Journal of clinical and diagnostic research

Granular Cell Tumour Masquerading as Carcinoma Breast

Sadiya Shafi, Charles Mano Sylus, Salapathi Shanmugam, P Darwin

Granular Cell Tumour (GCT) is a rare benign tumour that affects head and neck, the most frequent site being the tongue. GCT with localisation to breast is very rare with an incidence of 4-6%. It is an uncommon cause of breast mass in premenopausal women. The usual clinical presentation is with a painless solitary nodule. But rarely the lesions can be multifocal as a manifestation of a multicentric disease. On clinical and radiological examination, GCT can be confused with infiltrating carcinoma, therefore making its diagnosis challenging for the clinicians, radiologists and pathologists. It is pertinent to differentiate this tumour from other malignant tumours of the breast and avoid misdiagnosing as mammary carcinoma. Definitive preoperative diagnosis helps to prevent unnecessary mastectomy. We report a breast lump in a post-menopausal woman, which was mimicking malignancy clinically and radiologically, but on histopathological examination was diagnosed as a GCT.

Infective Endocarditis in a Pregnant Female with Chronic Sialadenitis Associated with Gingivobuccal Sulcus Malignancy: A Rare Presentation

Sakshi Gagneja, Samarth Shukla, Sourya Acharya, Neema Acharya

Infective Endocarditis (IE) in cancer is not very frequently reported. We report an interesting case of a 27-year-old primigravida with 30 weeks pregnancy, who presented with high grade fever with severe anaemia and thrombocytopenia. Twenty days before this presentation, she was evaluated for a gingivobuccal sulcus mass in this hospital, oral examination had revealed a soft, bluish, non-tender patch on her left gingivobuccal sulcus; as per her old document (clinical picture was retrieved from Department of Oral and Maxillofacial Surgery) for which a biopsy was done. Biopsy revealed chronic sialadenitis with metaplastic changes of mucoepidermoid carcinoma. In search of the cause of her fever with anaemia and thrombocytopenia, exhaustive investigations were done but were inconclusive. Dilemma occurred, when she developed preterm labour at 32 weeks and post-delivery, she went into respiratory distress. Embolism was kept as a differential but CT Pulmonary angiography was negative. Then, 2D-ECHO showed a vegetation on the mitral valve. Three sets of blood cultures obtained from different venipuncture sites at 12 hourly intervals were negative however, she responded to intravenous antibiotics. We presume that the chronic sialadenitis associated with malignancy lead to the blood stream dissemination of organisms from oral cavity to native valves causing endocarditis.

Treatment of Genital Warts with a Combination of Cryotherapy and 5% Imiquimod

Sneha Deshmukh, Sudhir Singh, Sugat Jawade, Bhushan Madke, Adarsh Lata Singh

Genital warts (condyloma acuminata) are benign, proliferative tumours which occur in the genital, anal, perineal and/or perianal areas. These warts are caused by Human Papilloma Virus (HPV). They are double-stranded DNA viruses which replicate in squamous epithelial cells. Many types of HPV has been recognised but 6 and 11 HPV types accounts almost 75-90% of genital warts cases. Many medical and ablative treatment modalities are available like topical podophyllin, imiquimod, cryotherapy, but recurrence is still a problem in many patients. Recently, a concept of combination treatment has been practiced and it was found to be better than monotherapy because of the synergistic effect of both the compounds. There are studies on the use of combination of cryotherapy with topical podophyllin and various other combinations but to achieve complete clearance of genital warts with no recurrence is still a challenge for the dermatologists. Thus, a combination treatment was needed to overcome this problem. So, a thought was given to use a combination of two modalities having different mechanism of action for treating genital warts. We hereby report a case of multiple giant genital warts in an immunocompetent female in whom complete clearance of lesions was achieved by a combination of Cryotherapy and 5% Imiquimod cream within six weeks of treatment.

A Case of Tracheo-Bronchomegaly in a Young Male

Priti Meshram, Sanchit Mohan, Vishwanath Pujari, Rohit Hegde

Tracheobronchomegaly (TBM) or Mounier-Kuhn syndrome is a disorder characterised by dilatation of trachea and major bronchi with tracheal diverticula leading to bronchiectasis as a complication. We report a 39-year-old male who was admitted at the tertiary care centre for breathlessness and recurrent lower respiratory tract infections, symptomatic for 15 years. He was a non smoker, with no history of similar illness in his family. Chest X-ray (posterior-anterior view) showed tracheal dilatation with bilateral bronchiectasis. Spirometry showed mixed ventilatory defect with poor bronchodilator reversibility in the obstructive component. Dynamic CT scan showed TBM. Fibreoptic bronchoscopy revealed a dilated trachea with prominent tracheal rings and widening of the bronchial tree bilaterally with mucopurulent secretions which were positive for streptococcus pyogenes and Acinetobacter baumanii.

CT Findings in Melioidosis: A Case Report

Amala Ammu Mathew, Rohini Avantsa, U Shrikrishna

Melioidosis is caused by Burkholderia pseudomallei. Even though it affects multiple organs, the most affected organ is lung followed by spleen. It has radiological features which is a mimicker of tuberculosis and is being commonly misdiagnosed as tuberculosis in India. In patients with septicaemia or a fever of unknown aetiology high suspicion is required for the diagnosis. We present a pictorial review of the radiological manifestations in a patient presenting with multi-visceral abscesses which will help radiologists to arrive at an early diagnosis.

Defect of Conduction System of the Attention Pathway Leading to Development of Inattentive Spells in a Young Female

Hussain Hussain, Aya Fadel, Haider Alwaely

Inattentive spells are neurological disorders affecting the neuronal pathways that lead to a decrease in neuronal conduction velocity. The pathways of attention normally function systematically by utilising an electrical conduction system, in order to transmit and process neuronal information. A defect in the attention pathways leads to cognitive impairments that have a detrimental effect on the patient’s health and well-being. Interestingly, patients with a defective attention pathway reported higher incidence of motor vehicle collisions and injuries. The authors report the case of an index patient, 26-year-old female, with chief complaints of frequent prolonged gaze, mild anxiety, insomnia, poor concentration and a decrease in attention span, to assess the correlation between neuronal pathway defects and the efficacy of Omega 3-6-9 treatment. Also, to facilitate the conduction velocity between the neurons. The patient’s symptoms and progression were observed during a five months period. This patient after being treated with Omega 3-6-9, noticed a drastic improvement in concentration, mood, and circadian rhythm. However, after an abrupt interruption of the treatment, her symptoms recurred over a short period of time.

Rhupus Syndrome: An Overlap with Renal Complications

Priyabhasini Chinmoyee Roy, Subal Kumar Pradhan

Rhupus syndrome is a rare condition of overlap of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) presenting with erosive polyarthritis and symptoms of SLE. It occasionally has renal involvement as its complication makes the diagnosis more difficult. Here the authors present a case of a 13-year-old female with severe arthritis, which gradually progressed into lupus nephritis with the presence of specific autoantibodies confirming the diagnosis of Rhupus. The child was managed with disease modifying anti-rheumatic drug (hydroxychloroquine), immunosuppressants (mycophenolate mofetil), steroid (prednisolone) and calcium channel blocker (amlodipine). Accurate diagnosis is the key for early detection since Rhupus is a very rare disorder with very limited reported cases.

Anterior Abdominal Wall Lymphangioma in a Child: Challenging Reconstruction at an Unusual Location

Amit Kumar Sinha, Amit Kumar, Rashi, Bindey Kumar, Prem Kumar

Lymphangiomas are rare benign hamartoma resulting from sequestered lymphatic channels. They mostly occur at head, neck and axilla. Abdominal wall is an unusual location for the lesion. This is a report of abdominal wall lymphangioma in a three year eleven-month-old male child, having painless abdominal wall swelling, which presented a challenge at diagnosis as well as surgical reconstruction while treating the child. It is important to consider lymphangioma as an important differential diagnosis during evaluation of any abdominal wall swelling.

Systemic Strongyloidiasis- Is It Dissemination or Hyperinfection?

An intestinal nematode, with clinical presentations ranging from asymptomatic state to catastrophic outcomes, Strongyloides stercoralis can be a potential cause of mortality, especially in patients with immunosuppressed state. Here, we present a patient with relatively short duration of immunosuppression, developing systemic strongyloidiasis and eventually succumbed after a brief duration of ailment. The index case satisfied the description of a case of hyperinfection. However, there existed a challenge in ruling out dissemination in her since she could not be evaluated completely due to a fulminant course.

Variation in the Branching Pattern of Superior Thoracic Artery- A Rare Case

Superior thoracic artery is usually a branch from the first part of axillary artery. It descends down up to the 2^nd intercostal space and anastomose with internal thoracic and intercostal arteries. However, during routine dissection for medical students it was observed that the superior thoracic artery on the right side showed unusual branching pattern, dividing into medial and lateral branches. The lateral branch coursed around the medial wall of axilla horizontally superficial to the long thoracic nerve of bell which divided into medial and lateral branch. This variation is of radiological, surgical and morphogenic importance as no such branching pattern have been described in the literature previously.

Unusual Presentation of Primary Ovarian Carcinoid Tumours with Low-to-Moderate Proliferative Potential

Primary Ovarian Carcinoid Tumour (OCT) are rare benign neuroendocrine neoplasms. Herewith, two cases of ovarian tumour has been described. In case 1, patient was a 63-year-old postmenopausal woman with vague abdominal pain. On examination, she had right pelvic tumour. Right salpingo-oophorectomy was performed. Cut surface showed solid, yellowish-white tumour tissue. Microscopically, tumour showed adenomatous, insular and trabecular patterns. Sheets of tumour cells were separated by fibrovascular septa. Tumour consisted of proliferated epithelial cells showing mild nuclear pleomoprhism. Nucleomegaly and capsular invasion were also seen. Carcinoid tumour cells may convert a silver salt to metallic silver (argentaffin reaction). Imunohistochemical (IHC) staining of tumour revealed strong positivity for pancytokeratin and chromogranin A. Mild reaction with anti-neuron-specific enolase antibody was seen. Ki-67 labelling index of 6% suggested moderate proliferative potential of current tumour. Caudal type home box transcription factor 2 (CDX2) non-reactivity suggested it to be a primary neoplasm. In case 2, the patient was 60-year-old. She had left ovarian tumour. Tumour formed solid masses (insular) and nests forming rosettes. IHC showed strong reactivity with anti-chromogranin A and mild reactivity with anti-neuron-specific enolase. Anti-Ki-67 did not stain most of tumour cells (Ki-67 index 1%). Anti-CDX2 failed to stain tumour cells.

Tuberous Sclerosis: A Rare Cause of Seizure in an Older Adult

Shubhransu Patro, Pankaj Kumar Khora, Bijay Kumar Sahoo, Debasis Pathi

Tuberous sclerosis is a rare autosomal dominant genetic disorder caused by mutation of TCS1 or TCS2 gene. The birth incidence is estimated to be 1 in 6000. It is a multisystem neurocutaneous disorder characterised by widespread hamartomas, cutaneous changes and neurological manifestations. It may present as seizures in adult patients and being a rare aetiology, presents a diagnostic challenge to physicians. Here, the authors report a case of a 48-year-old male who presented with recent onset of seizures and subsequently was found to have tuberous sclerosis. He was managed with oral levetiracetam and remained asymptomatic during follow-ups, over a period of two years.

Rare Cutaneous Ischemia and Pain during Infiltrative Anaesthesia for Dental Surgery: Case Reports and Literature Review

Local Anaesthetics (LA) is commonly used for surgical and dental procedures. Complications related to local anaesthesia can be divided into local, systemic and immediate complications. Immediate complications include positive blood aspiration, blanching of the tissue, pain, facial paralysis and burning sensation on impingement of the nerve. Blanching develops from decreased blood flow to the tissues as a result of blood vessels narrowed by adrenaline. The precise cause of this complication is unknown; however, it may be derived because of intraarticular injection, anatomical variation, rapid injection of local anaesthetic solution, retrograde flow of the solution, misdirection of the needle and neuronal basis. This report of 2 cases describes patients with ischemic areas on their faces resulting from maxillary and mandibular buccal infiltrative anaesthesia techniques. After the skin ischemia associated with the severe and instant pain occurs, the patient should be calmed and informed about the reversibility of the situation. It also includes information about the diagnosis, management, literature review and proposes some mechanisms for cutaneous ischemia and pain.

Waldenstrom’s Macroglobulinaemia with Villous Lymphocytes

Sushma Nayar, Annapurn Eswari Subramanyan, Priyanka Suryadevara

Waldenström’s Macroglobulinemia (WM) is a chronic B-cell lymphoproliferative disorder with bone marrow infiltration with small lymphocytes, lymphoplasmacytoid cells and plasma cells and presence of IgM paraprotein in the serum. We report here a case of a 63 years old male patient, who presented with chronic back pain. The pain was initially thought to be due to disc prolapsed, but on further examination of successive bone-marrow aspirations and biopsies and serum electrophoretogram, proved to be WM. The B cell lymphoproliferative disorders are indolent and include Splenic Lymphoma with Villous Lymphocytes (SLVL), Chronic Lymphocytic Leukaemia (CLL) with IgM paraprotein, and Splenic Marginal Zone Lymphoma (SMZL) and Waldenstrom’s macroglobulinaemia. They can be differentiated on the basis of levels of paraprotein, lymphocytic morphology, and degree of marrow involvement in relation to spleen size, as the malignant cells have the same phenotype in this group of diseases which has been highlighted in the index case.

