abhay S Dube

Introduction: Idiopathic clubfoot is one of the most common and oldest congenital foot anomalies. There are controversies regarding its optimum management protocol and methodologies to be employed for its functional outcome evaluation. This paper attempts to propose a simple, reasonable and easily reproducible technique of podography for clinical and functional evaluation of clubfoot treated by the popular Ponseti technique. Aim: To compare the Foot Bimalleolar (FBM) angle method (podography) and radiography with respect to management of idiopathic clubfoot by Ponseti’s Technique and its functional evaluation. Materials and Methods: Sixty feet of 48 patients with idiopathic clubfoot deformity were assessed in terms of FBM by podography (foot print on paper and FBM angle drawing) and radiologically; before starting treatment, after 6 weeks and at 6 monthly intervals with a maximum follow up period of 4.8 years (Range 1.2 to 4.8 years). Mean age at start of treatment was 1.5 years (2 months to 2.5 years). Functional evaluation was done by Magone’s scoring system. Results: After treatment, 92 percent patients had good correction (FBM greater than 70 degrees) which correlated well with post treatment Magone’s score of greater than 80 (good to excellent) in nearly 85 percent of cases. Radiologically, talocalcaneal angles in both the views improved in only 60 percent of cases. Conclusion: Radiological criteria show inconsistent correlation with functional outcome for feet treated by Ponseti’s Technique. Podography (FBM angle analysis) is a very simple, objective, cost effective, radiation free, easily reproducible and highly reliable clinical criterion for the assessment of deformity correction in club foot by Ponseti’s Technique with an excellent correlation with functional outcome.

Protein Mediated Oxidative Stress in Patients with Diabetes and its Associated Neuropathy: Correlation with Protein Carbonylation and Disease Activity Markers

Ebtehal Almogbel, Naila Rasheed

Introduction: Free radicals have been implicated as Diabetes Mellitus (DM) contributors in type 2 DM and its associated Diabetes Mellitus Neuropathy (DMN). However, the potential for protein mediated oxidative stress to contribute disease pathogenesis remains largely unexplored. Aim: To investigate the status and contribution of protein mediated oxidative stress in patients with DM or DMN and to explore whether oxidative protein modification has a role in DM progression to DM associated neuropathy. Materials and Methods: Sera from 42 DM and 37 DMN patients with varying levels of disease activities biomarkers (HbA1C, patients’ age or disease duration) and 21 age- and sex-matched healthy controls were evaluated for serum levels of protein mediated oxidative stress. Results: Serum analysis showed significantly higher levels of protein carbonyl contents in both DM and DMN patients compared with healthy controls. Importantly, not only was there an increased number of subjects positive for protein carbonylation, but also the levels of protein carbonyl contents were significantly higher among DM and DMN patients, whose HbA1C were =8.8 as compared with patients with lower HbA1C (HbA1C<8.8). Similar pattern of protein carbonyls formation was also observed with patients’ ages or with patient’s disease durations, suggesting a possible relationship between protein oxidation and disease progression. Furthermore, sera from DMN patients had higher levels of protein carbonylation compared with non-neuropathic DM patients’ sera, suggesting an involvement of protein oxidation in the progression of diabetes to diabetes neuropathy. Conclusion: These findings support an association between protein oxidation and DM or DMN progression. The stronger response observed in patients with higher HbA1C or patients’ ages or disease durations suggests, that protein mediated oxidative stress may be useful in evaluating the progression of DM and its associated DMN and in elucidating the mechanisms of these disorders pathogenesis.

Effect of Pneumoperitoneum and Lateral Position on Oropharyngeal Seal Pressures of Proseal LMA in Laparoscopic Urological Procedures

Preeti Rustagi, Geeta A. Patkar, Anil kumar Ourasang, Bharati A. Tendolkar

Introduction: A sustained and effective oropharyngeal sealing with supraglottic airway is required to maintain the ventilation during laparoscopic surgery. Previous studies have observed the Oropharyngeal Seal Pressure (OSP) for Proseal Laryngeal Mask Airway (PLMA) after pneumoperitoneum in supine and trendelenburg position, where PLMA was found to be an effective airway device. This study was conducted with ProSeal LMA, for laparoscopic Urologic procedures done in lateral position. Aim: To measure OSP in supine and lateral position and to observe the effect of pneumoperitoneum in lateral position on OSP. Secondary objectives were to assess adequacy of ventilation and incidence of adverse events. Materials and Methods: A total number of 25 patients of American Society of Anaesthesiologists (ASA) physical status II and I were enrolled. After induction of anaesthesia using a standardized protocol, PLMA was inserted. Ryle’s tube was inserted through drain tube. The position of PLMA was confirmed with ease of insertion of Ryle’s tube and fibreoptic grading of vocal cords. Patients were then put in lateral position. The OSP was measured in supine position. This value was baseline comparison for OSP in lateral position and that after pneumoperitoneum. We assessed the efficacy of PLMA for ventilation, after carboperitoneum in lateral position (peak airway pressure, End Tidal Carbon dioxide (EtCO2), SPO2). Incidence of adverse effects (displacement of device, gastric insufflation, regurgitation, coughing, sore throat, blood on device, trauma) was also noted. Results: The OSP was above Peak Airway Pressure (PAP) in supine (22.1±5.4 and 15.4±4.49cm of H2O) and lateral position (22.6±5.3 and 16.1±4.6). After pneumoperitoneum, which was in lateral position, there was statistically significant (p-value <0.05) increase in both PAP (19.96±4.015) and OSP (24.32±4.98, p-value 0.03). There was no intraoperative displacement of PLMA. There was no event of suboptimal oxygenation. EtCO2 was always within normal limits. Gastric insufflation was present in one patient. One patient had coughing and blood was detected on device. Three patients had throat discomfort post-operatively. Conclusion: In this study, Oropharyngeal seal pressures with PLMA were found to increase after pneumoperitoneum in lateral position. PLMA forms an effective seal around airway and is an efficient and safe alternative for airway management in urological laparoscopic surgeries done in lateral position.

Clinico-radiological Outcome Analysis of Parallel Plating with Perpendicular Plating in Distal Humeral Intra-articular Fractures: Prospective Randomised Study

Introduction: The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. Aim: To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. Materials and Methods: A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow-up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. Results: In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Conclusion: Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques.

Attitude of Reproductive Healthcare Providers to Prenatal Diagnosis in a Low Resource Nigerian Setting

Introduction: Prenatal diagnosis comprises all diagnostic modalities aimed at gaining information about the embryo or fetal wellbeing. It enables antenatal care tailored to the individual need(s) of the fetus. Aim: To determine the knowledge, practice and prospect of prenatal diagnosis among reproductive health care providers in Abakaliki, Nigeria. Materials and Methods: This was a cross-sectional descriptive study in which completely filled self-administered semi-structured questionnaires were retrieved from 182 reproductive healthcare providers at Federal Teaching Hospital, Abakaliki (FETHA). The questionnaires contained 17 items covering the socio-demographic data, knowledge, practice and prospects of prenatal diagnosis among the respondents. Result: A total of 179 respondents (98.4%) were aware of the prenatal diagnosis. One hundred and sixty four (90.1%) of the respondents agreed that, prenatal diagnostic services is offered in the study centre and 97% of these respondents cited ultrasound scan as the prenatal diagnostic investigation. While 133 respondents (73.1%) would allow parents to decide the next line of action after due counseling for the diagnosis of a condition not compatible with extrauterine life was made, 23(12.6%) of the respondents would offer termination of the pregnancy. Among the respondents, 173(95.1%) would encourage prenatal diagnosis at the study centre and 153(88.4%) of the 173 respondents would do so by educating the populace on the benefits of the procedure. However, 2(1.1%) of the respondent would not encourage the practice of prenatal diagnosis in FETHA citing adverse effects on the woman and her fetus. Conclusion: Reproductive healthcare providers in Abakaliki have a high level of awareness and favorable disposition to prenatal diagnosis. However, prenatal diagnosis is still rudimentary in this environment.

Diagnostic and Prognostic Significance of Ki-67 Immunohistochemical Expression in Surface Epithelial Ovarian Carcinoma

Asha Mahadevappa, Shruthi Mysore Krishna, Manjunath Gubbanna Vimala

Introduction: The Surface Epithelial Ovarian Carcinoma (SEOC) at the moment of diagnosis, the disease is extended beyond the structures of the pelvis. Ki-67 is one of the prognostic marker which determines the growth fraction of a tumour and its over expression is associated with malignancy, tumour aggression, reserved prognosis and metastasis. Aim: To evaluate the proliferative activity using Ki-67 immuno-staining in SEOC and to correlate with histological subtype, grade, Federation of Gynecology and Obstetrics (FIGO) stage, CA125 levels for diagnostic and prognostic purpose. Materials and Methods: The study was conducted in JSS Medical College and Hospital, JSS University, Mysuru. It was a descriptive cross-sectional study involving 40 cases of SEOC over a period of two years. The proliferation expression related to Ki-67 antigen was evaluated by immunohistochemical monoclonal MIB-1 antibody. In each case, the Ki-67 labeling index (Ki-67 LI) was articulated as percentage of positively stained cells using high power objective of the microscope (x400). Results: Among the 40 carcinomas, 26 were serous, five mucinous, four each of clear cell and undifferentiated and one transitional cell carcinoma. A total of 75% were high grade tumours. High Ki-67 LI was associated with high grade tumours (69.9%), high grade serous tumours (65.34%) and advanced FIGO staging (70.6%) with the p-value of <0.001. CA 125 levels did not have a significant correlation with Ki-67 LI. Conclusion: Ki-67 is an exceptionally a cost effective marker to determine the growth fraction of a tumour cell population. In SEOC histological grade and FIGO stage when combined with Ki-67 LI in histopathology report would help in diagnostic differentiation of subtypes, prognostication, deciding the need for adjuvant chemotherapy and in predicting survival analysis.

Fracture Resistance of Endodontically Treated Roots Restored with Fiber Posts Using Different Resin Cements- An In-vitro Study

Introduction: The influence of the remaining coronal tooth structure along with intra-radicular esthetic posts increases fracture resistance of fractured teeth especially in the anterior region. The advent of resin based luting cements improves the adhesion of fiber posts. Aim: To evaluate the fracture resistance of endodontically treated roots restored with fiber posts using different resin cements – Calibra (etch and rinse), PermaFlo® DC (self-etch primer) and SmartCem2 (self-adhesive). Materials and Methods: Extracted human maxillary central incisors having similar dimensions were decoronated at the Cemento-Enamel Junction (CEJ) to create 16mm long specimens and endodontically treated. A total of 45 teeth were divided into three groups with 15 teeth each for cementation of easy fiber posts (size1, 0.8mm diameter). Post spaces were prepared to a depth of 10mm. Group 1 – Caulk 34% phosphoric acid gel, dual cure adhesive Prime and Bond NT followed by luting of post with Calibra cement. Group 2 – Ultra – etch then Primer A and Primer B, and PermaFlo® DC was used to cement the post. Group 3 – SmartCem2 [1:1 ratio] was used to cement the post. The excess lengths of posts were seared and teeth were mounted on acrylic blocks and loaded under compressive force to the long axis of the tooth which increased in periodic pattern of 1mm/min. The value of the force at which each root section gets fractured was noted. The data were statistically analysed using ANOVA and Tukey’s Test. Results: The mean fracture load (and SD) were as follows Group 1 – 762.400 (251.490); Group 2 – 662.933 (206.709); Group 3 – 657.800 (57.372). No statistically significant differences were seen among all three Groups, p-value (0.228). Conclusion: Posts cemented using self -adhesive resin cement SmartCem2 have highest fracture resistance and bonding efficacy of self-adhesive technique showed reliably better results but was comparable to total–etch and self–etch techniques.

