Journal of clinical and diagnostic research

An Ingenious Modification in Conventional Swing Lock Cast Partial Denture for Rehabilitating A Hemi Mandibulectomy Defect

Mandibular resections compromise the balance and symmetry of mandibular functions. Since centuries there has been advent of various prosthetic treatment modalities to improve the masticatory efficiency. Swing lock dentures, a treatment facet with high degree of clinical effectiveness, yet gradually fading into oblivion due to its design complexities, has been resurrected by retaining its indigenous concept of reciprocation, and consolidating aesthetics with introduction of newer breed of aesthetic material (Thermoplastic Acetal resin).

Triple Synchronous Malignancies in Genital Tract; Primary Endometrial, Ovarian and Fallopian Tube Carcinoma: A Case Report

Ozgur Kan, Aysegul Alkilic, Batuhan Turgay, Ali Gemici, Cem Somer Atabekoglu

Synchronous malignancies, including three or more tumours, are extremely rare. Herein, we present a case of a woman with a concurrent simultaneous endometrial, ovarian and fallopian tubal carcinoma with different histopathological characteristics. A 55-year-old postmenopausal woman with a diagnosis of endometrial adenocarcinoma by pipelle biopsy, underwent surgical staging. Final pathology result was reported as synchronous stage IA grade 2 endometrioid adenocarcinoma of the uterus, stage IA grade 2 mucinous adenocarcinoma of the right ovary and in situ serous cystadenocarcinoma of the right fallopian tube. In the postoperative period, patient followed without adjuvant therapy. To our knowledge, this a very rare case report in the literature of sychronous triple gynaecologic cancers including fallopian tube cancer and with the longest disease free survival time with over 39 months due to better prognosis than metastatic or advanced primitive diseases.

Post-Caesarean Drain Placement - Minor Procedure Leading to Major Complication

Richa Sharma, Kiran Guleria, Amita Suneja, Vishnu Bhartiya

Intra abdominal drain insertion in doubtful cases has been practised since many years. It may be associated with certain minor as well as major complications like drain site haemorrhage, infection, intestinal perforation and even visceral herniation from the site. Herein, we report a case of 28-year-old unbooked G2P1L1 at 33 weeks gestation with previous caesarean, who underwent Lower Segment Caesarean Section (LSCS) in view of breech presentation in labour. On sixth postoperative day, tubular structure herniation through the drain site was observed. She was undertaken for laparotomy and fallopian tube herniation through the drain site was confirmed. Ipsilateral salpingectomy was done. Thus, drain placement lead to prolonged hospital stay and maternal morbidity.

Twin Reversed Arterial Perfusion: To Treat or Not?

Sunita Dubey, Meesha Verma, Poonam Goel, RPS Punia

Acardiac twinning or Twin Reverse Arterial Perfusion (TRAP)-sequence is a rare complication of monochorionic twin pregnancy. Whether to start elective or therapeutic treatment in TRAP-sequence is still controversial. In the present case, acardiac twin was not diagnosed till her delivery at 39 weeks. A healthy baby weighing 2.45 kg was delivered along with another amorphous mass (acardiac twin) of about 150 g which was attached to the placenta with a short and separate cord. As outcome of normal twin vary according to the growth of acardiac twin, frequent follow-up of the normal twin is required to look for the features of heart failure. Hence, the diagnosis of acardiac twin is essential in early pregnancy.

Primary Extrapulmonary Extensively Drug Resistant Tuberculosis of the Hip in an Immunocompetent Female-A Case Report

Sankalp Yadav, Gautam Rawal

The problem of drug resistant Tuberculosis (TB) is looming large in the developing countries. TB of the skeletal system is rare and the primary extensively drug resistant TB (XDR-TB) of the hip joint has never been reported in the medical literature so far. The present case is a very rare case of primary XDR-TB of right hip joint in an immunocompetent Indian female. The present case is an important addition to the medical literature, as it will serve as a valuable source of information to the medical and surgical fraternity.

Primary Cutaneous Histoplasmosis Masquerading as Lepromatous Leprosy

Jenna Blah Bhattacharya, Poonam Rani, Radhika Aggarwal, Seema Kaushal

Histoplasmosis is a genus of dimorphic fungi having various varieties of which the commonest one causing infection is Histoplasma capsulatum known to cause histoplasmosis. It has a varied disease spectrum ranging from an acute infection to chronic disease especially in lungs, disseminated disease and cutaneous disorder. Histoplasma capsulatum usually causes subclinical infection and serious infections only manifest in immunocompromised patients. Frank cases of infection are seen in pulmonary histoplasmosis. The spores of these organisms are seen to be strongly associated with droppings of birds and bats. A combination of these droppings and some soil types provide for an excellent environment for the proliferation of spores. Pulmonary histoplasmosis and disseminated disease are very common in AIDS patients and are a great cause of morbidity and mortality in these patients. Primary cutaneous histoplasmosis is very rare and occurs due to penetrating injuries. Once diagnosis is made, the lesions respond very well to oral itraconazole, fluconazole or amphotericicn B. We report a rare case of Cutaneous Histoplasmosis (CHP) in a 70-year-old male with complaints of multiple nodules all over his body in a HIV seronegative and otherwise immunocompetent patient.

ANCA Associated Mononeuritis Multiplex with Overlap in Vasculitic Syndromes

Ravi Anadure, Coim batore Narayanan, Govindraj Varadraj, Bevinahalli Nandeesh

Mononeuritis multiplex is a common manifestation of many illnesses which includes Hansen’s disease and certain types of systemic vasculitis. The Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis (AAV) is a group of rare diseases which show typical characteristic inflammatory cell infiltration and blood vessel wall necrosis. AAV syndromes include Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA). We describe a patient who presented with mononeuritis multiplex and had features of overlap between EGPA and MPA. The patient was treated with standard regimen of steroids and pulsed cyclophosphamide and she achieved excellent clinical remission.

Prosthetic Rehabilitation of Completely Blind Subject with Bilateral Customised Ocular Prosthesis: A Case Report

Chetan Pathak, Salil Pawah, Gurpreet Singh, Ila Yadav, Shrey Kundra

The special sensory organs play significant role in our daily lives. Until one of them is totally or partially lost, its real value is not fully appreciated. The most tragic, yet common loss of sensory organ is that of an eye. Restoration of unilateral ocular defects is very challenging for a maxillofacial prosthodontist and requires great skill to mimic bilateral eye. Restoration of bilateral defects using customized eye prosthesis presents even more difficult task for clinician especially in communication with patient, impression procedures, and patient education regarding insertion, removal and maintenance of prosthesis. Such loss of eyes may have a tremendous emotional and psychological impact on the patient. This article presents a technique for fabrication of bilateral ocular prosthesis of completely blind patient.

Multifocal Eosinophilic Granuloma of Jaws and Skull with Classical and Unusual Radiographic/Imaging Findings

Eosinophilic granuloma is basically a disorder of reticuloendothelial system and is one of the variants of langerhans cell histiocytosis. Multifocal eosinophilic granuloma affecting jaws and skull is relatively a rare disorder. We hereby report a case of multifocal eosinophilic granuloma involving mandible, maxilla and several skull bones. The present case has mixture of classical floating teeth appearance and an unusual radiographic/imaging finding of periosteal remodeling, which is rarely seen in adult patients of eosinophilic granuloma and pseudo-multilocular appearance in anterior mandibular region in coronal sections and moth-eaten appearance of skull was appreciated in axial slices of Computed Tomography (CT).

Treatment of Periradicular Bone Defect by Periosteal Pedicle Graft as a Barrier Membrane and Demineralized Freeze-Dried Bone Allograft

Awadhesh Kumar Singh, Anurag Saxena

The purpose of this case report is to describe the usefulness of Periosteal Pedicle Graft (PPG) as a barrier membrane and Demineralized Freeze-Dried Bone Allograft (DFDBA) for bone regeneration in periradicular bone defect. A patient with intraoral discharging sinus due to carious exposed pulp involvement was treated by PPG and DFDBA. Clinical and radiological evaluations were done immediately prior to surgery, three months, six months and one year after surgery. Patient was treated using split-thickness flap, PPG, apicoectomy, defect fill with DFDBA and lateral displacement along with suturing of the PPG prior to suturing the flap, in order to close the communication between the oral and the periapical surroundings through sinus tract opening. After one year, successful healing of periradicular bone defect was achieved. Thus, PPG as a barrier membrane and DFDBA have been shown to have the potential to stimulate bone formation when used in periradicular bone defect.

A Rare Familial Presentation of Facial Talon Cusp

Sankaran Sudhakar, Abhishek Madhavan, Senthil Balasubramani, Sundar Shreenivas

Talon cusp is a rare developmental anomaly presenting as a wisp like structure arising from the cervical region of anterior teeth. They are predominantly seen in permanent dentition with a male predilection and are commonly seen associated with incisors and on the lingual/palatal surface. The aetiology appears to be multifactorial with a possible likelihood of genetic and environmental involvement routing to disturbances in tooth development at the morphodifferentiation stage. Over the years, few cases of talon cusp among the family members have been reported which strongly supports the genetic influence. We report rare presentations of talon cusp among two family members involving the facial surface of incisors.

Molluscum Contagiosum of Cervix – A Case Report

Molluscum Contagiosum (MC) is a common viral infection of skin caused by a double stranded DNA Pox virus affecting both adults and children. MC is primarily an infection of school-going children (one to five years), occasionally it affects adults and immunocompromised individuals. Transmission of virus occurs by direct contact with infected person or contaminated objects. Most common sites are skin of face, trunk and extremities in children, genitals in adults and rarely palms, soles and mucous membranes. The occurrence of MC in genitals is lowest (3%). We present a case report of Molluscum Contagiosum of cervix which is a rare site; only one case has been reported in medical literature till date.

Sectional Impressions and ‘Every Other Tooth’ Technique in FPD

Swathi Sudhapalli

Gingival displacement procedure is an important component of fixed prosthodontics. It helps in delivery of the impression material subgingivally to record the finish line as well as the tooth contour apical to it, so as to produce restorations with closely adapted margins in harmony with the tooth anatomy and gingiva. While displacing gingiva with retraction cords, the health of the tissues must be maintained. In case of multiple anterior tooth preparations with close root proximity, placing the retraction cord simultaneously around all teeth will result in strangulation of interdental papillae. This can impair gingival health as well as cause black inter-dental triangles. To avoid this, ‘every other tooth’ technique of gingival displacement in combination with sectional impressions may be used to provide a better master cast in multiple tooth preparations. The present case report describes the use of this simple combination procedure for the restoration of lower six anterior teeth as a part of full mouth rehabilitation.

Florid Osseous Dysplasia-Report of Two Cases and Review of Literature

Gayathri Mahalingam, G.V. Murali Gopika Manoharan

Florid osseous dysplasia is a rare benign fibro-osseous multiquadrant dysplastic lesion confined to the alveolar process of jaws, generally asymptomatic and usually detected incidentally during radiologic examination and requires no treatment unless symptomatic or cosmetically concerning. In this article, we present two rare cases of florid osseous dysplasia in Indian women with their clinical, radiographic and histologic findings and a brief review of literature. The first case was asymptomatic and the lesion was detected during routine radiographic examination and required no treatment whereas, the second case presented with features of osteomyelitis. Based on the clinical findings, the case was diagnosed as chronic suppurative osteomyelitis, but, after radiologic examination, diagnosis of florid osseous dysplasia with secondary osteomyelitis was made. Besides diagnostic challenge, management of the lesion is difficult due to poor vascularity. In our case, antibiotic prophylaxis along with surgical debridement and sequestrectomy was done with regular recall visits.

A Rare Case Report of Spindle Cell Ameloblastic Carcinoma Involving the Mandible

Ameloblastic Carcinoma (AC) is uncommon malignant epithelial odontogenic tumour of jaw, with characteristic histologic features and behavior. Clinically, it has aggressive, infiltrative growth pattern with a distinct predilection for mandible. It exhibits histologic features of ameloblastoma and gets dedifferentiated overtime to culminate in carcinoma. Majority of the cases arise denovo (primary) and only few cases arise from a pre-existing ameloblastoma (secondary). Spindle-cell differentiation in ameloblastic carcinoma is rare; Salter described it as a separate entity “low-grade spindle cell ameloblastic carcinoma. Here we report a case of 32-year-old female patient who presented with a swelling present for past six months. It was diagnosed as Spindle cell Ameloblastic Carcinoma (SpAC), after the hemimandibulectomy the patient was under regular follow up for 14 months, no sign of recurrence was seen.

Extra Nasopharyngeal Angiofibroma Simulating a Mucocele: A New Location for the Rare Entity

Srikanth Goud, Tipirisety Swapna, Hima Bindu, Sanjeeva Reddy Gari Shylaja

Angiofibromas are rare, benign, but locally aggressive vascular tumours which account for 0.05-0.5% of all head and neck neoplasms. The common variant of angiofibromas of head and neck region is Juvenile Nasopharyngeal Angiofibroma (JNAF) which is well published in the literature. Incidence of Extranasopharygeal Angiofibromas (ENAF) is relatively rare and most of the published literature favours maxillary sinus as the most common site. We report a rare clinical entity of ENAF involving the upper lip which is first of its kind in the light of literature review owing to its anatomical location. The present article not only complements a new location of angiofibroma (in the upper lip) but also concretely reinforces the inclusion of angiofibromas in the spectrum of differential diagnosis of soft tissue lesions pertaining to oral cavity.

OVisible Evidence of Lumbar Epidural Catheter Misplacement–A Critical Incident Case Report

Rajkiran Shah, Beena Butala, Geeta Parikh, Rajesh Pargi

One of the causes of failed epidurals is catheter misplacement. Though various techniques of epidural space identification have been developed, none of them is 100% successful. Here, we present a case of lumbar epidural catheter misplacement in a patient scheduled to undergo right sided open nephrectomy. Catheter was found in the surgical field coming out of psoas major muscle.

Renal Clear Cell Sarcoma - Anaplastic Variant: A Rare Entity

Vaishali Atmaram Walke, Nitin Y Shende, D T Kumbhalkar

Clear Cell Sarcoma of Kidney (CCSK) is known for its morphologic diversity, aggressive behaviour, tendency to recur and metastasis to bone. Amongst the various morphologic subtypes, anaplastic CCSK is associated with worse prognosis. Here, we report a case of this rare variant of CCSK. A five-year-old boy presented with history of lump and pain in abdomen since one week. The Computed Tomography (CT) scan revealed a large mass occupying the middle and inferior pole of right kidney. The clinical impression was Wilms tumour. Nephrectomy specimen was received and the diagnosis of CCSK anaplastic variant was offered only after excluding the differentials and after performing ancillary tests such as Immunohistochemistry (IHC). Thus, this case emphasizes the diagnostic challenges on morphology and the essential role of IHC in arriving at a definitive diagnosis, because failure to do so may deprive the child from optimal treatment.

Amelanotic Melanoma Arising in Filarial Leg: A Report of a Rare Case

Mamita Nayak, Susama Patra, Susanta Meher, Prakash Kumar Sasmal

Amelanotic melanoma arising on chronic lymphoedema has not been reported earlier. We reported a case of amelanotic melanoma of right leg developing in a background of chronic lymphoedema of filarial origin in an elderly male of 60 years, who underwent wide local excision of the lesion followed by skin grafting for the same. A histopathological diagnosis of amelanotic melanoma was made. The patient was on follow up when he developed brain metastasis within a period of nine months for which he was operated and is on regular follow up now. We believe this as the first case report of this unusual combination.

Cyclophosphamide and Doxorubicin Induced Melanonychia: A Case Report

Chemotherapeutic agents may rarely cause discoloration and hyperpigmentation of the nails. We present a patient who developed blackish discoloration of nails also referred as melanonychia during six cycles of R-CHOP chemotherapy regimen (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) for the treatment of Non Hodgkin Lymphoma (NHL) follicular type. The patient developed blackish brown discoloration in all the nails. As suggested by previous literature evidence the melanonychia could be associated with cyclophosphamide and doxorubicin. According to the Naranjo causality assessment scale, we established that there was a ‘probable’ association of nail discoloration with the drug.

Obturation of a Retained Primary Maxillary Second Molar Using BiodentineTM: A Case Report

Ganesh Jeevanandan

Maxillary molars have highly variable root canal morphology. However, the presence of the two roots is a rare occurrence. The success of pulpectomy treatment depends on removal of infected pulp and filling it with a biocompatible material. In order to achieve it, the clinicians should understand the morphology of the individual root canal and atypical root canal configuration. The purpose of this article was to describe an unusual anatomy in primary maxillary second molar with missing successor tooth. BiodentineTM a new dentine substitute was used as an obturating material for retained maxillary second molar. After 24 months follow up, the success of BiodentineTM for management of primary tooth with missing successor was evaluated and reported.

Versatility of Tongue Flaps for Closure of Palatal Defects- Case Report

Vishnu Mohan, Roopesh U Nair, Arjun Madhu Usha

Palatal defects following congenital anomalies, traumatic injuries, benign and malignant pathologies frequently require resection and reconstruction. Reconstruction of these defects is challenging and complex due to the amount of tissue left for primary closure after excision, compromised vasculature as on repaired cleft palate and limited pedicled flaps around the lesion. Tongue flap though doesn’t fulfil all the ideal requirements of a flap, however because of its flexibility, good blood supply and position it can be considered as the best among other flaps for reconstruction of oral and palatal defects. In this article we describe two different cases in which tongue flap was used to reconstruct palatal defects, one an oroantral communication secondary to a tumour excision and the other an oro-nasal fistula secondary to cleft palate repair.

Oral Carcinoma Cuniculatum: A New Entity in the Clinicopathological Spectrum of Oral Squamous Cell Carcinoma

Uma Vasant Datar, Alka Kale, Deepa Mane

Carcinoma cuniculatum is principally recognized as a variant of carcinoma involving foot. The World Health Organization (WHO) recognizes Oral Carcinoma Cuniculatum (OCC) as a distinct and rare clinicopathological variant of Oral Squamous Cell Carcinoma (OSCC). OCC is confused clinically and histologically with Verrucous Carcinoma (VC) and is often misdiagnosed as either VC or OSCC. To best of our knowledge, till date, only 50 cases of this tumour have been reported in oral cavity (including the present case) and only limited number of cases have been reported from Indian subcontinent. Pathognomonic feature of OCC is proliferation of stratified squamous epithelium and its infiltration into underlying stroma forming a complex pattern of keratin cores and keratin filled crypts. These complex crypts give it a likeness of rabbit burrow hence, the name cuniculatum (cuniculatus=‘rabbit warren’). The report aims to present a case of OCC of mandibular gingiva, discuss its diagnostic features and highlight its differences from VC and OSCC.

Herpes Zoster with Post Herpetic Neuralgia Involving the Right Maxillary Branch of Trigeminal Nerve: A Case Report and Review of Literature

Herpes Zoster (HZ) is an acute, self-limiting, neuro cutaneous viral infection caused by the reactivation of the Varicella Zoster Virus (VZV) that remains latent in the dorsal root ganglion. About 50% of occurrence is seen in older age groups and immunocompromised patients. Less than 5% occur in children. HZ is characterized by the unilateral pain, burning and tingling sensation followed by the vesicular eruptions limited to the single dermatome that are innervated by the single cranial ganglion, sometimes it leads to Post Herpetic Neuralgia (PHN). We report a case of a HZ in a 22-year-old young female patient involving the right maxillary branch of the trigeminal nerve along with PHN.