Magnetic Resonance Diagnosis of Anomalous Infraoptic Course of Anterior Cerebral Artery

Shibani Mehra, Rushil Jain

Variations of the anterior cerebral artery and anterior communicating artery complex are common. However, an infraoptic course of A1 segment of Anterior Cerebral Artery (ACA) is a rare anatomic variation, detection of which is critical due to its association with formation of aneurysms in the anterior circulation. The diagnosis is purely radiological and MRI, Magnetic Resonance Angiography (MRA), and Computed Tomography angiography (CT angiography) have emerged as the modalities of choice because of their ability to depict the intracranial vessels accurately. Both CT and MR angiography are preferred over catheter angiography because of their non-invasive nature. Time of flight MR angiography is an MR angiography technique which demonstrates intracranial vessels without administering gadolinium based MR contrast medium and is therefore safe for all age groups and all patient categories. Here, authors present the MR findings that lead to the radiological diagnosis of anomalous infraoptic anterior cerebral artery in a patient presenting with an episode of transient ischaemic attack.

Laterally Closed Tunnel Approach with A-PRF for Isolated Miller’s Class II Gingival Recession: A Case Report

The displacement of the gingival margin below the level of Cementoenamel Junction (CEJ) is referred to as gingival recession. The main indication to treat isolated gingival recession is to increase soft tissue thickness and stability to facilitate plaque control, improve the patient aesthetics and prevent further periodontal breakdown. Though various root coverage techniques are available with numerous regenerative materials, autologous material such as Advanced Plasma Rich Fibrin (A-PRF) along with latest approach by Laterally Closed Tunnel (LCT) technique has been used in present case report as a predictable approach for the treatment of isolated gingival recessions.

Pyonephrosis Drainage Failure with Two Ureteric Stents in a Paediatric Patient

Gautamram Choudhary, Pritesh Jain, Prateek Gupta, Likhiteswar Pallagani

For obstructed uropathy causing pyonephrosis, immediate decompression by urinary diversion is the temporary mode of treatment. The type of procedure should be individualised depending on the size and position of stone, the degree of obstruction and the definite treatment planned for the obstruction in the near future. Percutaneous Nephrostomy (PCN) and retrograde Double J (DJ) stenting are the most widely used methods. According to currently available literature, there is no significant difference between these procedures with regards to availability, technical success, percentage of complications and the effect on quality of life of patients. Here, the present authors present a case of a six-year-old male where internal drainage with two DJ stents did not drain the pyonephrosis. He had a right flank pain and fever on evaluation; was found to have right renal pelvic calculus with pyonephrosis. Even after putting two double J stent of size 3.6 French (Fr) the pyonephrosis could not be drained, eventually, right PCN of 6 Fr was placed, symptoms relieved and later on stone cleared with percutaneous nephrolithotomy.

Pancreatic Plasmacytoma Misdiagnosed as Neuroendocrine Tumour: A Pathologist’s Dilemma

Extramedullary plasmacytomas are rare, constituting to about 5% of plasma cell neoplasms. Pancreatic involvement is uncommon constituting to about 2.3%. Localised solitary plasmacytomas has a good response to radiation. When they are associated with pre-existing multiple myeloma, their prognosis is poor. A case of plasmacytoma of pancreas presenting with obstructive jaundice preceding plasma cell leukaemia is presented here. The lesion was misdiagnosed by fine needle aspiration cytology as neuroendocrine neoplasm. The patient did not present with symptoms of myeloma initially. The present case highlights the significance of considering other causes of pancreatic mass than primary carcinomas.

A Rare Variation of Left Testicular Arteries in Position, Number and Course and its Clinical Significance

Xiangyang Zang, Jianjun Ma, Weiqiang Jin, Yu Qian, Man Dong

Variations of gonadal vessels are frequently reported. A comprehensive awareness of the morphologic variations of testicular vessels can avoid accidental injuries to the vessels during surgery. In the present case, there were three left testicular arteries existing in ipsilateral side. Especially, two left testicular arteries originated from the abdominal aorta, arched over and then descended in front of the left renal vein. Besides, another left testicular artery had a low origin but was a little superior to the inferior mesenteric artery. Such a variation is significant and may be attributed to the pathogeny of varicocele and orthostatic proteinuria. The variation could show surgeons an ingenious idea and may educate surgeons to consider more potential hazards during abdominal surgery.

Anecdote from Editors Desk Anecdote 2- Salami Slicing of Case Report

Hemant jain, Sunanda Das, Aarti Garg

Death Audit by Verbal Autopsy and Social Autopsy: Potential Yet Unutilized Tool

Bobby Paul, Indranil Saha

Effect of Thymus Vulgaris Extract against Toxic Effects of Diabetes on the Coronary Heart Angiogenesis of Rats

Introduction: Thymus vulgaris (T. vulgaris), with its antioxidant properties has therapeutic applications. Diabetes causes disruption in process of cardiac angiogenesis. Aim: To evaluate the therapeutic effects of T. vulgaris against destructive effects of diabetes in the field of coronary angiogenesis in rats. Materials and Methods: In this experimental study, 64 male rats were randomly sorted into 8 groups: 1) control group; 2-4) three extract groups (4.5, 9 and 18 mg/kg of T. vulgaris); 5) diabetic group; and 6-8) three diabetic + extract groups (4.5, 9 and 18 mg/kg of T. vulgaris) from April 2019 to November 2019. Diabetes was induced and various doses of T. vulgaris were administered for 60 consecutive days intraperitoneally. The serum level of Vascular Endothelial Growth Factor (VEGF) was determined by ELISA method, Nitrite Oxide (NO) measured by Griess assay, and the cardiac capillary density evaluated by immunohistochemistry assay. Data were analysed by one-way ANOVA test. Results: The values of VEGF, nitrite oxide, glucose and capillary density reduced significantly in diabetic group compared to the control group (p<0.05). No significant differences were detected among the studied variables (VEGF, nitrite oxide, glucose and capillary density) in all extract groups, compared to the control group as well as diabetic + extract groups compared to the diabetic rats (p>0.05). Conclusion: The hydroalcoholic extract of T. vulgaris represented no cardiac angiogenesis effects in normal and diabetic groups. This is due to the insufficient amounts of active biochemical ingredients, especially flavonoids in T. vulgaris.

Letter Regarding the Article, 'Hyponatremia in Patients Admitted with Stroke'; From the Viewpoint of Similarity to Hyponatremia Associated with Traumatic Brain Injury

Takahiko Nagamine

Timeliness of Childhood Vaccination and its Decisive Factors in Bihar: A Community-Based Study

Introduction: The effectiveness of immunisation depends on its timely administration. With delay, the duration of susceptibility of child and chances of disease outbreak is increased. In developing countries, it is further aggravated by poor socio-economic status and inadequate health care facility. No data for timeliness of vaccination available of Bihar. Aim: To study the timeliness of vaccination, drop-out rates and the association of timeliness of vaccination with demographic characteristics of household. Materials and Methods: A cross-sectional study was conducted in the month of January and February, 2019, on 12-23 months old children in 59 low-performing blocks of Bihar. Cluster-random sampling was done for selection of villages and house order was calculated for selection of children. Data collection was done using mobile-based application. Timeliness and median age at vaccination was calculated and association was calculated using chi-square. Results: Although, vaccination coverage was high, only 20% were vaccinated timely. Timely vaccination was maximum for Bacillus-Calmette Guerin (BCG); 75% and Measles Containing Vaccine (MCV); 86% and low for first dose of Penta (35%). Timely vaccination was associated with male gender, urban setting, birth at health care facility and low birth order. The study reports 5.8% drop-out rate for BCG-MCV series. Conclusion: Along with vaccination coverage, its timeliness should also be improved. Strengthening of health care facility must be ensured to improve timeliness.

Bacterial Aetiology of Community Acquired Pneumonia in a Tertiary Care Hospital of Southern India

Chaithra Kanishan, Veena A Shetty, S Hampana, Raghav R Sharma, Avinash K Shetty

Introduction: Community Acquired Pneumonia (CAP) is associated with high morbidity and mortality worldwide. Knowledge of common microbial patterns in CAP is crucial for making initial therapeutic decisions for empiric antimicrobial treatment. Aim: To determine the bacterial aetiology of CAP among hospitalised patients in a tertiary care hospital of Southern India. Materials and Methods: A descriptive study was carried out among 220 adult subjects, enrolled from a period of August 2012 to August 2014, admitted to a tertiary care hospital of Southern India, with a provisional diagnosis of CAP. Subjects were recruited based on chest radiography and clinical criteria. Blood, sputum, pleural fluid, Bronchoalveolar Lavage (BAL) and tracheal aspirates were obtained for microbiological investigations. Antimicrobial susceptibility testing was carried out on Streptococcus pneumoniae and Staphylococcus aureus isolates. The clinical specimens were further subjected to Polymerase Chain Reaction (PCR) to confirm the bacterial aetiology of S.pneumoniae and Haemophilus influenzae. Study data were summarised by frequency and percentage using SPSS (Statistical Package for Social Sciences) version 16.0. Results: A total of 220 subjects who were diagnosed for CAP of which 154 (70%) were culture negative and 66 (30%) were culture positive cases of CAP. The most commonly isolated pathogens were 29 (44%) of S.pneumoniae followed by 21 (32%) of S.aureus, 10 (15%) of H.influenzae and 6 (9%) of Klebsiella pneumoniae. Resistance to penicillin occurred in 24 (82.75%) of S.pneumoniae isolates. Methicillin-Resistant Staphylococcus aureus (MRSA) was demonstrated among 10 (48%) of the 21 total S.aureus CAP cases. Conclusion: Culture-based aetiologic diagnosis of CAP was made in only one-third of the cases. Ongoing antimicrobial resistance surveillance to S.pneumoniae and S. aureus is recommended. Determining the resistance profile of Klebsiella pneumoniae and H.influenzae is needed as pneumonia caused due to Gram negative aetiology is rising in the community setting. Rapid screening of bacterial CAP pathogens from clinical samples using PCR may be beneficial for clinicians to make a prudent antibiotic choice for CAP.

Prevalence of Bifid Mandibular Canals in Turkish Eastern Anatolia Population: A Retrospective Study

Numan Dedeoglu, Suayip Burak Duman

Introduction: Mandibular canal is between mandibular foramen and mental foramen and it includes inferior alveolar neurovascular bundle. For surgical procedures on mandible such as impacted tooth extraction, dental implant surgery, and sagittal split ramus osteotomy, assesing variations and anatomic location of the mandibular canal is very important. Aim: The aim of this study was to assess bifid mandibular canals by analysing Cone Beam Computed Tomography (CBCT) images in Turkish population of eastern Anatolia region. Materials and Methods: A retrospective study was conducted in which prevalance of bifid mandibular canal was assessed in 4 groups; group with third molar {group A: impacted (A1) and erupted (A2)} and without third molar {group B: only third molars missing (B1) and posterior edentulous area (B2)} with types and sub-types. Descriptive analysis and chi-square test were used for statistical analyses. Results: Of the 501 CBCT images assessed, bifid mandibular canal was found in 210 (41.9%). No significant difference was found between genders (p>0.05). The frequency of bifid mandibular canal was found as 47.3% in group A (45.8% in group A1 and 48.9% in group A2), and as 35.1% in group B (41.7% in group B1 and 31.2% in group B2). In patients who had third molars, bifid mandibular canal was seen more when compared with those who did not (p<0.05) had. Among bifid mandibular canals, retromolar canals were seen the most. Conclusion: The prevalence of bifid mandibular canal analysed by CBCT was found to be 41.9%. No difference was found between genders in terms of prevalence. CBCT is significantly useful tool before the surgical procedures especially removing third molars.

Assessment of Enamel Permeability Using Scanning Electron Microscopy in Permanent Teeth with and without Molar Incisor Hypomineralisation- An In Vivo Study

Introduction: Molar Incisor Hypomineralisation (MIH) is a qualitative defect of enamel which is more prone to posteruptive enamel breakdown resulting in the early invasion of dental caries compared to a normal enamel tooth structure. Aim: To assess the differences in the enamel permeability of permanent teeth with and without MIH using Scanning Electron Microscopy. Materials and Methods: Out of the sixteen children, eight children with and eight without MIH were randomly selected. Fully erupted maxillary anterior teeth were subjected for evaluation in this study. Vinyl Polysiloxane impression material was used to make impressions for SEM evaluation. The teeth surfaces were divided, into 9 different morphological areas for assessment. Negative replicas representing enamel droplets were assessed. Odd’s ratio was calculated by Logistic Regression Analysis. Results: Presence of enamel droplets was noticed in both the groups, more predominantly in teeth with MIH. On comparing the individual regions, presence of enamel droplets in the hypomineralised areas had significant difference compared to normal enamel, with p-value 0.0012, which was statistically significant, with an odds ratio of 3.4. Conclusion: This study demonstrated a high presence of droplets in MIH teeth compared to teeth without MIH, suggesting a possible high enamel permeability which in turn can be a predisposing factor for dental caries in teeth with MIH.