Amelogenin Gene - The Pioneer in Gender Determination from Forensic Dental Samples

Introduction: In the event of any mass fatality incident, DNA analysis plays a vital role in disaster victim identification. Teeth are one of the most resistant structures in the human body that resist decomposition hence making them prime choice for extracting DNA for identification of individuals. Polymerase Chain Reaction (PCR) analysis that target regions of Amelogenin gene have become the method of choice for sex determination of biological samples. Aim: Determining the sex of a given DNA sample from either dental pulp or dentin of tooth and help in identification of missing persons and disaster victims. Materials and Methods: In our study 50 teeth samples were studied and they were subjected to various environmental conditions along with freshly extracted teeth taken as control for duration of one month and three months. Pulpal tissue was retrieved from the teeth specimens by access opening of root canals and for incinerated samples, the specimens were crushed. From the DNA that was extracted from the dental pulp sample Amelogenin gene locus was used for sex determination by amplifying a segment of X-Y homologous gene locus through PCR analysis. Results: ANOVA test and t-test proved to be statistically significant and 100% retrieval rate was observed in samples. Conclusion: Pulpal tissue along with degenerating odontoblastic processes yield sufficient amount of DNA for gender determination when subjected to various forensic conditions with maximum accuracy.

Assessment of Musculoskeletal Strength and Levels of Fatigue during Different Phases of Menstrual Cycle in Young Adults

LC Pallavi, Urban John D Souza, G Shivaprakash

Introduction: Some of the physiological factors and athletic performance might show variation along the phases of menstrual cycle. The alterations seen in these physiological parameters of various systems relating to oscillations in hormonal levels do affect the autonomic nervous system and metabolic functions. Former studies heave inconclusively about the influence of hormones on exercise performance, predominantly muscle strength and rate of fatigue during different phases of the menstrual cycle. Studies regarding influence of these variations during bleeding phase were not done. Aim: To evaluate the muscle strength variations and also the rate of fatigue during various phases of the menstrual cycle in young adults. Materials and Methods: This was a prospective study conducted among 100 healthy adult female volunteers aged 18-24 years, with normal regular menstrual cycles persistent between 26- 32 days (average of 28 days), for a minimum of last 6 months. Muscle strength was assessed by calculating the work done and fatigue rate using Mosso’s ergograph and by handgrip dynamometer strength. Each subject was evaluated consecutively for two menstrual cycles in all three phases which were classified as Phase 1- Menstrual phase, Phase 2- Follicular phase and Phase 3- Luteal phase. The data obtained was analysed by statistical tool One-way ANOVA followed by a post-hoc Tukeys test. A p-value of = 0.05 was considered significant. Results: The amount of work done and handgrip strength was significantly higher in phase 2 (p<0.001) and relatively reduced in phase 1 and 3 (p<0.001) of menstrual cycle. In terms of fatigue rate percentage, phase 2 showed significantly lesser values (p<0.001) as compared to phase 1 and 3 of menstrual cycle. Conclusion: We conclude that the cyclical variation in endogenous reproductive hormones increases the muscle strength in follicular phase of the menstrual cycle. Thus provide support for the influence of these hormones in regulation of these parameters in the premenopausal age group.

A Rare Case of Successfully Treated Coombs Negative Immune Haemolytic Anaemia in Pregnancy

Immune haemolytic anaemia in pregnancy, although rare, but it can be life threatening. Severe anaemia with jaundice, unresponsive to blood transfusion can clinch the diagnosis of immune haemolytic anaemia. Our patient was a 27-year-old second gravida, with all the above features, but there was diagnostic challenge as her Coombs test was negative. A high index of suspicion and rapid response to glucocorticoids, pointed towards the diagnosis. Thereafter, the course of pregnancy and postpartum period was uneventful. Thus, successful maternal and fetal outcome can be achieved with prompt diagnosis and treatment.

Enzymatic and Non-Enzymatic Virulence Activities of Dermatophytes on Solid Media

Elangovan Elavarashi, Anupma Jyoti Kindo, Sudha Rangarajan

Introduction: Dermatophytes are keratinophilic fungi causing superficial cutaneous infections that account 20-25% of the global population. As per literature search, there is a dearth in the study on virulence factors of dermatophytes from the Indian sub-continent and moreover the association of the virulence factors and the host tissue in vitro helps in understanding the host-pathogen interaction. Aim: To analyse the enzymatic and non-enzymatic virulence activities of dermatophytes on solid media. Materials and Methods: A total of 11 isolates, three standard American Type Culture Collection (ATCC) strains- Trichophyton rubrum- 28188, Trichophyton mentagrophytes- 9533, Trichophyton tonsurans- 28942, one CBS KNAW Fungal Biodiversity Centre strain- Arthroderma grubyi- 243.66, five clinical isolates- T. rubrum, T. mentagrophytes, Trichophyton rubrum var. raubitschekii, Trichophyton interdigitale, Epidermophyton floccosum, and two laboratory isolates - Microsporum gypseum and Microsporum canis were screened for the production of virulence enzymes such as phospholipase, lipase, protease, gelatinase and non-enzyme virulence factors (haemolytic activity) of dermatophytes. The clinical isolates were identified from a tertiary care hospital, Chennai. These dermatophytes were tested upon specific substrates on solid media such as egg yolk, tween 80, bovine serum albumin, gelatin powder and sheep blood respectively. Results: The virulence activity of phospholipase, lipase, protease and gelatinase was observed from all the dermatophyte species. T. rubrum, T. rubrum ATCC strain, T. rubrum var. raubitschekii, T. mentagrophytes, T. mentagrophytes ATCC strain, T. interdigitale and A. grubyi CBS strain produced complete haemolysis, whereas other dermatophytes showed no haemolytic activity. Conclusion: Phospholipase, lipase, protease and gelatinase act as enzymatic virulence marker and the T. rubrum complex, T. mentagrophytes complex and A. grubyi showed complete haemolysis and hence they may also act as a non-enzymatic virulence marker for dermatophytes.

Profile of Tumour Necrosis Factor Alpha -308 G/A Gene Polymorphism in Psoriatic Patients in Karnataka, India

Introduction: Tumour necrosis factor-alpha (TNFa) gene -308G/A polymorphism (rs1800629) are associated with psoriasis in several populations worldwide. Presently, there is no literature on the status of this polymorphism in the South Indian population. Aim: To determine the profile of TNFa -308G/A polymorphism among psoriatic patients. Materials and Methods: This case-control study involved 74 patients with Psoriasis Vulgaris (PsV) and 74 age and gender matched healthy individuals. Patients were recruited from the Department of Dermatology of R.L. Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka, India, from March 2014 to March 2016. TNFa -308G/A polymorphism was genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. Results: The frequency of TNFa -308A allele 7.4% among psoriatic and 8.8% among non-psoriatic individuals. The difference was not statistically significant (p=0.82). Conclusion: Our results indicate that TNFa gene -308G/A polymorphism is not a significant marker for the risk of developing PsV among South Indian (Karnataka) psoriatic patients.

Inflammation and Outcome in Traumatic Brain Injury: Does Gender Effect on Survival and Prognosis?

Taraneh Naghibi, Mina Mohajeri, Faramarz Dobakhti

Introduction: Traumatic Brain Injury (TBI) accounts for the majority of trauma deaths and there has been increased interest in the understanding the role of prognostic factors. C-Reactive Protein (CRP) level increases rapidly in response to trauma. Aim: Aim of the present study was to indicate the role of CRP as a predictor of outcome in TBI patients based on their gender category. Materials and Methods: A prospective cohort study in a surgical Intensive Care Unit (ICU) in one of the Zanjan University of Medical Science hospital was designed. Fifty nine head trauma patients were divided into two groups based on their gender. Serum CRP was measured 48 hours after trauma. All data including the length of ICU stay, the duration of mechanical ventilation, the Glasgow Coma Scale (GCS) at discharge, and mortality were collected. The relationship between the clinical features and serum CRP level was also studied. Results: In the male group, CRP level was not significantly correlated with the length of ICU stay, the duration of mechanical ventilation and GCS at discharge. In the female group, CRP level was positively correlated with the length of ICU stay and the duration of mechanical ventilation; however, CRP level was not significantly correlated with GCS at discharge. These results remain constant in female sub group with severe head injury contrast to female with mild injury. Conclusion: The GCS level can predict the outcome of females with severe head injury better than females with mild head injury and males.

Morphometry of Proximal Femur in Indian Population

Introduction: Total hip arthroplasty is a commonly performed surgery now-a-day. There are regional and racial variations in the stature of the population worldwide. So there is always need of population specific data for making best fit prosthesis. Aim: The present study was done to measure the parameters of proximal femur and to analyse their correlation by using standard statistical analysis. Materials and Methods: Ninety one dry bones (44 left and 47 right) were used. Femur Head Diameter (FHD), Femur Neck Length (FNL), Femur Neck Diameter (FND), Femur Neck Thickness (FNT), Cervicodiaphyseal Angle (CDA) was directly measured with the help of anthropometric instruments. Femur Head Offset (FHO) and Vertical Offset (VO) were measured in the anteroposterior digital photographs. Result: Normally distributed variables were compared using Student t-test (Unpaired data) to analyse significant effect. There was a significant difference between right and left side of FND and CDA. Pearson correlation coefficient was used to analyse the relationship among variables. FHO had high correlation with the vertical offset (0.687, p<0.001). Conclusion: These parameters can be used for designing the prosthesis and plates for hip joint reconstructive surgeries suitable for Indian population.

Sinus Rhythm in Rheumatic Mitral Stenosis after Balloon Mitral Valvotomy: Is it Feasible?

Introduction: Atrial Fibrillation (AF) is largely present in patients with rheumatic valvular disease, leading to hospitalizations. Aim: We aimed to study the restoration and maintenance of Sinus Rhythm (SR) in rheumatic patients with Mitral Stenosis (MS) and AF after Balloon Mitral Valvotomy (BMV) and evaluated the factors which affect the maintenance of SR. Materials and Methods: A total of 50 patients who underwent BMV at U. N. Mehta Institute of Cardiology and Research Centre from 2010 November to 2013 January were included in the study. Subsequently, all patients were treated with amiodarone and electrical cardioversion was applied in patients in whom it was necessary. The patients were followed for six months for conversion and maintenance of SR. Results: Total 34 (68%) patients reverted to SR. Twelve patients reverted to SR with amiodarone and 22 patients with electrical cardioversion and amiodarone. Out of the total, 29 patients and 26 patients remained in SR at the end of follow up at 3 months and 6 months respectively. Conclusion: Smaller Left Atrial (LA) size and greater Mitral Valve Area (MVA) are the chief predictors of restoration and maintenance of SR. Combining BMV with an aggressive anti-arrhythmic strategy offers the best prospect of rhythm control.

Level of Fluoride in Soil, Grain and Water in Jalgaon District, Maharashtra, India

Introduction: Fluoride has an influence on both oral as well as systemic health. The major source of fluoride to body is through drinking water as well as through diet. Staple diet mainly depends on local environmental factors, food grains grown locally, its availability etc. Determination of fluoride level in these food grains is important. So, estimation of the amount of fluoride in grains and its relation to the sources of fluoride used for their cultivation viz., soil and water is important. Aim: To estimate the relation of fluoride concentration in grains (Jowar) with respect to that of soil and water used for their cultivation. Materials and Methods: Fifteen samples each of soil, water and grains were collected using standardized method from the same farm fields of randomly selected villages of Jalgaon district. Fluoride ion concentration was determined in laboratory using SPADNS technique. Mean difference in fluoride levels in between the groups were analyzed using ANOVA and Post-Hoc Tukey test. Linear regression method was applied to analyse the association of the fluoride content of grain with water and soil. Results: There was a significant difference in between mean fluoride levels of soil and water (p<0.001) and in between soil and grain (p<0.001); however, difference in between mean fluoride levels of water and grain was found to be non significant (p=0.591). Also fluoride levels in all the three groups showed significant association with each other. Conclusion: Fluoride level of soil, grains and water should be adjusted to an optimum level. Soil has positive correlation with respect to uptake of fluoride by Jowar grains. So, Jowar grains with optimum fluoride content should be made available in the commercial markets so that oral and general health can be benefitted.