Physiological Root End Closure in a Traumatized Young Permanent Tooth Using Collagen Particles as Pulpal Dressing

Krishnapriya V, Divya Gaur, Santosh Kumar Ch, Shilpa G

The management of traumatized young permanent teeth has always been a challenge to the clinician, considering the importance of retaining the vitality of the tooth. Recently, collagen particles have been successfully used as pulpotomy medicaments in primary teeth. This case report shows the use of collagen particles as pulpal dressing in a traumatized young permanent tooth of a nine-year-old child presenting with complicated fracture of young permanent left maxillary central incisor. Partial pulpotomy was performed with collagen particles (Biofil-AB) as pulpal dressing. At six months follow up, apexogenesis was found to be nearly complete. Thus, collagen can be considered as a potential pulpal medicament for apexogenesis procedures.

Expect the Unexpected: Mycobacterial Infection in Post Total Knee Arthroplasty Patients

Vikram Kishor Kandhari, Mohan M Desai, Roshan N Wade, Surendar S Bava

Orthopaedic Surgeons rarely encounter mycobacterial infections in Post Total Knee Arthroplasty (TKA) patients. We present series of two cases to create awareness among clinicians to expect the unexpected. Tuberculosis typical/ atypical is a hidden culprit in catch clinical situations when chronic infection is Suspected, but the lab investigations are negative in persistently symptomatic patients. In such situations clinicians should suspect atypical or complex mycobacterial infections and evaluate the patients accordingly. Clinical suspicion, evaluation, isolation and treatment of atypical or complex mycobacterial infections with sensitive chemotherapy, leads to complete resolution of infection and full functional rehabilitation.

Mesenteric Teratoma in Elderly Female: A Rare Case Report

Dermoid cysts rarely present as mesenteric cysts. Mesenteric cysts are rare pathologic entities, with a reported incidence of approximately 1 of 27 000 to 1 of 100 000 admissions. Mesenteric cyst was first described by Florentine anatomist Benevieni in 1507, while performing an autopsy on an eight-year-old boy. Most commonly, teratoma occurs in the early age group. Mature mesenteric teratoma in adulthood is extremely rare. Teratoma are germ cell tumours commonly composed of multiple cell types derived from one or more of the 3 germ layers. We present the case of a 69-year-old elderly female who presented with abdomen pain for nine months with right lumbar and right iliac fossa mass. Computed Tomography (CT) abdomen revealed bilocular cystic lesion with possibility of mucinous cystadenoma with no definitive organ of origin. She underwent explorative laparotomy and total excision of the cystic mass. Histopathologic examination confirmed diagnosis of mature cystic teratoma of mesentery. This case report highlights the need to maintain high index of suspicion while evaluating abdominal mass.

Facial Dysmorphism: An Unreported Teratogenicity with Levetiracetam

Jyotsana Gupta, Sandhya Jain, Shalini Rajaram, Neerja Goel, Bindiya Gupta

Levetiracetam (LEV) is a relatively newer anticonvulsant drug used to treat epilepsy and is approved by United States Food and Drugs Administration (USFDA). The drug binds to a synaptic vesicle glycoprotein and inhibits presynaptic calcium channels, thus reducing neurotransmitter release. Commonly reported side effects include drowsiness, weakness, unsteady gait, mood changes and loss of appetite. Like most other antiepileptics, it is a Category C drug in pregnancy. We report the first case of facial dysmorphism in the neonate of a mother taking LEV antenatally. A 30-year-old lady, G2P1L1 presented at 38 weeks gestation with history of previous caesarean and leaking per vaginum. She was a known epileptic, taking carbamazepine since three to four years. She was switched over to LEV at fifth week of pregnancy. Her antenatal period was uneventful. Basic investigations including anomaly scan were normal. Unfavourable cervix necessitated caesarean section. Neonate (female) had dysmorphic facies with bilateral preauricular appendages and lateral cleft. Infantogram was suggestive of bifid vertebra in thoracic region. Computed Tomography (CT) scan chest revealed bifid vertebral body at D5 level with fusion of spinous process of D5 and D6 vertebra on left side. This is the first case of LEV induced facial dysmorphism, highlighting the need of further studies on LEV safety during pregnancy.

Risperidone Induced Granulomatous Mastitis Secondary to Hyperprolactinemia in a Non-Pregnant Woman-A Rare Case Report in a Bipolar Disorder

Idiopathic granulomatous lesion is a rare entity of the breast seen in young-middle aged women. Diagnosis and management of granulomatous lesions with known aetiology does not impose major clinical problems. However, most often these lesions are undetected or unnoticed due to lack of timely diagnosis and inappropriate management, as primarily it is idiopathic. Hyperprolactinemia have been proposed as one of the mechanisms underlying the development of granulomatous lesions of the breast. We report a case of hyperprolactinemia due to risperidone therapy for bipolar mood disorder in a woman who eventually developed granulomatous mastitis. Histologically, the diagnosis was confirmed by the presence of granulomatous lesion and by ruling out other potential causes. In this case, raised prolactin was possibly an important factor which was secondary to risperidone therapy. However, idiopathic granulomatous mastitis could not be completely ruled out.

Palliative Care with Attachment Hybrid Removable Prosthesis

Gopi Naveen Chander

Abutment injury, unsatisfactory aesthetics and lesser retention exist with the cast partial denture. Though these constraints exist in the Removable Partial Denture (RPD) it is still widely used because of the simplicity in design, fabrication, economics and patient comfort. This clinical report describes a hybrid RPD technique which uses extra coronal attachment that reduces the limitations and provides better comfort for the patient.

Epignathus Leading to Fatal Airway Obstruction in a Neonate

Teratomas are benign tumours containing cells from ectodermal, mesodermal and endodermal layers with an incidence of about 1 in every 4,000 births. Their commonest site is sacro-coccygeal region, followed by anterior mediastinum. The incidence of teratomas localised to the head and neck region is around 2–9% of all cases. Epignathus is a rare congenital oropharyngeal teratoma originating from the base of the skull. Here we present a rare case of oropharyngeal teratoma in a neonate who was referred to our institute with an ill-defined oral mass protruding through a cleft in the hard palate. Computed tomography scan showed a contrast-enhanced solid mass with areas of calcification and fat extending to oropharynx and nasal cavity with hard palate defect suggestive of a teratoma. Unfortunately, the patient succumbed due to respiratory compromise before the biopsy could be done. Postmortem histopathological examination confirmed diagnosis of benign teratoma consisting of mature tissue.

Giant Antrochoanal Polyp-A Rare Presentation

Swati Kodur, Shruti Malavalli Siddappa, Andanooru Mahalingappa Shivakumar

Antrochoanal polyp (ACP), also called as Killian polyp, is an infrequent, benign lesion of maxillary origin in non-atopic patients. The antrochoanal polyp is shaped according to the anatomical constraints of the lateral nasal wall, particularly the middle meatus and antrum, resembling typically a dumbbell. Here presenting a common problem with unusual presentation.

Successful Management of the Masochistic Habit in a Child with Santovuori-Haltia-Hagberg Disease (Infantile Neuronal Ceriod Lipofuscinoses)

Laresh N Mistry, Shivayogi M Hugar, Vidyavathi H Patil, Punit Patel

Self-injurious behaviours are usually related to paediatric patients with mental retardation. The management of such patients is quiet challenging to the paediatric dentists because of the difficulty to communicate with such patients regarding their feelings verbally. Here, we present a case report of successful management of self-injurious behaviour in a child with Infantile Neuronal Ceriod Lipofuscinoses (INCL).

A Report of Successful Procedural, Clinical, and Angiographic Outcomes with a Tapered Stent of a Patient in Naturally Tapered Coronary Vessel

Rajendra Kumar Premchand, Yerra Shiv Kumar

In cases involving stenosis or occlusions in major parts of a long vessel, natural tapering of coronary vessels may create dilemma in deciding the optimal stent size during percutaneous coronary intervention. In this regard, tapered stents have been developed recently. Herein, we present a case of 67-year-old male patient with triple vessel disease including two tandem lesions in naturally tapered Left Anterior Descending (LAD) artery. The patient received a 3.0–2.5x60 mm Sirolimus-eluting BioMime Morph stent (Meril life Sciences, Gujarat, India) in the mid-distal LAD lesion along with conventional stent implantations in other two lesions. The procedure was successful and good coronary flow was obtained after revascularization. The patient remained asymptomatic thereafter. At one year, angiographic follow-up revealed good flow and no restenosis in the LAD vessel. We are of opinion that using tapered stents with decremented diameter may offer the advantages of excellent adaptation to vessel size, vessel tapering, and good apposition in patients with long coronary lesions in tapered vessels.

Dangerous Headache: A Case of Dural Venous Sinus Thrombosis with Protein S Deficiency

Dural Venous Sinus Thrombosis (DVST) is a sporadic cause of headache. DVST is a recherché complication of maxillary sinus infection. Maxillary sinusitis infection may spread directly to orbit via lamina papyracea and it is expedited by the presence veins of breschet. The authors present a clinical case of dural sinus thrombosis with protein S deficiency and also describe an effective management approach for DVST.

Prinzmetals Angina Masquerading as Acute Pericarditis

Ashwal Adamane Jayaram, Mugula Sudhakar Rao, R Padmakumar, UK Abdul Razak

Coronary artery spasm is an intense vasoconstriction of the coronary arteries and may be responsible for the myocardial ischemia, myocardial infarction as well as sudden deaths. Coronary angiography is generally needed to identify the cause. Coronary artery spasm is a multifactorial disease with underlying mechanism still poorly understood. Here, we present case of a 48-year-old male with no significant past history who presented with acute episodic onset chest pain. Clinical, Electrocardiography (ECG) and echocardiographic findings suggested pericarditis but a diagnostic coronary angiography revealed significant coronary vasospasm. Patient’s symptoms significantly improved with calcium channel blockers and Nitroglycerine (NTG).

Disseminated Intravascular Coagulation and Excessive Fibrinolysis (DIC XFL) Syndrome in Prostate Cancer: A Rare Complicated Disorder

Disseminated Intravascular Coagulation (DIC) develops in patient with prostate cancer, which is manifested by systemic, intracranial, intracavitary or intracutaneous bleeding indicating uncompensated or excessive fibrinolysis (XFL). This case report is a description of a 61-year-old male with metastatic prostate cancer that progressed to manifest DIC. The condition is rare in clinical practice, and even rarer when is coupled with XFL. Treatment was mainly replenishing coagulation factors, platelets and controlling the disease progression with aggressive hormonal therapy. The patient progressed to coagulopathy further with fibrinolysis, hence leading to mortality. This case study discusses the pathophysiology of this complication and various methods to monitor the disease progression are discussed.

Aerococcus Viridans: A Rare Pathogen Causing Urinary Tract Infection

Balvinder Mohan, Kamran Zaman, Naveen Anand, Neelam Taneja

Aerococci are Gram-positive cocci with colony morphology similar to viridans streptococci. Most often these isolates in clinical samples are misidentified and considered insignificant. However, with the use newer techniques like Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), aerococci have been recognized as significant human pathogens capable of causing a diverse spectrum of infections. Among the different species of aerococci, Aerococcus urinae is the most common agent causing Urinary Tract Infection (UTI) followed by A. sanguinocola. Aerococcus viridans (A. viridans) have been reported rarely in urinary tract infections. The antimicrobial resistance in aerococci in terms of its intrinsic resistance and evolving resistance to penicillin and vancomycin has raised the concern for better understanding of this pathogen. We recently encountered two cases of nosocomial UTI caused by A. viridans which are being reported here.

Aesthetic Retainer cum Trainer

Tulika Tripathi, Shilpa Kalra, Priyank Rai

Tongue thrust habit is one of the contributing factors in the relapse of orthodontic treatment results. Compliance with removable habit breaking appliance is a major issue to the dental practitioners treating patients of any age group. Through this case we introduce a more aesthetic and comfortable option to the patients requiring habit control for tongue thrusting and retention of treatment results. Hence, this appliance acts as a retainer cum trainer in such patients.

Benefits of Alcohol on Arsenic Toxicity in Rats

Purnima Singh, Shubha Ranjan Dutta, Deepak Passi, Jaya Bharti

Introduction: It has been demonstrated earlier that exposure to ethanol and/or arsenic compounds (such as sodium arsenite) produces toxic effects as shown by both in vitro and in vivo experiments. Chronic exposure of humans to arsenic through drinking water, pesticides or consumption of alcoholic beverages has produced major health problem and concern in recent years. Water being one of the main ingredients for alcohol formation (beer fermentation process) can lead to contamination with arsenic. Thus, people consuming such alcohol are getting continuously exposed to arsenic compounds as well along with alcohol. Aim: The present study was undertaken to investigate the effect of alcohol co-administration on arsenic induced changes in carbohydrate metabolic status in adult male albino rats. Materials and Methods: Adult male albino rats of Wistar strain (weighing~100g) were divided into three groups (n=8 rats/group) including Control or vehicle treated (C), Arsenic treated (As) and Arsenic treated alcohol co-exposed (As+Alc). Treatment with Sodium-arsenite included intra-peritoneal injection consecutively for 14 days at a dose of 5.55 mg/kg (equivalent to 35% of LD50) per day. Absolute alcohol (15% v/v) was fed at a dose of 0.5 ml/100 g body weight per day for five consecutive days from start of the treatment schedule. Distilled water (D/W) was used as vehicle. Blood Glucose (BG) level, levels of glycogen, Pyruvic Acid (PA), Free Amino Acid Nitrogen (FAAN), total protein, Glutamate Oxalate transaminase (GOT) and Glutamate Pyruvate Transaminase (GPT) activity, and glucose-6-phosphatase (G6Pase) activity were measured in tissues including liver, kidney and muscle. Results: Treatment with arsenic decreased the levels of BG, liver glycogen and PA, tissue protein and G6Pase activity, GOT activity in liver and muscle, and increased free amino acid content in kidney and muscle, GPT activity in liver and kidney. Alcohol administration to rats co-exposed to arsenic treatment reversed these changes. Conclusion: Thus, it is suggested that combined administration of alcohol with arsenic can result in the suppression of the down-regulating action of arsenic on glucose homeostasis as evidenced by its hypoglycaemic effect and increased gluconeogenesis and transamination in liver.

Treatment of Skeletal Class III Malocclusion by Surgery First Orthodontic Approach

Variants of Talon Cusp (Dens Evaginatus)

Mythri Sarpangala, Ashwin Devasya

Knee X-Ray in Short Stature: Helpful Indicator to Diagnose SHOX Deficiency

Partha Pratim Chakraborty, Rana Bhattacharjee, Subhankar Chowdhury

Design of Low Cost Automated Vision Screening Test for Awarding Driving License

Ganesan Kaliyaperumal, D Shalini

Collodion Baby: A Rare Clinical Entity

Bikash Chandra Satapathy, Diptirekha Satapathy

Correspondence: Periodontal Health among Non-Hospitalized Chronic Psychiatric Patients in Mangaluru City-India

Keith Fluegge

Ball Headed Mini Implant

Burkitt’s Lymphoma in HIV- Positive Child: Diagnostic Ascitic Fluid Cytology

Zeba Choudhary, Prajwala Gupta, Madhumitha Udaya kumar

Biofilm Formation by Drug Resistant Enterococci Isolates Obtained from Chronic Periodontitis Patients

Sonia Bhonchal Bhardwaj, Manjula Mehta, Shaveta Sood, Jyoti Sharma

Introduction: Enterococci are an important cause of opportunistic nosocomial infections and several multidrug resistant strains have emerged.The severity of periodontal diseases is managed by reduction in the pathogenic bacteria. There is a need to assess the prevalence and antibiotic susceptibility of enterococci colonizing the periodontal pocket and correlate its biofilm formation ability because oral biofilms provide a protective environment and are a reservoir of bacterial colonization of the gingival crevice. Aim: To investigate possible association between antibiotic susceptibility and biofilm formation in enterococci isolates from chronic periodontitis patients. Materials and Methods: This retrospective study was conducted at Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh from January 2015 to October 2015. Sterile paper points were inserted in the periodontal pocket of 100 subjects and put in a transport media. Forty -six isolates were identified as enterococci. The isolates were further examined for their ability to form biofilm by microtitre plate assay and antimicrobial susceptibility testing was done by disc diffusion method for clinically relevant antibiotics. Results: Significant relationship (p<0.001) was found between biofilm production with antibiotic resistance to Vancomycin, Erythromycin, Ciprofloxacin, Tiecoplanin, Amoxycillin and Gentamycin. Conclusion: The study demonstrates a high propensity among the isolates of Enterococci to form biofilm and a significant association of biofilm with multiple drug resistance.

Healthcare Associated Infections in a Resource Limited Setting

Introduction: Health Care associated Infections (HAI) are the most common complications affecting the hospitalized patients. HAI are more common in developing and under developed countries. However, there are no systematic surveillance programs in these countries. Aim: To find out the burden, predisposing factors and multidrug resistant organisms causing HAI in a resource limited setting. Materials and Methods: This prospective observational study was done at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Patients aged 13 years or more with stay of more than 48 hours in a 16 bedded Medical Intensive Care Unit (MICU) between November 2011 and April 2013 were included in the study. Patients were prospectively followed up till discharge or death for the development of HAI. Device associated HAI like Ventilator Associated Pneumonia (VAP), Catheter Related-Blood Stream Infection (CR-BSI) and Catheter Associated-Urinary Tract Infections (CA-UTI) were studied. Standard laboratory methods were used for identification of microorganisms causing HAI and to test their antibiotic sensitivity. Results: A total of 346 patients were included in the study with median age of 38 years. Common indications for admission to Medical Intensive Care Unit (MICU) were poisoning (31.5%); neurological illness (23.4%) like Guillian-Barre syndrome, tetanus, meningitis, encephalitis; respiratory illness (14.5%) like pneumonia, acute respiratory distress syndrome and tropical infections (7.2%) like malaria, scrub typhus, leptospirosis. Fifty percent (174/346) patients developed one or more HAI with VAP being the most common. The rates of HAI per 1000 device days for VAP, CR-BSI, CA-UTI were 72.56, 3.98 and 12.4, respectively. Acinetobacter baumannii was the most common organism associated with HAI. Multidrug resistance was seen in 74% of the isolates. Conclusion: The burden of HAI, especially with MDR organisms, in resource constrained setting like ours is alarming. There is urgent need for infection control and monitoring system to reduce HAI.

Comparative Assessment of Oral Health Related Quality of Life of Children Before and After Full Mouth Rehabilitation under General Anaesthesia and Local Anaesthesia

Jaai Vinod Rane, Jasmin Winnier, Rupinder Bhatia

Introduction: Early Childhood Caries (ECC) is an aggressive form of caries in a child who is 71 months of age or younger. If the child is cooperative, the treatment may be completed under Local Anaesthesia (LA). General Anaesthesia (GA) is considered if the child is uncooperative, medically compromised or if the parents are unable to return for regular visits and requests treatment under GA. Improved Oral health Related Quality of Life (OHRQoL) has been reported after dental treatment under GA. Aim: To assess and compare the improvements in OHRQoL of children who have undergone dental treatment under GA or LA. To study the preoperative severity of events that may prompt the parents to consider treatment under GA. Materials and Methods: Parents of paediatric patients who had to undergo full mouth rehabilitation under GA and LA were selected for this study. Parents were given a questionnaire to evaluate OHRQoL of children before and after completion of treatment. Preoperative and postoperative assessments were analyzed using paired t-test. Results: Dental disease was found to have a significant impact on children’s overall well being. There was a considerable improvement with relation to eating preferences, amount of food intake, sleep and pain relief before and after dental treatment. There was no significant difference if the child was treated under GA or LA. Conclusion: Severe caries affects the quality of life of preschool children and improvement on quality of life is significant regardless of treatment performed under GA or LA.