Dietary Habits of Patients with Type 2 Diabetes Mellitus-An Exploratory Study in a Tertiary Care Hospital of Eastern India

Introduction: Diabetes Mellitus (DM) is a medical condition that is caused by insufficient production and/or secretion of insulin from the pancreas. Type 2 Diabetes Mellitus (T2DM) accounts for 90 to 95% of all diagnosed cases of diabetes and is the most common form. Diet plays an important role in T2DM. Aim: To explore the dietary habits of patients with T2DM. Materials and Methods: It was a hospital-based exploratory study and cross-sectional in nature done to provide inputs for the interventions and the informatics tool in the clinical trial of the researchers. A total of 100 consecutive OPD patients with T2DM were included. Dietary habits were explored using 72-hour recall method and analysed using SPSS. Results were expressed as proportions for categorical data and mean with standard deviation. Results: Out of 100 participants, 58% were male with mean age of 54.25±12.03 years. The mean BMI was 23.99±4.36 kg/m². Overweight and obesity was seen in 48% and 17%, respectively. Recall bias was 28% for dietary intake in past 24-48 hours and 48% for intake 48-72 hours. A 77% of patients told that they could follow the advice of their doctor or dietician, but 67% were taking the recommended diet. Out of study subjects, 51% told that they face difficulties in obeying the diet advice and the difficulties listed were food craving, traveling, nature of job, etc. More than 20% patients were not taking food on time and the reasons quoted were nature of the job, carelessness, etc. A 62% of patients were avoiding sweets but 77% were found taking foods with high glycaemic index. Conclusion: Intervention in the form of intensive diet education including behaviour change and communication activities during hospital visits may be needed regarding the role of various food items (with emphasis to high glycaemic index) in controlling diabetes and preventing complications, and has to be captured in the tool planned for public health informatics trial.

Perception Regarding Narrative and Reflective Writing among Fellowship Candidates

Darshana Tote, Alka Rawekar

Introduction: Research is an integral part of medical field including medical education. Medical report writing is a specialised technique in the field of clinical research. Narrative and reflective way of medical report writing is an individual perception. Narration helps in expressing the situation while reflection of situation helps in reciprocating it well. Aim: To assess perception regarding narrative and reflective writing in fellowship candidates. Materials and Methods: Forty candidates enrolled for fellowship course were assessed in a prospective study for perception regarding narrative and reflective way of medical report writing of their allotted projects. Assessment was done on the basis of questionnaire based score (Likerts scale). Software used in the analysis was SPSS 22.0 version to assess the percentage of various score against a specific question. Results: Maximum participants were in the age group of 36-40 years (45%). A total of 80% candidates were of the opinion that narrative and reflective way of research writing is applicable in the current research writing; 50% percent candidates strongly agreed that reflective writing is better in analysing the situation; 80% candidates experienced that it is useful in gaining self-knowledge and understanding the topic better. Conclusion: Narrative and reflective writing is an effective way to describe the research methodology and its results. Also, reflective writing helps in framing future applications of the research.

Quantitative Analysis of Streptococcus Mutans, Streptococcus Sobrinus and Streptococcus Sanguinis and their Association with Early Childhood Caries

Kemthong Mitrakul, Boontarika Akarapipatkul, Piamporn Thammachat

Introduction: Severe Early Childhood Caries (S-ECC) remains highly prevalent worldwide. Streptococcus mutans and Streptococcus sobrinus are causative pathogens of dental caries and strongly involved in plaque or oral biofilm formation. Streptococcus sanguinis has antagonistic relationship with S. mutans and it might delay the colonisation of S. mutans in the oral cavities. Aim: To quantify S. mutans, S. sobrinus and S. sanguinis between 2 groups {S-ECC and Caries Free (CF)} of Thai children and to analyse the association between these bacteria and caries-related factors. Materials and Methods: Supra-gingival overnight plaque samples were collected from 120 Thai children aged 2-5 years (S-ECC=CF=60) using sterile toothpicks and released in 1 mL of TrisBase and EDTA buffer from January 2015 to December 2017. They were asked to expectorate saliva into a cup, plaque and gingival indices and dmft scores were recorded, parent’s demographic and children’s oral hygiene care and diet were assessed using questionnaire. DNA extraction and quantitative real-time PCR was performed. Different amounts of each bacterium were analysed by Mann-Whitney U test (p<0.05). The correlation between amounts of each bacterium and other clinical factors were analysed by Spearman’s correlation test (p<0.05). Results: The guardian’s demographic data, habit of milk bottle and breast feedings, oral hygiene care and consumption of cariogenic snacks were different between the two groups. S.mutans and S.sobrinus in plaque were higher in S-ECC. S.sanguinis in saliva and total bacteria were higher in the CF group. Plaque and gingival indices in S-ECC were higher than in the CF group. S.mutans levels in dental plaque and saliva was not significantly different. Conclusion: S.mutans and S.sobrinus were associated with S-ECC while S.sanguinis was associated with caries-free. Socioeconomics and children’s oral hygiene care and diet were important factors associated with S-ECC.

Stress among Clinical Dental Students in a Private Dental College in Jeddah

Othman Wali, Kavita Marusamy, Amit Vanka, Shanthi Vanka
Introduction: Environment in many dental colleges is highly competitive and stressful. Stress of students has two main factors personality-oriented and work/study-oriented. Aim: To assess the factors responsible for stress among the dental students in a private dental college. Materials and Methods: The cross-sectional study population included the students of dentistry program who were from fourth year to sixth year which are clinical years and students spend most of their time in the dental clinic. To investigate relevance and influence of the factors on stress experienced by students in the clinical years, a questionnaire was designed. The questionnaire has been tested for its validity and reliability based on a pilot study and pre-survey discussions with peers in the college. The association of the responses of the students to factors associated with stress was calculated using chi-square test. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: The responses of the students have been analysed, 64% of the students do feel that they are stressed during exams. A 52% students strongly agreed that the amount of work assigned was more. A 22% students agree that they lack the confidence of being a successful dental student. More than half of the students (71%) have lack of time for relaxation. The p-value of <0.05 was considered as statistically significant. Conclusion: This is an important study as dental students of Jeddah, are under tremendous amount of stress which is due to their own personality traits or created by environment.

Role of Extended Spectrum Beta Lactamases in Cephalosporin and Carbapenem Resistance in Escherichia coli from Inpatients and Outpatients in Nigeria
Introduction: Antimicrobial resistance requires global coordinated action with a view to addressing its rising threat. Prevalence of antimicrobial resistance has been increasing worldwide in both developed and developing countries. Whilst cephalosporin and carbapenem resistance is a problem in Escherichia coli in Nigeria, there is a paucity of information regarding the mechanisms of resistance underpinning this in prevalence and types of extended spectrum in clinical E. coli. Aim: To detect and characterise Extended Spectrum ß Lactamases (ESBL) in clinical E. coli from inpatients and outpatients in Nigeria. Materials and Methods: A total of 104 E. coli were obtained from 498 non-duplicate clinical specimens from Northern Nigeria between November 2017 and November 2018. Antibiotic susceptibility of third generation cephalosporin including other important antibiotics and phenotypic detection of ESBL of the isolates were determined. Genotypic detection of ESBL and randomly amplified polymorphic DNA to determine clonality were used to further characterise 44 E. coli isolates selected based on their phenotypes and clinical specimens. The data were analysed with the aid of statistical package for social sciences (IBM SPSS), version 21.0 and were reported in frequency tables and in percentages. Results: Majority of the E. coli isolates showed no clonal relationships. More than half of E. coli were resistant to third generation cephalosporin class of antibiotics. There was no difference between MIC₅₀ and MIC₉₀ values for the majority isolates for most drugs where MICs =256 µg/mL were the norm except for carbapenems with low level resistance. In total, 44/104 (42.3%) E. coli were ESBL producers. bla_CTX-M was the dominant ESBLs seen in 75% (33/44) of isolates, of these bla_CTX-M-15 variant was most common and seen in 72.7% (24/33) of isolates followed by bla_VEB, 21/44 (47.7%) and bla_PER 6/44 (13.6%). No AmpC or carbapenemase genes were identified. Conclusion: E. coli isolates from Northern Nigeria are highly multi-drug resistant with only carbapenems of common therapeutic drug classes retaining significant activity. Beta-lactam resistance is largely underpinned by carriage of CTX-M-15 and carbapenem resistance is likely to be a result of ESBL carriage with other mechanisms.

Caspase 9 Promoter Polymorphisms (-1263G>A, -905T>G, -712C>T) in Coronary Artery Disease
Introduction: Apoptosis has been involved in a number of pathological conditions including Coronary Artery Disease (CAD). Caspases are important regulators and executioners in both extrinsic and intrinsic apoptotic pathways. Caspase 9 is an initiator caspase involved in intrinsic apoptotic pathway activated by mitochondrial damage and cytochrome c, forms an apoptosome with procaspase-9 and activates the CASP9 cascade to execute apoptosis. Aim: To evaluate the association between CASP9 (-1263G>A, -905T>G, -712C>T) genotypes/haplotypes and their susceptibility to CAD. Materials and Methods: This case-control study consisted of 300 CAD patients admitted in Durgabai Deshmukh Hospital and Research centre, Hyderabad, Telangana, India, along with 300 age and gender matched healthy controls from local population between January 2012 to December 2016. The DNA samples were genotyped for polymorphisms in CASP9 (-1263G>A, -905T>G, -712C>T) by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. The data of CAD cases and controls were compared using the Student’s t-test for continuous variables and a Chi-square test for categorical variables using online statistical tools such as Interactive Chi square analysis and OpenEpi version 3.03. Linkage Disequilibrium (LD) and haplotype analysis were carried out by Haploview software. Interaction between single nucleotide polymorphisms and epidemiological parameters were determined by Multifactor Dimensionality Reduction (MDR) analysis. Results: Molecular analysis revealed that TG, TT genotypes of CASP9 -905T>G, -712C>T conferred 3 and 17 fold risk respectively for the development of CAD. Promoter polymorphic combinations of CASP9 were in perfect LD in controls. G-T-C, A-T-C haplotype of -1263G>A, -905T>G, -712C>T polymorphisms were found to be significantly predominant in the disease group. Further, MDR analysis showed that caspase 9 -712C>T polymorphism with positive family history, consumption of beverages and alcohol have high degree of redundancy. Conclusion: The present study suggests that CASP9 -712C>T variant might be used as a diagnostic marker for susceptibility to CAD.

Maximum Oxygen Consumption (VO₂ max) Estimation using Direct and Indirect Method in Indian Population: A Pilot Study

Karampreet Kour Buttar, Neha Saboo, Sudhanshu Kacker
Introduction: The maximal oxygen consumption (VO₂ max) has been considered the single best indicator of the cardio respiratory fitness. Maximal oxygen consumption (VO₂ max) is the maximum amount of oxygen a person can intake and utilise during intense exercise. Aim: To estimate and compare VO₂ max measured by using direct and indirect methods. Materials and Methods: A prospective cross-sectional pilot study in which total of 100 apparently healthy students (male and female) were recruited from RUHS-College of Medical Sciences, Jaipur from January 2019 to August 2019. VO₂ max of each participant was determined. Direct estimation of VO₂ max comprised of sub-maximal exercise test on treadmill using gas analyser whereas VO₂ max was indirectly predicted by standard protocol of Queen College step Test (QCT) with a gap of four days in between the tests. Collected data were entered in Microsoft-Excel and Paired t-test was used for statistical analysis of data. Results: The mean value of VO₂ max (mL/kg/min) using direct method was 44.66±9.25 and that of using indirect method was 48.00±8.02. There was statistically very significant difference between two methods of VO₂ max estimation (p=0.0032). Mean value of VO₂ max for males was 47.56±8.37 mL/kg/min and for females it was 37.62±7.40 mL/kg/min, which was found statistically significant (p=0.0001) higher in males than in females. Conclusion: From the present investigation it may be concluded that the actual VO₂ max is lower than the predicted VO₂ max from the QCT which suggest that the prediction equation is not applicable to the studied population due to difference of ethnicity. With the help of estimated VO₂ max we can find out physical fitness in individuals and creating awareness about physical activity and life style modification for primary prevention of cardiovascular, metabolic and mental disorders.

A Clinicopathological Analysis and Functional Outcomes of Claviculectomy in Primary Malignant Tumours of Clavicle
Introduction: Primary malignant tumours of the clavicle are exceptionally uncommon. In the literature the number of publications reporting long-term oncologic outcomes after claviculectomy is quite low. Aim: To analyse clinicopathological presentation of functional results of 15 patients with primary malignant clavicular tumour after claviculectomy and also to evaluate relationship of resection amount and the postoperative complication state with functional results. Materials and Methods: Fifteen patients (9 males, 6 females; mean age 44.8 years; range 2-87 years) with primary malignant tumours of clavicle who were performed claviculectomy between 2002 and 2017 were included the study. Patient’s mean follow-up duration was 41 months (range 14 to 68 months). Twelve patients underwent partial and 1 patient underwent total clavicle resection without reconstruction. Two patients underwent reconstruction with allograft fibula after partial clavicle resection. The functional result was assessed with the Constant-Murley scores, International Society of Limb Salvage-Musculoskeletal Tumour Society (MSTS) evaluation system and The University of California-Los Angeles (UCLA) shoulder rating scale. Mann Whitney u test was used for comparison of data sets. Spearman correlation was used to test the association between resection amount and patient’s scale scores. Linear regression analyses were carried out to evaluate the association of resection amount with patient’s scale scores. Results: The mean postoperative MSTS score was 63.1±14.1 (range, 33-80), the mean Constant-Murley score was 57.8±13.7 (range, 30-74) and the mean UCLA score was 20.8±6.8 (range, 8-31). A statistically significant and perfect negative corelation was found between resection amount and MSTS score (r=-0.907 p<0.001), Constant-Murley score (r=-0.910, p<0.001) and UCLA score (r=-0.975, p<0.001). It has been found that resection amount was significantly higher in the patients with complication than in the patients without complication (p=0.005), and MSTS score (p=0.014), Constant-Murley score (p=0.026) and UCLA score (p=0.007) were significantly lower. Conclusion: The present study concluded that the extent of claviculectomy resection has an effect on shoulder functions. Although the shoulder functional scores were found to be ow, patient’s daily activities were affected minimally. Beside, reconstruction has not been suggested due to the high rates of complications.