A Comparison of Antibacterial Efficacy of 0.5% Sodium Fluoride Impregnated Miswak and Plain Miswak Sticks on Streprococcus mutans - A Randomized Controlled Trial

Introduction: Miswak (Salvadora persica) is a tooth cleaning stick made from the Salvodora Persica tree. It serves as a natural dentifrice with anti-bacterial, anti-plaque and anti-fungal properties. Fluoride, impregnated in chewing sticks will bestow comparable safety against dental caries as the fluoride containing dentifrice. Aim: The aim of the present study was to assess and compare the anti-bacterial effect of 0.5% sodium fluoride impregnated miswak and plain miswak sticks on Streptococcus mutans. Materials and Methods: A randomized controlled concurrent parallel triple blind clinical trial was conducted for a period of 8 days. The trial included 30 subjects aged 20–23 years, who were randomly allocated in 1:1 ratio to Group A [0.5% Sodium Fluoride (NaF) impregnated Miswak sticks) and Group B (Plain Miswak sticks) respectively. The participants were instructed to chew miswak sticks for 6 minutes in the morning before breakfast. Unstimulated saliva was collected at baseline and after chewing miswak sticks to estimate S. mutans count using Mitis Salivarius Bacitracin agar. Data was statistically analyzed using paired and unpaired t-test. Results: A statistically significant reduction in S. mutans Colony Forming Units (CFU) count in saliva was observed after using fluoridated miswak sticks compared to the baseline count (p=0.001). There was no significant difference in anti-bacterial effect of fluoridated miswak sticks and plain miswak sticks on S. mutans count (p=0.58). Conclusion: The efficacy of miswak impregnated with 0.5% NaF and plain miskaw sticks in reducing S. mutans counts in saliva is analogous.

Golden Hours in Severe Paraquat Poisoning-The Role of Early Haemoperfusion Therapy

Raghavendra Rao, Rama Bhat, Swathi Pathadka, Sravan Kumar Chenji, Savio Dsouza

Introduction: Paraquat is a commonly ingested poison especially in Southern India. There is no antidote for paraquat poison and consumption is often fatal. The usual cause of death is either acute lung injury or multi-organ failure. Aim: To evaluate the role of early haemoperfusion as a therapy in paraquat poisoned patients. Materials and Methods: This study was a retrospective analysis of patients admitted to a Tertiary Medical College Hospital between January 2012 and December 2015 with history of paraquat consumption, comparing outcomes in those who received only gastric lavage and symptomatic treatment with those who received haemoperfusion as a therapy. The role of early haemoperfusion (= 6 hours) vs late haemoperfusion (> 6 hours) in paraquat poisoned patients was also compared. The data of these patients was extracted and analysed with respect to age, sex, mode of treatment, the outcome in patients who received early and late haemoperfusion. Results: A total of 101 patients were studied out of which 62 died. Deaths were more in those patients who received only gastric lavage with symptomatic treatment as therapy compared to those who received haemoperfusion i.e., 92.1% vs 42.9% respectively. We also found that, the survival rate was better in patients who received early haemoperfusion. Conclusion: Early haemoperfusion was helpful in the management of severe paraquat poisoning and improved the survival rate in these patients.

A Comparative Study of the Quality of Apical Seal in Resilon/Epiphany SE Following Intra canal Irrigation With 17% EDTA, 10% Citric Acid, And MTAD as Final Irrigants – A Dye Leakage Study Under Vacuum

Introduction: Adequate apical sealing ability of the root canal filling material is an essential requisite for a successful endodontic therapy. Various endodontic irrigants are used for the removal of smear layer before obturating with a solid core material, thereby, reducing microleakage and improving apical seal. Resilon, a synthetic material was developed as an alternative to replace the conventional gutta-percha (standard root canal filling material) and traditional sealers for the obturation of endodontically treated teeth. Aim: To evaluate and compare in-vitro, the post obturation apical seal obtained with Resilon /Epiphany SE (Self Etch) sealer following irrigation with 17% Ethylenediamine Tetra-Acetic Acid (EDTA), 10% citric acid, and MTAD (a mixture of doxycycline, citric acid, and a detergent, Tween 80), as final irrigants in combination with Sodium hypochlorite (NaOCl) using dye leakage under vacuum method. Materials and Methods: Fifty five single rooted human maxillary central incisors were subjected to root canal instrumentation. Based on the final irrigation solution, samples were divided into three experimental groups (n=15); (I) 17% EDTA + 1.3% NaOCl, (II) 10% citric acid + 1.3% NaOCl, (III) MTAD + 1.3% NaOCl and two control groups (positive and negative) with 0.9% normal saline as a final irrigant. The samples were obturated with resilon/epiphany SE sealer according to manufacturer instructions and placed in 2% rhodamine B dye solution under vacuum pressure for 30 minutes and allowed to remain in the dye for seven days. All samples were then longitudinally split and examined for dye leakage under stereomicroscope and the data were statistically analysed using one-way ANOVA and post hoc tukey test. Results: Statistically significant difference (p=0.001) was observed in the mean apical leakage between the experimental and the control groups. However, there was no significant difference (p>0.05) observed in the mean apical leakage amongst the three experimental groups. Conclusion: 17% EDTA, 10% citric acid, and MTAD were equally effective in achieving the post-obturation apical seal with resilon/epiphany SE sealer when used as a final irrigant in combination with NaOCl.

Antimicrobial Resistance Surveillance among Intensive Care Units of a Tertiary Care Hospital in South India

Introduction: Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Aim: To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them. Materials and Methods: The record based retrospective data of culture reports of the patients admitted to all the ICUs of JIPMER during the period from April 2015 to March 2016 were collected. A total of 3,090 isolates were obtained from the clinical specimens of 1,244 patients. Data on various factors like demographic characters, type of ICU, infecting organism, site of infection, type of HAI’s and AMR including co-resistance were collected and analysed using Microsoft Excel. Results: Most common culture positive clinical specimen received was tracheal aspirate (29.9%) followed by exudate (22.7%). Acinetobacter spp from tracheal aspirate and Pseudomonas spp from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 22.2% infections were HAIs, out of which pneumonia (6.24%) was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli (GNB) was Multi Drug Resistant (MDR) i.e., resistant to three or more class of antibiotics such as cephalosporins, carbapenems, aminoglycosides, tetracyclines and fluoroquinolones. The prevalence of Methicillin- resistant Staphylococcus aureus (MRSA) and Vancomycin- resistant Enterococci (VRE) were found to be 40.6% and 11.9% respectively. Conclusion: The increasing trend AMR among the hospital acquired pathogens such as MDR-GNBs, MRSA and VRE pose a great threat to HCWs as well as to the other critically ill patients of the ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. It also guides the clinicians to choose appropriate empirical therapy and assist escalation and de-escalation wherever possible. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial use.

Perception of Learning Environment among Undergraduate Medical Students in Two Different Medical Schools through DREEM and JHLES Questionnaire

Parama Sengupta, Abhishek Sharma, Nina Das

Introduction: Assessment of learning environment is essential to assess the acceptability of the curriculum among students. Several tools are available to assess undergraduate medical students’ perception of learning environment. Dundee Ready Education Environment Measure (DREEM) questionnaire is the most commonly used tool. Here, we have used both the widely used DREEM questionnaire and a relatively new questionnaire Johns Hopkins Learning Environment Scale (JHLES). Aim: Assessment of students’ perception of learning environment of two eastern Indian medical schools using DREEM and JHLES questionnaire. Materials and Methods: In this cross-sectional questionnaire based study, 200 students from Nil Ratan Sircar Medical College (NRSMC) and 78 students from College of Medicine and Sagore Dutta Hospital (CMSDH) of 5th semester batch duly completed the two questionnaires, DREEM scale and JHLES tool. The DREEM questionnaire has 50 questions arranged in five domains. The JHLES questionnaire has 28 questions arranged in seven domains. Comparison of scores between the two colleges was done by unpaired t-test. Results: There were altogether 100 female and 178 male participants with mean age of 20.46±0.67. There were no significant difference between the overall DREEM score (p=0.81) and the JHLES scores (p=0.10) obtained from NRSMC and that obtained from CMSDH. Analysis of individual domain scores on DREEM scale revealed that there were no significant differences in domain scores for the two medical schools except for Students’ Perception of Atmosphere (SPA) score (p=0.0086). JHLES revealed significant differences in terms of engagement, inclusion and safety, and physical space (p<0.001). The DREEM and JHLES results revealed positive correlation (r=0.59). Conclusion: Both DREEM and JHLES scores revealed comparable results from two schools with positive correlation between DREEM and JHLES tools, however some areas with low scores require modification especially the domain assessing Students’ Academic Self-Perception (SASP) and Students’ Social Self Perceptions (SSSP).

A Study of Haematological and Haemostasis Parameters and Hypercoagulable State in Tuberculosis Patients in Northern India and the Outcome with Anti-Tubercular Therapy

Aditya Singh Kutiyal, Naresh Gupta, Sandeep Garg, Harmanjit Singh Hira

Introduction: Tuberculosis is one of the leading infectious diseases with high morbidity and mortality in the developing countries. Tuberculosis is also rarely associated with hypercoagulable state and very limited literature is available on this association. Aim:To study the haematological and haemostasis laboratory parameters, to correlate the abnormalities for a hypercoagulable state and to study the outcome with anti-tubercular therapy. Materials and Methods: The study population included 128 patients with newly diagnosed tuberculosis. Anti-tubercular therapy naïve patients were studied for haemostasis parameters like Prothrombin time, Activated Partial Thromboplastin time, Factor VIII, Fibrinogen and D-dimer and haematological parameters like Haemoglobin, White Blood Cells, Platelet count, Erythrocyte Sedimentation Rate (ESR), Lactate Dehydrogenase, C-reactive protein and albumin. At the end of the second month of anti-tubercular therapy, results were compared and analysed using statistical package for the social sciences software (SPSS). Results: Prothrombin levels were deranged in 50%. Activated Partial Thromboplastin time levels were deranged in 18%. Deranged Factor VIII levels were found in 35.15%. Fibrinogen levels were deranged in 57%. D-Dimer positivity was found in 57.8% patients. Anaemia was found in 75.78%, Leukocytosis in 49.21%, Thrombocytopenia in 37.5% and Hypoalbuminaemia in 75%. ESR levels were raised in 98.43%. Follow up comparison analysis revealed significant p-value for all the parameters except Factor VIII and Activated Partial Thromboplastin time. Similar trend was also observed within different groups of Tuberculosis patients. Conclusion: Tuberculosis does favour a hypercoagulable state with increased risk of developing thrombosis and significant improvement with the anti-tubercular treatment alone.