Radiotherapy in Phyllodes Tumour

Introduction: Phyllodes Tumour (PT) of the breast is a relatively rare breast neoplasm (<1%) with diverse range of pathology and biological behaviour. Aim: To describe the clinical course of PT and to define the role of Radiotherapy (RT) in PT of the breast. Materials and Methods: Retrospective analysis of hospital data of patients with PT presented from 2005 to 2014 was done. Descriptive statistics was used to analyze the results. Simple description of data was done in this study. Age and duration of symptoms were expressed in median and range. Percentages, tables and general discussions were used to understand the meaning of the data analyzed. Results: Out of the 98 patients, 92 were eligible for analysis. The median age of presentation was 43 years. A total of 64/92 patients were premenopausal. There was no side predilection for this tumour but 57/92 patients presented as an upper outer quadrant lump. Fifty percent of the patients presented as giant (10 cm) PT. The median duration of symptoms was 12 months (range: 1-168 months). A 60% of patients had Benign (B), 23% had Borderline (BL) and 17% had malignant (M) tumours. The surgical treatment for benign histology included Lumpectomy (L) for 15%, Wide Local Excision (WLE) for 48%, and Simple Mastectomy (SM) for 37%. All BL and M tumours were treated with WLE or SM. There was no recurrence in B and BL group when the margin was =1 cm. All non-metastatic M tumours received adjuvant RT irrespective of their margin status. Total 3/16 patients with M developed local recurrence. Total 6/16 M patients had distant metastases (lung or bone). Our median duration of follow up was 20 months (range: 1-120 months). Conclusion: Surgical resection with adequate margins (>1 cm) gave excellent local control in B and BL tumours. For patients with BL PT, local radiotherapy is useful, if margins are close or positive even after the best surgical resection. There is a trend towards improved local control with adjuvant radiotherapy for malignant PT. Metastatic malignant PT has a poor outcome.

Intra and Inter-Observer Variability of Transformation Zone Assessment in Colposcopy: A Qualitative and Quantitative Study

Introduction: Colposcopy is an important tool in the diagnosis of cervical precancer and early cancer. The assessment of women with abnormal cytology and selection of those who require further therapy or follow up depends on the colposcopic assessment of the Transformation Zone (TZ). Identification of the TZ is thus an important part of this examination. Intra and inter-observer variability is known to be relatively high in the colposcopic interpretation of abnormal features. However, there are hardly any studies on the observer variability in the assessment of the type of TZ. Aim: The present study was conducted with the aim to compare the intra and inter-observer variability of the TZ type classification and the Squamo-Columnar Junction (SCJ) visibility and to quantitatively measure the intra and inter-observer correlations of tracing of the TZ contours. Materials and Methods: Colposcopy images were obtained for a total of 170 cases. They were reviewed by three colposcopists independently. The colposcopists classified the TZ type and also marked the SCJ contours on the images. Each observer independently reviewed the cases on two different instances (few weeks apart) and the result was compiled for intra-observer variation. The intra and inter observer variability on the TZ type was compared using Cohen’s Kappa. This was followed by a quantitative measurement of TZ observation variability using Hausdorff distance. Results: The inter-observer agreement for the TZ type classification was moderate (Kappa= 0.53 to 0.66). The Intra-observer agreement was moderate to strong (0.60 to 0.86). Conclusion: Colposcopic in vivo examination increases the variability in the identification of the TZ when compared to the analysis of recorded images. The disagreement in the TZ type was mostly in categories Type 2 vs Type 3 followed by Type 1 vs Type 2. A computerized quantification method can be used for quality control and training purpose in colposcopy.

Evaluation of Gengigel® Application in the Management of Furcation with Coronally Advanced Flap through Surgical Re-Entry- A Split Mouth Clinical Study

Sugandha Gupta, Suresh D Kediege, Akanksha Gupta, Kanu Jain

Introduction: One of the challenging and unique periodontal problem of Grade II furcation defect has been managed through different treatment modalities in the past. A successful approach is based on complete closure of the defect. Different regenerative approaches have been tried. Aim: This study was carried out with an aim to evaluate the role of Gengigel® (0.8% hyaluronic acid) as a potential material for regeneration of lost attachment apparatus. Materials and Methods: A total of 20 sites with Grade II furcation defects from 10 patients were selected using random sampling technique. These were divided into Group A (place-ment of hyaluronic acid) and Group B (without placement of hyaluronic acid) according to treatment modality. Furcation defect assessment was done in vertical and horizontal depth preoperatively and postoperatively at six months through surgical re-entry. Recorded data was subjected to the statistical analysis unpaired and paired t-tests for intergroup and intragroup comparisons respectively. Results: Mean plaque index, gingival index and bleeding index score showed statistically highly significant and significant results respectively, for both the groups at baseline and six months. Mean difference in probing pocket depth and Relative Attachment Level (RAL) were statistically highly significant, whereas, mean difference of gingival position margin was non significant for both the groups, at baseline and six months. Mean difference in horizontal component at baseline and six months was statistically highly significant for both the groups. Mean difference in vertical component at baseline and six months was statistically significant for both the groups. On comparison, the mean difference in vertical and horizontal component of Group A and Group B at six months was statistically not significant. Conclusion: Both Gengigel® with coronally positioned flap and coronally positioned flap alone are effective in the treatment of Grade II furcation defects. The combination of Gengigel® with coronally positioned flap leads to better results in hard tissue measurement as compared to coronally positioned flap alone.

Explanatory Models and Medication Adherence in Patients with Depression in South India

Dushad Ram, Adarsh Lakkursiddappa, Rajesh Raman, Basavana Gowdappa Hattur

Introduction: Conceptualization of depression may have bearing on treatment seeking. It may affect adherence behaviour of the patients. Aim: To find out the explanatory models and their relationship with socio-demographic variables and medication adherence in patients with depression. Materials and Methods: Fifty-eight consecutive patients with depression in remission were recruited as per selection criteria. Socio-demographic details were collected. Patients were assessed using Mental Distress Explanatory Model Questionnaire (MDEMQ) and Morisky Medication Adherence Scale (MMAS). Results: Significant scores were observed in all dimensions of explanatory models. In the Mann-Whitney U test the patient’s marital status (MU=113.500, p=0.05, sig=0.05, 2-tailed), and family history of mental illness (MU=165.5, p=0.03, sig=0.05, 2-tailed) had a statistically significant group difference in the score of MDEMQ. In linear regression analysis, four predictors (MDEMQ subscales Stress, Western physiology, Non-Western physiology and Supernatural) had significantly predicted the value of MMAS (R2=0.937, f=153.558, p<0.001). Conclusion: Findings of this study suggested that patients with depression harbor multidimensional explanatory model. The levels of explanatory models are inversely associated with levels of medication adherence.

Ano–Genital Warts and HIV Status– A Clinical Study

Shashikant Balakrishana Dhumale, Shimpa Sharma, Arvind Gulbake

Introduction: Ano-Genital Warts (AGW) like other Sexually Transmitted Diseases (STD) is associated with Human Immunodeficiency Virus (HIV) infection. This study of AGW was done in HIV positive and HIV negative patients. Aim: To study the risk factors and clinical presentations of ano-genital warts in HIV positive and negative patients. Materials and Methods: A comparative, cross-sectional, descriptive study of 25 HIV positive and 25 HIV negative (n=50) AGW patients between 15-60 years of both sex was conducted in Dr. D. Y. Patil Hospital and Research Centre from July 2014 to July 2016. Results: Significant association of HIV positivity (p<0.05) was observed between age group of 15-30 years and HIV negative status (p<0.05) in age group of 31-45 years. HIV positive status significantly higher in patients with self-admitted multiple sexual partners (p<0.01), homosexuality (p<0.05) and presentation with anal warts (p<0.01). HIV negative status correlated significantly with single sexual partner admission (p<0.01) and hetero-sexuality (p<0.05). Gender did not show significant association with number of sexual partners or HIV positivity. Extra-genital or only genital warts had no association with HIV status. Co-STDs though more in number in ser-positive group, did not show any significant association with HIV positivity (p>0.05). No patient presented with changes of malignancy. Four were adolescents below 19 years. Two patients had atypical presentations of giant condylomata i.e., Buschke-Lowenstein Tumour (BLT). Conclusion: HIV positivity was significantly associated with the risk factors of age below 30 years, homo sexuality and multiple sexual partners. Anal warts were significantly common in HIV positive patients. Four adolescents with AGW underline the need for high risk behaviour counselling. No patient had malignant ano-genital warts. Follow up of these patients with Human Papilloma Virus (HPV) sub-typing is necessary.

Prevalence of Colour Vision Anomalies Amongst Dental Professionals and its Effect on Shade Matching of Teeth

Amrit Khosla, Anuj Paul Maini, Anuj Wangoo, Sukhman Singh, Damanpreet Kaur Mehar

Introduction: The success of a restoration is dependent on accurate shade matching of teeth leading to studies evaluating the factors affecting the perception of shades. Colour vision anomalies including colour blindness have been found to exist in the population and it has been thought to be a potential factor affecting the colour perception ability. Aim: The present study was done to evaluate the prevalence of colour vision anomalies and its effect on matching of shades of teeth. Materials and Methods: A total of 147 dental professionals were randomly selected for the study and were first tested for visual acuity using the Snellen’s Eye Chart so as to carry on the study with only those operators who had a vision of 6/6. Then, the Ishihara’s colour charts were used to test the operators for colour vision handicap. In the last stage of the study, test for accuracy of shade selection was done using the Vitapan Classical shade guide. The shade guide tabs were covered to avoid bias. Percentage was used to calculate the prevalence of colour vision handicap and its effect on matching of shades of teeth as compared to normal vision, which was evaluated using Chi square test. Results: Nineteen operators had colour vision anomalies out of hundred operators and only two operators presented with colour blindness. Colour vision anomaly was more prevalent than colour blindness and it was also found that it was more prevalent in males than females. The difference between the accuracy of shade matching between the operators with normal vision and colour vision defect and operators with normal vision and colour blindness was statistically not significant. Conclusion: Colour blindness and colour vision handicap are rare conditions, with the latter being more common in the population. According to our study, it was concluded that no statistically significant difference existed amongst the operators with normal vision and colour vision anomaly or operators with normal vision and colour blindness during the matching of shades of teeth.

Histomorphometric Analysis of Angiogenesis using CD31 Immunomarker and Mast Cell Density in Oral Premalignant and Malignant Lesions: A Pilot Study

M Jyothsna, M Rammanohar, Kiran Kumar

Introduction: Mast cells have been implicated in promoting angiogenesis in malignant tumors of lung, oesophagus and breast, but there are few studies on Oral Squamous Cell Carcinomas (OSCC). Most oral squamous cell carcinomas arise from pre-existing precancerous lesions exhibiting epithelial dysplasia. Aim: The present pilot study attempts to compare Mast Cell Density (MCD), Microvessel Density (MVD), Microvessel Area (MVA) histomorphometrically between normal buccal mucosa, severe epithelial dysplasia and OSCC and to correlate the role of mast cells and angiogenesis in tumor progression. Material and Methods: The retrospective study was conducted on eight cases of OSCC, eight cases of severe epithelial dysplasia and five cases of normal buccal mucosa. Immunohistochemical staining with anti CD–31, to demonstrate angiogenesis and toluidine blue staining for mast cells were employed. MVA, MVD and MCD were calculated using the measurement tools of the image analysis software and compared between the groups. One way ANOVA (Analysis of Variance) was used for comparing the parameter for multiple groups followed by Games Howell test. To assess the relationship between micro vessel density and mast cell density, Karl Pearson’s correlation was used. Results: MCD and MVD increased with disease progression and were statistically higher in OSCC than in severe epithelial dysplasia and normal buccal mucosa (p<0.001). MVA increased from normal to severe dysplasia and decreased from dysplasia to OSCC, may be due to revascularization of tumor tissue. A positive correlation was observed between MCD and MVD in OSCC and dysplasia, though were not statistically significant. Conclusion: These findings suggest that mast cells may up regulate angiogenesis in OSCC. MCD and MVD may be used as indicators for disease progression.

Evaluation of the Shear Bond Strength of Composite Resin to Wet and Dry Enamel Using Dentin Bonding Agents Containing Various Solvents- ARTICLE RETRACTED

Carounanidy Usha, Sathyanarayanan Ramarao, Bindu Meera John, Praveen Rajesh, S Swatha, Evaluation of the Shear Bond Strength of Composite Resin to Wet and Dry Enamel Using Dentin Bonding Agents Containing Various Solvents (Published in Journal of Clinical and Diagnostic Research. 2017 Jan,Vol-11(1): ZC41-ZC44) This article has been retracted at the authors' request due to concerns regarding authorship and author consent. One of the listed authors reported that the article was published without her knowledge. In accordance with publication ethics standards and with the agreement of the Registrar of the University of the authors', this article has been retracted.

Effect of Mechanical and Chemical Root Surface Treatment on the Shear Bond Strength of Intracanal Post in Primary Anterior Teeth: An In vitro Study

Introduction: Aesthetic restoration of severely mutilated primary anterior teeth still remains as a special challenge to paediatric dentist. Due to increased parent’s concern for aesthetic rehabilitation for their children, paediatric dentist are in a state to improve technique sensitive restorative procedure to improve aesthetic rehabilitation in children. Aim: The purpose of the study was to evaluate the effect of different root surface treatment on the shear bond strength of glass fibre reinforced post in primary anterior teeth using Universal Testing Machine (UTM). Materials and Methods: Twenty single rooted primary anterior teeth were selected. Coronal portions of the teeth were sectioned transversally 2 mm above the Cemento-Enamel Junction (CEJ) and specimens were treated endodontically and obturated using metapex. Then the specimens were randomly divided into four groups. Group 1: Control group; Group 2: Chemical surface treatment of the root with 2% chlorhexidine; Group 3: Mechanical surface treatment with mushroom-shaped undercut; Group 4: Combination of mechanical and chemical surface treatments. Samples were tested for shear bond strength. ANOVA and Post-hoc Tukey test were used for statistical analysis using SPSS version 20.0. Results: Combination of mechanical and chemical surface treatments exhibited higher mean shear bond strength (8.41 MPa), followed by mechanical surface treatment (4.68 MPa), chemical surface treatment (3.92 MPa) and control group (2.76 MPa). Conclusion: Mechanical and chemical surface treatments together led to a improved shear bond strength and increased the retention of the post to the root surface.

Increased Advanced Oxidation Protein Products Generation by Cyclosporine–A and Angiotensin II in Human Gingival Fibroblasts – Ex–vivo Study

Introduction: Cyclosporin-A (CsA), an immunosuppressant, induces renal fibrosis and Renin Angiotensin System (RAS) is known to play a major role. CsA has the potential to increase the oxidative stress; specifically through the Advanced Oxidation Protein Products (AOPP) which could possibly stimulate fibrosis. A similar type of pathology occurs even in the gingiva known as CsA Induced Gingival Overgrowth (CIGO). Aim: This study was undertaken to estimate the AOPP generation by Human Gingival Fibroblasts (HGF) under the influence of CsA and Angiotensin II (Ang II). Materials and Methods: Six healthy gingival tissue samples were obtained during crown lengthening procedure and primary HGF were cultured using enzymatic digestion method. The ideal non-cytotoxic concentrations of CsA and Ang II were identified using cytotoxicity assay. Later, HGF were incubated with CsA and Ang II for 12 hours and AOPP assay was performed at zero and one hour interval. Results: There was a statistically significant increase in AOPP production in both the CsA and Ang II when compared to the control group with a p value<0.05 . Conclusion: CsA can induce oxidative stress and preventing/controlling it may be necessary to prevent untoward effect of the drug.

An Assessment of Curve of Spee in Healthy Human Permanent Dentitions: A Cross Sectional Analytical Study in a Group of Young Indian Population

Sushma Krishnamurthy, Rajendra B. Hallikerimath, Praveenkumar S. Mandroli

Introduction: An awareness of the standard value of the maxillary and the mandibular curves of Spee may aid the clinician in developing occlusion in the sagittal plane and would be useful when providing prosthetic rehabilitation for patients with occlusal derangement. Aim: To assess and compare the radius and depth of curve of Spee in maxillary and mandibular arches in men and women, in a group of young Indian population. Materials and Methods: The study cohort consisted of 25 men and 25 women between 19 to 24 years. Impression of maxillary and mandibular arches were made with alginate. Casts were poured in die stone. Standardized digital pictures of the right side of maxillary and mandibular dental casts were made with a digital camera and transferred to a computer. Tips of the distal cusps of molars, premolars and canines of the maxilla and mandible were located. The radius and the depth of the curve of Spee were measured from the digital photographs of dental casts, with the help of ‘dimension tool’ in the computer software (Corel DRAW X5). Mann-Whitney test was used to analyze the difference in the curve of Spee between men and women and the difference between maxillary and mandibular arches. Results: The mean values were as follows: a) Men: Radii of curve of Spee in the maxillary and mandibular arch were 140.22±65.98 and 109.67±46.80 respectively; depths of curve of Spee in maxillary and mandibular arch were 1.65±0.67 and 1.49±0.74 respectively; b) Women: Radii of curve of Spee in the maxillary and mandibular arch were 120.58±63.91 and 98.31±63.59 respectively; depths of curve of Spee in maxillary and mandibular arch were 1.45±0.54 and 1.40±0.61 respectively. In the mandibular arch, the difference in the radii (p=0.0467) was statistically significant between men and women. In women, the difference in radii (p=0.0467) between maxillary and mandibular arches was statistically significant. Conclusion: The radii and depths of curve of Spee were larger in maxillary than mandibular arches in both men and women. Also, the difference in the radii of mandibular arch was statistically significant between men and women.

Role of Cross Sectional Imaging in Isolated Chest Wall Tuberculosis

Introduction: Isolated chest wall tuberculosis though a rare entity, the incidence of it has been on rise among immunocompromised population making it an important challenging diagnosis for the physicians. Its clinical presentation may resemble pyogenic chest wall abscess or chest wall soft tissue tumour. Sometimes it is difficult to detect clinically or on plain radiograph. Aim: The present study was conducted with an aim to evaluate the common sites and varying appearances of isolated chest wall tuberculosis. Materials and Methods: A hospital based cross-sectional retrospective study was conducted in Assam Medical College and Hospital, a tertiary care centre in North East India. The study group comprise of 21 patients (n=15 male and n=6 females) with isolated chest wall tuberculosis without associated pulmonary or spinal involvement who were subjected to Computed Tomography/Magnetic Resonance Imaging (CT/MRI) of the thorax following initial Ultrasonogram (USG) evaluation of the local site. Pathological correlation was done from imaging guided sampling of the aspirate or surgery. Results: Variable sites of involvement were seen in the chest wall in our patients (n=21), with chest wall abscess formation being the most common presentation and rib being the most common bony site affected in the thoracic cage. Bony sclerosis was noted in 11 patients (52.4%), periosteal reaction in 10 patients (47.6%) and sequestration in five patients (23.8%). CT/MRI not only localized the exact site and extent of the abscesses which facilitated guided aspirations, but also helped in detecting typical bony lesions thereby, differentiating from pyogenic osteomyelitis besides ruling out associated pulmonary or pleural involvement in such patients. Conclusion: Cross-sectional imaging plays an important role by giving a wholesome picture of both soft tissue and bony pathology, indentifying anatomic extent, aiding in aspiration of deep seated collections, depicting underlying bony erosion, assessing response to treatment on follow up in patients with isolated chest wall tuberculosis which helps in planning management.