The Perception of Asymmetries in Occlusal Plane in the Frontal View among Laypeople: An Eye-tracking Study
Introduction: Eye-tracking studies have explored the need for orthodontic treatment and treatment outcomes from a lay perspective as a newer diagnostic tool versus traditional assessments based on static photographs. Aim: To evaluate the visual aesthetic perceptions of laypeople with regard to occlusal plane cant in a frontal smile analysis. Materials and Methods: Images of smiling male and female faces had occlusal plane cant added with Photoshop CC on the magnitudes of 0°, 2°, and 2.5° to the left side on the female face and the male to the right side. To obtain eye-tracking data, two software programs, OGAMA and The Eye Tribe Tracker® , were used together. Thirty male and 30 female laypeople raters were selected from the student population of a university (Pontifícia Universidade Católica do Paraná) and consisted of undergraduate students and not those of dentistry, to visualise ocular movement in the Areas of Interest (AOI). A One-Way Analysis of Variance (ANOVA) was applied to compare one of the independent variables with the dependent variable. Results: Eye-tracking showed that the laypeople identified a triangle shape between the right eye, left eye, and mouth with greater fixation of the eyes. There were statistically significant differences according to the number of fixations at the mouth and menton. Conclusion: Laypeople were not able to perceive the occlusal plane cant located on the right side of the male face or to the left on the female face. However, it is important to do take the laypeople perspective into consideration when making treatment alternatives.

Infant and Young Child Feeding Practices- An Interventional Behaviour Change Communication Approach

S Aswathy, KN Panicker, G Rajani, P Nimitha, Rithima Anvar
Introduction: Infant and young child feeding have the single greatest potential impact on child nutrition and survival. The period between conception and two years is critical in a child’s life and this is when interventions to improve nutrition must be delivered. Aim: To determine the impact of a tailored intervention on Infant and Young Child Feeding (IYCF) practices among mothers of children under three years of age and antenatal women. Materials and Methods: An interventional study was carried out among Antenatal women, mothers of children under three years of age and influencers in a self-administration area. The calculated sample size for the primary objectives varied between 30-50. In order to give representation to at least 80% of the panchayat, all underthree mothers and antenatal women numbering numbering 351 and 87 for each category from the randomly selected 12 of the 16 wards were enrolled in the study. Knowledge and practice of diet during pregnancy, antenatal check-up, breastfeeding initiation, exclusive breastfeeding, expressed breast milk, complementary food items, consistency and frequency of feeding, hygiene, feeding during illness, dangers of bottle feeding were assessed before intervention. After the intervention, an endline survey was conducted to assess the change in the knowledge and practice of the infant and young child feeding practices. Statistical analysis was carried out by comparison of mean, proportions before and after the study. Mc Nemar’s chi-square was done on variables with significant improvement followed by multivariate logistic regression. Results: The mean age of the mothers was 27.42±4.53 years. There was a significant increase in knowledge with regard to initiation, exclusive breastfeeding (p=0.01, p<0.01) and bottle feeding (p<0.01) among respondents and influencers. About half (47.9%) of the mothers had initiated breastfeeding within 1 hour of birth registering, a marginal increase from 45.2%. Reasons cited for non-initiation (n=187) were caesarean section (84.5%), child in intensive care unit (10.7%), delay in getting baby (2.1%) and no breast milk (1.07%). A significant decline in prelacteal feeds from 28.9% at baseline to 23.4% after the intervention was observed. Regression analysis for the IYCF practices with significant change demonstrated that belonging to a nuclear family was a predictor of improvement in diet of antenatal women; decrease in bottle feeding was a predictor of prelacteal feeds (OR=10.9 95%CI 3.9-29.9, p<0.001) and vice versa. Conclusion: Complex behaviour in relation to IYCF can be successfully addressed through a multisectoral approach; though follow-up is necessary to sustain it.

Effect of Silodosin and Deflazacort Combination in Reducing Symptoms Related to Indwelling Ureteric Stent: A Randomised, Double-Blind Trial

Debabrata Kumar Sabat, Daisy Karan
Introduction: Endoscopic stent placement is an eminent procedure in urological practice and it substantially helps in reducing severe symptoms of ureteral obstruction. However, there may be few adverse events which may significantly affect the Quality of Life (QoL) of patients. These include stent related pain, sexual dysfunction, and Lower Urinary Tract Symptoms (LUTS). Appropriate therapy will reduce LUTS and improve QoL. Aim: To assess the effect of silodosin and deflazacort combination, when compared to silodosin alone, in improving symptoms and QoL in patients with indwelling Double J (DJ) ureteral stents. Materials and Methods: A randomised, controlled trial was conducted at the Department of Urology of a Tertiary Care Hospital, in Eastern India between August 2018 and December 2018; in patients with insertion of DJ stent after ureteroscopy and percutaneous stone removal. Patients were randomised into; Group A, silodosin (8 mg) once daily for two weeks and Group B, silodosin (8 mg) and deflazacort (30 mg) once daily for two weeks. Outcomes including pain, voiding flank pain, storage symptoms (frequency, urgency, nocturia), QoL were determined. Student’s t-test was used for comparison of Visual Analogue Scale (VAS) and International Prostate Symptom Scale (IPSS) scores. Results: Total 144 patients were analysed in the study and were divided into group A (n=72) and group B (n=72). The mean age was 50.93 and 50.91 years; with 60 and 58 males in Group A and B, respectively. The mean VAS for pain was 1.05 and 2.01 for group B and A (p<0.05), respectively; similarly, voiding flank pain was also significantly lower in group B (1.56) than group A (2.80) (p<0.05). Mean score for frequency and urgency were significantly lower in group B (2.16 and 1.64) than group A (3.08 and 2.85); while, score for nocturia were similar between both the groups (p=0.87). The QoL score was significantly better in group B than in group A (1.44 vs. 2.81: p<0.05). Conclusion: Combination therapy with silodosin and deflazacort, instead of monotherapy with silodosin alone, was safe and effective in alleviating stent related LUTS and improving QoL.

Fournier’s Gangrene: A Study of 14 Cases

Achom Bala Chanu, Chetan Maibam, Th Sudhir Chandra Singh
Introduction: Fournier’s Gangrene (FG) is a life-threatening form of infective necrotising fasciitis affecting the genital, perineal or perianal regions. Men are mostly affected though women and children may also be affected. Despite aggressive treatment, the mortality rate of FG remains high. Aim: To study demographic pattern of FG, its predisposing factors and aetiological agents, locations of infective gangrene and outcomes of treatment in a geographical area. Materials and Methods: This retrospective study included data of 14 patients of FG admitted to the surgical units of the Institute with FG, between July 2017 to June 2019, which were analysed. The commonly affected sites, predisposing factors, causative organisms, and outcomes of management of FG were studied. Results: All the 14 patients were males; their mean age was 54.57 years (28-75 years). The mean duration from the onset of symptoms to admission to the hospital was 6.7 days (2-11 days). The mean hospitalisation time was 22.6 days (2-35 days). Six (42.86%) and 3 (21.43%) patients had FG secondary to perianal and scrotal infections respectively. Diabetes mellitus as a predisposing factor was found in 9 (64.29%) patients. There was no definite predisposing or co-morbid condition in 3 (21.43%) patients. The most frequent bacterial organism was Escherichia coli in 11 (78.57%) patients. The overall mortality was 5 (35.71%) out of the 14 patients. Mortality was highest in patients presenting with sepsis and diabetes mellitus. Conclusion: FG is a rapidly progressive, fulminant infection. In spite of aggressive surgical approach and broad spectrum antimicrobial combinations, the prognosis remains grave especially when it is associated with diabetes mellitus and sepsis.

Visual Outcome after Cataract Surgery in Rural Hospital of Wardha District: A Prospective Study

Madhumita Prasad, Sachin Daigavane, Vishal Kalode
Introduction: The most common cause of blindness is cataract, affecting over 17 million people worldwide. Cataract surgery is the most common surgical procedure done in the developed world. Aim: To study visual outcome of patients who underwent cataract surgery. Materials and Methods: It was a prospective study carried out in the Department of Ophthalmology for 1 year and total of 1750 patients with cataract underwent cataract surgery and the pre-operative and post-operative visual acuity was assessed. By using convenient random sampling, all patient who are admitted in the Department of Ophthalmology for cataract extraction surgery were included in this study. Statistical analysis was done by using descriptive and inferential statistics using Chi-square test. Software used was SPSS 17.0 and Graph Pad 6.0 and p<0.05 was considered as level of significance. Results: Total 1750 cases were enrolled and the maximum number of cases were in the age group of 51-60 years (54.86%) whereas the least cases were found in 41-50 years of age group, Out of 1750 cases, 64.28% were males and 35.72% were females. Pre-operative uncorrected visual acuity (UCVA) was <6/60 in maximum 630 cases (36%) cases, Out of 1750 cases surgeries was performed with phacoemulsification in 1120 (64%) cases and Small Incision Cataract surgery (SICS) in 945 (54%) cases, post-operative Best corrected visual acuity was 6/24-6/9 in maximum 1479 (84.51%) cases. Conclusion: The present study identified the factors that affect the visual outcomes such as surgical procedure, pre-operative Visual acuity, post-operative visual acuity. The phacoemulsification can be utilised due to evidence for better cataract surgery outcomes when compared to SICS. There is a need for community-based approach to increase awareness of eye health which is very important.

Effect of the Vitamin D Receptor Polymorphism on Bone Mineral Density and Bone Metabolism
Introduction: Vitamin D Receptor (VDR) polymorphisms are known to affect some aspects of bone metabolism, but the manifestations in a vitamin D deficient population are not that well known. Aim: To assess the effect of VDR polymorphisms on Bone Mineral Density (BMD) and biochemical manifestations of vitamin D deficiency in a vitamin D deficient population. Materials and Methods: Thirty participants with vitamin D deficiency {25 (OH)D=<20 ng/mL} and other biochemical features of vitamin D deficiency, i.e., elevated serum ALP, plasma PTH or decreased serum phosphate, were recruited as cases. Thirty participants with vitamin D deficiency (<20 ng/mL) who had no biochemical features of vitamin D deficiency were recruited as controls. Biochemical investigations and BMD were measured in all participants. VDR polymorphism (Fok1 and Bsm1) were analysed with Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP) analysis. Chi-Square, Analysis of variance (ANOVA) and Multivariate Analysis Of Variance (MANOVA) are used as statistical analysis. Results: Genotype frequency of Bsm1 and Fok1 were similar among cases and controls. BMD at L3 vertebra (lumbar spine lateral) was higher in Ff genotype of Fok1, whereas BMD at lumbar spine (L4 vertebra) was lower in bb genotype of Bsm1. In multivariate analysis BMD at lumbar spine, was affected by genotype of Bsm1 (Bb). Body Mass Index (BMI) was higher among participants with BB in comparison to bb genotype. Conclusion: An association was found between BMD, BMI and VDR polymorphisms. However, distribution of different VDR polymorphisms was similar among participants who had and who did not have subtle manifestations of vitamin D deficiency.

Minoxidil a Youth Elixir for Eyebrow Hypotrichosis

Varsha Gajbhiye, Yeshwant Lamture
Introduction: Eyebrows being prominent feature of the face contributes majorily for aesthetics. Eyebrow hypotrichosis means the reduction or absence of the eyebrow hair. This is associated with negative self-esteem. Minoxidil has been found to act at the level of hair follicle by direct stimulation of follicular epithelial growth, increase cutaneous blood flow, and stimulate resting hair follicles. Aim: To study the potential role of Minoxidil for the treatment of eyebrow hypotrichosis. Materials and Methods: It was a prospective interventional study comprising of 22 subjects aged 18 years or more having eyebrow hypotrichosis. These patients garded as Grade 1 or 2 hairloss on the Allergan Global Eyebrow Assessment (GEBA) scale. All the patients were advised to apply 1 mL of 2% minoxidil lotion to eyebrow twice a day for four months. Comparison of the change in global photographic score (Subject’s satisfaction) before and after Minoxidil treatment was done, also comparison of the diameter and number of eyebrow hairs/cm² areas between pre and post-treatment done. Paired t-test was used to compare diameter and number of eyebrow before and at the end of treatment. Results: Before treatment with Minoxidil the average hair shaft diameter was 0.034±0.0057 mm and density was 17±5.03 hairs/ cm² . After treatment this improved to 0.07±0.0045 mm and 30±7.03 hairs/cm² , respectively. The global photographic score was -2.1±0.76 before treatment that increased to -1.3±0.89 at four weeks and reached a peak of 2.3±0.55 at 16 weeks. The incidence of adverse events was 22.72% (5/22 subjects) which included mild itching and burning. Conclusion: This study showed that 2% Minoxidil is a welltolerated and effective treatment for eyebrow hypotrichosis.