TRUS Biopsy Yield in Indian Population: A Retrospective Analysis

Introduction: The reported cancer detection rate of Trans-Rectal Ultrasonography (TRUS) biopsies (TRUS biopsy yield) has been around 30 percent in western countries. However it is much lower in Asian countries, including India. Hence a larger proportion of patients in India undergo unnecessary biopsies. Aims: To find out the cancer detection rate of TRUS biopsy (TRUS biopsy yield) in contemporary Indian population. Also, to study the positive predictive values at different serum Prostate-Specific Antigen (PSA)/PSA Density (PSAD) cut off levels and suspicious Digital Rectal Examination (DRE) findings. Materials and Methods: This retrospective study was carried out in a tertiary care institute. All symptomatic patients who underwent TRUS guided biopsy for indication of raised serum PSA level (>4 ng/ml) or suspicious DRE findings (nodule, irregularity, hard consistency, immobile rectal mucosa) from January 2012 to December 2014 were included. For serum PSA range (4-10) ng/ml, TRUS guided biopsy was done in patients with percent free/total PSA < 25. Statistical analysis used were Chi-square test, Mann-Whitney U-test, Spearman’s rank correlation analysis and Receiver-Operating Characteristic (ROC) curve. Results: Out of the 235 patients included, 60 patients had malignancy (overall cancer detection rate= 25.53%). The cancer detection rate for PSA ranges of (4-10) and (10-20) ng/ml was as low as 5.95% and 13.16% respectively. Patients with malignant disease had significantly smaller prostate gland size than patients with benign disease (53.89 vs 63.06; p-value <0.05). On the other hand, cancer detection rate was 100% for PSA greater than 50ng/ml. The cancer detection rates were only upto 10% for PSA density ranges upto 0.25 ng/ml/cm3. The Area Under the Curve (AUC) for PSA and PSAD was 0.876 and 0.884 respectively. Only one patient (0.43%) had post-biopsy complication (acute bacterial prostatitis) requiring hospital admission. Conclusion: The current serum PSA and PSAD cut offs of 4 ng/ml and 0.15 ng/ml/cm3 need to be raised for Indian population to increase its positive predictive value. Prospective study validation of this finding is lacking.

Awareness of Dental Trauma Management among School Teachers of Kannur, Kerala, India

Introduction: Dental trauma can overtake dental caries and periodontal disease as the most significant threat to dental health among young people. The prognosis of traumatized teeth depends on prompt and appropriate treatment. The role of school teachers in the prevention of traumatic dental injuries is a topic that has received a great deal of attention in recent years. However, studies conducted in different regions of the world have demonstrated that teachers and other lay people’s knowledge about traumatic dental injuries is inadequate and their behavior does not contribute to reduce the sequelae. Aim: The purpose of this study was to evaluate the knowledge of school teachers about dental trauma and its management in Kannur district. Materials and Methods: The survey was conducted under the Department of Paedodontics and Preventive Dentistry; Kannur Dental College among 303 school teachers randomly selected from 16 schools. Four schools were selected from 16 schools using stratified cluster sampling technique. A cross sectional study design was used. A stratified cluster sampling method was done to select the study subjects. The nature and purpose of the study was first explained to the teachers in local language. Following this the printed questionnaire was distributed to school teachers. The questionnaire was prepared based on the needs of the study after referring similar questionnaires used in studies conducted in different parts of the world. Results: A statistically significant association was found between the teacher’s knowledge regarding trauma and their teaching experience. Out of the total school teachers who participated in the study, 90.1% responded correctly that the teeth most frequently affected by traumatic accidents are the upper front teeth. Nearly 23.4% responded correctly regarding management of traumatic tooth fracture. Almost 46.5% had correct knowledge regarding the reimplantation of avulsed permanent teeth. Only 14.2% responded correctly to the proper storage medium for avulsed teeth. Conclusion: It was concluded from the study that among the school teachers surveyed there was significantly very low knowledge of emergency management of dental trauma.

Comparison of Cone Beam Computed Tomography and Multi Slice Computed Tomography Image Quality of Human Dried Mandible using 10 Anatomical Landmarks

Samira Saati, Fatemeh Kaveh, Shiva Yarmohammadi

Introduction: Cone Beam Computed Tomography (CBCT) has gained a broad acceptance in dentomaxillofacial imaging. Computed Tomography (CT) is another imaging modality for diagnosis and preoperative assessments of the head and neck region. Aim: Considering the increased radiation exposure and high cost of CT, this study sought to subjectively assess the image quality of CBCT and Multi Slice CT (MSCT). Materials and Methods: A dry human mandible was scanned by five CBCT systems (New Tom 3G, Scanora, Cran ex 3D, Promax and Galileos) and one MSCT system. Three independent oral and maxillofacial radiologists reviewed the CBCT and MSCT scans for the quality of 10 landmarks namely mental foramen, trabecular bone, Periodontal Ligament (PDL), dentin, incisive canal, mandibular canal, dental pulp, enamel, lamina dura and cortical bone using a five-point scale. Results: Significant differences were found between MSCT and CBCT and among the five CBCT systems (p<0.05) in visualization of different anatomical structures. A fine structure such as the incisive canal was significantly less visible and more variable among the systems in comparison with other anatomical landmarks such as the mental foramen, mandibular canal, cortical bone, dental pulp, enamel and dentin (p<0.05). The Cranex 3D and Promax systems were superior to MSCT and all other CBCT systems in visualizing anatomical structures. Conclusion: The CBCT image quality was superior to that of MSCT even though some variability existed among different CBCT systems in visualizing fine structures. Considering the low radiation dose and high resolution, CBCT may be beneficial for dentomaxillofacial imaging.

Estimation of Serum Protein in Oral Potentially Malignant Disorders and Oral Malignancy – A Cross-Sectional Study

Chandramani B More, Palak H Shah, Rashmi Venkatesh

Introduction: In carcinogenesis, increased oxidative stress and weakened antioxidant defense produces damage to the macromolecules like proteins. Thus, protein can act as potential biomarker in oral premalignant and malignant lesions. Aim: To determine and compare the levels of serum proteins in Oral Submucuous Fibrosis (OSMF), Oral Leukoplakia (OL), Nicotina Stomatitis (NS), Oral Malignancy (OM) and Healthy Controls (HC). Materials and Methods: A total of 250 participants, were equally divided in five groups i.e., OSMF, OL, NS, OM and HC. Five ml of blood was collected from antecubital vein from each participant. The serum was analyzed for total protein, albumin and globulin levels using EBRA EM 200 semi-quantitive analyzer with the help of diagnostic kits. Results: There were total 193 males and 57 females, who were between 18 to 82 years of age, with a mean of 46.32±13.89 years. The serum protein and globulin levels were significantly decreased in OSMF, OL and NS and increased in OM as compared to HC (p<0.001). No statistically significant difference was found in serum albumin levels between the study groups (p>0.05). Conclusion: Serum proteins can be used as diagnostic and prognostic marker for oral premalignant and malignant lesions.

Perception of Acceptable Range of Smiles by Specialists, General Dentists and Lay Persons and Evaluation of Different Aesthetic Paradigms

Introduction: One of the most important goals of restorative dentistry is to restore the patient’s aesthetic. Smile analysis is subjective and it differs from person to person. An aesthetic smile involves a harmonious relationship between various parameters including the hard and soft tissues. Aim: The aim of the study was to identify the acceptable range of several smiles (alone and in conjunction with the face) by specialists, general dentists as well as lay persons; and to identify the values of different criteria i.e., the Golden Proportion (GP), the Recurrent Esthetic Dental proportion (RED), Width to Height ratio (W/H ratio), the Apparent Contact Dimension (ACD), and lateral incisor position in a smile. Materials and Methods: Hundred photographs of 50 subjects were taken, 50 of the smile alone and 50 of the individual’s frontal view of face. The photographs of the smiles and the faces were assessed for the aesthetic acceptability by 30 evaluators including 10 specialists with advanced training, 10 general dentists and 10 lay persons. Irreversible hydrocolloid impressions were made of the dentitions of all the individuals using stock trays and were poured in dental stone. Measurements were made on the facial surface of the teeth on the models and were recorded in millimeters using a sharp tipped digital vernier calliper. Data was analyzed to evaluate the presence of different parameters assessed in the smiles. Mean and standard deviation values for the percentage of only the agreeable smiles were calculated in both individual smile analysis and in conjunction with the face. The non agreeable smiles were excluded from further statistical analysis. Pearson Correlation Coefficient was calculated to compare the values obtained in all the three groups. Results: More number of smiles were considered agreeable by the general dentists when compared to the specialists and the number even increased in case of evaluation by lay persons. Greater number of smiles was found to be agreeable when they were evaluated in conjunction with the face. Conclusion: Rather than assessment of individual numeric parameter that defines an ideal aesthetic smile, a smile to be aesthetic should harmonize with the composition of the face.

Levels of Apolipoprotein A1, B100 and Lipoprotein (a) in Controlled and Uncontrolled Diabetic Patients and in Non-Diabetic Healthy People

Introduction: Diabetes Mellitus (DM) is always a multifactorial metabolic disorder having a wide range of abnormalities in carbohydrate, lipid and protein metabolism. Dyslipidemia is a natural process of DM causing abnormal variations of different lipoproteins and it is one of the significant risk factors for Cardiovascular Disorder (CVD). There is a need to closely evaluate newer approaches in case of DM because even if dyslipidemia is treated, there is always a risk of CVDs in DM patients because of the hyperglycemia itself. So, lipid abnormalities should be assessed aggressively and treated as part of diabetes care. Apolipoprotein B100 (Apo B100), Apolipoprotein A1 (Apo A1) and Lipoprotein (a) {Lp(a)} are newer markers which are always welcome and necessary as many of the reported cases with normal conventional lipid profile have developed cardiac events. Aim: Study the correlation between glycemic control and the levels of Apo A1, Apo B100 and Lp(a). Materials and Methods: Total 56 patients of (DM) diagnosed on the basis of American Diabetic Association guidelines were recruited, out of which 28 were identified as uncontrolled-diabetic patients and remaining 28 as controlled-diabetics on the basis of Glycosylated HbA1c (HbA1c). The control group consisted of normal healthy 28 individuals. Apo B100, Apo A1 and Lp(a) along with traditional lipid profile, FBS and HbA1c were estimated in all the subjects. Results: Apo B100/Apo A1 ratio and Lp(a) levels showed highly significant difference (p-value <0.001) between uncontrolled diabetics, controlled diabetics and healthy Controls. Apo B100/Apo A1 ratio and Lp(a) showed significant positive correlations with HbA1c (r= 0.494, p <0.0001) and with each other. Conclusion: Apo B100/Apo A1 ratio and Lp(a) show a highly significant positive relationship with glucose tolerance of the patients as reflected in the HbA1c values. If proper glycemic control is maintained, the levels of Apo B100/Apo A1 ratio and Lp(a) can be controlled as reflected by the lower levels of these parameters observed in controlled diabetics in comparison to uncontrolled diabetics.

Application of Sigma Metrics and Performance Comparison Between Two Biochemistry Analyser and a Blood Gas Analyser for the Determination of Electrolytes

Yasemin Ustundag-Budak, Kagan Huysal

Introduction:Electrolytes have a narrow range of biological variation and small changes are clinically significant. It is important to select the best method for clinical decision making and patient monitoring in the emergency room. The sigma metrics model provides an objective method to evaluate the performance of a method. Aim: To calculate sigma metrics for electrolytes measured with one arterial blood gas analyser including two auto-analysers that use different technologies. To identify the best approach for electrolyte monitoring in an emergency setting and the context of routine emergency room workflow. Materials and Methods: The Coefficient of Variation (CV) was determined from Internal Quality Control (IQC). Data was measured from July 2015 to January 2016 for all three analysers. The records of KBUD external quality data (Association of Clinical Biochemists, Istanbul, Turkey) for both Mindray BS-2000M analyser (Mindray, Shenzhen, China) and Architect C16000 (Abbott Diagnostics, Abbott Park, IL) and MLE clinical laboratory evaluation program (Washington, DC, USA) for Radiometer ABL 700 (Radiometer Trading, Copenhagen, Denmark) during the study period were used to determine the bias. Results: The calculated average sigma values for sodium (-1.1), potassium (3.3), and chloride (0.06) were with the Radiometer ABL700. All calculated sigma values were better than the auto-analysers. Conclusion: The sigma values obtained from all analysers suggest that running more controls and increasing the calibration frequency for electrolytes is necessary for quality assurance.