Morphological Variations of Middle Ear Ossicles and its Clinical Implications

Ritaban Saha, Phalguni Srimani, Ardhendu Mazumdar, Sibani Mazumdar

Introduction: The middle ear ossicles form a semi rigid chain in the middle of the ear for conduction and amplification of sound waves from the tympanic membrane to the inner ear. Although, our knowledge of the ear ossicles dates back to the 15th century, and various studies have been carried out on their morphometry, morphology, anomalies, embryology, function and structure throughout the world, information about the morphology of middle ear ossicles is meagre in Indian subjects. Aim: To find out the morphological variations of middle ear ossicles of right and left sides. Materials and Methods: In the present study, the middle ear ossicles were bilaterally dissected out from the temporal bones obtained from 26 cadaveric heads from the Department of Anatomy under a surgical oto-microscope with micro instruments. Morphological variations were studied under the magnification of the operating microscope. Attempt was also made to evaluate the clinical implications related to such variants and compare the results with those observations made in other parts of India and abroad. Age variation was not considered as the ossicles reach their full size at birth. Results: It was observed that the stapes was the most variable and the incus as the most stable ossicle so far as morphological variations are concerned. Malleus presented variations in the free ends of manubrium, lateral process and anterior process. Variation in morphology of stapes did not follow any fixed pattern. Conclusion: It is expected that this work may also inspire many others to continue temporal bone dissection with a view to gather more ossicles which might be preserved in ossicular banks by following proper sterilization methods for future use as homografts in ossiculoplasty. These harvested ossicles may be used to replace eroded middle ear ossicles as an alternative to manufactured prosthesis.

Comparative Study on the Estimation of Estrous Cycle in Mice by Visual and Vaginal Lavage Method

Gnanagurudasan Ekambaram, Senthil Kumar Sampath Kumar, Leena Dennis Joseph

Introduction: Evaluation of estrous cycle in laboratory animals can be a useful measure of the integrity of hypothalamic-pituitary-ovarian reproductive axis. Assessment of vaginal cytology is crucial to assess the milieu and compare the endocrine status of animals among the experimental groups. Aim: The present study was attempted to compare the estimation of estrous cycle by visual method and non invasive vaginal lavage method. Materials and Methods: Sixty healthy female swiss albino mice were used for the present study. The appearance of the vagina with respect to the opening of vagina, vaginal swellings were observed. Non-invasive method was used in vaginal lavage method in which nucleated epithelial cells, cornified squamous epithelial cells and leucocytes present in vaginal smears were used to identify the estrous stages. Results: The estimation of estrous cycle by visual method coincides with the vaginal lavage method. In Vaginal lavage method, the accurate proportion of cells and the transition phases can be evaluated. Conclusion: The non-invasive method reduces the risk of pseudo -pregnancy and mechanical trauma. Though, visual method is quick and reliable, for accurate estimation of the stage of the estrous, non-invasive vaginal lavage method is ideal.

Teaching and Assessing Reflecting Skills among Undergraduate Medical Students Experiencing Research

Vasudha Devi, Reem Rachel Abraham, Ullas Kamath

Introduction: Reflection is the integral component of lifelong learning. Hence, there is a need for incorporating opportunities for students in the curriculum, to develop these skills. Aim: To evaluate the feasibility of incorporating teachinglearning activity on reflection early in the undergraduate medical curriculum using research experience as a context, and, to determine whether the reflective skills of students improve upon training. Materials and Methods: The study was experimental with test and control groups and was conducted at Melaka Manipal Medical College, India. Senior batch of medical students in the second year of the course, about to complete their research project were considered as the test group and subsequent junior batch which was in middle of the research activity was the control. The test group was provided with a teaching-learning activity on reflection. Following this, students were asked to write reflective summary on experience of doing research. The control group who did not receive any training on reflection were also requested to write reflective summaries. Reflective summaries were graded by two authors independently using a newly developed rubric. Later, the grades were designated with scores. Perspective regarding this teaching-learning activity was collected from the test group. Feasibility was examined during teaching-learning activity and assessment. Mean reflective summary scores of control and test groups were expressed as mean±standard deviation and compared using independent samples t-test. A p-value of <0.05 was considered as statistically significant. Inter-rater reliability of the rubric was analyzed using Kappa statistics. Results: The teaching-learning activity lasted for two hours. It took an average of five minutes for researchers to assess each reflective summary. There was a statistically significant (p<0.001) difference in the mean reflective summary scores between control (26.45±9.43) and test (51.66±6.56) groups. Kappa for inter-rater reliability was 0.784 denoting substantial agreement between two raters. Perceptions revealed acceptability of module (median 4, scale 1-5). Conclusion: Teaching and assessing reflecting skills among students using research experience as context was feasible. This study demonstrated that students acquire better reflecting skills after undergoing training.

To Operate or not to Operate the Mid-Shaft Fractures of the Clavicle: A Comparative Study of Functional Outcomes of the Two Methods of Management

Introduction: Fractures of the clavicle are some of the most common fractures which are seen in the adult population. Mid-shaft fractures of the clavicle are considered the most common form of clavicle fractures and about half of them are displaced fractures. They have been managed non-operatively over the years. However, severe displacement and comminution of these fractures have warranted the requirement of operative intervention, due to increased incidence of mal-union, worsening of shoulder functions etc., after conservative management. The introduction of locking compression plates, have increased the incidence of operative intervention in the management of these injuries. Aim: To study and compare the functional outcome of the shoulder after open reduction and internal fixation versus non-operative management of mid-shaft clavicle fractures. Materials and Methods: A prospective study was conducted from June 2013-October 2015 in the Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Mangalore. A total of 30 skeletally mature patients between the age groups of 20-50 years with diagnosed fresh mid-shaft clavicle fractures, AO type A and B mild to moderate displacement, were enrolled into the study with. They were divided into two groups randomly. Group 1 consisted 16 patients who underwent open reduction and locking compression plate fixation and Group 2 consisted of 14 patients who were managed with application of a clavicle brace and arm pouch for three weeks. Reviews were done at three, six and 24 weeks postoperatively. The patients were assessed clinically and radiographs were taken during all the reviews. Scoring of shoulder function was done using the Disabilities of the Arm, Shoulder and Hand (DASH) score during all the reviews. The results were tabulated compared and analyzed statistically using the ‘Independent t-test’ and Chi-square test. Results: The DASH scores at the end of 24 weeks were noted to be 8.57±6.073 points for the 14 patients in the conservative management group and 7.74±16.422 points for the 16 patients in the open reduction and internal fixation group. This indicated that there was no significant difference noted in terms of shoulder function between the two groups. Six of the 14 patients in the conservative management group were noted to have mal-union of the fracture. No non-unions were noted in the conservative or operative groups. No mal-union was noted in the open reduction and internal fixation group. Conclusion: Though open reduction and internal fixation of mid-shaft clavicle fractures reduced the incidence of mal-union, no significant difference was noted in the functional outcome of shoulder function as compared to when the fracture was managed conservatively.

A Comparative Study to Assess the Predictability of Different IOL Power Calculation Formulas in Eyes of Short and Long Axial Length

Dharmil Doshi, purvi limdi, nilesh parekh, neepa gohil

Introduction: Accurate Intraocular Lens (IOL) power calculation in cataract surgery is very important for providing postoperative precise vision. Selection of most appropriate formula is difficult in high myopic and hypermetropic patients. Aim: To investigate the predictability of different IOL (Intra Ocular Lens) power calculation formulae in eyes with short and long Axial Length (AL) and to find out most accurate IOL power calculation formula in both groups. Materials and Methods: A prospective study was conducted on 80 consecutive patients who underwent phacoemulsification with monofocal IOL implantation after obtaining an informed and written consent. Preoperative keratometry was done by IOL Master. Axial length and anterior chamber depth was measured using A-scan machine ECHORULE 2 (BIOMEDIX). Patients were divided into two groups based on AL. (40 in each group). Group A with AL<22 mm and Group B with AL>24.5 mm. The IOL power calculation in each group was done by Haigis, Hoffer Q, Holladay-I, SRK/T formulae using the software of ECHORULE 2. The actual postoperative Spherical Equivalent (SE), Estimation error (E) and Absolute Error (AE) were calculated at one and half months and were used in data analysis. The predictive accuracy of each formula in each group was analyzed by comparing the Absolute Error (AE). The Kruskal Wallis test was used to compare differences in the (AE) of the formulae. A statistically significant difference was defined as p-value<0.05. Results: In Group A, Hoffer Q, Holladay 1 and SRK/T formulae were equally accurate in predicting the postoperative refraction after cataract surgery (IOL power calculation) in eyes with AL less than 22.0 mm and accuracy of these three formulae was significantly higher than Haigis formula. Whereas in Group B, Hoffer Q, Holladay 1, SRK/T and Haigis formulae were equally accurate in predicting the postoperative refraction after cataract surgery (IOL power calculation) in eyes with AL more than 24.5 mm. Conclusion: Hoffer Q, Holladay 1 and SRK/T formulae were showing significantly higher accuracy than Haigis formula in predicting the postoperative refraction after cataract surgery (IOL power calculation) in eyes with AL less than 22.0 mm. In eyes with AL more than 24.5 mm Hoffer Q, Holladay 1, SRK/T and Haigis formulae were equally accurate.

A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis

Introduction: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease where assessment of disease activity is essential for management of patient. Currently, many composite scoring systems are used for evaluation of disease activity but they are mainly clinical-based. As several haematological parameters are altered due to systemic inflammatory process in RA, this study was intended to evaluate role of common haematological parameters to assess disease activity in RA. Aim: To find out the association of disease activity of Rheumatoid Arthritis (RA) with platelet count, Mean Platelet Volume (MPV) and Haemoglobin (Hb) level so that these cost-effective haematological parameters can be used as additional factors to assess disease activity. Materials and Methods: This hospital based cross-sectional study was done on newly diagnosed patients of RA along with age and sex matched healthy control population. Patients suffering from malignancies, renal failure, diabetes mellitus or RA patients on drug therapy were excluded. Clinically, disease activity of RA was measured using DAS 28-3 Score (Modified Disease Activity Score using three variables- tender joint count, swollen joint count and ESR). Haematological parameters were measured by automated cell counter. Results: Total 80 cases were selected (60 female and 20 male). 48 patients with high disease activity (DAS 28-3>5.1) were labelled as Group-A and 32 with low to moderate disease activity (DAS 28-3 =5.1) as Group- B. Mean platelet count of patients of group A and group B were 4.53 lacs/cmm and 2.17 lacs/cmm respectively (p <0.001). MPV mean in group A and B were 11.86 fl and 10.19 fl respectively (p <0.001). Mean Hb (g/dl) was 10.05 and 12.25 for group A and B respectively (p=0.001) for male patients while in females it was 10.12 and 11.91 for group A and B, respectively (p=0.003). Mean platelet count and MPV in control population were 2.07lacs/cmm and 9.4 fl, respectively while mean Hb (g/dl) were 13.31 (male) and 12.01 (female). Conclusion: In our study it was observed that Hb is significantly lower in patients with high disease activity whereas platelet count and MPV are significantly higher with high disease activity compared to patients with low to moderate disease activity.

An In-vitro Comparative Stereomicroscopic Analysis and Evaluation of Marginal Accuracy in Porcelain Fused to Metal Copings Fabricated in Two Different Finish Lines Using Variant Die Materials

Priya L Vaswani, Pronob K Sanyal, Siddharth Y Gosavi, Abhijeet R Kore

Introduction: Little published information is available about the influence of preparatory designs and die materials on marginal accuracy of porcelain fused to metal copings using recently developed die materials. Aim: To detect the influence of margin geometries and dimensional accuracy of contemporary die materials on vertical marginal gaps in Porcelain fused to metal coping using a Stereomicroscope (three dimensional analysis). Materials and Method: Two chrome cobalt alloy models of mandibular first molars prepared to have shoulder and deep chamfer finish lines were CADAD-CAM milled. Elastomeric impressions of these models were made in a custom tray, poured in Type IV Gypsum(n=10) and Resin modified Gypsum(n=10) and also packed with Epoxy resin (n=10) as a die material to form a total of 60 samples, 30 in each group (shoulder and deep chamfer). Wax patterns were fabricated, invested and castings in ceramic alloy were obtained in traditional manner. These copings were later analyzed on CAD /CAM models using stereomicroscope. Results: Both the designs did not exhibit significant difference (p<0.05). Whereas, the three die materials exhibited significant difference (p<0.05) by Two way ANOANOANOVA test and Tukey’s multiple Post Hoc test. Results from this study showed that vertical marginal gaps for copings fabricated on resin modified gypsum as a die material were within the clinically acceptable range. Conclusion: Margin geometries both shoulder and deep chamfer have equal influence on vertical marginal gaps in metal ceramic restorations. Copings fabricated on Epoxy resin dies exhibited highest value of vertical marginal discrepancy, where as least value was determined for copings constructed on dies fabricated from resin modified gypsum.

Efficacy of Triple Antibiotic Paste, Moxifloxacin, Calcium Hydroxide And 2% Chlorhexidine Gel In Elimination of E. Faecalis: An In vitro Study

Introduction: Root canal treatment is incomplete without usage of intra canal medicaments. They help in the reduction of bacterial count and its by-products, making canals clean and decreasing postoperative pains. Aim: The aim of this study was to evaluate and compare the antimicrobial activity of triple antibiotic paste, Moxifloxacin, calcium hydroxide and 2% Chlorhexidine (CHX) gel in elimination of Enterococcous faecalis (E. faecalis). Materials and Methods: Seventy-five root blocks were obtained from extracted single rooted human teeth. The canal diameter was increased using Gates- Glidden drill up to size 3 and then contaminated with E. faecalis for 21 days. The contaminated samples were then divided into following 5 groups. Group 1: Saline (negative group), Group 2: Calcium hydroxide Ca(OH)2, Group 3: 2% CHX gel, Group 4: Triple Antibiotic Paste (TAP) (50 µg – metronidazole of 400 mg, 50 µg – minocycline of 100 mg, 50 µg – ciprofloxacin of 100 mg) and Group 5: Moxifloxacin (50 µg – moxifloxacin of 400 mg). Dentin debris was obtained at the end of first, 7th, and 10th day using Gates Glidden drill sizes 4 and 5. The bacterial load was assessed by counting the number of Colony Forming Units (CFUs). The data were analyzed with the ANOVA and Post-Hoc tests to assess the differences in antibacterial efficacy between groups (p=<0.001). Results: A 2% CHX gel alone completely inhibited the growth of E. faecalis after one, seven and 10 days. The 2% CHX gel was the most effective medicament against E. faecalis, as it showed significant differences with normal saline, calcium hydroxide, Moxifloxacin or triple antibiotic paste at all time intervals. The triple antibiotic paste group showed a moderate antibacterial effect as its difference with all group was significantly better at all days. Moxifloxacin was more effective than calcium hydroxide on 7th and 10th day. Conclusion: Best antimicrobial efficacy was shown by 2% CHX gel. Moxifloxacin was equally efficient compared to triple antibiotic paste against E. faecalis at longer intervals of time.

Stability of Vertical, Horizontal and Angular Parameters Following Superior Repositioning of Maxilla by Le Fort I Osteotomy: A Cephalometric Study

Introduction: The restoration of normal jaw function, optimal facial aesthetics and long term stability are the goals of any orthognathic surgical procedures. During the last two decades, several cephalometric investigations have been reported on the skeletal changes following maxillary surgical procedures. The stability following LeFort I osteotomy and maxillary superior repositioning of the maxilla has not been studied extensively. Aim: This study was aimed at determining the surgical changes brought about by superior repositioning of the maxilla by Le Fort I osteotomy and evaluate the stability of the surgical procedure one year following surgery. Materials and Methods: Presurgical and postsurgical and one year post surgical lateral cephalograms of 10 adult patients (age group - 17 to 40 years, with a mean age of 22.2 years) who had been treated successfully by maxillary Le-Fort I osteotomy and impaction were obtained. The lateral cephalograms were grouped into three categories: T1- Presurgical, T2- Postsurgical, T3- One year postsurgical. Comparisons were made between T1-T2 and T2-T3 to assess the changes following surgery and to evaluate the stability, one year following the surgery using 5 horizontal, 5 vertical linear and 2 angular measurement. Statistical analysis was done with SPSS ( Version 17). Results were expressed as mean±standard deviation. A paired t-test was used to analyze the paired observations. Results: The difference between T1 and T2 values of vertical changes showed that they were statistically highly significant whereas from T2 to T3 they were insignificant. The difference between T1 and T2 values of all the horizontal changes showed that they were statistically significant whereas True Vertical Line (TVL) to point Anterior Nasal Spine (ANS) was not statistically significant. The horizontal changes from T2 to T3 were statistically not significant whereas TVL to point Incisal edge of upper incisor (Is) was statistically significant. The angular changes from T1 to T2, T2 to T3 were statistically not significant. Conclusion: There was a significant reduction in the facial height and significant anterior movement of maxilla after surgery. Even after one year of surgery, negligible amount of relapse was recorded except at the incisors.

Clinico-Pathological Spectrum of Ophthalmic Lesions: An Experience in Tertiary Care Hospital of Central India

Yashita Gupta, Renuka Gahine, Nighat Hussain, Mohd Jafar Memon

Introduction: Ophthalmic lesions show varied distribution on the basis of geographical location. Eye being a unique sensory organ need to be studied both clinically and pathologically. Aim: This study was aimed to evaluate the histomorphological and clinico-pathlological spectrum of ophthalmic lesions at a tertiary care hospital of Central India. Materials and Methods: We reviewed all the ophthalmic biopsies performed in the Department of Pathology of our institute between January 2008 and November 2014. Total 488 biopsies of the orbito-ocular region were obtained from patients attending the ophthalmology department. Ophthalmic biopsies were studied as per epidemiological and histomorphological data. Results: The patients ranged in age from one month to 85 years with bimodal distribution. With a male to female ratio of 1:1. Ophthalmic lesions were highest (44.8%) in less than 20 years age group. Eyelid (33.6%) was the most commonly involved site. Clinical diagnosis was consistent with histopathological diagnosis in approximately 76% cases. The non-neoplastic, benign and malignant lesions were 61.1%, 7.8% and 31.1% respectively. Retinoblastoma formed 40.1% of all malignant lesions followed by sebaceous carcinoma (19.1%) and Squamous Cell Carcinoma (SCC) (10.5%). Rare lesions were primary neuroblastoma of orbit and rhabdomyosarcoma of eyelid. Conclusion: Findings suggest that among neoplastic lesions the most common ophthalmic malignancies were retinoblastoma in children and sebaceous carcinoma in adults. Among non-neoplastic lesions, 89% cases of infectious aetiology were of rhinosporidiosis in our study making it an important differential diagnosis among ophthalmic lesions.