Evaluating the Effect of Cabergoline on Glycaemic Control of Patients with Type 2 Diabetes Mellitus: A Randomised Controlled Trial
Introduction: Although bromocriptine has been approved as an antidiabetic agent, few studies have reported the beneficial effects of other anti-hyperglycemic long acting dopamine agonist agents. In this regard, Cabergoline has fewer side-effects than that of Bromocriptine which can be administered as one or two days per week with higher compliance rates in patients. Aim: To determine the effect of Cabergoline on glycaemic control in patients with Type 2 Diabetes Mellitus (DM). Materials and Methods: In this double-blind clinical trial, initial laboratory parameters including Fasting Plasma Glucose (FBS), 2 Hours Postprandial Plasma Glucose (2HPPG), HbA1c, Total Cholesterol (T-Chol), Triglycerides (TG), and High Density Lipoproteins (HDL) were assessed. The subjects were randomly assigned into two case and control groups. The intervention group received 0.25 mg Cabergoline tablets weekly for the first 2 weeks and 0.5 mg per week for the next 12 weeks. Control group also received placebo tablets. All clinical and laboratory assessments were repeated 3 months after initial visit. Paired t-test, independent t-test and chi-square were used for the comparison of quantitative and qualitative variables, respectively. Covariance analysis was also used to adjust for confounding variables. p<0.05 was considered as statistically significant. Results: HbA1c (p=0.01) and TG (0.04) levels were significantly decreased after intervention in the case group compared to the controls. Conclusion: Cabergoline, over a 3 months period, exhibits beneficial effects on HbA1C and TG levels and may possibly be useful as a long-term anti-diabetic drug in patients with type 2 DM.

Metabolic Syndrome and its Components in Patients with Rheumatoid Arthritis, and their Association with Disease Activity and Duration
Introduction: Rheumatoid Arthritis (RA) is the most common inflammatory rheumatic disease and there are some concerns about the association of Metabolic Syndrome (MetS) with this disorder. Aim: To evaluate the association between MetS and its components with RA disease activity and chronicity. Materials and Methods: The present investigation was a cross-sectional study on 200 consecutive RA patients (30-60-year-old, all of them female) according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010. MetS was diagnosed according to the definition of 2005 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP) III and International Diabetes Federation (IDF). Disease activity was measured by the 28 joint count of Disease Activity Score (DAS 28), and functional status was evaluated by Health Assessment Questionnaire (HAQ). Disease chronicity was defined as early or established RA, based on disease duration of less or more than six months. Statistical analysis was performed in SPSS version 19 by Student's t-test and chi-square test and ANOVA tests and results were considered significant at p<0.05. Results: The mean age of RA patients was 50.29±6.2 years, and all were female. MetS according to NCEP/ATP III and IDF criteria was present in 109 (54.5%) and 112 (56%) patients. Hyperglycaemia was significantly higher in patients with established active RA (p=0.003), but other MetS components were not different between groups. MetS had more related active disease as assessed by DAS28 and greater disability as assessed by the HAQ (p<0.001). Conclusion: The frequency of MetS was not significantly different in subgroups of RA according to disease activity or duration, but it was found in more than half of RA patients. Comparison of MetS components showed more frequency of hyperglycaemia in patients with active disease.

Assessment of Association Between Tooth Morphology and Psychology
Introduction: Visagism is the science which explores the possible connection between one’s personality and teeth shape. Clinicians maybe able to design a smile that blends with physical appearance, personality and desire of the patient. Aim: To evaluate the association between tooth morphology and psychological traits. Materials and Methods: A total of 102 participants aged between 20 and 35 years among medical professionals were selected for the study conducted from November 2018 to March 2019. The tooth forms, long axis, and occlusion lines were drawn using photograph editing software after capturing the photographs of frontal view of teeth in centric occlusion of the participants. And this was assessed with questionnaire. Temperaments of the participants were identified using a self-reporting questionnaire and classified according to Big Five Personality Traits. The type of temperament obtained from the questionnaire for each participant was compared with tooth form (oval, square, rectangle and triangular) obtained from photographic evaluation. Statistical analysis used were One-way ANOVA followed by post-hoc and Chi-Square test by keeping level of significance ≤0.05. Results: Females (82.4%) were more than males with a mean age of 23 years. Extraversion had square tooth form (34.1%). Conscientiousness trait had oval tooth form (31.6%). The Chi-square test presented that square tooth form showed extraversion trait (34.1%) and neuroticism (29.7%). However, the results were statistically insignificant (p>0.05). Conclusion: Although the concept of visagism is an appreciable idea, it lacks a practical approach to create a personalised smile.

Immediate Effects of Traditional Thai Massage on Heart Rate Variability in Major Depressive Disorder Patients
Introduction: Depression can affect people of all ages around the world. Patients with major depressive disorder always have stress and anxiety as their common symptoms. Traditional Thai Massage (TTM) is one of the most popular alternative treatments in Thailand to relieve psychological stresses and anxiety which may be reflected by increased Heart Rate Variability (HRV). Aim: To preliminarily examine the immediate effects of TTM on Heart Rate (HR) and HRV in patients with major depressive disorder. Materials and Methods: The study was conducted at two psychiatric departments in Thailand. A single group pre-post design was applied. Twenty-four patients (3 males and 21 females, aged 34.54±11.08 year) who were diagnosed with major depressive disorder participated while they were on standard medication. HRV, resting HR, and Blood Pressure (BP) were assessed before and immediately after having a session of TTM. Paired t-test was used to compare the outcomes between the pre and post-treatment procedure. Results: There was significant increase in HRV especially for time domain {the Standard Deviation of all Normal to Normal intervals (SDNN) (31.27±10.45 vs 37.76±11.55, p<0.01)} and the root mean square of successive differences: RMSSD (24.23±11.69 vs 34.49±16.51, p<0.01) while there were no change in HR and BP. Conclusion: A single treatment of TTM could increase HRV in this patient population. Further investigation with a larger sample size with a randomised controlled trial is suggested.

Maternal Factor V Leiden Mutation in Pre-eclampsia: A Case-Control South Eastern Indian Tertiary Care Hospital Based Study
Introduction: Pre-Eclampsia (PE) is a pregnancy-specific disorder which further complicates and leads to eclampsia. The Factor V Leiden (FVL) is an autosomal dominant genetic abnormality with incomplete penetrance predisposes to thrombosis. It codes for Factor V, as it is a missense mutation where arginine is replaced by glutamine. The FVL is a heterozygous condition which has risk of complicated pregnancy outcomes. Aim: To find out association between the Factor V Leiden Mutation (FVLM) and PE. Materials and Methods: The study was designed as case-control, where 150 PE gravid women were cases and 150 healthy normotensive gravid women were controls enrolled from the Department of Obstetrics and Gynaecology in RL Jalappa Hospital and Research Centre, Tamaka, Kolar, Karnataka, India. The methodology for maternal FVLM adopted was, isolation of the Deoxyribo Nucleic Acid (DNA) by using salting-out method followed by Polymerase Chain Reaction and Restricted Fragment Length Polymorphism (PCR-RFLP) with MNL1 enzyme. On digestion FVL allele was visible as an uncut 268 base pair fragment with PCR while the Leiden was cleaved to produce 163 and 67 base pair fragments (wild type). The 37 base pair fragment was not visible on the gel due to its small size. Homozygous Leiden mutation produces two bands corresponding to 200 base pair and 67 base pair (homozygous Leiden) for heterozygous Leiden Mutation four bands corresponding to 200 base pair, 163 base pair, 67 base pair, 37 base pair (heterozygous/Wild Type/mutant Leiden). Statistical analysis was done by using the SPSS software 13. The difference in frequency between two groups was not statistically significant. Results: Frequency of the leiden variant was 5.3% among cases and 6.7% in the control groups. Leiden variant of factor V in homozygous condition was not found in either of the study groups. Conclusion: FVLM is not a significant marker for PE in the Kolar population.

Distant Chest Skin Metastasis in Squamous Cell Carcinoma of Gingivobuccal Sulcus: A Rare Case Report

Venkatesh Anehosur, Sayali Kiran Desai , Swetha Acharya , Niranjan Kumar
The sixth most common cancer in the world is head and neck squamous cell carcinoma with an annual estimated incidence of around 275,000 for oral carcinoma. India has been cited frequently as the country with the highest incidence in the world with over 100,000 cases noted every year. Recurrence of oral squamous cell carcinoma are commonly seen as locoregional failure which is at the primary site or in the neck lymph nodes. Distant metastasis incidence is very uncommon and they are reported in lung, liver, and spinal cord. There are few reported cases of squamous cell carcinoma from oral cavity which has shown metastasis over the chest skin. This case report highlights a rare metastasis which, in spite of good locoregional control with surgery and adjunctive radiotherapy, resulted in a poor outcome.

Menstrual Disorders and its Association with Migraine

Shahrzad Fakhraee, Omid Hesami, Zahra Soroureddin
Introduction: Migraine is a common disorder which can be seen in approximately 18% of women. The highest prevalence of this disorder has been reported vastly in the women of age between 18 and 49, when they are in the menstrual period and this is supposed to be associated with the same. Aim: To study the menstrual disorders in women with and without migraine. Materials and Methods: A case-control study was conducted with total population of 175 women (Jan 2018-Feb 2019), diagnosed with migraine, using International Headache Society criteria. Age and sex-matched control group was included in the present study. A semi-structured questionnaire about migraine and migraine-related disabilities, menstrual and headache history was conducted. All results were evaluated by SPSS version 22.0 statistical software; Independent t-test and to investigate the relationship between quantitative variables, Spearman’s correlation coefficient was used. Results: In case group, 25.6% of women had menstrual cycle <24 days, and their population was significantly more than control group (10.1%). Also, in case group, 12.8% of women had menstrual cycle >38 days, which was significantly more than control group. The proportion of women with period lasting <4 days in case group (17.4%) was significantly more than that in control group (6.7%). In addition, the percentage of women with last period more than 8 days in case group was 12.8% and in control groups it was (6.7%) which was significantly high. Conclusion: There is significant relation between period duration, oligomenorrhea, polymenorrhea and prevalence of migraine; however, there is no significant relation between other menstrual disorders such as dysmenorrhea and menstrual regularity with migraine. This study demonstrates no relation between severity and duration of headache and menstrual disorders.

Expression of Immunohistochemical Markers (CD56 and P63) in Various Non-Neoplastic and Neoplastic Lesions of Thyroid Gland

Resmi P Sasi, Sushma
Introduction: Thyroid disorders are very common all over India, more so in Kerala. Although definite histologic criteria exist for diagnosing various thyroid lesions, there is an overlap of many nuclear and cytoplasmic features like nuclear atypia, enlargement etc., between both non-neoplastic and neoplastic lesions. This sometimes leads to a diagnostic dilemma in differentiating these lesions. CD56 is expressed by many tissues in the body including normal thyroid follicular epithelium, this expressivity being absent or reduced in Papillary Thyroid Carcinoma (PTC). Normal thyroid follicular cells do not express p63. Aberrant expression of p63 on thyroid epithelium is thus a marker of proliferation and tumourigenesis. Aim:To assess the expression of CD56 and p63 in various non-neoplastic and neoplastic thyroid lesions and to calculate the percentage of positivity and negativity in these lesions. Materials and Methods: This was a prospective study of 100 thyroidectomy specimens submitted to the Department of Pathology, Govt. TD Medical College, Alappuzha from January 2016 to June 2017. H&E stained sections of these specimens were studied and Immunohistochemical (IHC) staining with CD56 and p63 markers was performed on all and their expressions, positive or negative, were evaluated and expressed as percentage values. Results: Out of 100 thyroidectomy specimens studied, total number of non-neoplastic cases was 58 and neoplastic lesions (benign and malignant) were 42. The most common non-neoplastic lesion was lymphocytic thyroiditis (39/58). Most common malignant thyroid neoplasm was PTC (35/42). CD56 showed membranous positivity in 53/58 (91.4%) non-neoplastic lesions and only 4/42 (9.5%) neoplastic lesions. Nuclear positivity for p63 was seen in only a small proportion (18/100, i.e., 18%) of all lesions. Conclusion: Significance of this study lies in the fact that CD56 is expressed in most non-neoplastic lesions of thyroid and is found negative in thyroid malignancies. The p63 even though considered to be a proliferation marker is negative in most of non-neoplastic as well as neoplastic lesions in the present study.

Effect of Very Early Mobilisation on Symptoms of Depression and Anxiety Following Acute Stroke: A Randomised Controlled Trial

Purusotham Chippala, Raghava Sharma
Introduction: Depression and Anxiety are one of the most commonly experienced problems by stroke survivors. It affects the functional status and quality of life of stroke survivor. Early physical activity may reduce symptoms of depression and anxiety. Aim: To determine the effect of very early mobilisation coupled with standard care compared with the standard care alone on symptoms of depression and anxiety following acute stroke. Materials and Methods: Study design was parallel active controlled, randomised controlled trial from December 2013 to December 2015. The intervention group received very early mobilisation including out of bed activities such as sitting, standing upright, walking begun within 24 hours of stroke onset for 5-30 minutes (Determined by patient tolerance) at least twice a day, for seven days. All the participants received standard physiotherapy care for 45 minutes once a day. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression (HAD) rating scale on admission, at discharge and at three months follow-up. The Mann-Whitney U-test was used to compare the HAD rating scale measures between groups and the p-value <0.05 was considered as significant. Results: A total of 105 individuals with acute stroke (62 male and 43 female) aged 30-81 years were recruited in the study. The intervention group (n=48) demonstrated a significant decrease in symptoms of anxiety and depression at discharge (p<0.05) and at three months follow-up (p<0.05) than the standard care group (n=47). Conclusion: Very early mobilisation may be potential treatment to prevent or reduce symptoms of depression and anxiety following acute stroke.