Evaluation of HiaureusTM Coagulase Confirmation Kit in Identification of Staphylococcus aureus

Introduction: Staphylococcus aureus is a facultative anaerobic Gram positive coccal bacterium whose incidence ranges to different infections. It is a cause of various uncomplicated skin infections, abscesses, septicaemia/bacteraemia, gastroenteritis, endocarditis, toxic shock syndrome and food intoxications. Various methods with varied time, sensitivities, specificities and costs are available, but may not be used as a reliable test for the identification and differentiation of S. aureus. Therefore, there is a need to evaluate newer tests. Aim: To compare the conventional tests with a commercial available kit for reliable, cost effective identification and confirmation of S. aureus. Materials and Methods: The current prospective study was conducted in the Department of Clinical Pathology, Haffkine Institute for a period of six months. A total of 341 clinical isolates of staphylococci isolated from pus, urine, blood culture and sterile body fluids were subjected to conventional tests like Tube Coagulase Test (TCT) using Rabbit Plasma (RP) and Human Plasma (HP), culture media such as Mannitol Salt Agar (MSA) and Deoxyribonuclease (DNase) media in parallel to HiaureusTM Coagulase Confirmation Kit (HACCK), a commercially available kit for identification of S. aureus. Amplification of the femA gene was used as a comparative reference point test to calculate the sensitivity, specificity and concordance values of the conventional tests. Results: Amongst the coagulase based tests, HACCK was 100% sensitive and specific. The TCT using RP was 98.58% sensitive while TCT using HP was less sensitive (95.37%). A total of 100% specificity was observed for TCT using RP while TCT using HP was 96.68% specific. The MSA and DNase media were 97.86% vs 96.44% and 96.67% vs 91.67% sensitive and specific respectively. The combination tests had varying sensitivity and specificity ranges. The HACCK demonstrated 100% concordance with femA amplification and was labelled as an ideal perfect test (?=1) with MSA as an alternative test for S. aureus identification. Conclusion: The HACCK can be used as an exclusive, reliable and cost effective test for identification of S. aureus. Alternatively, in view of the cost factor MSA either as a single test or in combination with TCT using HP could be used as screening tests and confirm discordant results with HACCK.

Biometrics of Pyramidalis Muscle and its Clinical Importance

Sushant Swaroop Das, Sandeep Saluja, Neelam Vasudevava

Introduction: Pyramidalis is classified as a vestigial muscle which is frequently present. It is muscle of the anterior abdominal wall. It is thought to tense the linea alba. It has been used as a surgical landmark, source of muscle stem cells and in various surgical procedures. Aim: The aim of this study was to describe the morphometry and morphology of pyramidalis muscle in an adult Indian population and its correlation with the clinical significance. Materials and Methods: A cadaveric study on 25 formalin fixed cadavers (males-17, females-8) was conducted in context with prevalence, morphology and morphometry of pyramidalis muscle. Statistical analysis was done using the Chi-Square test and student’s t-test using SPSS version 23. Results: The pyramidalis muscle was present in 92% cases, usually bilaterally (72%) than unilaterally (20%) and more frequently in males (94.11%) than in females (87.5%). This study was conducted in Department of Anatomy, Maulana Azad Medical College, New Delhi, India from August 2014 to August 2016. Bilateral asymmetry was reported. The mean length of the muscle in males and females was 52.21±14.32 and 50.13±13.62mm on the right and 53.97±15.11 and 51.22±13.78mm on the left side. No significant gender predominance existed on the right and left-sided pyramidalis lengths. The mean width of the right-sided pyramidalis in males and females was 18.35±5.15 and 17.05±4.99mm and the left-sided was 17.8±4.80 and 16.21±4.23mm without gender dimorphism. The mean thickness of the right-sided pyramidalis in males and females was 4.91±1.33 and 4.53±1.29mm and the left-sided 4.33±1.28 and 4.38±1.27mm without gender differences. The mean pyramidalis-puboumbilical index was 35.15±4.38%, 36.01±4.97% in males and females respectively. No anatomical variations with regard to origin and insertion were seen. Conclusion: This study provides valuable information on pyramidalis muscle which may help in appropriate understanding of anatomy, functions and clinical significance of the muscle.

Fungal Opportunistic Pneumonias in HIV/AIDS Patients: An Indian Tertiary Care Experience

Introduction: Opportunistic pneumonias are a major cause of mortality and morbidity in Human Immunodeficiency Virus (HIV) reactive patients. Despite the significant role that fungi play in causation of this opportunistic mycoses, very few Indian studies have attempted to investigate the burden and aetiological spectrum of HIV/AIDS-associated fungal pneumonias. Aim: To document the prevalence of fungal aetiology in HIV/AIDS-related opportunistic pneumonias in an Indian setting; and to elucidate the various fungal opportunists responsible for the same. Materials and Methods: The present study was a prospective, cross-sectional analysis conducted at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from October 2008 to September 2011. Expectorated sputa were collected from 71 HIV reactive patients with a clinical diagnosis of pneumonia and subjected to direct microscopic examination employing Gram stain, 10% KOH wet mount and India ink preparation. In addition, direct immunofluorescence of sputum samples was performed for detection of cysts and trophozoites of Pneumocystis carinii. Also, each sputum sample was inoculated in duplicate onto Sabouraud Dextrose Agar (SDA) for culture. A blood sample was drawn from each patient and a battery of serological tests was performed, including Cryptococcal Antigen Latex Agglutination System (CALASTM) for detection of cryptococcal capsular polysaccharide antigen; Platelia™ Aspergillus EIA for detection of Aspergillus galactomannan antigen; SERION ELISA antigen Candida for detection of Candida antigen and Histoplasma DxSelect™ for detecting antibodies to Histoplasma species. Descriptive statistics were employed to depict results as proportions and figures. Further, arithmetic mean and standard deviation were calculated for central tendencies and median for non-normal/skewed distributions. Results: A definite fungal aetiology was established in 25 (35.2%) of 71 HIV reactive patients with pneumonic involvement. Of these, sputa of 21 patients yielded single fungal isolates, while mixed fungal isolates were reported in four patients. Pneumocystis carinii was the predominant fungal pathogen isolated in our study and was reported in 14 (19.7%) patients. Pulmonary aspergillosis was reported in 7 (9.9%) patients, with Aspergillus flavus (4), Aspergillus fumigatus (2) and Aspergillus niger (1) being the commonly recovered Aspergillus species. Candida pneumonia was documented in 6 (8.5%) patients and the Candida species isolated included Candida albicans in four, Candida glabrata in one and Candida tropicalis in one of these six patients respectively. Pulmonary cryptococcosis was diagnosed in 2 (2.8%) patients; a coexisting cryptococcal meningitis was documented in one of them. Furthermore, antibodies against Histoplasma species were detected in 21 (29.6%) cases suggesting its possible aetiological role. Conclusion: Fungal opportunistic pneumonias are common in HIV reactive patients in Indian setting and warrant a prompt and accurate diagnostic evaluation in the form of a combination of microbiological, serological and histopathological techniques, for an effective prophylactic and therapeutic management.

Anthropometric Basis of Vertical Jump Performance: A Study in Young Indian National Players

Introduction: Vertical Jump (VJ) is a good measure of athletic performance and occupational activities. Earlier studies reported conflicting results on anthropometric influence. Aim: To evaluate the relationship between anthropometric characteristics and VJ in national level hockey and cycling players. Materials and Methods: Fifty four (32 males) national level hockey and cycling players of 11-21 years were the volunteers. Following standard protocols, these variables were measured: VJ, Weight (WT), Height (HT), Trochanterion-Height (TH), Sum of Skinfold Thickness (SSF), Lengths [Acromiale-Stylion (AS) and Midstylion-Dactylion (SD)], Breadths [Biacromial (AB), Biiliocristal (IB), Biepicondylar Humerus (HB) and Biepicondylar Femur (FB)], Girths [Relaxed Arm (AG), Mid Thigh (TG) and Calf (cg )], Lower Back and Hamstring Flexibility (sr ), Grip [Left Hand Grip (LHG) and Right Hand Grip (RHG)] and Back Strength (BS). International Society for the Advancement of Kinanthropometry (ISAK) procedures were followed for anthropometric variables measurement. Unpaired-t-test was used for comparison between genders. Pearson’s correlation and multiple regression analysis were used to evaluate correlates and predictors of VJ respectively. Results: Males had significantly higher VJ, HT, SD, AB and BS; but lower SSF, AS and TG. VJ correlated positively with age, WT, HT, SD, TH, girths, SR and strength among males; but only with WT and LHG among females. After controlling gender, TH and LHG predicted VJ significantly with 69% of total variance. HT, SSF and BS; and LHG were the significant predictors among males and females respectively. Conclusion: Anthropometric and physiological variables like TH, grip, HT, skinfold and BS had major influence on VJ. The result might help in training-monitoring and player’s selection.

Cardiac Effect of Interstitial Lung Disease Correlated with Spirometry and Six Minute Walk Test

Mitali Bharat Agrawal, Nilkanth Tukaram Awad

Introduction: The cardiac effect of different pulmonary functions, six minute walk distance, arterial blood gases and saturation in Interstitial Lung Disease (ILD) is not much known. So this study, a tertiary care hospital experience that entails to know the various factors in Pulmonary Hypertension (PH) mentioned above causing PH and their correlation with PH. Aim: To study the correlation of PH in patients with ILD with spirometry and six minute walk test (6MWT) Materials and Methods: All consecutive patients with confirmed diagnosis of ILD taken over a period of 1½year in tertiary care hospital. 6MWT and spirometry were performed as per the American Thoracic Guidelines. Percent predicted 6 minute walk distance was calculated using Enright et al., and Indian reference equation. PH was diagnosed using 2-D echo. The spirometry variables and 6MWT were then correlated with the mean pulmonary artery pressure. Results: There were 75 patients. About 66.66 % had PH on 2-D echo. The mean% predicted six minute walk distance as per the Indian reference equation, pre- and post- exercise PaO2 as well as desaturation had a significant correlation with PH. Spirometry variables Forced Expiratory Volume in First Second (FEV1) and Forced Vital Capacity (FVC) did not correlate with PH. Conclusion: Thus, the 6MWT correlated significantly with PH while spirometry did not.