Role of CD10 Immunoexpression in Grading Phyllodes Tumour of the Breast

Introduction: Fibroepithelial tumours are a heterogeneous group of biphasic neoplasms consisting of a proliferation of both epithelial and stromal components. Fibroadenoma (FA) and Phyllodes Tumour (PT) constitute the major entities. It is crucial to distinguish benign from borderline PT (low grade malignant PT), because the former do not metastasize, have a lesser risk of local recurrence and initial local recurrences are histologically benign in almost all instances. Multiple Immunohistochemical (IHC) markers are being studied to find their utility in grading the PT accurately for planning proper treatment. Aim: To study, the IHC expression of CD10 in the stromal cells of a series of PTs and FA, with the aim of determining whether the degree of CD10 expression in the stromal cells is related to the grade of the tumour. Materials and Methods: Records of 28 cases of PT and 35 cases of FA received in the Department of Pathology in a tertiary care hospital were obtained. Histopathology reports and slides of all the cases were reviewed and clinical data such as age and histomorphological features such as tumour cellularity, stromal overgrowth, mitotic count and nuclear atypia were noted. Representative block of the tumour with maximum cellularity was subjected to CD10 staining. For FA and benign PT a technique of tissue microarray was used. For borderline and malignant PT, representative section was used. Stromal cell staining was assessed, using cytoplasmic staining of the breast myoepithelium as internal control. Results: Present study included 35 cases of FA, 20 cases of benign PT, five cases of borderline PT and three cases of malignant PT. The mean age of the patients increased with the increasing tumour grade of PT and this was also observed for FA and benign PT. The mean age increased with increase in tumour grade of PT and was statistically significant (p<0.05). The mean size did not increase with the increasing tumour grade of PT and was statistically insignificant (p=0.0429). Mean tumour size was more in benign PT as compared to FA and was highly statistically significant (p<0.01). CD10 staining was diffuse (Grade-3) and strong in malignant PT. The staining intensity was strong but patchy (Grade-2) in borderline PT. Weak and patchy (Grade-1) CD10 staining was seen in four benign PT and six FA. Other cases of benign PT and FA were negative for CD10 immunoreactivity. Conclusion: Our study showed that CD10 expression strongly correlates with the PT grade, which can help in the differentiation between benign and malignant variants of PT.

Effects of Laparoscopic Sleeve Gastrectomy on Central Obesity and Metabolic Syndrome in Indian Adults- A Prospective Study

Introduction: Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. Aim: To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m2] and severely obese (BMI>35 kg/m2) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. Results: Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. Conclusion: LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.

Study of Risk Factors for Development of Voice Disorders and its Impact on the Quality of Life of School Teachers in Mangalore, India

Aratati Alva, Megna Machado, Kiran Bhojwani, Suja Sreedharan

Introduction: School teachers are most prone to the development and detrimental effects of voice disorders as a consequence of their work. The risk factors for development of dysphonia in teachers are multifactorial. Aim: The primary aim of our study was to investigate the various risk factors that influence the onset and progression of voice disorders in school teachers in the Indian context. We wanted to assess the effect of voice problems on the physical, psychosocial and functional aspect of a teacher’s life. Materials and Methods: It was a cross-sectional study conducted across three English medium institutions. A total of 105 teachers consented to participate in the study and they had to answer a semi-structured, pre-tested questionnaire, which included demographic details, living habits (drug intake, smoking and alcohol intake) health condition [any Deviated Nasal Septum (DNS), Gastroesophageal Reflux Disease (GERD), stress, etc., or any history of surgery], teaching characteristics, voice symptoms and physical discomforts and quality of life assessment. The completed questionnaires were collected and analyzed based on the responses obtained. Results: It was found that 81% of the study population had voice problems at some point of their career. A total of 26% of them fell into the voice disorder category. The association of upper respiratory infections DNS and GERD with voice disorders was found to be statistically significant. We also found that a significant number of teachers with voice disorders had changed their teaching styles and were planning to opt for an early retirement. Most importantly, it was also seen that teachers with voice disorders were more likely to have a poorer quality of life as compared to those without a voice disorder (p<0.001). Conclusion: Voice disorders had a significant bearing on all the spheres of a school teacher’s life. The affected teachers were more likely to take sick leaves, change overall job opinions, retire early, reduce overall communiations, repeat statements and avoid talking to people in person as well as over the telephone. It reduced their overall social abilities and made them avoid social activities. They got easily upset and were dissatisfied with their job performance. All these in turn deteriorate the quality of life in these individuals.

Use of Dexmedetomidine in Patients Undergoing Craniotomies

Introduction: The neuroanaesthesia ensures stable perioperative cerebral haemodynamics, avoids sudden rise in intracranial pressure and prevents acute brain swelling. The clinical characteristics of dexmeditomidine make this intravenous agent a potentially attractive adjunct for neuroanaesthesia and in the neurological intensive care unit. Aim: This study aimed to assess the effect of dexmedetomidine on intraoperative haemodynamic stability and to assess the intraoperative requirements of analgesic and other anaesthetic agents and also to assess postoperative sedation, respiratory depression and any other side effects of dexmedetomidine as compared to placebo. Materials and Methods: This prospective randomized study was done in 60 patients of either sex, age between 18 to 60 years and American Society of Anaesthesiologist (ASA) Grade I and II undergoing elective craniotomies under General Anaesthesia (GA) for intracranial Space Occupying Lesion (SOL). These 60 patients underwent thorough history, clinical examination and laboratory investigations. They were randomly divided into two groups, Group D (received Inj. Dexmedetomidine) and Group P (received Inj. Placebo). During bolus and infusion Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Peripheral oxygen saturation (SPO2) was recorded at every five minutes interval for first 20 minute. Results: The mean age in Group D was 39.5 years and in Group P was 40 years. The sex distribution in two groups was in Group D, 12 patients (40%) were females and 18 (60%) patients were males. While in Group P 10 (33.3%) were females and 20 (66.7%) patients were males. The two groups were comparable with respect to diagnosis and type of surgery of patients and difference was not statistically significant. The mean HR, the mean DBP and the mean MAP was lower in Group D as compared to Group P and the difference was statistically significant. Conclusion: Dexmedetomidine provided intraoperative haemodynamic stability. It attenuates the haemodynamic responses to laryngoscopy, intubation, at pin fixation and the emergence from anaesthesia.

Dentists´ Knowledge, Attitude and Practice in Treating Patients Taking Oral Antithrombotic Medications – A Survey

Introduction: India lists high on patients suffering from diabetes, hypertension, stroke and myocardial infarction. Hence, a large proportion of the population is on long term Oral Antithrombotic Medications (OAM). Though several guidelines exist on dental management of these patients, previous surveys have shown variation among the dentists. Aim: The purpose of this study was to assess the knowledge, attitude and practice of dentists in Chennai, India, towards dental management of patients taking OAM using a questionnaire survey. Materials and Methods: The survey was conducted among 256 dentists in Chennai, India using a printed questionnaire containing 16 questions, at their university location. Descriptive statistical analysis was used to analyze the data. Results: Of the final population of dentists who were included in the survey (n =212), majority of them were aware about drugs such as warfarin and aspirin compared to other newer drugs (dabigatran, rivaroxaban). Most participants took physician’s opinion before proceeding with any invasive dental procedure and thromboembolic events were their major concern while treating patients on OAM. Conclusion: The survey revealed dentists are knowledgeable about management of patients on OAM. However, they tend to overestimate the bleeding risk, thus being cautious in their treatment approach. Based on the results of the study, the authors suggest that continuing dental education programs and further training on management of such medically complex patients will be beneficial in order to provide optimum dental care to people taking OAM.

Efficacy of Natural and Allopathic Antimicrobial Agents Incorporated onto Guided Tissue Regeneration Membrane Against Periodontal Pathogens: An In vitro Study

Neha Mehrotra, Ajay Reddy Palle, Rajani Kumar Gedela, Sanjay Vasudevan

Introduction: Periodontal disease is one of the most prevalent afflictions worldwide. It is an infection of the periodontium as a result of subgingival colonization of the specific microbiota, leading to loss of attachment, which requires optimal care for regeneration to its pre-disease state. Guided Tissue Regeneration (GTR) is one of the successful treatment modalities in Periodontal Regenerative Therapy, but is vulnerable to bacterial colonization. The conflict between usage of classical antibiotics and plant origin antimicrobial agents has recently been in the limelight. Aim: The aim of this study was to assess the in vitro antimicrobial activity of amoxicillin, metronidazole and green coffee extract loaded onto GTR membrane against periodonto-pathogens. Materials and Methods: Pure form of amoxicillin, metronidazole and green coffee extract were obtained. One percent concentration of each antimicrobial agent was prepared by appropriate dilution with distilled water. GTR membrane was cut into a size of 1x0.5 cm under sterile conditions and was coated with the antimicrobial agents respectively and with distilled water as the negative control. Antimicrobial activity was checked against Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) and Porphyromonas gingivalis (P. gingivalis) using agar disc diffusion method. The statistical analysis was done using Kruskal Wallis ANOVA and Mann-Whitney U test. Results: One percent amoxicillin showed level of significance (p>0.05) against both A. actinomycetemcomitans and P. gingivalis. Green coffee extract showed no zone of inhibition against both the bacterial species. Conclusion: Loading of commercially available antimicrobial agents onto GTR membrane can prevent its bacterial colonization leading to better treatment outcomes for periodontal regeneration.

Unusual Dyslipidemia in Patients with Chronic Kidney Diseases

Rashmi Rekha Phukan, Rohini K Goswami

Introduction: Chronic Kidney Disease (CKD) is a major and globally increasing health problem in the general population arising from a spectrum of diseases. Majority of the patients die even before reaching End Stage Renal Disease (ESRD) due to cardiovascular complications which arise due to altered lipoprotein compositions. Aim: Present study was aimed at evaluating the serum lipid profile in CKD patients and to find the pattern of its alteration in both haemodialyzed and conservatively treated CKD patients. Materials and Methods: Seventy one randomly selected CKD patients attending a tertiary care hospital of Assam during one year of time frame (40 haemodialyzed and 31 conservatively treated) along with 50 apparently healthy controls were included in the study. Test for serum lipid profile, urea creatinine, FBS, PPBS, total protein and albumin were carried out in all the cases and controls. The results were analyzed and compared with the controls using Microsoft Excel software. Results: Triglyceride Level (TGL) of CKD group 157.88±61.82, controls 96.98±37.52, Very Low Density Lipoprotein (VLDL) of CKD group 31.58±12.36, controls 19.39±7.50 was marginally elevated and High Density Lipoprotein (HDL) of CKD group 33.40±9.06, controls 45.95±10.35 was significantly reduced in the patient group as compared to the controls and the results were statistically highly significant with p-value<0.001. Total cholesterol (CKD group 128.2±53.57, controls 142.53±31.44) and LDL (CKD group 63.23±46.47, controls 77.35±26.81) were lower in the patient group as compared to the controls, however the difference was statistically not significant (p value 0.09 and 0.059 respectively). There was no statistically significant difference of lipid profile between hemodialyzed and conservatively treated ckd groups and there was no gender related variation of lipid profile too. Conclusion: Increased TGL and reduced HDL, rather than increased total cholesterol and increased LDL are responsible for the high incidence of cardiovascular complications in CKD patients. Hypolipidemic drugs and low fat diet may be helpful in impeding the progression of cardiovascular complications and decrease mortality and morbidity in those patients.

Effectiveness of Two Topical Anaesthetic Agents used along with Audio Visual Aids in Paediatric Dental Patients

Nidhi Agarwal, Jayata Dhawan , Dipanshu Kumar, Ashish Anand, Karan Tangri

Introduction: Topical anaesthetic agents enable pain free intraoral procedures, symptomatic pain relief for toothache, superficial mucosal lesions and pain related to post extraction time. Most common anxiety provoking and fearful experience for children in dental operatory is administration of local anaesthesia because on seeing the needle, children usually become uncooperative. One of recent trend of behaviour management technique is using non-aversive techniques out of which audiovisual distraction has emerged as a very successful technique for managing children in dental settings. Audio visual distraction could decrease the procedure related anxiety of patients undergoing dental treatment and can be very relaxing for highly anxious patients. Aim: The aim of the present study was to compare the efficacy of topical anaesthetics EMLA (Eutectic Mixture of Local Anaesthetics) cream and benzocaine (20%) gel in reducing the pain during the needle insertion with and without the use of Audio Visual (AV) aids. Materials and Methods: The study was conducted on 120 children, the age range of 3-14 years attending the outpatient department for their treatment. EMLA and benzocaine gel (20%) were assessed for their effectiveness in reducing the pain on needle insertion during local anaesthesia administration. Based on the inclusion and the exclusion criteria, children requiring local anaesthesia for the dental treatment were randomly divided into four equal groups of 30 children based upon whether AV aids were used or not. AV aids were given using Sony Vaio laptop with earphones with nursery rhymes and cartoon movies DVD. The pain assessment was done by using the Visual Analogue Scale (VAS) scale and measurement of the physiological responses of pulse rate and oxygen saturation were done by pulse oximeter. Results: There was a statistically significant difference in the mean pain score, pulse rate and mean oxygen saturation rate when it was compared between the four groups. EMLA with AV aids was found to be a better topical anaesthestic agent as compared to other three groups. Conclusion: EMLA with AV aids was better when compared with EMLA without AV aids followed by benzocaine with AV aids. Benzocaine topical anaesthetic agent without AV aids was least effective in reducing the pain scores and improving the oxygen saturation rate.

Clinicopathological Features of Triple Negative Breast Carcinoma

Gowry Maram Reddy, Pooja K. Suresh, Radha R. Pai

Introduction: Breast carcinoma is one of the most common malignancies affecting women in developing countries. Molecular studies of breast carcinoma have classified the tumour based on the immunohistochemical staining into 4 subtypes, such as Luminal A, Luminal B, HER2/neu Positive and Triple Negative Breast Carcinoma (TNBC). TNBCs are reported to have an aggressive behaviour and wide metastasis, leading to selective treatment outcomes. Aim: The aim was to study the clinicopathological features such as age, site, tumour size, histopathological type, histologic grade, lymph node status, stage and treatment outcomes of triple negative breast carcinoma. Materials and Methods: A retrospective study was conducted on 108 cases of breast carcinoma received during the period of 2 years. The tumour was classified based on immunohistochemical staining into four subtypes. The clinicopathological details, histomorphological and immunohistochemical features of TNBC were studied. Results: Of the 108 patients, 34 patients were diagnosed as TNBC. The average age at presentation was 48 years. Most of the cases showed Nottingham Modification of Scarff Bloom- Richardson (NMBR) grade 3 (55.9%) and stage II (67.6%). Lymph node metastasis was seen in 50% of cases. Infiltrating ductal carcinoma (not otherwise specified) type (91.2%) was the most common histological type. Among the other subtypes, Luminal A carcinoma was the most common (36.1%), followed by TNBC (31.5%) and HER2/neu positive carcinomas (28.7%). Compared to the other types of tumours, TNBC showed the most frequent distant lymph node metastasis (50%) when compared to luminal A (38.5%), luminal B (25%), HER2/neu positive (48.4%). Unlike the other types of tumours, TNBC were mostly high-grade. Conclusion: TNBC have an aggressive behaviour compared to other subtypes with higher NMBR grade, nuclear pleomorphism, high mitotic rate and lymph node metastasis.

Effect of Instrumentation Length and Instrumentation Systems: Hand Versus Rotary Files on Apical Crack Formation – An In vitro Study

Madhuri. R. Devale, Mahesh MC, Shreetha Bhandary

Introduction: Stresses generated during root canal instrumentation have been reported to cause apical cracks. The smaller, less pronounced defects like cracks can later propagate into vertical root fracture, when the tooth is subjected to repeated stresses from endodontic or restorative procedures. Aim: This study evaluated occurrence of apical cracks with stainless steel hand files, rotary NiTi RaCe and K3 files at two different instrumentation lengths. Materials and Methods: In the present in vitro study, 60 mandibular premolars were mounted in resin blocks with simulated periodontal ligament. Apical 3 mm of the root surfaces were exposed and stained using India ink. Preoperative images of root apices were obtained at 100x using stereomicroscope. The teeth were divided into six groups of 10 each. First two groups were instrumented with stainless steel files, next two groups with rotary NiTi RaCe files and the last two groups with rotary NiTi K3 files. The instrumentation was carried out till the apical foramen (Working Length-WL) and 1 mm short of the apical foramen (WL-1) with each file system. After root canal instrumentation, postoperative images of root apices were obtained. Preoperative and postoperative images were compared and the occurrence of cracks was recorded. Descriptive statistical analysis and Chi-square tests were used to analyze the results. Results: Apical root cracks were seen in 30%, 35% and 20% of teeth instrumented with K-files, RaCe files and K3 files respectively. There was no statistical significance among three instrumentation systems in the formation of apical cracks (p=0.563). Apical cracks were seen in 40% and 20% of teeth instrumented with K-files; 60% and 10% of teeth with RaCe files and 40% and 0% of teeth with K3 files at WL and WL-1 respectively. For groups instrumented with hand files there was no statistical significance in number of cracks at WL and WL-1 (p=0.628). But for teeth instrumented with RaCe files and K3 files significantly more number of cracks were seen at WL than WL-1 (p=0.057 for RaCe files and p=0.087 for K3 files). Conclusion: There was no statistical significance between stainless steel hand files and rotary files in terms of crack formation. Instrumentation length had a significant effect on the formation of cracks when rotary files were used. Using rotary instruments 1 mm short of apical foramen caused lesser crack formation. But, there was no statistically significant difference in number of cracks formed with hand files at two instrumentation levels.

Antimicrobial Effects of Garcinia Mangostana on Cariogenic Microorganisms

Introduction: Garcinia mangostana commonly called as Mangosteen fruit has been used as an antibacterial agent since age old times. The mangosteen pericarp has proven to have antibacterial effect, but the effect of the same on cariogenic organisms has not been explored. The present study was an attempt to gain a better understanding of the antibacterial effect of mangosteen pericarp on the cariogenic bacteria, to unravel the therapeutic potential for the same. Aim: The aim of the study was to assess the antibacterial efficacy of the crude chloroform extract of mangosteen pericarp against cariogenic bacteria. Materials and Methods: The study was done under laboratory settings using an in vitro design. The microorganisms namely Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus oralis and Lactobacillus acidophilus were procured from American Type Cell Culture (ATCC) and Microbial Type Culture Collection (MTCC) were revived and lawn cultured. The antibacterial effect of mangosteen pericarp was tested using agar well diffusion method on Trypticase Soy Agar-Blood Agar (TSA-BA) and de Man, Rogosa and Sharpe (MRS) agar media. The standard antiplaque agent chlorhexidine was used as the positive control. This cross-sectional, experimental study was done in Central Research laboratory, Meenakshi Ammal Dental College for period of eight weeks. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values were determined by microbroth dilution method. Statistical analysis was done by calculating the mean of the zones of inhibition on tested microorganisms. Mann-Whitney test was done to compare the zones of inhibition of mangosteen and chlorhexidine. Results: The antibacterial bioassay showed the highest activity for Lactobacillus acidophilus (13.6 mm) and Streptococcus sanguis (13.6 mm), whereas, it showed a medium and low activity for Streptococcus oralis (11.3 mm), Streptococcus mutans (10.6 mm) and Streptococcus salivarius (3 mm) respectively. The MBC and MIC values were lowest for Lactobacillus acidophilus (MIC 25 mg/ml, MBC 50 mg/ml) and Streptococcus oralis (MIC 50 mg/ml, MBC 100 mg/ml). Conclusion: Mangosteen pericarp extract had a higher zone of inhibition against the tested microorganisms which suggests its potent antibacterial action against cariogenic organisms. However, further analytical studies are needed to isolate the key molecules of mangosteen pericarp, to explore its anticariogenic therapeutic potential on gram negative oral microorganisms.