Efficacy of Passive Ultrasonic Activation Assisted Hand vs. Rotary Retreatment Files in the Removal of Root Canal Filling Material: An In Vitro Study
Introduction: Endodontic treatment failures are caused by persistent or secondary intraradicular infection due to inefficient treatment or re-infection of the obturated root canal system because of coronal or apical leakage. Complete removal of Gutta-Percha (GP) from the root canal system is essential during retreatment procedures in order to re-establish healthy periapical tissues. Many techniques and materials have been advocated in root canal-treated teeth to remove the obturating materials. However, residues of the filling materials have been observed on the canal walls in all the techniques. Therefore, this study was designed to explore the application of passive ultrasonic activation in the removal of gutta-percha and epoxy resin based root canal sealer during endodontic retreatment by rotary and hand instruments. Aim: To evaluate the efficacy between passive ultrasonic activation assisted hand vs. rotary retreatment files in the removal of gutta-percha and sealer during endodontic retreatment. Materials and Methods: The current study was an experimental in vitro study where all the procedures were carried out in extracted human teeth from October 2018 till February 2019. Forty extracted human single rooted teeth were selected. The root canals were prepared using ProTaper Next rotary files and obturated by a hybrid warm gutta-percha technique. They were divided into four groups of ten specimens each based on the retreatment procedures: Group 1: H-files, Group 2: H-files and passive ultrasonic activation of xylene, Group 3: ProTaper Universal retreatment files and Group 4: ProTaper Universal retreatment files and passive ultrasonic activation of xylene. The specimens were sectioned buccolingually after retreatment procedure and viewed under stereomicroscope for evaluating the percentage of remaining gutta-percha. Data obtained was subjected to Normality tests. Further statistical analysis was done using one-way ANOVA followed by Tukey Kramer Test for pairwise comparisons. Results: Irrespective of the technique, all the specimens showed residual filling materials on the canal walls. ProTaper Universal retreatment files with or without ultrasonic activation of solvent showed significantly (p<0.05) less filling material remnants when compared to H-files with/without ultrasonic activation of solvent. Conclusion: Rotary instrumentation supplemented with passive ultrasonic activation was found to be more efficient in removing root canal filling materials.

Assessment of Pentosidine as a Marker for Advanced Glycation End Products in Type 2 Diabetes Mellitus Patients

Sarath Kumar Jaganathan Jaishankar, Amrutha Murali, Amrin Marzooka
Introduction: With Diabetes Mellitus (DM) becoming a global burden, quantifying the number of people affected, both now and in the future, is vital so that the preventive component of diabetes and its complications can be emphasised. Many studies suggest that DM associated with persistent or uncontrolled hyperglycaemia leads to the production of Advanced Glycation End Products (AGEs) and Advanced Oxidation Protein Products (AOPPs) resulting in various micro and macrovascular complications. Pentosidine, an AGE, is a glycated protein product formed as a result of non-enzymatic glycation, mainly Maillard reaction between plasma glucose and plasma proteins. Aim: To determine the efficacy of pentosidine as a marker for AGEs in Type 2 DM patients. Materials and Methods: A case-control study was conducted in a tertiary care institution with approval of the institutional ethical committee August to September 2014. Forty four individuals who have been diagnosed with type 2 DM for more than five years were taken as cases and 44 healthy individuals who were age and gender matched were included as controls.The medications taken by cases were: Metformin (n=44); Glimepiride (n=26); Glibenclamide (n=7); Glipizide (n=4); and Atorvastatin (n=44). All the participants underwent routine and special (AGEs-pentosidine-ELISA) investigations. Data were analysed using the SPSS version 16 software. Results: In this study, the mean level of pentosidine (AGE) among cases was 3.073 ng/dL, and among controls was 2.682 ng/dL. Although the levels of pentosidine (AGE) was found to be higher in cases than controls, this difference among the groups was not found to be statistically significant. Conclusion: Levels of AGEs (pentosidine) in cases were higher than the controls, but not statistically significant. Although AGEs have been considered to play a role in the development of many micro and macro angiopathic complications both independently and synergistically in patients with DM, it must be conducted on a larger scale to extrapolate the results in order to assess the effectiveness of AGEs in supplementing routine investigations.

Effect of Telenursing on Level of Anxiety in Parents of Hospitalised Premature Neonates in Neonatal Intensive Care Unit
Introduction: Hospitalisation in the Neonatal Intensive Care Unit (NICU) as a closed chamber, separates neonates from their parents and causes anxiety in the parent’s mind. Nurses can provide a great volume of information in a short period by telenursing. Aim:Materials and Methods: This before-after Quasi-experimental study, with a control group, was conducted from November 2018 to April 2019 among parents of premature neonates admitted in NICU of Mofid Children’s Medical Centre, Tehran, Iran. They were selected through the convenience sampling method, 60 individuals were selected for this research, and they were divided into 30 participants for intervention and control groups. In the intervention group, 15 telephonic conversations between parents and nurses were done totally for 15 days. During these phone contacts, the researcher provided information to one of the parents about the neonate’s respiration, recent vital signs, consciousness level, sleeping rhythm, feeding. The data was collected by using the self-report Beck Anxiety Inventory, and socio-demographics questionnaires. The Beck Anxiety Inventory was filled out once before the intervention and then after phone calls on the first day and fifth, tenth and fifteenth day of admission in the intervention groups. This was also filled out in control groups and were compared in both the groups. Results: The findings indicated that there was a significant difference in terms of anxiety in the intervention group before (51.80±11.2) and after (25.1±3.4). There was a significant statistical difference between the intervention group and the control group in the fifth, tenth and fifteenth day of hospitalisation (p≤0.001). The anxiety level in the control group before (52.45±11.9) and after (50.43±10.18) intervention showed no significant difference. Conclusion: The telenursing intervention was effective in reducing anxiety in parents who had their premature neonates in NICU.

Impact of Diabetes Mellitus and Ischemic Heart Disease on the Blood Resistivity Index of Renal Arteries in Hypertensive Patients
Introduction: Hypertension (HTN) is considered as one of the most common health problems. Doppler sonography plays an effective role in haemodynamic assessment of renal arteries in patients with essential HTN. Aim: To assess renal vascular Resistive Index (RI) in patients with essential HTN in co-existence with Diabetes Mellitus (DM) and Ischemic Heart Disease (IHD). Materials and Methods: This was a cross-sectional study which involved 100 hypertensive patients selected by a simple, convenient sampling method from June 2014 to August 2016. The participants were categorised into four groups; 55 patients with controlled HTN while the uncontrolled HTN groups included 20 with HTN coupled with DM, 18 with HTN and IHD, and seven patients of HTN accompanied by both DM and IHD. The patients were investigated using Duplex Doppler ultrasonography to assess the RI of the renal arteries. Analysis of variance and Student’s t-test were performed to compare renal RI values between controlled and uncontrolled hypertensives. Results: The mean renal RI in patients with controlled HTN was 0.59±0.093, 0.71±0.035 in DM, 0.70±0.029 in IHD, and 0.72±0.029 in patients with IHD and DM. Controlled hypertension revealed a stable blood RI across the renal arteries (RI=0.59±0.093). The renal RI was significantly higher in patients with DM, IHD and DM+IHD group compared to patients with controlled HTN (p-values=0.004, 0.014 and 0.001). Conclusion: The renal RI is an important parameter which provides useful information about haemodynamics of renal arteries in essential HTN complicated with DM and IHD.

Use of Scatterplot Patterns Derived from Automated Haematological Analysers in the Diagnosis of Acute Febrile Illnesses

Ronit Juthani, Debdatta Basu
Introduction: Acute Febrile Illness (AFI) is common in the tropics and caused by diverse pathogens. Dengue, malaria, enteric fever and scrub typhus are few common causes of AFI in India. Peripheral blood smear and complete blood counts are important investigations carried out in the investigation of acute febrile illness. Cell abnormalities in AFI produce unique scatterplot diagrams which may aid in diagnosis. Aim: To differentiate the scatter plot patterns of normal blood samples from those in AFI and to assess whether the abnormal scatter plot patterns (if they exist in AFI) can be used for predicting the common acute febrile illness. Materials and Methods: The descriptive study was conducted in JIPMER for a period of two months on EDTA blood samples of patients reported for complete blood count and peripheral blood smear examination in the haematology laboratory. Consecutive blood samples of patients with acute febrile illness were collected for a two month period and analysed for scatterplot patterns. Controls included samples with normal counts, scatterplots and no history of fever. A total of 323 samples of AFI and 100 control samples were assessed. AFI and control samples were processed in SysmexXT2000i haematological analyser and simultaneous serological and culture investigation was carried out to detect the nature of AFI. Sensitivity and specificity were calculated based on differences between AFI and control blood samples. Results: Out of 323 AFI samples, 158 were bacterial, 2 were of enteric fever, 18 were fungal, 17 were viral, 9 were mycobacterial, 5 were malarial, 1 was helminth, 1 was rickettsial while 139 were serology and culture negative. Negative y-axis monocyte deviation was a common sensitive finding in bacterial (sensitivity-0.87), fungal (sensitivity-0.88) and viral aetiology (sensitivity-0.82) while neutrophilic leukocytosis was sensitive in bacterial (sensitivity-0.79), fungal (sensitivity-0.78) and mycobacterial aetiology (sensitivity-0.78). Lymphopenia was also found in fungi (sensitivity-0.78). Malaria showed splitting of eosinophils (specificity-0.98), RBC granularity increase (specificity-0.99) and increased neutrophil-eosinophil merge (specificity-0.83). Other common findings included monocytosis, left shift of neutrophils and presence of blue areas in RBC region. Conclusion: Scatterplot patterns obtained from a complete blood count can give a clue in the diagnosis of the aetiologies of acute febrile illnesses.

A Cross–sectional Study of Eruption Time of Primary Teeth in South Indian Children

Gunashekhar Madiraju, Harsha Basavaraja
Introduction: Eruption chronology of primary teeth can be a very valuable asset in the diagnosis and treatment planning of children in the field of dentistry. Aim: The present study aimed to determine the mean eruption time and sequence of eruption of primary teeth in South Indian children. Materials and Methods: This cross-sectional study from September 2017 to December 2018 involved a random sample of 954 South Indian children (452 boys and 502 girls) aged six to thirty-six months. The mean age of eruption for each tooth was calculated using the Karber method, as modified by Hayes and Mantel. The student t-test was used to assess possible differences in the mean age of primary teeth eruption between males and females for both the maxilla and mandible. Results: The mandibular central incisors were the first teeth to erupt with an overall mean eruption time of 10.3±0.6 months.Girls displayed significant earlier eruption of first primary molar in both the maxilla and the mandible (p<0.05). Conclusion: South Indian children experienced delayed eruption of primary teeth when compared to their counterparts in other populations. Data from the present study can be used as a reference. The mean age of eruption was 10.2±0.79 months in boys and 10.4±0.38 months in girls. All the teeth, except canines and first molars emerged earlier in the mandible in both the genders.

The Impact of Pre-haemodialysis Systolic Blood Pressure on One-year Survival Rate in Chronic Haemodialysis Patients in Medan, Indonesia

Riri Andri Muzasti, Mariati Gurning
Introduction: Haemodialysis (HD) patients have higher mortality than the general population. Hypertension is frequent in dialysis, but there is no consensus for an optimal target for blood pressure on HD patients. Systolic Blood Pressure (SBP) levels, which are considered "normal" in the general population, are associated with adverse outcomes in HD patients referred to as "reverse epidemiology." Aim: To evaluate the impact of pre-haemodialysis Systolic Blood Pressure (pre-SBP) on a one-year survival rate. Materials and Methods: This was a cohort retrospective study done on 133 HD patients in Adam Malik Hospital in January 2017. The patients were divided into two, based on pre-SBP, <130 mmHg, and ≥130 mmHg for each patient. Demographic data, clinical, and laboratory parameters were collected, and the survival rate observed from January 1^st, 2017 until December 31^th, 2017. For the processing of data, SPSS 22.0 was used. A statistical analysis using Kaplan-Meier survival analysis and conventional Cox regression was performed to evaluate one-year survival. Results: Forty one patients (30.8%) were in category pre-SBP <130 mmHg and 92 patients (69.2%) were in category pre-SBP ≥130 mmHg. One year mortality rate was 25.6%. There was a statistically significant association between pre-SBP <130 mmHg and one-year mortality. After adjusted with age, gender, HD vintage, and Hb, pre-SBP <130 mmHg had greater mortality with Hazard Ratio (HR) 2.235 (CI: 1.110-4.499, p=0.024) compare to pre-SBP ≥130 mmHg. Conclusion: The relationship between pre-SBP and mortality in HD patients consistently differs from those in the general population. Patients with "low" pre-SBP (<130 mmHg) is associated with greater mortality compared to those with "high" pre-SBP (≥130 mmHg).