Effect of Antioxidants (ß-mercaptoethanol and Cysteamine) on Assisted Reproductive Technology In vitro

Introduction: Oocyte Culture of Germinal Vesicle (GV) and its growth improves Assisted Reproductive Technology (ART) invitro and infertility. Inappropriate culture medium environment, low quality of oocytes, increase in Oxidative Stress (OS) events, Reactive Oxygen Species (ROS) and free radicals production are the main factors that result in unsuccessful Invitro Maturation (IVM) and decrease in reproduction. Aim: The present study was conducted with the aim to evaluate the effect of ß-mercaptoethanol (BME) and Cysteamine (CYS) on IVM improvement, embryo fertilization and development of blastocyst of mouse immature oocyte. Materials and Methods: Oocytes were obtained from 4-6 weeks old Naval Medical Research Institute (NMRI) female mice, 48 hours after stimulation with Intraperitoneal (IP) injection of 10 IU Pregnant Mare Serum Gonadotropin (PMSG). GV oocyte with and without cumulus cells were isolated from ovaries and cultured in Tissue Culture Medium (TCM) 199 with availability of 100 µM of antioxidants (BME and CYS). After 24 hours, mature oocyte in metaphase II (MII) were fertilized with sperm in In vitro Fertilization (IVF) medium (T6) and evaluated for fetal development into blastocyst. Results: BME and CYS could significantly (p<0.05) increase the rate of IVM and oocyte evolution, and embryo formation in medium culture. Furthermore, it is demonstrated that existence of Cumulus Oocyte Complexes (COC) significantly showed better IVM, fertilization and evolution trend as compared to oocytes without cumulus cover or Denuded Oocytes (DO), especially in TCM199 plus BME and CYS. So that the change in GV stage oocytes to MII (maturation rate), fertilization rates or 2PN formation, and two cell embryos formation or blastocyst development rate in the treatment group with addition of BME & CYS and COC was statistically significant as compared to the DO group (p-value < 0.0001). Conclusion: Both cellular and environmental factors could be important and involved in ART improvement.

Computed Tomographic Evaluation of Condylar Symmetry and Condyle-Fossa Relationship of the Temporomandibular Joint in Subjects with Normal Occlusion and Malocclusion: A Comparative Study

Introduction: The relationship of the condyle and the mandibular fossa differs in shape with type of malocclusion and skeletal pattern. A review of literature shows till date there are no studies on Temporomandibular Joint (TMJ) condyle-fossa relation to the type of malocclusion based on growth pattern. Computed Tomography (CT) provides optimal imaging of the osseous components of the TMJ. Aim: The purpose of this study was to investigate the condyle-fossa relationship and the dimensional and positional symmetries between the right and left condyles in subjects with normal occlusion and malocclusion in different growth patterns utilizing the CT scans of the TMJ. Materials and Methods: Sixty subjects with age group of 18-30 years were selected for the study. The sample was divided into three groups based on overbite and growth pattern. The groups included 20 subjects with normal occlusion and average growth pattern, 20 patients with horizontal growth pattern and deep bite, 20 patients with vertical growth pattern and deep bite. The depth of the mandibular fossa, the condyle-fossa relationship, and the concentric position of the condyles were evaluated by the images obtained from the sagittal slices. ANOVA was performed to assess the significance. If it was found significant, post-hoc Tukey’s test was performed to see which two groups were statistically significant. Results: No statistically significant difference was found in the anterior joint space and the superior joint space in horizontal and vertical growers with deep bite. Statistically significant (p <0.05) posterior positioning of the condyles was observed (nonconcentric positioning) in vertical growers with deep bite. Conclusion: There is a significant change in the position of the condyle in vertical growers compared to average and horizontal growers. Left condyle is more anteriorly placed than the right condyle in all the three groups. There is no significant change in the vertical depth of the mandibular fossa in all the three groups.

Evaluation of Cyclin D1 Expression in Head and Neck Squamous Cell Carcinoma

Vishal Dhingra, Jyoti Verma, Vatsala Misra, Sapan Srivastav, Faheema Hasan

Introdution: Squamous Cell Carcinoma (SCC) is an aggressive epithelial malignancy of the upper aero digestive tract and comprises 90% of all Head and Neck Squamous Cell Carcinoma (HNSCC). It is the sixth leading cancer worldwide with approximately 600,000 cases reported annually. It is one of the most common cancers in India. Tumour Lymph Node and Metastases (TNM) staging has been the most useful indicator to predict prognosis in HNSCC but recently various biomolecular markers have potentially offered new methods for early diagnosis and treatment alternatives for HNSCC patients; one amongst them being cyclin D1. Aim: This study has been undertaken to evaluate expression of cyclin D1 in HNSCC cases and to find out its association with various pathological prognostic factors. Materials and Methods: A 48 formalin fixed paraffin embedded tumour sections, stained with Haematoxylin & Eosin were graded and staged. Immunohistochemistry for cyclin D1 was evaluated as Extent Score (ES), Intensity Score (IS) and Total Score (TS) was calculated. Statistical Analysis: All the relevant data collected was transferred on to the excel sheet. Chi square test with and without Yates correction was used to compare various parameters. The p-value = 0.05 was taken as critical level of significance. Results: A significant association was seen between TS of Cyclin D1 expression with tumour stage and with lymph node metastasis but not with grade. Conclusion: Higher Cyclin D1 expression is associated with higher tumour stage and lymph node metastasis. Therefore, there is value of analysing cyclin D1 amplification and expression, for prognostic evaluation. This may also be further used for targeted therapy in head and neck cancers.

Comparative Study of Pituitary Volume Variations in Mri in Acute Onset of Psychiatric Conditions

Introduction: The growing belief that endocrine abnormalities may underlie many mental conditions has led to increased use of imaging and hormonal assays in patients attending to psychiatric OPDs. People who are in an acute phase of a psychiatric disorder show Hypothalamic Pituitary Adrenal (HPA) axis hyperactivity, but the precise underlying central mechanisms are unclear. Aim: To assess the pituitary gland volume variations in patients presenting with new onset acute psychiatric illness in comparison with age and gender matched controls by using MRI. Materials and Methods: The study included 50 patients, with symptoms of acute psychiatric illness presenting within one month of onset of illness and 50 age and gender matched healthy controls. Both patients and controls were made to undergo MRI of the Brain. A 0.9 mm slices of entire brain were obtained by 3 dimensional T1 weighted sequence. Pituitary gland was traced in all sagittal slices. Anterior pituitary and posterior pituitary bright spot were measured separately in each slice. Volume of the pituitary (in cubic centimetre- cm3) was calculated by summing areas. Significance of variations in pituitary gland volumes was compared between the cases and controls using Analysis of Covariance (ANOVA). Results: There were significantly larger pituitary gland volumes in the cases than the controls, irrespective of psychiatric diagnosis (ANOVA, f=15.56; p=0.0002). Pituitary volumes in cases were 15.36% (0.73 cm3) higher than in controls. Conclusion: There is a strong likelihood of HPA axis overactivity during initial phase of all mental disorders along with increased pituitary gland volumes. Further studies including hormonal assays and correlation with imaging are likely to provide further insight into neuroanatomical and pathological basis of psychiatric disorders.

Vascular Endothelial Growth Factor as an Angiogenic Marker in Malignant Astrocytoma and Oligodendroglioma: An Indian Scenario

Introduction: The role of Vascular Endothelial Growth Factor (VEGF) in angiogenesis has been extensively studied in gliomas, such as astrocytoma and oligodendrogliomas, worldwide. However, there is limited information available with regard to the Indian population. Aim: To study, whether VEGF is expressed in the Indian population in a pattern similar to that in other population. Materials and Methods: In this prospective study approved by the Institute Ethics Committee for Human Studies at Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) the patients operated for glioma in 2014 and 2015 (n = 60) were included. Tumours were graded as per the World Health Organization (WHO) grading system. VEGF expression in various grades was analysed using immunohistochemistry. Results: Of the 60 patients included in this study, 15 were Grade II- (diffuse astrocytomas – 12; oligodendrogliomas- 3), 15 were Grade III-(anaplastic astrocytomas- 2; anaplastic oligodendrogliomas – 13) and 30 were Grade IV-glioblastomas. For VEGF antibody staining, two patients (3.33%) showed negative results and 58 patients (96%) showed positive results. VEGF positivity was 100% in Grade II and III, while it was 93.3% (28/30) in Grade IV tumours (p=0.012). Conclusion: The expression of VEGF was associated with the grade of tumour, which gradually increased from Grade II to Grade IV. We conclude that VEGF-regulated angiogenesis plays an important role in tumour progression of astrocytomas and oligodendrogliomas in the Indian population as observed worldwide.

Nomophobia: A Cross-sectional Study to Assess Mobile Phone Usage Among Dental Students

Introduction: Mobile phones were originally seen as a gadget for communication but currently, the internet enabled mobile phones have become an integral part of our daily life. Their benefits are incomparable but at the same time, they have some negative effects too. Aim: To assess the pattern of usage of mobile phones and its effects on the academic performance of students. Materials and Methods: A descriptive cross-sectional study was conducted amongst 554 students of D. J. College of Dental Sciences and Research through a self-administered questionnaire to collect the data regarding the usage and associated anxiety with mobile phone. Results: About 39.5% students agreed that they score low marks in professional exams if they spend more time on phone. The number of students who frequently checked their cell phone during their classes or while doing clinical work were 24.7% . A total of 24.12% of the students were found to be nomophobic and at risk of being nomophobes were 40.97%. A statistically significant difference was found among preclinical, clinical, interns and postgraduates regarding the usage and effect of mobile phone on them. Conclusion: The pattern of usage of mobile phone among dental students showed alarming indication that students have been addicted to mobile phone which in turn affect their academic performance in a negative way. It would be useful to advise the students about the controlled as well as proper usage of mobile phone.

Applicability of Demirjian’s Method and Modified Cameriere’s Methods for Dental Age Assessment in Children

Introduction: Tooth development is extensively used for age estimation as a part of forensic science. Aim: The purpose of this study was to evaluate the reliability of Demirjian's, Cameriere's and modified Cameriere's population-specific regression equation methods in the dental age estimation of West Godavari children. Materials and Methods: The study included orthopantomograms (OPG) of 60 children of West Godavari district with age group between 9 to 14 years on whom all the three methods were used for age estimation. The OPG were traced with the help of a tracing paper and lead pencil and the appropriate dimensions were measured. Age estimation was done based on canine calcification stage as per Demirjian's method and measurements of the seven permanent left mandibular teeth using Cameriere's formula and modified population-specific regression equation obtained for the South Indian population from Cameriere's formula. The resultant data were subjected to statistical analysis by student’s paired t-test. Results: The estimated age was closer to the chronological age when the modified Cameriere's population-specific regression equation was used (p=0.68); whereas, the difference was more in Demirjian's method (p=0.008) followed by Cameriere's method (p<0.001). Conclusion: The method using modified Cameriere's population-specific regression equation exhibited a least significant difference in chronological and dental age assessment in children of West Godavari district as compared to the other two methods.

Transvaginal Sonography Versus Cystoscopy for Detecting Urinary Bladder Invasion in Early Stage Cervical Cancer

Vijay Zutshi, Binni Makkar, Anju Garg, Swaraj Batra

Introduction: Cervical cancer is a major cause of mortality from cancer among women. In its early stage pre operative staging with cystoscopy is a standard procedure for the detection of urinary bladder involvement. Aim: The present study was conducted with the aim to compare the efficacy of Transvaginal Sonography (TVS) and cystoscopy in diagnosing bladder involvement in early stage cervical cancer patients by confirming it intraoperatively and further by histopathologic examination. Materials and Methods: A prospective partially blinded study was conducted between March 2006 and September 2008 on 30 patients with early stage cervical cancer (Stage I and IIa) who were planned to undergo radical hysterectomy. Pre operatively, these patients underwent both TVS and cystoscopy to diagnose bladder involvement. Presence or absence of bladder involvement was then confirmed intra operatively and by histopathologic examination. Results: In all the 30 patients studied, no bladder involvement was seen on cystoscopy where as TVS showed bladder involvement in three patients. Involvement of the bladder in these three patients was confirmed intra operatively and by histopathologic examination. Thus, in our study, TVS was 100% sensitive in detecting bladder involvement. Conclusion: TVS is highly sensitive in diagnosing bladder involvement in early stage cervical cancer and could potentially detect cases missed with a cystoscopy.