Can Salivary Acetylcholinesterase be a Diagnostic Biomarker for Alzheimer?

Introduction: The loss of brain cholinergic activity is a key phenomenon in the biochemistry of Alzheimer's Disease (AD). Due to the specific biosynthesis of Acetylcholinesterase (AChE) of cholinergic neurons, the enzyme has been proposed as a potential biochemical marker of cholinergic activity. AChE is expressed not only in the Central Nervous System (CNS), Peripheral Nervous System (PNS) and muscles, but also on the surface of blood cells and saliva. Aim: This study aimed to measure salivary AChE activity in AD and to determine the feasibility of creating a simple laboratory test for diagnosing such patients. Materials and Methods: In this cross-sectional study, the recorded data were obtained from 15 Alzheimer’s patients on memantine therapy and 15 healthy subjects. Unstimulated whole saliva samples were collected from the participants and salivary levels of AChE activity were determined by using the Ellman colorimetric method. The Mann Whitney U test was used to compare the average (median) of AChE activity between AD and controls. In order to adjust for possible confounding factors, partial correlation coefficient and multivariate linear regressions were used. Results: Although the average of AChE activity in the saliva of people with AD was lower compared to the control group, we found no statistically significant differences using Mann Whitney U test (138 in control group vs. 175 in Alzheimer's patients, p value=0.25). Additionally, no significant differences were observed in the activity of this enzyme in both sexes or with increased age or duration of the disease. After adjusting for age and gender, there was no association between AChE activity and AD (regression coefficient ß=0.08; p value= 0.67). Conclusion: Saliva AChE activity was not significantly associated with AD. This study might help in introduce a new diagnostic aid for AD or monitor patients with AD.

Spectrophotometric Evaluation of Colour Stability of Nano Hybrid Composite Resin in Commonly Used Food Colourants in Asian Countries

Jyothi Chittem, Girija S Sajjan, Madhu Varma Kanumuri

Introduction: There is growing interest in colour stability of aesthetic restorations. So far few studies have been reported. Aim: This study was designed to investigate the effects of different common food colourants i.e., Turmeric and Carmoisine (orange red dye) consumed by patients in Asian countries on a recent nano hybrid composite resin. Materials and Methods: A total of sixty disk shaped specimens measuring 10 mm in diameter and 2 mm in thickness were prepared. The samples were divided into two groups {Z 100 (Dental restorative composite) Filtek Z 250 XT (Nano hybrid universal restorative)}. Baseline colour measurement of all specimens were made using reflectance spectrophotometer with CIE L*a*b* system. Specimens were immersed in artificial saliva and different experimental solutions containing food colourants (carmoisine solution and turmeric solution) for three hours per day at 37ºC. Colour measurements were made after 15 days. Colour difference (?E*) was calculated. Mean values were compared by one-way analysis of variance (ANOVA). Multiple range test by Tukey Post-hoc test procedure was employed to identify the significant groups at 5% level. Results: Z 100 showed minimum staining capacity when compared to Z 250 XT in both the colourant solutions. Conclusion: The nanohybrid composite resin containing TEGDMA showed significant colour change when compared to that of microhybrid composite resin as a result of staining in turmeric and carmoisine solution.

Evaluation of Cyclosporine A with ß–TCP in the Treatment of Human Infra bony Defects – A Randomized Controlled Pilot Study

Introduction: Cyclosporine A (CsA), an immunosuppressant, is considered a life saver drug in organ transplant cases. It has also been tested in animal and human studies for periodontal applications as it selectively inhibits T lymphocyte proliferation, Interleukin-2 (IL-2) and other cytokine production, without any effect on T suppressor cells, thereby suppressing the cell mediated immunity and suppressing the inflammation. Inflammatory and immunological responses have been found to be decreased and bone formation is found to be increased in immunosuppressed animals. CsA is also supposed to potentiate osseous regeneration due to increase in the bone alkaline phosphatase levels and a direct activating effect on osteoblasts. Aim: The present study was aimed at evaluating locally administered low dose of CsA which is potent immunosuppressant along with ß-Tricalcium phosphate (ß-TCP) in comparison with ß TCP alone, in the treatment of human infrabony defects, over a period of six months. Materials and Methods: Thirty two systemically healthy chronic periodontitis patients with infrabony defects were included in the randomized, controlled, parallel arm study and were allocated into either Group A (n =16), patients treated with ß-TCP + CsA (2 mg) or Group B (n =16), patients treated with ß-TCP. Clinical parameters [Relative Attachment Level (RAL), Probing Depth (PD), Gingival Recession (GR)] and radiographic parameters were measured at baseline and six months postoperatively. Statistical analysis was done using SPSS version 16 software. Student’s paired and independent t-test were used for intra and inter-group analysis. Results: Both Group A and Group B showed statistically significant improvements in clinical and radiographic parameters from base line to six months post-operatively. The Clinical Attachment Level (CAL) gain, Linear Bone Growth (LBG) and Percentage Bone Fill (% BF) were 2.38±1.12 mm, 1.90±1.48 mm and 49.83±29.23 mm in Group A and 2.57±1.22 mm, 2.03±1.16 mm and 62.84±29.70 mm in Group B respectively, inter group comparison showed no statistically significant difference. Conclusion: Both the groups revealed statistically significant improvement in clinical and radiographic parameters and adjunctive use of CsA did not prove beneficial.

Comparative Study on Antenatal and Perinatal Outcome of Vivax and Falciparum Malaria in a Tertiary Care Hospital of Kolkata, India

Introduction: Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. In India, the problem is compounded by dual parasitological aetiology of Plasmodium vivax (P. vivax) and Plasmodium falciparum (P. falciparum). Aim: To compare the outcome of infections by P. vivax and P. falciparum species among pregnant women in a hospital setting. Materials and Methods: Pregnant women who tested positive for malaria either by microscopy of peripheral blood smear or ELISA test for double antigen were enrolled in the study. They were followed up till their delivery and discharge from hospital. Demographic, clinical and laboratory data was collected at enrolment, on event of complication and at delivery. Data was analyzed for univariate and multivariate associations. Results: There were 64 pregnant women diagnosed with malaria. A total of 76.6% study subjects had vivax infection rest was infected with p. falciparum. Anaemia (84%) was the commonest complication. A total of 60.9% women had pathological placenta. Preterm delivery, low birth weight and Apgar score <7 were the adverse pregnancy outcomes which were more frequent with falciparum infection. There were three perinatal deaths. Multigravidas were at significantly higher risk for low birth weight and low Apgar score of newborn. Infection in later trimester was associated with low Apgar score. Conclusion: Both types of malaria cause considerable morbidity in pregnant women. More cases occurred among primigravida but multigravida and later trimester of pregnancy had more severe disease.

Prevalence of Hypertension and its Risk Factors Among School Going Adolescents of Patna, India

Introduction: Hypertension (HT) has its origin in childhood and adolescent period but it goes undetected due to absence of sign and symptoms, unless specifically looked for during this period. It has been seen that one with raised blood pressure level in this period will also have raised Blood Pressure (BP) level in their adulthood and elderly period. Aim: The present study was conducted to estimate the prevalence of HT and its risk factor among apparently healthy school going adolescents of Patna district. Materials and Methods: A cross-sectional study among 2913 school going adolescents of eighth to 10th standard was conducted from April 2014 to August 2015 by adopting a two stage cluster sampling technique. The questions pertaining to risk behavior in relation to cardiovascular diseases from WHO’s Global School based Student Health Survey were used for this study. Results: The mean systolic and diastolic blood pressure of study population was 107.4 mm of Hg (95% C.I. 106.93-107.77) and 67.4 mm of Hg (95% C.I. 67.26-67.54), respectively. Prevalence of pre-HT and HT was 10.9% and 4.6% in school going adolescents while prevalence of overweight/obesity was 1.5%. Both systolic and diastolic blood pressures had positive and significant correlation with age, height and body mass index. The proportion of children who had ever taken tobacco was 5.3%, cigarette smoking 4.3%, alcohol consumption 2.1%, and excess salt intake 22.3%. Only 49.1% children were doing physical activity at least one hour a day in past seven days for maintenance of good health. Conclusion: The present study recommends that regular screening of blood pressure level must be initiated in adolescents so that remedial measure can be initiated as early as possible.

Comparison of Cord Blood Lipid Profile in Preterm Small for Gestational Age and Appropriate for Gestational Age Newborns

Tejasree katragadda, Rajesh Shimoga Mahabala, Subodh Shetty, Shantharam Baliga

Introduction: Coronary heart disease is one of the major causes of morbidity and mortality in current era. The roots of this epidemic have been traced to as early as foetal life by foetal origin hypothesis. There are a few studies which have compared the cord blood lipid profile of preterm and term babies and thereby leading a path to primordial prevention of chronic diseases. Aim: To study cord blood lipid profile of preterm appropriate for gestational age and preterm small for gestational age neonates and compare atherogenic index of both groups. Materials and Methods: This cross-sectional study was conducted in 109 preterm infants. Cord blood samples were collected from placental side of umbilical cord at birth and analyzed for lipid profile which includes serum cholesterol, triglycerides, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and apolipoproteins which include ApoA1, Apo B. Results: Preterm Small for Gestational Age (SGA) neonates had statistically significant higher values of triglycerides, Apo B and atherogenic index compared to preterm Appropriate for Gestational Age (AGA) neonates. Other measured lipid levels were not statistically significant, though the values were higher than reference ranges for term babies. Conclusion: Prematurity as a factor associated with a more atherogenic lipid profile is re-affirmed and SGA as an additional risk factor has been proven giving scope for future research and primordial prevention.

Use of Frontal Sinus and Nasal Septum Pattern as an Aid in Personal Identification and Determination of Gender: A Radiographic Study

Kavita Verma, Prashant Nahar, Mohit Pal Singh, Hemant Mathur, S. Bhuvaneshwari

Introduction: Personal identification and gender determination of unknown person has a vital importance in forensic investigation. Human skull radiography is a useful tool in human identification in natural disaster, in any accidents such as fire accident and road traffic accident where body remains become degraded or severely destroyed. Aim: Present study was performed to evaluate the measurement of frontal sinus, uniqueness of various pattern of nasal septum when combined with frontal sinus observed on posterio anterior cephalogram for sex determination as well as personal identification. Materials and Methods: A total of 80 individuals, 40 males and 40 females, between the age ranges of 18-30 years were selected. The selected individuals had their Posterio Anterior (PA) cephalogram performed after taking their informed consent. Right and left areas and the maximum height and width of the frontal sinus were determined and septum patterns were evaluated and both patterns were also combined and compared. The radiographs were taken on Xtropan 2000 OPG X-ray machine with cephalography attachment and KODAK CR 7400 digital radiography system. Mean and SD values of the greatest height and width of frontal sinus in male and female patients were thus evaluated. The mean values of the frontal sinus were greater in males and the left area was larger than the right area, based on student’s t-test at the 5% level of significance. Results: The combination of Frontal Sinus Patterns and Nasal Septum Patterns (FP+NSP) were assessed and found that there were nine classifiable patterns in 26 (32.5%) individuals (12 males and 14 females), each of which had common representations in more than one individual. Besides these patterns, there were unique unclassifiable patterns in 54 (67.5%) individuals. Conclusion: The present study supports the use of radiographic evaluation of frontal sinus dimensions, frontal sinus patterns, nasal septum deviations and the combination FP+NSP patterns for personal identification and gender determination in forensic investigations.

Effect of Calcium Hydroxide Based Intracanal Medicaments on the Apical Sealing Ability of Resin Based Sealer and Guttapercha Obturated Root Canals

Rithima R Sokhi, MV Sumanthini, Vanitha U Shenoy, Mohit A Bodhwani

Introduction: Calcium Hydroxide (CH) is one of the most commonly used intracanal medicaments which can be used with various vehicles. Aim: The aim of this in vitro study was to evaluate the effect of three CH based intracanal medicaments on the apical sealing ability of AH Plus – guttapercha obturation. Materials and Methods: Crowns of 100 extracted single rooted human teeth were sectioned at the Cemento-Enamel Junction (CEJ) to a standardized length. The root canals were instrumented upto ISO size 40 using step back technique and the specimens were randomly divided into two control and four experimental groups. The control groups were not medicated. Specimens in positive control group (Group I) were obturated with guttapercha without placing sealer and in negative control group (Group II) were obturated with guttapercha and AH Plus sealer. Among the experimental groups, specimens of Group III were not medicated while groups IV, V and VI were medicated with CH-saline, CH-2% Chlorhexidine (CHX) and Vitapex respectively for a period of 14 days. The medicaments were removed from the specimens and the teeth were obturated with AH Plus sealer and guttapercha using lateral compaction technique. The specimens were immersed in India ink dye, demineralized and diphanized. The extent of dye penetration was assessed using a 10X stereomicroscope. Data obtained was statistically analyzed by one-way ANOVA (p<0.05) followed by Post-hoc Tukey test. Results: Amongst the three CH medicaments, CH-2% CHX when used as an intracanal medicament showed a significantly higher microleakage as compared to the other groups with p<0.001. The microleakage values between the remaining groups were not statistically significant. Conclusion: Under the conditions of this study it was concluded that all groups with or without intracanal medicament showed apical leakage. The vehicle used to carry CH may significantly influence the apical sealing ability of guttapercha – AH Plus obturated canals.

Organochlorine Pesticide-Mediated Induction of NADPH Oxidase and Nitric-Oxide Synthase in Endothelial Cell

Introduction: Organochlorine Pesticides (OCPs) are detected ubiquitously in human and have been shown to be associated with Cardiovascular Disease (CVD) and atherosclerosis. Aim: To find out the effect of organochlorine pesticides in endothelial cell with regard to oxidative stress and associated expression of enzymes producing superoxide and Nitric Oxide (NO). Materials and Methods: Human Umbilical Vein Endothelial Cells (HUVEC) were cultured and treated with four OCPs which were found in human blood at a concentration of 0.1µM. The cells were tested for Reactive Oxygen Species (ROS) generation, NO production and mRNA expression of NAPDH oxidase (p47phox) and endothelial Nitric Oxide Synthase (eNOS). ROS generation was measured by using 2’, 7’-dichlorodihydrofluorescein diacetate (H2DCFDA) method. NO was analysed by Bioxytech nitric oxide assay kit method and mRNA of NADPH oxidase and eNOS was quantified by real time PCR. Data were expressed as the mean±SEM. Comparison between the groups were made by student’s t-test (2-tailed) or one-way ANOVA with Tukey’s posthoc analysis depending on number of groups. For all statistical tests, p< 0.05 was considered to be significant. Results: All the four pesticides generated ROS accompanied by enhanced expression of NADPH oxidase. Maximum effect was observed with ß-endosulfan. Level of NO was found to be decreased significantly in endothelial cells treated with these pesticides accompanied by enhanced expression of eNOS. The antioxidant N-acetylcysteine (NAC) reduced ROS generation and enhanced NO formation. Pesticide-mediated ROS generation possibly reacts with NO forming peroxinitrite and thereby reducing the bioavailability of NO although eNOS expression is increased. Conclusion: OCPs induce endothelial dysfunction through increased ROS generation via NADPH oxidase expression and reduced bioavailability of nitric oxide.

Emergence of Carbapenem Resistant Non-Fermenting Gram-Negative Bacilli Isolated in an Icu of a Tertiary Care Hospital

Sonika Agarwal, Barnali Kakati, Sushant Khanduri, Shalini Gupta

Introduction: The emergence and spread of Multi-Drug Resistant (MDR) Non-Fermenting Gram-Negative Bacilli (NFGNB) in Intensive Care Units (ICU) and their genetic potential to transmit diverse antibiotic resistance regardless of their ability to ferment glucose poses a major threat in hospitals. The complex interplay of clonal spread, persistence, transmission of resistance elements and cell-cell interaction leads to the difficulty in controlling infections caused by these multi drug-resistant strains. Among non-fermenting Gram-negative rods, the most clinically significant species Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia are increasingly acquiring resistant to carbapenems. Carbapenems once considered as a backbone of treatment of life threatening infections appears to be broken as the resistance to carbapenems is on rise. Aim: To document the prevalence of carbapenem resistance in non-fermenting Gram-negative bacilli isolated from patients with respiratory tract infections in the ICU of Himalayan Institute of Medical Sciences, Dehradun. Materials and Methods: This is a cross-sectional study conducted in ICU patients between October 2015 to March 2016. A total of 366 lower respiratory tract samples were collected from 356 patients with clinical evidence of lower respiratory tract infections in form of Endotracheal (ET) aspirate, Tracheal Tube (TT) aspirate and Bronchoalveolar Lavage (BAL) specimen. Organism identification and the susceptibility testing was done by using an automated system VITEK 2. Results: Out of 366 samples received 99 NFGNB were isolated and most common sample was ET aspirate sample 256 (64.5%). Acinetobacter baumannii was the most common NFGNB isolated 63 (63.63%) followed by Pseudomonas aeruginosa 25 (25.25%), Elizabethkingia meningoseptica seven (7.07%) and Strenotrophomonas maltophilia four (4.04%). We observed that 90.5% Acinetobacter baumannii were resistant to imipenem and 95.2% resistant to meropenem, Pseudomonas aeruginosa came out to be 52% resistant to imipenem and 56% resistant to meropenem while Stenotrophomonas maltophilia and Elizabethkingia meningoseptica were 100% resistant to carbapenems as they are intrinsically resistant to carbapenems. Conclusion: The resistance rate of carbapenems for NFGNB infections is very high in our study and variable in different regions. Overall carbapenem resistance is on rise. So, the infection control team and microbiologist needs to work together to determine the risk carried by multi drug resistant non-fermenting gram-negative infections and the resistance surveillance programs are mandatory to control these bacteria in ICU settings.