Role of 3 D Ultrasound in Objective Evaluation of Caesarean Scar

Sangeeta Gupta, Swapnika Boppudi, Taru Gupta, Nupur Gupta
Introduction: The alarming number of caesarean deliveries is a growing concern in India as it has great impact on maternal health. The scar strength can predict performance during Trial of Labour After Caesarean (TOLAC). A 3D ultrasound is a very valuable technique in the scar assessment as it analyses many other volume based parameters apart from just the scar thickness. This adds objectivity in predicting the scar integrity and improves the patient selection for a successful TOLAC. Aim: To evaluate the most accurate ultrasonographic parameter (2D, 3D USG and colour doppler) for assessing the quality of scar on the uterus. Materials and Methods: This was an observational prospective study enrolling antenatal women with previous LSCS after 28 weeks of gestation in which after history and antenatal exam, 2D, 3D and colour Doppler were done and scar parameters were analysed. The Pearson's chi-square test was used to determine the relationship between two categorical variables. The sensitivity, specificity, PPV and NPV of each parameter was calculated. ROC analysis was done to determine the optimum cut-off values. The p-value of <0.05 was taken to indicate a significant difference. Results: Among the 245 patients analysed 160 (65.3%) had a Vaginal Birth After Caesarean section (VBAC) and 85 (34.7%) underwent a repeat Lower Segment Caesarean Section (LSCS). The ultrasonographic parameters which showed a statistically significant difference in affecting the mode of delivery were shape of the scar, thickness of the scar and echostructure of the lower uterine segment. The mean scoring of all the parameters taken together also showed a statistically significant difference affecting the mode of delivery. Conclusion: The scar parameters analysed in the present study did show a statistically significant difference in affecting the mode of delivery, and the clinical factors analysed, especially induced versus spontaneous mode of delivery, also showed a significant statistical difference in the mode of delivery.

Serum Lactate Dehydrogenase Levels with Birth Asphyxia in Term Neonates
Introduction: It is difficult to diagnose birth asphyxia if neonatal records are not available. Serum Lactate Dehydrogenase (LDH) level is an easily accessible tool in most of routine laboratories. Aim: To assess the relation of serum LDH with birth asphyxia in term neonates. Materials and Methods: This was a prospective study, done on 50 asphyxiated newborns (cases) and 50 non asphyxiated term newborns (controls) which were taken from Neonatal Intensive Care Unit (NICU), Department of Paediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India from November 2017 to September 2019. LDH levels were estimated in 50 non asphyxiated neonates of Cord Blood (CB) at birth and in 50 asphyxiated newborns of CB at birth and at 24 hours of life. Chi-square test, Fischer-exact test and student’s t-test were applied in this study. The Software used to analyse and compute data was SPSS version 20. Results: On comparing the controls and cases, mean LDH of CB was 299.90 U/L vs. 999.04 U/L. Mean LDH level in cases at 24 hours was 1574.72 U/L. LDH (CB) sensitivity was 94% with Confidence Interval (CI) 83.45% to 98.75%, specificity was 90.00% with CI 78.19% to 96.67%. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of LDH were estimated as 90.38%, 93.75%, respectively. The LDH (CB) value in mild, moderate and severe asphyxia was 585.33±424.78 U/L, 694.91±444.22 U/L, 1369±672.59 U/L, respectively. The LDH at 24 hours of postnatal life values in mild, moderate, severe asphyxiated newborns were 772.33±108.61 U/L, 1103.69±605.25 U/L, 2457±1019.81 U/L, respectively and it showed a highly significant p-value of <0.001. LDH level at 24 hours had more area under curve so have more diagnostic value than LDH (CB) (0.861 vs 0.725), both timing is good for differentiating asphyxiated and normal neonates. Conclusion: The present study found a good correlation between LDH levels in cases with severity of birth asphyxia. It concluded that LDH at 24 hours is a more accurate time to differentiate newborn with birth asphyxia than without birth asphyxia. The LDH for diagnosis of birth asphyxia can be used in cases without past records or sick newborns which are referred from peripheral hospitals.

Assessment of Risk Factors and Microbial Profile of Otomycosis in Patients Attending Tertiary Level Hospital of Western Rajasthan, India

Vishakha Ashopa, Usha Verma, Pooja Nareda, Eshank Gupta, Prabhu prakash
Introduction: Otomycosis or fungal otitis externa is a superficial, subacute or chronic infection of External Auditory Canal (EAC) with irregular complications involving the middle ear, which is characterised by inflammation, pruritus, scaling, otalgia, fullness of ear, tympanic membrane perforation, hearing impairment and ear discharge. Fungi can either be the primary pathogen or be superimposed on bacterial infections. Aim: To identify causative agents of otomycosis and to determine the associated predisposing factors. Materials and Methods: The present study was a hospital based prospective study which was conducted from April to September 2019 in Department of Microbiology and Department of Ear Nose and Throat (ENT) in a tertiary level hospital. Total 150 samples was collected from clinically diagnosed patients of otomycosis of any age group. Identification of fungal and bacterial isolates were done by standard microbiological procedures, and demographic profile, occupation, predisposing factors were evaluated. Categorical data was presented as frequencies and percentages. The association between the pre-disposing factors (Ear pricking, oil instillation) and the prevalence of otomycosis was analysed by chi-square test. The p-values <0.05 was considered significant. Results: Male to female ratio in present study was 1:1.30, females were more than males. Maximum cases were in the age group of 21-30 years i.e., 37 (24.67%), occupation wise maximum cases were seen in housewives 55 (36.67%). Ear pricking was the most common predisposing factor leading to otomycosis i.e., 122 (81.33%). Aspergillus species and Candida species were the most commonly identified fungal pathogens in otomycosis 76 (70.37%) and 17 (15.74%), respectively. In bacterial isolates Pseudomonas species 20 (13.33%) was the most common causative agent, cases of mixed bacterial and fungal infection were also seen. Conclusion: In the present study, Aspergillus species was found to be the most common fungi involved in otomycosis. There is need to educate the community about the common practice of ear pricking and instilling oil in ear which leads to otomycosis.

A Study on Range of Near Visual Acuity in Children with Pseudophakia

Melinda P Letitia, Deepa John, Sarojini Ramani, Malavika Babu, Thomas Kuriakose
Introduction: Accommodation is the ability to see over a range of distances by changing the power of the natural lens. With cataract surgery, this ability is partially or completely abolished. Apparent accommodation or pseudo-accommodation is the potential of pseudophakic eyes to sustain a good amount of near vision. Aim: To measure near vision in children with pseudophakia unaided, with distance vision correction alone (mono focal lens) in-situ and to measure the minimum near add (bifocal near segment power) required to read 1M (normal reading print size) at 30 cm and 40 cm. Materials and Methods: A cross-sectional study was conducted among children between 5-15 years of age with pseudophakia. Vision assessment was done using Lea symbol chart, at 3 metres for distance and at 30 cm and 40 cm for near. Near vision assessment was done unaided and with distant vision correction alone in place. Minimum spherical power needed to read 1M and child’s class textbooks were also assessed. Results: Sixty-four children were included in the study. Mean age was 10.5 (±3.12) years. Refractive status showed spherical power ranging from -7.00 DS to +1.00 DS (-0.8 Mean, (±1.33 SD), astigmatism ranging from -4.50 DC to +3.00 DC (-1.29 mean, ±1.37 SD). Unaided near vision assessment showed that 41 (64%) could read <2M at 30 cm. Nine children could read 1M at 30 cm and three children could read 1M at 40 cm with distant vision correction alone in place. Conclusion: Sixteen (25%) children in our study were independent of spectacles for reading 1M at a reading distance of 30 cm. Nine children (14.1%) read 1M at 30 cm with monofocal spectacles. Twenty-three children (35.9%) had good functional near vision and did not require any add for near work. Forty-six children (71.8%) required only 2 D or less near add for their classwork at 30 cm. Thus, monofocal or reduced near add can give these children a better quality of vision.

Single Strand Conformation Polymorphism and Sequencing of HS6ST2 Gene in Patients of Idiopathic Premature Ovarian Failure

Isha Rishi, Ashutosh Halder, JB Sharma, Manish Jain, Mona Sharma
Introduction: Premature Ovarian Failure (POF) is a condition characterised by hypergonadotropic hypoestrogenic amenorrhea in women under the age of 40 years. Most cases of POF remain idiopathic despite of various aetiologies described. X-chromosome aberrations remain the major underlying cause of idiopathic POF. Heparan Sulfate 6-O Sulfotransferase 2 (HS6ST2) gene is one of the gene of X chromosome implicated in POF. Aim: To detect HS6ST2 gene mutations in patients of idiopathic POF by Single Strand Conformation Polymorphism (SSCP) and to confirm the results by Sanger sequencing. Materials and Methods: A cross-sectional study was planned from february 2017 to february 2018 by including total of 25 women with secondary amenorrhea and age less than 40 years as cases. Out of those 25 cases, 10 idiopathic cases of POF were selected by excluding the other causes of POF. The study also included 10 healthy fertile women with normal hormonal profile as the control group. Study was done in two parts. In the first part, idiopathic cases of POF were identified based on clinical and laboratory parameters. In second part, SSCP was standardised and was applied to identify mutations in HS6ST2 gene and results were confirmed by Sanger sequencing. Results were compared statistically by using two sample t-test and two sample Wilcoxon rank sum (Mann-Whitney) test. The values obtained were expressed as mean±SD along with the p-value. Results: Idiopathic cases of POF were selected based on clinical and laboratory parameters. There were no mutations found in the selected HS6ST2 exons and results were confirmed by Sanger sequencing. Conclusion: As the present work was planned in smaller number of cases, involvement of HS6ST2 gene cannot be completely ruled out. The study shall be planned in larger cohorts to confirm validity of results. In case if genomic variants are found in more number of studies planned, it will help in developing functional studies in both human cell lines and in vivo mouse models to validate the association of genomic variants in POF. SSCP is a rapid, easy technique and it is as sensitive as Sanger sequencing for identifying gene mutations.

Epidemiological Prevalence of Pediculosis and its Influencing Factors in Iranian Schools: Systematic Review and Meta-analysis
Introduction: Pediculosis is an endemic parasitic infestation in many countries of the world. Iran is one of the countries with a high rate of pediculosis. Aim: To investigate the prevalence and factors associated with pediculosis in primary school students of Iran. Materials and Methods: The literature search was carried out by two researchers on national databases including: SID, Iranmedex, Magiran, Irandoc and international database including: Scopus, Pubmed and Web of Science to find relevant articles between 2000 and 2016. The search strategy was performed using keywords such as: "epidemiology", "prevalence", "infestation", "head louse", "head lice", "Pediculus humans capitis", "pediculosis", "primary school students", "primary students", "school children", and "Iran", as well as their Farsi equivalents. In this study, a random effects model and a fixed effect model were used. To test heterogeneity, the Q-Cochran test was used at an error level of less than 10% and the quantity was estimated by I2. The Begg Rank Correlation Test and Eggers Regression Method were used to measure the publication bias. Results: The results showed that 428,993 students were studied in 55 papers between 2000 and 2016 and the prevalence of head louse (Pediculosis human capitis) was 6.4% (95% CI: 6-6.9). The prevalence of lice (pediculosis) infestation among girls was 6.1% (95% CI: 4.6-7.4) and in boys was 1.2% (95% CI: 0.8-1.7) and in rural areas prevalence was more than urban areas. Conclusion: The results of this study demonstrated a high incidence of pediculosis among rural school-girls. It is recommended that, creating awareness among this population is required, especially schools that do not have a health teacher. Large families, having low education among parents, must be educated about the condition and its prevention.

Role of Curcumin in Alleviating Symptomatic Oral Lichen Planus: A Systematic Review

Sreedevi Dharman, Karishma Ravinthar
Introduction: Oral Lichen Planus (OLP) is a chronic inflammatory, immune mediated disease that affects the oral mucosa and skin. Though conventional therapies have aimed to alleviate the signs and symptoms of OLP, they have side effects. To combat this, trend is towards natural products such as curcumin which has antioxidant, anti-inflammatory and anti-cancer properties. Aim: This systematic review aimed to evaluate the existing literature on the role of curcumin in the alleviation of pain, burning sensation, erythema and ulceration in OLP patients. Materials and Methods: Articles on curcumin in the treatment of oral lichen planus were extensively searched in PubMed, Google scholar, Science direct, Cochrane database using key terms “turmeric extracts”, “curcuma longa”, “curcumin”, “curcuminoids”, “oral lichen planus,” “erosive oral lichen planus” with no year restrictions. Screening was based on title and abstract with preset inclusion and exclusion criteria, and full text articles were procured. Included studies were 7 randomised clinical trial, 2 pilot clinical trial, 3 comparative studies. Primary outcome measure was reduction in pain symptoms and clinical improvement, secondary outcome was to achieve complete healing without recurrence. Results: Publications identified through electronic search revealed 1499 articles, from which twelve studies met inclusion criteria. This systematic review comprised 315 OLP patients, wherein four studies revealed that topical curcumin had no statistically significant difference when compared to corticosteroids in treating pain, burning sensation, erythema and ulceration. In three clinical trials compared with placebo, one study showed statistical significance with increased oral dosage (6000 mg) of curcumin, two were not significant due to its reduced oral dosage (2000 mg). Two studies showed that curcumin was effective with increased concentration. Three studies with no controls were statistically significant in reducing burning sensation and clinical appearance of OLP. Conclusion: Though curcumin exhibited promising effects in alleviating symptomatic OLP, majority of studies were evaluated in very small sample size, hence there is insufficient evidence to draw definitive conclusions. We recommend novel curcumin formulations to increase their bioavailability and to initiate high quality Randomised Controlled Trials (RCT).

Recent Development in Disease Diagnosis by Information, Communication and Technology

Shabana Urooj, Astha Sharma, Chitransh Sinha, Fadwa Alrowais
The usage of Information, Communication and Technology (ICT) in health sector has a great potential in improving the health of individuals and communities, disease detection, prevention and overall strengthening the healthcare systems, vital for development and poverty reduction. Large ICT establishments offer a variety of Artificial Intelligence (AI) based solutions; and their tenacities are inclusive of wearable therapeutic devices, healthcare management arrangements, extrapolative healthcare diagnostics, ailment prevention systems, detection and screening of diseases and automated tactics. In the field of healthcare related instrumentation, AI plays a prevalent role with the amalgamation of several technological progressions. This enables machines to sense, comprehend, act and learn to perform organisational and clinical healthcare functions as well as serves the research and training purposes. Additionally, it enables to accomplish the anticipated directorial and medicinal benefits. The major causes of life threats reported in literature are; heart and brain diseases. In this paper, an extensive review is presented exploring the evolving ICT technologies in machine learning and AI to help ICT enthusiasts to be able to catch up with the emerging trends in healthcare.