Comparison of Intravenous Dexmedetomidine with Midazolam in Prolonging Spinal Anaesthesia with Ropivacaine

Balwinder Kaur Rekhi, Tejinderpal Kaur, Divya Arora, Panka j Dugg

Introduction: Midazolam and dexmedetomidine both being sedatives, but the latter with additional analgesic properties is expected to prolong the duration of sensory and motor block obtained with spinal anaesthesia. Aim: To compare intravenous dexmedetomidine with midazolam and placebo with respect to sensory and motor block duration, analgesia, and sedation in patients undergoing lower limb and lower abdominal surgeries with intrathecal ropivacaine anaesthesia. Materials and Methods: In this single blind placebo controlled trial, 60 patients, classified as American Society of Anaesthesiologists’ (ASA) physical status I–II, were randomized into three groups (n=20 per group). All patients were administered ropivacaine (15 mg) for spinal anaesthesia. Intravenous dexmedetomidine was administered in Group D (1 µg/kg loading dose over 10 minutes, followed by a continuous infusion (0.5 µg/kg/hr), intravenous midazolam was administered in Group M (0.05 mg/kg) loading dose, followed by a continuous infusion (0.02 mg/kg/hr) and normal saline was infused in Group C. Intraoperative haemodynamic changes, onset, level and duration of sensory block, onset and duration of motor block, level of sedation, postoperative analgesia and side effects were recorded. Results: Heart rate was seen to fall significantly in Group D patients for the first 15 minutes. Measurements of mean blood pressure revealed significant decrease in Group D after 40 minutes, whereas the fall in Group C occurred after 15 minutes. Duration of sensory block was significantly longer in Group D patients (208±19.358 mins) as compared to Group M and C where the duration was (177±15.252 mins) and (177±17.800 mins) respectively. Higher levels of sedation were achieved in Group D and M where sedation score was 3 (fully asleep but arousable), 90% cases in Group D and 100% cases in Group M. The time at which first analgesic was given to patients (VAS score 4) was (271.50±21.831) in Group D and (202±25.047) in M and (218.50±38.013) in Group C. Dexmedetomidine significantly prolongs duration of analgesia providing pain relief in intraoperative and postoperative period. Injection of diclofenac sodium 75 mg intramuscular was used as rescue analgesic. The VAS score reached a value of 4 earlier in the midazolam and saline group than dexmedetomidine group. Conclusion: Intravenous dexmedetomidine prolonged spinal anaesthesia, though midazolam did not. It also provided sedation and additional analgesia. Therefore, dexmedetomidine is appropriate during spinal anaesthesia, although heart rate needs to be monitored cautiously.

Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy

Introduction: Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. Aim: To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. Materials and Methods: Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkins scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. Results: Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkins score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV with JOMIVA balloon. Post procedure mean mitral valve area was 1.7 cm2 as assessed by echocardiography. Post procedure mean gradient across the mitral valve as assessed by echocardiography was 5 mmHg. Two patients had moderate to severe mitral regurgitation after the procedure and the rest had either no mitral regurgitation or mild mitral regurgitation after the procedure. None of the patients warranted mitral valve replacement after BMV. No patients had any manifestations of systemic embolism like cerebrovascular accident or limb ischemia after the procedure. None of the patients had preterm delivery or adverse fetal outcome during index hospitalisation. Conclusion: Over the wire BMV is safe and effective method during pregnancy. The results are comparable to that of Inoue technique. BMV offers a good symptomatic improvement in pregnant women presenting with symptoms of pulmonary congestion because of Rheumatic mitral stenosis.

Role of Vitamin D in the Outcome of Ischemic Stroke- A Randomized Controlled Trial

Shuba Narasimhan, Prakash Balasubramanian

Introduction: Vitamin D deficiency has reached epidemic proportions in India with prevalence rates of 70-100% in the general population. Low vitamin D levels are associated with worse outcomes in ischemic strokes. The outcome of stroke after vitamin D replenishment has not been much studied. Aim: To compare the stroke outcome between patients receiving vitamin D supplementation and patients without vitamin D supplementation by Scandinavian Stroke Scale (SSS) and thus, to assess the long term outcome of ischemic stroke patients with low vitamin D level by supplementation of vitamin D. Materials and Methods: This is a non blinded randomized controlled trial conducted in ischemic stroke patients. The patients were divided into two groups (A and B) where Group A received a single dose of 6 lac IU of Cholecalciferol Intramascular (IM) injection and Group B were not given vitamin D. Finally 30 patients in each group were analyzed. SSS was applied to evaluate the stroke severity at the onset and at the follow up after three months in both groups. The difference in SSS was analyzed using SPSS software. Independent t-test was applied and p-value < 0.05 was taken as significant. Results: Mean±SD of vitamin D levels in Group A and Group B were 17.98±3.81ng/ml and 18.44±4.69 ng/ml respectively. Mean±SD of SSS at time of admission and after three months for Group A was 32.50±11.61 and 38.89±8.34; and for Group B 35.82±8.56 and 38.32±7.10. The difference in SSS from time of admission and after three months, in Group A (6.39±4.56) and Group B (2.50±2.20) were analyzed statistically and found to be highly significant (p<0.001). Conclusion: The results showed that there is a significant improvement in the stroke outcome after three months in those patients who were supplemented with vitamin D. Thus screening for vitamin D deficiency in stroke patients is essential and vitamin D replenishment will improve the stroke outcome.

Recent Advances in the Management of Major Postpartum Haemorrhage - A Review

P Reddi Rani, Jasmina Begum

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity worldwide and 75-90% of these haemorrhage results from uterine atony. Delayed and substandard obstetrics care can kill a woman within hours of Major Obstetric Haemorrhage (MOH). Prenatal identification of at risk women, prompt assessment of blood loss, effective management and involvement of multidisciplinary teams is of utmost importance to save the lives of these women. However, even with the best prenatal care, PPH occurs, it can occur without any risk factors. The first step in management is achieving haemodynamic stability, second being arrest of bleeding, both are done simultaneously. Cases of refractory PPH is managed by postpartum hysterectomy which results in complete inability in hosting a future pregnancy, a psychological impact and risk of intra operative surgical morbidities. This review discusses the current evidence based management of PPH, existing controversies in transfusion of blood and blood products and newer advances in this field. It was conducted by searching the English language medical literature using Medline (1994-2015). The current scenario in developing countries mandates research on newer and practicable strategies to tackle PPH which can be implemented effectively and have an upper edge over the existing practices in the management of PPH.

Surgical Implications of Portal Vein Variations and Liver Segmentations: A Recent Update

Showkathali Iqbal, Raiz Iqbal, Faiz Iqbal

The Couinaud’s liver segmentation is based on the identification of portal vein bifurcation and origin of hepatic veins. It is widely used clinically, because it is better suited for surgery and is more accurate in localizing and monitoring various intra parenchymal lesions. According to standard anatomy, the portal vein bifurcates into right and left branches; the left vein drains segment II, III and IV and the right vein divides into two secondary branches - the anterior portal vein drains segments V and VIII, and the posterior drains segments VI and VII. The portal vein variants such as portal trifurcation, with division of the main portal vein into the left, right anterior, and posterior branches, and the early origin of the right posterior branch directly from the main portal vein were found to be more frequent and was seen in about 20 - 35% of the population. Accurate knowledge of the portal variants and consequent variations in vascular segments are essential for intervention radiologists and transplant surgeons in the proper diagnosis during radiological investigations and in therapeutic applications such as preparation for biopsy, Portal Vein Embolization (PVE), Transjugular Intrahepatic Porto-Systemic Shunt (TIPS), tumour resection and partial hepatectomy for split or living donor transplantations. The advances in the knowledge will reduce intra and postoperative complications and avoid major catastrophic events. The purpose of the present review is to update the normal and variant portal venous anatomy and their implications in the liver segmentations, complex liver surgeries and various radiological intervention procedures.

Hybrid Doctors: The Need Risen From Informed Patients

Shyamala Karnam, Prasanna Raghavendra

In the last decade, we have seen a significant surge in the number of patients whom we can term as “Informed patients”. Informed patients are well read on the medical condition that they are looking to resolve. They may have often over researched and may be paranoid about what they may be going through; they may also know all potential medications that may be used for treatment and also potential side effects of these. However, they may not be in a position to judge what is actually right and what is actually applicable for what they are going through. This causes patients to go through, what we define as hyper information, where they have a lot of information but are unaware what applies to them. In this paper, we classify patients driven by this hyper-information, and discuss how this may lead to different patient states. We also discuss the need for doctors to adapt themselves to become what we call Hybrid Doctors. We briefly discuss how Hybrid Doctors can handle informed patients of various types and states.

Application of CAD -CAM for Fabrication of Metal-Free Band and Loop Space Maintainer

Harleen Kaur Soni

An ideal occlusion with proper tooth alignment and fully functional teeth is the ultimate goal of all dental treatments. Premature extraction of deciduous teeth is a common sequeale of untreated dental caries in teeth in which the damage is far beyond repair. Premature extraction might lead to loss of space for the successor tooth, drifting of teeth and loss of arch integrity leading to malocclusion in the permanent teeth. To prevent the space loss, space maintainers are designed and delivered at the time of extraction to allow for development of proper functional occlusion in children till the eruption of the succedaneous permanent tooth. A six-year-old female patient with chronic intra-radicular abscess in upper right first primary molar was treated with extraction followed by the placement of BruxZir zirconia space maintainer. Clinical and radiographic examinations were performed at one and six months. At the end of six months, the patient was completely asymptomatic and there were no visible signs of gingival inflammation and tissue irritation at the site of the space maintainer.

Invasive Papillary Carcinoma of the Male Breast Misdiagnosed as Fibroadenoma on FNAB

Richa Katiyar, Shashikant C.U. Patne, Sandip Kumar, Rahul Khanna

Male breast cancers constitute less than 1% of all the breast cancers. Papillary carcinoma is a very rare tumour of the male breast. Due to rarity, Fine Needle Aspiration Biopsy (FNAB) findings of papillary carcinoma in male breast are seldom reported. A 55-year-old male presented with a lump in the left breast of two years’ duration. FNAB was reported as fibroadenoma. Histopathological examination of the excised breast lump revealed invasive papillary carcinoma. Immunohistochemistry showed expression of pancytokeratin, oestrogen receptor, and progesterone receptor. Negative immunostaining was seen for HER2, p53, 34bE12, and CD34. Ki-67 proliferative index was 5%. We have discussed cytological findings of invasive papillary carcinoma and its differential diagnoses. Cytopathologists must be aware of cytologic findings of invasive papillary carcinoma of the male breast.

A Rare Case of Twinning Involving Primary Maxillary Lateral Incisor with Review of Literature

Twinning is referred to the development of two separate teeth that arose from the complete separation of one tooth bud. To the best of our knowledge very few cases of twinning in primary or permanent dentition have been previously reported. Here, we report an additional case of twinning involving primary maxillary left lateral incisor and a literature review of clinical and radiographic findings of previous reported cases of gemination and twinning is also discussed. A six-year-old male patient reported to the dental clinic with the complaint of decay in the left front teeth region of the upper jaw. On clinical examination, dentinal caries was observed on the labial surface of primary maxillary left lateral incisor. The tooth showed a deep groove present in relation to the labial surface and incisal edge and continued cervically as a shallow groove. The patient had normal compliment of teeth for his age. The intra-oral periapical radiograph of the maxillary anterior region revealed large crown and a radiolucent notch was observed in relation to the incisal edge of the maxillary left primary lateral incisor. Relatively one pulp chamber and two root canals were observed in relation to the primary maxillary left lateral incisor, which was suggestive of a case of twinning involving primary maxillary left lateral incisor. This present case is the first case report of twining seen in primary dentition.