Stenotrophomonas maltophilia: An Emerging Pathogen in Paediatric Population

Charu Nayyar, Preeti Thakur, Vibhor Tak, Karnika Saigal

Introduction: Stenotrophomonas maltophilia (formerly Pseudomonas maltophilia/Xanthomonas maltophilia), a Gram- negative, non-fermenting bacillus, is being increasingly recognized as a threatening nosocomial pathogen, associated with significant mortality. Aim: To determine the prevalence of infection, antimicrobial susceptibility pattern and clinical outcome of S. maltophilia in a paediatric population. Materials and Methods: This was a retrospective study conducted over a period of eight months, i.e., October 2015 to May 2016. All clinical samples received in the microbiology laboratory during the study period were processed using standard microbiological procedures. S. maltophilia isolates were selected. Antibiotic susceptibility was performed for levofloxacin and trimethoprim-sulphamethoxazole by Vitek 2C system (Biomerieux, France). Average length of stay and mortality caused by S. maltophilia infection was compared with age and sex matched controls without S. maltophilia infection. Results: A total of 16,234 clinical specimens were received in the microbiology laboratory in the study period, with 2,734 pathogenic bacteria isolated. A total of 1,339 (1.7% of total isolates) Gram-negative bacteria were isolated, out of which 414 were non-fermenters. Among the non-fermenters, 23 (5.5%) were S. maltophilia. Out of the 23 isolates, 15 (65.2%) were isolated from blood, 4 (17.3%) were isolated from urine and tracheal aspirate each. A total of 91.3% of strains were susceptible and 8.6% were resistant to trimethoprimsulphamethoxazole. Total 80% of strains were sensitive and 20% had intermediate susceptibility for levofloxacin. None of the strains were resistant to levofloxacin. Average length of stay of patients with S. maltophilia infection was found out to be 23.3 days as compared to 44.8 days in controls. The average mortality of patients with S. maltophilia infection was found to be same as that of controls (35.2%). Conclusion: S. maltophilia is becoming an important nosocomial pathogen and its isolation rate is reported to be increasing. Trimethoprim-sulphamethoxazole still remains the drug of choice but resistance has been reported for this drug as well. As its isolation is increasing, it is important to study the epidemiology, antimicrobial susceptibility profile and clinical outcomes of these isolates.

The Role of Serum Fibrinogen Level in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is the most common indication for emergent surgery and affects a wide range of patients at any age group. However, inspite of the presence of various imaging modalities, biochemical markers, and scoring systems the negative appendectomy rate remain high. Serum fibrinogen, an acute inflammatory mediator is usually raised in any acute inflammatory condition and the same is expected to rise in acute appendicitis, which may be used as a new inflammatory marker in the diagnosis and more importantly in decision making of management of acute appendicitis. Aim: To determine the relationship between the rise in the level of serum fibrinogen and acute appendicitis and its role in reducing the negative appendectomy rate. Materials and Methods: A total of 82 patients with clinical signs and symptoms of acute appendicitis who underwent emergency appendectomy were included in the study, the serum fibrinogen level were measured just before the operation and the sensitivity and the specificity was calculated. The final diagnosis was based on the histopathological examination. Results: In our study, the Mean±SD of serum fibrinogen in mg/dl in those patient proved to be having acute appendicitis by histopathology was 436.6±40.6 while those with normal appendix was 391.91±66.54. The area under the curve was 0.697 i.e., it has an accuracy of around 70% and this is statistically significant (p=0.018). On further sub-analysis when the cut off level of fibrinogen level was reduced to 397, it resulted in a sensitivity of 82% and specificity of 60% and if the level was further reduced to 375 it increased the sensitivity to 88% with a specificity of 55%. Conclusion: In the diagnosis of acute appendicitis, use of fibrinogen blood level may be a new diagnostic acute-phase reactant with possible role in reducing negative appendectomy rate.

Visual Outcome of Phacoemulsification versus Small Incision Cataract Surgery in Pseudoexfoliation Syndrome – A Pilot Study

Anmol Ulhas Naik Shveta Bhimashankar Gadewar

Introduction: Available data has highlighted the efficacy of both Phacoemulsification (PHACO) and Small Incision Cataract Surgery (SICS) in the presence of Pseudoexfoliation (PEX) syndrome. In developing countries, both are commonly performed procedures for cataract extraction. But, no direct comparison between these two procedures is available in the setting of PEX syndrome. With this lacuna in mind, this pilot study decided to compare the visual outcomes of both these techniques in the setting of PEX syndrome. Aim: To compare and analyze the efficacy and safety of PHACO versus SICS in patients of PEX syndrome who underwent cataract surgery. Materials and Methods:A prospective, conveniently sampled, observational, pilot study was conducted over six months in ophthalmology department of a tertiary eye institute in India. A total of 200 eyes of 100 patients conforming to pre-defined criteria were conveniently sampled and allotted to two groups of 50 patients each. First group underwent PHACO and second underwent SICS. The demographic profile, pre-operative, intraoperative and post-operative details and complications as well as visual acuity were recorded. Data obtained was analyzed using chi-square test. Statistical significance was set at 95% Confidence Intervals (CI), i.e., at a p-value of <0.05. Results: Of 76 males and 24 females, the mean age was 67.95 years. No statistically significant differences were observed between PHACO and SICS groups with regards to intraoperative complications {overall n=13 in PHACO versus n=21 in SICS, p=0.13}. Controlled sphincterotomy was required in a significantly higher number of SICS cases (p=0.03). No statistically significant differences were observed in terms of post-operative complications (overall n=5 in PHACO versus n=10 in SICS, p=0.26). Conclusion: With careful pre-operative assessment, due intraoperative modifications and surgical expertise, both PHACO and SICS are apparently safe procedures in PEX syndrome.

Morphometric Evaluation of Adult Acromion Process in North Indian Population

Susmita Saha, Neelam Vasudeva

Introduction: Dimensions of acromion process are important to show linkage to the shoulder girdle pathologies. Also morphometric analysis of acromion process would be helpful for surgeons while performing surgical procedures on the shoulder joint. Aim: The purpose of this present study was to observe the detailed morphometric evaluation of adult acromion processes in North Indian population because different morphometric dimensions play an important role in various disorders of the shoulder, particularly sub acromial impingement syndrome. Materials and Methods: Two hundred adult dry scapulae from the osteology museum of MAMC, New Delhi, were obtained for evaluation of various measurement of acromion process. The length, width, thickness of acromion, coraco-acromial (C-A) distance and acromio-glenoid (Ac-g) distance were measured. The measurements were compared with other osteological studies performed on different population group. Data was analysed using SPSS version 12.0 and mean values with standard deviation for each dimension were presented. Results: The mean values of each measurement were: length: 41.007 mm; width: 21.82 mm; thickness: 6.58 mm; C-A distance: 28.34 mm and Ac-g distance: 26.21 mm. Conclusion: It is expected that various dimensions of adult acromion process will serve as a reference base and will assist the surgeon in the approach to be used and precision of the operative technique. So, the study will provide a vital support for planning and executing acromioplasty in the treatment of impingement syndrome.

Evaluation of Efficacy of Intraligamentary Injection Technique for Extraction of Mandibular Teeth-A Prospective Study

Raunak Pradhan, Deepak Kulkarni, Lakshmi Shetty

Introduction: Fear of dental pain is one of the most common reasons for delaying dental treatment. Local Anaesthesia (LA) is the most commonly employed technique of achieving pain control in dentistry. Pterygomandibular Nerve Block (PNB), for achieving mandibular anaesthesia has been the traditional technique used and is associated with a few set of complications which include pain, nerve injury, trismus, and rarely facial nerve palsy, and sustained soft tissue anaesthesia. These complications have resulted in a rapid need for research on alternative local anaesthetic techniques. Aim: This study was undertaken with the objective to determine pain, duration, profoundness and complications associated with administration of Intraligamentary Injection Technique (ILT). Materials and Methods: This study was conducted on 194 patients (male=122, female=72) who reported for dental extractions in mandibular posteriors. The ILT was administered with ligajet intraligamentary jet injector using cartridge containing lignocaine hydrochloride 2% with adrenaline 1:80000 and a 30 gauge needle at buccal (mesiobuccal), lingual, mesial and distal aspect of the mandibular molars. The data was analyzed by using statistical computer software SPSS 11.0 (Statistical package for social sciences 11.O version of SPSS Inc.). Median was derived for Pain on Injection (PI) and Pain during Procedure (PP). Mean and standard deviation was derived for Duration of Anaesthesia (DA). Results: Various advantages were seen such as, localized soft tissue anaesthesia, decreased PI (SD=0.83), and minimal PP (SD=0.94). The DA (SD=4.62) and mean value of 24.06 minutes. Conclusion: This study is one of its kinds where intraligamentary injection has been used for extraction of mandibular molars. It was also successfully used in patients with exaggerated gag reflex and patients suffering from trismus due to oral submucous fibrosis. The intraligamentary injection technique can thus be used effectively to anaesthetize mandibular molars, as a primary technique for extraction of mandibular posterior teeth.

“Rhetoric to Reality”– Efficacy of Punica Granatum Peel Extract on Oral Candidiasis: An In vitro Study

Introduction: Global usage of synthetic drugs inadvertently has resulted in deleterious effects and antimicrobial resistance. Phytoextarcts with therapeutic properties appear to be appropriate substitutes for synthetic drugs. Punica granatum (Pomegranate) is a fruit rich in nutraceuticals and therapeutic properties that has lead to its widespread use as folk-medicine for treating innumerable diseases. Aim: To determine the in vitro antifungal efficacy of Punica granatum peel extract against the oral Candida compared with clotrimazole. Materials and Methods: An in vitro study was carried out on 60 saliva samples collected from patients confirmed by clinical and mycological examination as oral candidiasis and subjected to culture on Saborauds Dextrose Agar (SDA) medium and incubated at 37°C for 48 hours. The cultured Candida species were subjected to antifungal susceptibility test by agar well diffusion method. Punica granatum peel extract (Group-I), Ethanol (Group-II Negative control), Clotrimazole (Group-IIIPositive control) were inoculated in wells and incubated. Zones of inhibitions were measured with a digital Verniers callipers and subjected to statistical analysis. ANOVA (analysis of variance) was performed to compare inhibition zones and concentrations of all the three groups. Results: Antifungal efficacy of Punica granatum group and Clotrimazole group were statistically significant with p-value <0.05. Additionally, with the increase in the concentration there was an increase in the inhibitory efficacy against Candida species. Minimum Inhibitory Concentration (MIC) of peel extract of Punica granatum approximated with that of the clotrimazole. Conclusion: The present research was just a venture to usual clinical approach. The results of the study reveal that MIC of peel extract of Punica granatum approximated with that of the clotrimazole. Hence, peel extract of Punica granatum may be used as a substitute for antifungal agents in clinical trials with standardization so as to minimize the deleterious effects for patient compliance.

Comparison of Cone Beam Computed Tomography-Derived Alveolar Bone Density Between Subjects with and without Aggressive Periodontitis

Introduction: Understanding the changes in bone density of patients affected by aggressive periodontitis could be useful in early disease detection and proper treatment planning. Aim:The aim of this study was to compare alveolar bone density in patients affected with aggressive periodontitis and periodontally healthy individuals using Cone Beam Computed Tomography (CBCT). Materials and Methods:This cross-sectional study was conducted on 20 patients with a confirmed diagnosis of aggressive periodontitis. Twenty periodontally healthy patients attending the dental clinics for implant placement or extraction of impacted third molars served as controls. Alveolar bone density was measured using CBCT scanning. Comparisons between aggressive periodontitis group and controls for age and alveolar bone density of the anterior and posterior regions were performed using an independent sample t-test. Multivariable linear regression models were also performed. Results: The differences between groups in regard to age, anterior and posterior alveolar bone density was not statistically significant (p<0.05). In the posterior region, the multivariable regression model showed that bone density was not associated with age, gender or the study groups. Whereas, in the anterior region, patient’s age was found to be significantly associated with bone density, p=0.014. Conclusion: Alveolar bone density as measured by CBCT in aggressive periodontitis patients was not different from periodontally healthy individuals. Further studies are needed to confirm these findings.

Comparative Analysis of Salivary Alkaline Phosphatase in Post menopausal Women with and without Periodontitis

Introduction: Alkaline phosphatase is an intracellular destruction enzyme in the periodontium, and it takes part in the normal turnover of the periodontal ligament, alveolar bone, and root cementum formation and maintenance. Aim: The aim of this case control study was to evaluate the enzyme Alkaline Phosphatase (ALP) level in saliva of post menopausal women with and without chronic periodontitis. Materials and Methods: In this study, 40 individuals, satisfying the study inclusion and exclusion criteria, were recruited. They were categorically divided, on the basis of gingival index, probing pocket depth and clinical attachment level, into two groups: Group I (post menopausal women with a clinically healthy periodontium, n=20); and Group II (post menopausal women with generalized chronic periodontitis, n=20). Clinical parameters assessed were Plaque Index (PI), Gingival Index (GI), Clinical Attachment Level (CAL) and Probing Pocket Depth (PPD). Unstimulated salivary samples were obtained in which the ALP concentration was measured using p-Nitrophenylphosphate, and 2-amino-2-methyl-1-propanol reagents in Beckman and Coulter, AU 480 auto analyser. Mann-Whitney U test was used to find statistical difference with respect to all clinical parameters such as PI, GI, CAL, PPD and salivary ALP levels. Results: The mean ALP in saliva was found to be higher in Group II compared to Group I and the difference was statistically significant with the p-value of 0.008. Conclusion: A noteworthy increase in the ALP concentration was seen in saliva in our study (Group II) may be due to increased periodontal inflammation in post menopausal women. Thus salivary ALP can be taken as an additional biomarker to early diagnosis, development and progression of periodontitis especially among post menopausal women.

Acute Renal Failure in Dengue Infection

Girish Pamappa Vakrani, Nambakam Tanuja Subramanyam

Introduction: Acute Renal Failure (RF) is a rare but well recognized complication of Dengue Infection (DI). There has been paucity of published data regarding renal involvement in DI. Aim: The aim of the present study was to elucidate different clinical presentations, disease outcomes of DI. To study the frequency, severity and predictors of RF in DI. Materials and Methods: Patients diagnosed either as Dengue Fever (DF) or Dengue Haemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) respectively were enrolled for this study. The diagnostic criteria for DI were febrile illness associated with one of the following: 1) detection of dengue-specific IgM capture antibody or Non-Structural Protein1 (NS1) antigen; or 2) a four-fold or greater increase of dengue-specific IgG capture antibody by ELISA and haemoagglutination inhibition assay. Patients were diagnosed as having Acute RF, if serum creatinine was >1.2 mg/dl or who showed improvement by 50% in serum creatinine from the initial value. It is an observational study of medical charts, data of age, gender, and medical history of any underlying diseases in association with the severity of DI of each patient recorded. All of the laboratory results were collected. Parameters that influenced the clinical presentations and outcomes for development of classical DF or DHF/DSS in patients with or without RF were analysed and compared. Descriptive and inferential statistical analysis was carried. The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used. Results: Most common symptoms were fever followed by headache and pain in abdomen. Among the patients with RF, all patients had recovery. The patients with DHF/DSS were more susceptible to develop renal failure compared to DF group. There were statistically significant higher frequencies of renal failure, haemoconcentration, thrombocytopenia, low serum cholesterol. Patients in the RF group also had significantly higher percentages of shock, haemoconcentration, thrombocytopenia, raised AST and low serum cholesterol compared to non-RF group. There were no mortality and none of them had to receive renal replacement therapy during hospitalization. Conclusion: Patients with DHF/DSS were more susceptible to develop renal failure compared to DF group. Patients in the RF group had higher percentages of shock, haemoconcentration, thrombocytopenia, raised AST and low serum cholesterol.

Evaluation of the Role of ALDH1 as Cancer Stem Cell Marker in Colorectal Carcinoma: An Immunohistochemical Study

Introduction: Colorectal Carcinoma (CRC) is the third most commonly diagnosed cancer in males. Stem Cells (SC) may be involved in tumour growth, including colon cancer. Aldehyde Dehydrogenase 1 (ALDH1) is a detoxifying enzyme that might modulate SC proliferation. Aims: To evaluate the immunohistochemical expression of ALDH1 as stem cell marker in the pathogenesis of colorectal carcinoma. Materials and Methods: This retrospective study included 71 colorectal specimens (49 colorectal carcinoma, 13 adenoma and 9 normal cases) that were collected from Pathology Department, Faculty of Medicine, Menoufia University during the period from 2011 to 2015. All cases were stained by ALDH 1 antibody. Survival data were available for 31cases. Results: There was a statistical significant association between epithelial positivity of ALDH1 and younger age (p=0.003), right sided tumour (p=0.038), presence of lymph node invasion (p= 0.04), ulcerating gross picture (p=0.01) and presence of vascular invasion (p=0.05). Moreover, there was statistical significant association between stromal positivity of ALDH1 and smaller tumour size (p=0.03) and inverse association between stromal expression of ALDH1 and grade of tumour (p=0.000) and perineural invasion (p= 0.05). Furthermore, there was an inverse significant relation between CD44 and ALDH1 expression (p=0.001). Univariate recurrence free survival analysis revealed the bad prognostic impact of high grade (p=0.03) and female sex (p=0.02) on patient outcome. Conclusion: Epithelial expression of ALDH1 might be associated with poor prognosis while its stromal expression might be associated with good prognosis.

A Comparative Study on Weekly Versus Three Weekly Cisplatinum Based Chemoradiation in Locally Advanced Head and Neck Cancers

Tapan Kumar Sahoo, Dipti Rani Samanta, Surendra Nath Senapati, Karishma Parida

Introduction: Head and Neck Cancers constitute around 30% of cancers occurring in India and majority of cases present with locoregionally advanced disease. Cisplatin based concurrent chemoradiation is the most common modality of definitive treatment in these advanced cases. However, it is unclear regarding priority of weekly versus three weekly cisplatin based concurrent chemoradiation schedule in treatment of such advanced diseases. Aim: To evaluate the efficacy in terms of response, locoregional control, and disease status in both the arms, and to compare the acute and late toxicity in both arms. Materials and Methods: Thirty untreated patients of locally advanced Squamous Cell Carcinoma of head and neck were randomized into two arms: Arm A (n=15) patients received injection cisplatin 30 mg/m2 weekly along with radiation; Arm B (n=15) patients received injection cisplatin 100 mg/m2 on a three weekly basis along with radiation. Radiotherapy was delivered to a total dose of 66 Gy in conventional fractionation schedule in telecobalt machine. Results: Major toxicities included mucositis, dermatitis, vomiting, neutropenia, and anaemia. There was a trend towards increase in grade-III leukopenia and grade-III dermatitis in arm A compared to arm B, and increase in grade-III mucositis and grade-III vomiting in arm B in comparison to arm A although statistically not significant. Within a median follow-up of seven months, in arm A complete response was 73.33% (11/15) and partial response was 26.67%; whereas in arm B complete response was 85.71% (12/14) and partial response was 14.29%, which was not statistically significant. However, there was a trend towards better efficacy in arm B. Conclusion: We conclude that, weekly cisplatin arm is as good as three weekly cisplatin arms. But efficacy is not statistically significant. However, there was a trend of three weekly cisplatin arms towards better efficacy, with comparable haematological and mucosal toxicities.