Image Processing Techniques for Diagnosis of Glaucoma from Retinal Image: Brief Review

A Geetha, D Santhi, NB Prakash, GR Hemalakshmi, M Sumithra
Glaucoma is the second leading disease in the world that damages Optic Nerve Head (ONH) and causes permanent blindness. Glaucoma can be diagnosed using retinal fundus images. The detection and diagnosis of glaucoma is important in the field of Ophthalmology. This paper aimed to provide a brief review of glaucoma- its types, symptoms, risk, diagnostic tools, treatment and prevention. It also discusses retinal image datasets, different image processing techniques, diagnosing parameters and performance evaluation metrics of the methods used by various researchers. The literature search revealed that, exclusively for the retinal disease glaucoma, the detection of abnormality in optic disc and optic cup is to carry out at the initial stage. Therefore, for patients with the retinal disease glaucoma, the pathological signs and symptoms have to be analysed. From the review, it was inferred that, the many different techniques and diagnosing parameters can be used to detect glaucoma using the relevant fundus features.

Uniformity in Content and Delivery of Antimicrobial Component in Medical Curriculum: Need of the Hour

Ameya Ashok Hasamnis, Sapna Shridhar Patil
The use of antibiotics has transformed the nature of medical practice substantially. Exponential increase in the migration of people has converted the whole world into a global village. As medical experts, we need to recognise that most of the infectious diseases are no longer limited to a geographical area and their spread is very fast in the modern world, and we have very few weapons to fight against it. Unfortunately, the over-reliance on the use of antibiotics in medicine and veterinary branches to tackle these infections has led to antimicrobial resistance.

Clinical Manifestations of Celiac Disease in Children with Type 1 Diabetes Mellitus- An Institutional Experience from Southern India

B Arul Premanand Lionel, Sarah Mathai, Anna Simon, AJ Joseph
Introduction: The prevalence of Celiac Disease (CD) is known to be significantly higher in children with Type1 Diabetes (T1DM) as compared to the general population. Non-gastrointestinal symptoms are predominant manifestations of CD in these children. Aim: To estimate the prevalence of CD in children with T1DM and to assess the clinical presentation of CD in them. Materials and Methods: Data was collected retrospectively from the medical records of children with T1DM who were treated in a Paediatric endocrinology unit of a tertiary referral centre between January 2012 to December 2015 and screened for CD with Anti Tissue Transglutamase (ATTG) test. ATTG >15 U/mL was considered positive and Marsh criteria used for duodenal biopsy classification. The clinical manifestations of CD were analysed. Descriptive statistics (mean, standard deviation) were used to summarise the study variables. Results: Among the 152 children screened for CD, 18.4% (28) were positive for celiac serology and 78.5% (11) of the 14 children who underwent duodenal biopsy had mucosal changes. Unexplained asymptomatic hypoglycaemia, poor glycaemic control, and growth retardation were the most common indications for screening CD. Conclusion: This study emphasises that gastrointestinal symptoms of CD may be minimal in diabetic children and recognition of non-gastrointestinal symptoms helps in early detection. If resources permit universal screening for CD is recommended in T1DM children.

Turner Mosaic Karyotype in a Patient with Short Stature: A Rare Case Report

Gunasekaran Bhavani, S Pappathi, D Anuradha, Srinivasan Umadevi, K Indumathi
Turner syndrome is a 'complex developmental disorder in females caused by complete or partial absence of the second sex chromosome (monosomy X) X or Y, resulting in haploinsufficiency of multiple genes'. It is the only monosomy that is compatible with life. Turner syndrome affects almost 1 in 2,500 live female births. The most common phenotype observed in Turner patients is 45,X in more than 50% followed by isochromosome in about 5-10% subjects. Presence of similar copies of one arm of the chromosome and none of the other is defined as the isochromosome, resulting in partial monosomy of one arm and trisomy of the other which could be attributed to the abnormal transverse misdivision of centromere taking places during the meiotic or postzygotic cell division in the premeiotic gamete. The proband in the case report was referred for short stature and she revealed a rare Turner mosaic mos 45,X(6)/47,X,i(X)(q10),i(X)(q10)(6)/46,X,i(X)(q10)[88] karyotype. This article aimed to delineate the genotypic and phenotypic features exhibited by the patient.

Diagnosis of Retropharyngeal Abscess using Point of Care Ultrasound

Ghadeer Alsaif, Hassan Almaateeq, Auday Alkhonaizi
Point Of Care Ultrasound (POCUS) is a new concept and practice recently introduced into the clinical practice of medicine. It is commonly used by emergency and critical care physicians to help identify clinically significant as well as life-threatening pathologies. Retropharyngeal Abscess (RPA) can be presented in vague ways, and bedside Ultrasonography (USG) can aid in quick diagnosis, however it has been very rarely reported. This is a case report of a patient who presented with sore throat, fever and peritonsillar discharge. Neck USG showed a complex multi-loculated collection lateral to the thyroid gland and posterior to the right carotid artery (transverse view), a linear collection with anechoic center between the pharynx and cervical spine (longitudinal view), and a swirling phenomenon with respiration and swallowing as well as with carotid pulsation. CT scan showed retropharyngeal abscess with mediastinal extension. Possible aetiologies include spread from tonsillitis, dental abscess, pharyngeal or upper respiratory infection. It was treated with antibiotics and surgical drainage. The patient made a good recovery, and the collection resolved on repeat CT imaging.

Journal of clinical and diagnostic research

Granular Cell Tumour Masquerading as Carcinoma Breast

Infective Endocarditis in a Pregnant Female with Chronic Sialadenitis Associated with Gingivobuccal Sulcus Malignancy: A Rare Presentation

Treatment of Genital Warts with a Combination of Cryotherapy and 5% Imiquimod

A Case of Tracheo-Bronchomegaly in a Young Male

CT Findings in Melioidosis: A Case Report

Defect of Conduction System of the Attention Pathway Leading to Development of Inattentive Spells in a Young Female

Rhupus Syndrome: An Overlap with Renal Complications

Anterior Abdominal Wall Lymphangioma in a Child: Challenging Reconstruction at an Unusual Location

Systemic Strongyloidiasis- Is It Dissemination or Hyperinfection?

Variation in the Branching Pattern of Superior Thoracic Artery- A Rare Case

Unusual Presentation of Primary Ovarian Carcinoid Tumours with Low-to-Moderate Proliferative Potential

Tuberous Sclerosis: A Rare Cause of Seizure in an Older Adult

Rare Cutaneous Ischemia and Pain during Infiltrative Anaesthesia for Dental Surgery: Case Reports and Literature Review

Waldenstrom’s Macroglobulinaemia with Villous Lymphocytes

Magnetic Resonance Diagnosis of Anomalous Infraoptic Course of Anterior Cerebral Artery

Laterally Closed Tunnel Approach with A-PRF for Isolated Miller’s Class II Gingival Recession: A Case Report

Pyonephrosis Drainage Failure with Two Ureteric Stents in a Paediatric Patient

Pancreatic Plasmacytoma Misdiagnosed as Neuroendocrine Tumour: A Pathologist’s Dilemma

A Rare Variation of Left Testicular Arteries in Position, Number and Course and its Clinical Significance

Anecdote from Editors Desk Anecdote 2- Salami Slicing of Case Report

Death Audit by Verbal Autopsy and Social Autopsy: Potential Yet Unutilized Tool

Effect of Thymus Vulgaris Extract against Toxic Effects of Diabetes on the Coronary Heart Angiogenesis of Rats

Letter Regarding the Article, 'Hyponatremia in Patients Admitted with Stroke'; From the Viewpoint of Similarity to Hyponatremia Associated with Traumatic Brain Injury

Timeliness of Childhood Vaccination and its Decisive Factors in Bihar: A Community-Based Study

Bacterial Aetiology of Community Acquired Pneumonia in a Tertiary Care Hospital of Southern India

Prevalence of Bifid Mandibular Canals in Turkish Eastern Anatolia Population: A Retrospective Study

Assessment of Enamel Permeability Using Scanning Electron Microscopy in Permanent Teeth with and without Molar Incisor Hypomineralisation- An In Vivo Study

Dietary Habits of Patients with Type 2 Diabetes Mellitus-An Exploratory Study in a Tertiary Care Hospital of Eastern India

Perception Regarding Narrative and Reflective Writing among Fellowship Candidates

Quantitative Analysis of Streptococcus Mutans, Streptococcus Sobrinus and Streptococcus Sanguinis and their Association with Early Childhood Caries

Stress among Clinical Dental Students in a Private Dental College in Jeddah

Role of Extended Spectrum Beta Lactamases in Cephalosporin and Carbapenem Resistance in Escherichia coli from Inpatients and Outpatients in Nigeria

Caspase 9 Promoter Polymorphisms (-1263G>A, -905T>G, -712C>T) in Coronary Artery Disease

Maximum Oxygen Consumption (VO2 max) Estimation using Direct and Indirect Method in Indian Population: A Pilot Study

A Clinicopathological Analysis and Functional Outcomes of Claviculectomy in Primary Malignant Tumours of Clavicle

The Perception of Asymmetries in Occlusal Plane in the Frontal View among Laypeople: An Eye-tracking Study

Infant and Young Child Feeding Practices- An Interventional Behaviour Change Communication Approach

Effect of Silodosin and Deflazacort Combination in Reducing Symptoms Related to Indwelling Ureteric Stent: A Randomised, Double-Blind Trial

Fournier’s Gangrene: A Study of 14 Cases

Visual Outcome after Cataract Surgery in Rural Hospital of Wardha District: A Prospective Study

Effect of the Vitamin D Receptor Polymorphism on Bone Mineral Density and Bone Metabolism

Minoxidil a Youth Elixir for Eyebrow Hypotrichosis

Evaluating the Effect of Cabergoline on Glycaemic Control of Patients with Type 2 Diabetes Mellitus: A Randomised Controlled Trial

Metabolic Syndrome and its Components in Patients with Rheumatoid Arthritis, and their Association with Disease Activity and Duration

Assessment of Association Between Tooth Morphology and Psychology

Immediate Effects of Traditional Thai Massage on Heart Rate Variability in Major Depressive Disorder Patients

Maternal Factor V Leiden Mutation in Pre-eclampsia: A Case-Control South Eastern Indian Tertiary Care Hospital Based Study

Distant Chest Skin Metastasis in Squamous Cell Carcinoma of Gingivobuccal Sulcus: A Rare Case Report

Menstrual Disorders and its Association with Migraine

Expression of Immunohistochemical Markers (CD56 and P63) in Various Non-Neoplastic and Neoplastic Lesions of Thyroid Gland

Effect of Very Early Mobilisation on Symptoms of Depression and Anxiety Following Acute Stroke: A Randomised Controlled Trial

Efficacy of Passive Ultrasonic Activation Assisted Hand vs. Rotary Retreatment Files in the Removal of Root Canal Filling Material: An In Vitro Study

Assessment of Pentosidine as a Marker for Advanced Glycation End Products in Type 2 Diabetes Mellitus Patients

Effect of Telenursing on Level of Anxiety in Parents of Hospitalised Premature Neonates in Neonatal Intensive Care Unit

Impact of Diabetes Mellitus and Ischemic Heart Disease on the Blood Resistivity Index of Renal Arteries in Hypertensive Patients

Use of Scatterplot Patterns Derived from Automated Haematological Analysers in the Diagnosis of Acute Febrile Illnesses

A Cross–sectional Study of Eruption Time of Primary Teeth in South Indian Children

The Impact of Pre-haemodialysis Systolic Blood Pressure on One-year Survival Rate in Chronic Haemodialysis Patients in Medan, Indonesia

Role of 3 D Ultrasound in Objective Evaluation of Caesarean Scar

Serum Lactate Dehydrogenase Levels with Birth Asphyxia in Term Neonates

Assessment of Risk Factors and Microbial Profile of Otomycosis in Patients Attending Tertiary Level Hospital of Western Rajasthan, India

A Study on Range of Near Visual Acuity in Children with Pseudophakia

Single Strand Conformation Polymorphism and Sequencing of HS6ST2 Gene in Patients of Idiopathic Premature Ovarian Failure

Epidemiological Prevalence of Pediculosis and its Influencing Factors in Iranian Schools: Systematic Review and Meta-analysis

Role of Curcumin in Alleviating Symptomatic Oral Lichen Planus: A Systematic Review

Recent Development in Disease Diagnosis by Information, Communication and Technology

Image Processing Techniques for Diagnosis of Glaucoma from Retinal Image: Brief Review

Uniformity in Content and Delivery of Antimicrobial Component in Medical Curriculum: Need of the Hour

Clinical Manifestations of Celiac Disease in Children with Type 1 Diabetes Mellitus- An Institutional Experience from Southern India

Turner Mosaic Karyotype in a Patient with Short Stature: A Rare Case Report

Diagnosis of Retropharyngeal Abscess using Point of Care Ultrasound

Maximum Oxygen Consumption (VO₂ max) Estimation using Direct and Indirect Method in Indian Population: A Pilot Study