Polymyxin B-Induced Diffuse Cutaneous Hyperpigmentation

Polymyxin B is a polypeptide-antibiotic, primarily used for resistant Gram-negative infections, first obtained from bacterium Bacillus polymyxa in the late 1940s. Antibiotic spectrum are restricted to mainly gram negative bacterias like Enterobacter, E. coli, Klebsiella, Salmonella, Pasteurella, Bordetella, Shigella; and particularly organisms like Pseudomonas aeruginosa and Acinetobacter baumannii, which are extremely potent to acquire antibiotic resistance. Side effects include neurotoxicity and acute renal tubular necrosis. Here, we present a rare case of skin hyper-pigmentation in a 65-year-old elderly male of Indian origin, diagnosed as a case of Multi-Drug Resistant (MDR) Klebsiella pneumonia, treated with intravenous antibiotics. The manifestations were observed after 4 days of Polymyxin B therapy initiation. All other concomitant drugs, infections, or immunologic disorders that, could have caused this symptom, were carefully excluded. An objective causality assessment reveals that, the cutaneous hyperpigmentation was possibly associated with Polymyxin B therapy, though further studies may be needed to explain the underlying mechanism

Up the Duff With Non-Hodgkin’s Lymphoma: The Traumas and the Dilemmas

Sheeba Marwah, Harsha Shailesh Gaikwad, Ritin Mohindra, Manjula Sharma

Lymphoma is fourth most frequent malignancy diagnosed prenatally (~1:6000 cases), with Hodgkin’s Lymphoma (HL) forming the major chunk. However, in recent times, there has been an increase in occurrence of Non-Hodgkin’s Lymphoma (NHL) due to late child bearing age and high incidence of AIDS-related NHL in developing countries. Managing NHL in pregnancy involves intricate medical, ethical and psychological issues. Diagnostic and treatment delays may influence the prognosis for indolent cases. Seen the complexity of the management decisions associated with NHL, interdisciplinary and individualized approach becomes imperative for each woman. We present a case of 25-year-old G2P0010 at 32 weeks Period of Gestation (PoG) with right sided deep cervical lymphadenopathy, who was diagnosed as aggressive malignant NHL and was subsequently started on chemotherapy after confirmation of diagnosis and eventually had an optimal feto-maternal outcome. The critical appraisal of the accessible data, identification of controversies and unresolved issues and proposal of elucidations about varied facets of NHL in pregnancy are also provided.

Shade Guide for the Fabrication of Acrylic Denture Based on Mucosal Colour

Godwin Clovis Da Costa, Meena Ajay Aras, Paul Chalakkal

This article highlights the use of a simple and convenient shade guide system which not only helps in choosing the shade tab that matches with the colour of the mucosa, but, also helps in the fabrication of the precise shade of acrylic resin for making the denture. The shade guide is fabricated by mixing specified quantities of various colours of acrylic polymer in order to obtain various shade tabs. The method for fabrication of the shade guide and the clinical procedure has been discussed.

“Malignant Granular Cell Tumour Presenting as a Paravertebral Mass in an Adolescent Male– A Rare Presentation of an Uncommon Tumour”

Monika Singh, Ajay KR Singh, Swasti Shubham, Pratibha Maan, Udit Chauhan

1. Senior Resident, Department of Pathology, Dr. Rml Hospital, Delhi, India. 2. Assistant Professor, Department of Pathology, Kgmu, Lucknow, Uttar Pradesh, India. 3. Senior Resident, Department of Pathology, Dr Rml Hospital, Delhi, India. 4. Senior Resident, Department of Pathology, Dr. Rml Hospital, Delhi, India. 5. Senior Resident, Department of Radiology, Gb Pant Hospital, Delhi, India.

Orbital Myiasis with Scalp Pediculosis and Buccal Abscess–An Uncommon Presentation

Nidhi Kaeley, Rajeev Mohan Kaushik, Richa Rajput, Renu Dhasmana, Anurag Bhargava

We present a case of severe orbital myiasis caused by Osteris ovis, also known as sheep nasal botfly which is an uncommon manifestation of maggot infestation. Our patient was successfully treated with oral as well as topical ivermectin. The experience of ivermectin as an anti-parasitic agent in the treatment of orbital myiasis, although a known entity, is still limited among medical professionals including ophthalmologists. Thus, we would like to highlight the role of oral ivermectin as an anti-parasitic agent in the treatment of orbital myiasis facilitating the removal of maggots; thus, precluding the need for exploratory surgery.

Paraneoplastic Glomerulopathy in a Case of Collecting Duct Renal Cell Carcinoma

Paraneoplastic glomerulopathy has been described in established cases of the solid tumors of lung, gastrointestinal system, breast, etc., and rarely in patients with Renal Cell Carcinoma (RCC). Studies on secondary glomerular diseases have described a higher incidence of IgA nephropathy in patients with RCC compared to membranous glomerulopathy, which are commonly reported in malignancies of the lung and gastrointestinal tract. Collecting Duct Carcinoma (CDC), a rare high grade adenocarcinoma accounts for <1% of all renal malignancies. It arises from the cells of the collecting ducts of Bellini. We report a case of an elderly male who was diagnosed to have a disseminated CDC during his evaluation for nephrotic syndrome. Renal biopsy was suggestive of a secondary membranous glomerulonephropathy.

A Case Report on Multiple Stones in the Thyroid Gland in Association with Sclerosing Thyroiditis: An Unusual Encounter

Gaurav Shandilya, Ravish Kumar Sinha, Nishith Ekka, Vinod Kumar

Stones are very frequently found in the gallbladder and urinary tract. Rarely the thyroid gland can be a site for stone formation. Few cases of calcification in thyroid gland have been described in the medical literature in association with papillary carcinoma and multinodular goiter. A unique case of a thyroid swelling studded with multiple stones in its parenchyma, in the histopathological background of sclerosing thyroiditis in an 80-year-old male is documented here. Surgical excision was undertaken with an uneventful postoperative period.

Delayed Post-Surgical Hypoparathyroidism: The Forgotten Chameleon!

Sangita Deepak Kamath, Balllamudi Srinivas Rao

Delayed hypoparathyroidism, due to accidental gland removal or ischemia of parathyroids can present many years after thyroidectomy and symptoms may be non-specific. This condition, if not diagnosed timely, may prove fatal and have serious consequences. Hence, clinicians must have a high index of suspicion to treat this condition. All patients with a history of previous thyroid surgery, who come with vague symptoms like fatigue, muscle aches should undergo estimation of serum calcium, phosphorus and Parathyroid Hormone (PTH) due to the lack of any pathognomonic features of hypoparathyroidism. We report a rare case of delayed post-surgical hypoparathyroidism who became symptomatic 15 years after thyroid surgery and remained so for another 10 years before the final diagnosis was established.

Indian Soldiers Need Eye Protection

Kirti Nath Jha

Combat-related eye injuries entail enormous financial, social and psychological cost. Military Combat Eye Protection (MCEP) decreases both the incidence and severity of eye injuries. Experts have recognised the need for MCEP for Indian soldiers. We aim to review the combat-related eye injuries and combat eye protection among the Indian soldiers. Global practices of MCEP are also reviewed. We also aim to offer our recommendations for Indian soldiers. We carried out Medline search for combat-related eye injuries and MCEP and separately searched for eye injuries among Indian soldiers during war and other operations. We present the findings as results. Recommendations are based on the opinions of the experts. Combat-related eye injuries increased from 3% of injured in the 1965 Indo-Pakistan War to 4.8% in 1971 war. During peace-keeping operations in Sri Lanka (1987-89) eye injuries increased to 10.5% of the injured. Statistics on eye injuries during counterinsurgency operations are not available. MCEP have shown reduction in eye injuries, and thus MCEP forms a part of personal equipment of the soldiers in developed countries. Indian soldiers do not have provision of MCEP. Combat-related eye injuries among Indian Army soldiers have been increasing. Data on eye injuries during counterinsurgency operations are not available. Indian soldiers do not have provision of MCEP. Provision of MCEP is therefore desirable. Awareness program among the commanders and the soldiers shall result in attitudinal changes and increased compliance.

Lactobacillus coryniformis Causing Pulmonary Infection in a Patient with Metastatic Small Cell Carcinoma: Case Report and Review of Literature on Lactobacillus Pleuro-Pulmonary Infections

Lactobacilli are normal commensals of the gastrointestinal and female genital tract. Due to its low virulence these bacteria are known to cause opportunistic infections. They cause mostly bacteraemia with or without endocarditis and rarely cause pleuro-pulmonary infection. We report a case of Lactobacillus coryniformis pleuro-pulmonary infection and review 14 previously reported cases of lactobacilli causing pleuro-pulmonary infections. Our patient had small cell carcinoma with metastasis. All the 14 cases had pre-existing risk factors like immunosuppresion, cancer or chronic disease. There was no consensus on choice of antimicrobial agents to be used. Different species of lactobacilli were involved. Available susceptibility data showed that lactobacilli species were more susceptible to ampicillin, erythromycin, gentamycin, and clindamycin and decreased to ceftriaxone, ciprofloxacin and trimethoprim–sulphamethoxazole. Isolation of Lactobacillus species from a case of pleuro-pneumonia infection could be a marker of poor long-term prognosis. The diagnosis of these infections requires both microbiologist and clinical correlation to rule out contamination.

Non-Infiltrating Angiolipoma of Floor of Mouth-A Rare Case Report and Literature Review

Sanat Kumar Bhuyan, Ruchi Bhuyan, Priyanka Debta, Fakir Mohan Debta

Angiolipoma, a subtype of lipoma is a benign tumour in which adipose tissue and vascular component are intermingled. The tumour occurs commonly in the trunk and extremities and very rarely seen in maxillofacial region. Here we report a case of Non-Infiltrating Angiolipoma (NIAL) in floor of mouth which is the second case to be reported in literature to the best of our knowledge. We have reviewed all NIAL cases involving the oral cavity from 2008 to 2016 and found 12 cases of NIAL and assessment was made according to age, sex, site and size of lesion for better understanding of the lesion and its nature.

Prenatal Diagnosis and Management of Morbidly Adherent Placenta

Shreyasi Sharma, Chanchal Singh, Sohani Verma, Harsh Rastogi, Anita Kaul

Humanism in Rehabilitation: A Heartwarming Triumph

Shital Jalandar Sonune, Shankar Pandharinath Dange

Paediatric Post-Traumatic Bladder Neck Distraction Injury: Case Series

The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results.

Primary Sarcomas of Thyroid Gland–Series of Three Cases with Brief Review of Spindle Cell Lesions of Thyroid

Amita Jain Gupta, Meeta Singh, Poonam Rani, Nita Khurana, Anurag Mishra

Primary Malignant Fibrous Histiocytoma (MFH-T) and Leiomyosarcoma (LMS-T) of the thyroid gland are extremely rare tumors. Very few cases have been reported in the literature. Both entities occur more commonly in women than men. The closest clinical and histological differential diagnosis is anaplastic carcinoma of thyroid. We present three cases of rare primary sarcomas of thyroid gland. Case-1 was a 63-year-old woman and Case-2 was a 52-year-old woman. Both of them presented with a rapidly increasing thyroid mass clinically mimicking anaplastic carcinoma (AC-T). Both the patients developed pulmonary metastasis and succumbed to the illness soon after the diagnosis of MFH-T was made. Case 3 was 65-year-old woman with neck swelling since six months diagnosed as LMS-T. The present communication adds three new cases to the literature on sarcomas of thyroid gland with an emphasis on differential diagnosis of spindle cell lesions of thyroid. MFH-T and LMS-T needs to be differentiated from AC-T, metastatic sarcomas, spindle cell variant of medullary carcinoma, synovial sarcoma, fibrosarcoma; final diagnosis rests on histopathology and immunohistochemistry.