Career Satisfaction among Dental Public Health Specialists in India – A Cross-sectional Survey

Chandrashekar Janakiram, Joe Joseph, Bobby Antony

Introduction: The satisfaction in career is an important indicator for the growth of the discipline and the profession. An empirical investigation of satisfaction in career and amendments needed in course and profession may help in growth of discipline. Aim: To assess career satisfaction among Dental Public Health (DPH) specialists working in India and analyze their perspective on changes required in the profession. Materials and Methods: Questionnaire for this cross-sectional survey was adapted from Minnesota Job Satisfaction Survey which included 40 enquiries to understand the reasons for choosing public health dentistry as career, competencies of public health dentists, satisfaction as a public health dentist and changes required in the profession. The questions were both open and closed end type. Updated electronic mail details of all registered public health dentists were collected from the head office of Indian Association of Public Health Dentistry. Each participant was contacted by electronic mail and consent to participate were sought. Reminders were e-mailed thrice during three months. A total of 580 participants were contacted. A total of 183 responses were received, among which 179 consented. Results: Nearly half of the respondents felt they are yet to achieve the accomplishment from the present career as public health dentist. Only 46.9% felt that there is advancement in the profession as career. Nearly three-fourth of respondents could not attain recognition as a public health dentist. A 45.8% of respondents were of the opinion that career in public health dentistry would provide them a steady employment and 53.1% of public health dentists would envision as satisfied in their career in next 10 years. Nearly 85% felt public health dentistry training needs a major course correction. Conclusion: There has been some reservation or skepticism about the future of the specialty as the jobs are in declining stage. This information provides insight about success and failures of public health dentistry as profession which would be needed for planning the dental manpower.

Analysis of Prevalence and Clinical Features of Ameloblastoma and its Histopathological Subtypes in Southeast Myanmar and Lower Northern Thailand Populations: A 13-Year Retrospective Study

Chaidan Intapa

Introduction: Prevalence of ameloblastomas has been established worldwide but collective data of ameloblastoma in Southeast Asian countries has not been well analyzed. Aim: Aim of this study was to report analysis and comparison of the prevalence and demographic data of clinical features of ameloblastoma and its histopathological variants in Southeast Myanmar and lower Northern Thailand populations. Materials and Methods: A retrospective study on ameloblastoma was performed based on the availability of oral biopsy specimens in Faculty of Dentistry, Naresuan University, Phitsanulok, Thailand, between January 2002 and August 2015. The collected data were subjected to descriptive statistical analyses with the SPSS version 17.0 statistical software package (SPSS Inc., Chicago, USA). Pearson’s chi square (?2) test and t-test were employed. The critical level of significance was set at p<0.05. Results: Total of 616 cases were reviewed, 30 cases (5%) were diagnosed as ameloblastoma with male:female ratio of 1.14:1. The mean age of the patients was 31.3±15.6 years. The predominance anatomical distribution was observed in the mandible (86.7%). Posterior body-ramus-angle region was the most common site. Almost all cases were asyptomatic and most common clinical manifestation was swelling of affected region. Multilocular radiolucency was observed in 70% of cases, whereas 30% were unilocular. Three subtypes of ameloblastomas were diagnosed: unicystic ameloblastoma (20%), conventional solid/multicystic ameloblastoma (70%), and desmoplastic ameloblastoma (10%). The most common histologic pattern was the plexiform type (57.2%) followed by follicular type (23.8%). Conclusion: Prevalence of ameloblastoma in Southeast Myanmar and lower Northern Thailand populations correspond with data from other geographic areas of Thailand and other Asian countries. However, some demographic and histopathological profiles are different, with plexiform ameloblastoma being the most common subtype in this study.

Picrosirius Red and Polarization Microscopy – A Tool for Gender Differentiation

Introduction: Forensic dentistry is a branch of dentistry which in collaboration with legal profession serves an important role to maintain justice system of a country. Forensic dentists play a major role in identification of an individual. Within the literature various methods have been found to be useful in gender differentiation. An attempt was made for differentiation of gender using picrosirius red and polarization microscopy. Aim: To evaluate picrosirius red and polarization microscopy as a tool for gender differentiation by observing birefringence pattern and distribution of thick and thin collagen fibers in males and females. Materials and Methods: Labial mucosal tissue obtained from 30 deceased individuals (18 male and 12 female) during autopsy was fixed in 10% formalin at 12th hour. Tissue was processed, sectioned and stained using picrosirius red stain and the birefringence pattern of collagen fibers were studied with polarization microscope. The results were statistically analyzed using Z-test and one-way ANOVA to draw the significance. Results: The proportion of thick and thin fibres among males and females were compared. It was found that there was statistically significant difference in proportion of thick and thin fibers between male and female. Thick fibres in males were (78.13%) more than females (65.74%) and thin fibres were more in females (34.24%) than males (21.32%). Conclusion: Picrosirius red and polarization microscopy may be used as a tool for gender differentiation. Yet the manner of death has to be considered during gender differentiation using this method, as in the present study out of 30 cases studied three cases of death due to debilitating diseases and poison consumption showed altered collagen distribution.

Introducing a Favourite Tip Definition and Projection with Tripod Suture in Rhinoplasty

Introduction: Surgical manipulation of the lower lateral cartilages of nasal tip could cause subtle but significant responses to the manipulation. The suture-techniques almost always offer a reliable and dramatic method of tip reshaping without a need to break or interrupt the alar rim strip or even adding tip graft. Aim: The aim of this study was to describe and assess outcomes of a new suture technique in rhinoplasty by using cephalic dome septal rotation suture for better tip definition Materials and Methods: All consecutive women (62 women) who attended our centre with nasal tip drooping and some degree of columellar retraction, underwent this technique from January 2005 to September 2009. Their ages ranged from 17 to 32 years old. Fifty one primary open and 11 secondary open rhinoplasties were performed using the conventional techniques and then the new suture technique was applied before closing the incisions on each patient. Results: The patients were followed-up from 22 to 72 months (mean = 52.3). The projection and rotation was satisfactory in all patients and the final results persisted with only minimal changes over time. Conclusion: It is important to say that this new suture is different from ‘tip rotation suture’ that was described by Tebbets. Our suture maintains the favorite tip definition with slight dorsal tip inclination. Indeed, it causes a two-point definition as the columellar lobular angle and the supra tip break definition. In addition, long-term follow-up has shown that this new suture (i.e., cephalic dome-septal rotation suture) is able to maintain optimal position of the nasal tip projection and definition.

Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia

Ravikumar Manoharan, Tarun Jacob, Santosh Benjamin, Sumonth Kirishnan

Introduction: Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). However, LAS is often done under spinal or general anaesthesia incurring huge treatment costs and hospital stay. Aim: To study if LAS can be treated with Local Anaesthesia (LA) thereby, reducing the costs and the anaesthetic risk to patients with no significant change in the surgical ease or clinical outcome. Materials and Methods: A total of 79 patients with chronic fissure underwent randomized allocation to two treatment arms – The first to undergo LAS under LA and the second under Spinal Anaesthesia (SA). The primary outcome variables studied were complications like post-operative pain, infections, healing rate of fissure and incontinence rates. Secondary outcome variables studied were cost, hospital stay and need for additional anaesthetic. Results: A total of 79 patients underwent LAS procedure. A total of 42 patients had LA and 39 patients had SA. There was no statistically significant difference in the healing rate, pain, infection and incontinence rates between the two groups. Moreover, the LA group incurred lower cost, reduced hospital stay and reduced risk of anaesthesia. Conclusions: LAS can be satisfactorily performed under local anaesthesia with no increased risk of pain or complications, and is best suited for resource-poor surgical settings.

Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

Introduction: Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods: After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post-insertion and there after at five minutes interval for 30 minutes. Results: All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), eight (26.66%) vs 10 (33.33%) and five (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05). Conclusion: So the FLMA may be a better technique for management of patients with difficult airways.

Neurological Manifestations in Systemic Lupus Erythematosus: A Single Centre Study from North East India

Sanjeeb Kakati, Bhupen Barman, Sobur U Ahmed, Masaraf Hussain

Introduction: Neurological manifestations although common in Systemic Lupus Erythematosus (SLE), are often not recognized due to their diversed and varied presentation. Therefore, the study was planned to highlight the pattern of neurological involvement in SLE to help in early recognition. Aim: To study the pattern of neurological involvement in SLE and its correlation with disease activity and different investigation. Materials and Methods: This hospital based prospective observational study was carried out from August 2009 to July 2010. Diagnosed cases of SLE [based upon American Rheumatism Association (ARA) criteria] who presented with neurological manifestations at the time of diagnosis or develop during the course of the disease were included in the study. They were assessed clinically and investigated with neuroimaging and neurophysiological tests as applicable. Results: In total, 52 consecutive patients with SLE were evaluated, 92% were female. The most common age group was 21 to 25 years. Nervous system involvement was found in 19 (36.54%) patients. Cognitive impairment was the most frequent manifestation, present in 11 (57.89%) patients followed by seizure disorder in eight patients (42.1%). Peripheral neuropathy was diagnosed in eight (42.1%), acute confusional state in six (31.57%) and headache and depression was diagnosed in five (26.31%) patients each. Less common manifestations were psychosis, movement disorder and aseptic meningitis. Percentage of neurological manifestations directly correlated with disease activity. A significant difference was found in Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score between the patients with Neuro Psychiatric Systemic Lupus Erythematosus (NPSLE) and those without NPSLE (32.42±16.34 Vs 17.3±10.6). Conclusion: Neurological involvement in SLE is seen relatively early in the course of the disease with cognitive impairment being the most common manifestation and correlate with disease activity.

Role of Glutathione S-Transferase in Coronary Artery Disease Patients with and Without Type 2 Diabetes Mellitus

Sheetal Pahwa, Ritu Sharma, Balwant Singh

Introduction: Glutathione S – transferase (GST) is an important enzyme in detoxification and helps in lowering oxidative stress. It is speculated that this enzyme is induced under conditions of oxidative stress as a protective mechanism. Aim: To evaluate the status of Glutathione S–transferase in Coronary artery disease patients with and without type 2 Diabetes mellitus. Materials and Methods: The study was conducted in the Department of Biotechnology, Swami Satyanand College of Management and Technology in collaboration with Department of Biochemistry, Govt Medical College Amritsar. A total of 133 diagnosed cases of Coronary Artery Disease (CAD) were selected from the OPD and Medicine Ward of a private hospital, Amritsar. CAD patients were segregated into two groups i.e., group-1 and group-2 on the basis if they had Type 2 Diabetes mellitus or not. A total of 110 ages and sex matched healthy individuals were taken as controls from the general population. Written informed consent was obtained from all the subjects. All the subjects were investigated for serum GST activity, Total antioxidant status, plasma GSH levels, serum MDA and lipid profile. Results: Serum GST activity was significantly high (p<0.05) in CAD patients as compared to controls. CAD patients having Type 2 Diabetes had more raised serum GST activity, indicating marked oxidative stress in these patients. This was supported from the observation that serum MDA levels were also significantly (p<0.05) high in CAD patients with Type 2 Diabetes mellitus. Total antioxidant status was significantly depressed (p<0.05) in CAD patients whether diabetic or non-diabetic as compared to controls. No significant difference (p>0.05) in plasma GSH levels were observed between CAD patients and controls. Age and sex related variations in serum GST activity were insignificant (p>0.05) Conclusion: Increased serum GST activity in CAD patients especially with Type 2 Diabetes is suggestive of a protective mechanism to combat increased oxidative stress which was reflected by raised serum MDA level and depressed total antioxidant status in patient group. However, whether this effect is a short term or long term, a separate follow up study is required.

Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis

Prem Kotian, Srikanth Mudiganty, Rajendra Annappa, Jose Austine

Introduction: Distal radius fractures accounts for around 15% of all fractures diagnosed and treated in the emergency rooms. These fractures usually result secondary to high velocity injury such as a motor vehicle accident or fall on an out stretched hand. In the elderly, it is a common fragility fracture. Volar Locking Compression Plates (LCP) is effective devices for fixation of the distal radius fractures. There is a lacuna with regard to literature on the 2.7 mm volar LCP and the current study retrospectively assesses the postoperative radiological outcomes. Aim:To measure the radiological outcomes in patients with displaced distal radius fractures managed with 2.7 mm volar LCP fixation using Sarmiento’s Modification of Lindstorm Criteria. Materials and Methods: A retrospective study was conducted in the Department of Orthopaedic Surgery at Kasturba Medical College Allied Hospitals, Mangalore from May 2014 to July 2016. All displaced distal radius fractures of skeletally mature patients who underwent volar locking plate fixation between May 2014 to July 2016 and follow up with X-rays at six weeks and three months were included as part of the study. The study comprised of 20 patients and fractures were classified using the AO and Melone’s classification systems. The radiological outcome was scored based on Sarmiento’s Modification of Lindstorm Criteria. Results: Post operative check X-rays were analysed at immediate post operative, six weeks and three months. The mean immediate post operative radial shortening, decrease in radial deviation and loss of palmar tilt were 4.08±2.23, 5.91±4.01and 4.11±3.29 respectively. The corresponding values at last follow up were 4.71±2.31, 7.9±5.13 and 4.91±3.32 respectively. No statistically significant difference (p=0.930;874;716) in radial shortening, decrease in palmar angulation and loss of radial deviation was seen till the final follow up. Sarmiento’s Modification of Lindstorm Criteria showed a good radiological outcome in 60% followed by fair in 25% and excellent in 15%. Conclusion: Use of 2.7 mm volar LCP showed good to excellent post operative radiological outcomes in majority of the cases. The fracture reduction achieved in the immediate post operative period is maintained throughout the follow up duration.

Pharmaco Penile Duplex Ultrasonography in the Evaluation of Erectile Dysfunction

Introduction: The National Institute of Health defined ‘erectile dysfunction’ as the persistent inability to achieve and/or to maintain an erection for a satisfactory sexual performance. In last few years, the concept of erectile dysfunction has evolved from that of a disorder referred to as ‘impotence’ which used to be considered predominantly psychogenic to that of ‘Erectile Dysfunction’ (ED), a well understood physiologic result of multiple risk factors, both psychological and organic. The most common cause of organic erectile dysfunction is vasculogenic causes. Doppler evaluation of cavernosal arteries after intracavernosal injection of Papaverine is particularly useful in the evaluation of vasculogenic causes. Aim: To define the role of intracavernosal injection of Papaverine in the evaluation of vasculogenic causes of erectile dysfunction that includes arterial insufficiency and veno occlusive nature. Materials and Methods: Pharmaco Penile Duplex Ultrasonography (PPDU) was done using a linear broadband phased array transducer (7–12 MHz) on a E-Saote MyLab 60 ultrasound colour Doppler system on 73 patients over a period of three years. Informed consent was taken from all patients. Visual grading score for erection, Cavernosal Artery Diameter (CAD), PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), RI (Resistive Index), AT (Acceleration Time) and dorsal vein changes were obtained in all patients following intracavernosal injection of Papaverine. Results: Visual grading for erectile response was E0 in one patient, E1 in 11 patients, E2 in 9 patients, E3 in 7 patients, E4 in 4 patients and E5 in 41 patients. Eighteen patients were diagnosed as having arterial insufficiency, three patients were diagnosed as having venous insufficiency and two patients showed indeterminate results. Conclusion: In our study, Papaverine induced PPDU proved to be highly accurate and excellent method for assessing patients with erectile dysfunction.

Occlusal Traits of Primary Dentition among Pre-School Children of Mehsana District, North Gujarat, India

Occlusal characteristics, Primary dentition, Occlusion, Molar relationship

Urinary Uric Acid/Creatinine Ratio - A Marker For Perinatal Asphyxia

Background: Perinatal hypoxia is one of the leading causes of perinatal mortality in developing countries. Both apgar score and arterial blood pH predict the neonatal mortality in asphyxia. Apgar score alone does not predict neurologic outcome and as it is influenced by various factors. This study was conducted to evaluate the utility and sensitivity of urinary uric acid to creatinine ratio (UA/Cr ratio) in asphyxia diagnosis, compared to invasive Arterial Blood Gas (ABG) analysis. Aim: To assess the urinary uric acid/creatinine ratio as an additional marker for perinatal asphyxia compared with ABG analysis in apgar score monitoring. Materials and Methods: The present case control study was conducted at a teaching hospital in Central Gujarat. Data of 40 healthy newborns and 40 asphyxiated newborns were collected. In absence of regional estimates, a sample of size 39 was required to attain a power of 80% at 5% alpha (type I error) considering a moderate effect size of 0.65. (UA/Cr) ratio was measured from the spot urine sample collected during 24-72 hours of birth. Statistical analysis was performed by Independent t-test, Pearson’s correlation coefficient (r) and Receiver Operating Characteristic (ROC) plots. Results: The mean (UA/Cr ratio) (2.75±0.18 vs 1.78±0.23) is significantly higher in asphyxiated group than in the control group (p<0.0001). Urinary UA/Cr ratio had negative correlation with blood pH (r= -0.27, p=0.18), which was not significant (p>0.05). Urinary UA/Cr ratio with criterion of >2.3 had 100% sensitivity, 100% specificity with AUC of 1 (p<0.0001) had a better predictive value. Conclusions: Apgar score is usually reduced in neonates with congenital anomalies and premature neonates. Hence, it is preferable that the clinical diagnosis of asphyxia by apgar scores be supported by other investigations so that early decision can be taken about the level of care the baby needs. pH, lactates and base deficits change with establishment of respiration following resuscitation. However, pH, lactate, base deficit estimations are invasive and need rapid estimations. Non-invasive urinary UA/Cr ratio may be an answer to these issues as it easy, economical and equally efficient.

Symptomatic Remission in Schizophrenia and its Relationship with Functional Outcome Measures in Indian Population

Selvaraj Madhivanan, Komal Jayaraman, Sharon Joe Daniel, Jeyaprakash Ramasamy

Introduction: Schizophrenia is a chronic mental disorder with disabling symptoms and variable outcome. Outcome is a multidimensional construct that depends on description of clinical and social domains. Symptomatic remission is one such clinical domain which can determine the outcome of illness. Aim: The study aimed to assess functional outcome in symptomatic remitted schizophrenia patients compared to unremitted patients in Indian population. Materials and Methods: This cross-sectional observational study was conducted at the Institute of Mental Health, Chennai, India. Remitted (symptom free in preceding six months) and unremitted patients were assessed by Positive and Negative Symptom Scale (PANSS), Personal and Social Performance (PSP) scale, World Health Organization-Quality of Life BREF (WHOQOL-BREF) and Global Assessment of Functioning (GAF). There were 30 patients in each group. All statistical analysis was done using SPSS version 20.0 statistical software. Results: Patients in symptomatic remission were found to have better quality of life in personal, environmental and social domains (p<0.01). Their personal and social performance is significantly better in remission group. The overall functioning was assessed by GAF, was better in patients with symptomatic remission (p<0.001). Conclusion: Symptomatic remission may be a good indicator of better clinical status, personal and social functioning and quality of life.

Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates

Introduction: Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for approximately 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. Aim: The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. Materials and Methods: We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento’s modification of Lindstorm criteria respectively. Results: There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento’s modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. Conclusion: The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.

Validity of Current Treatment Protocols to Overcome Hypochondriasis

Shrayash Khare, Meher Narain Srivastava

Hypochondriasis has been difficult to define and its classification amongst diseases has been blurred since, time immemorial. Though decades have been passed since its discovery and known to the people that the disorder is of the mind itself, the treatment options are still limited for the disorder and therefore, in dire need of exploration and analysis. Hypochondriasis, also sometimes referred to as health anxiety, is much more common in general health ward than previously accounted for. Thus, an efficient way of its management needs to be formulated and this review article helps to shed out light on the current treatment protocol available for hypochondriasis and their efficacy for the same. The treatment modules for hypochondriasis are unfortunately few and limited. None of the review articles have evaluated the efficacy of the tried treatment interventions and through this review article we want to highlight the same. A Medline search of the relevant publications and the references of the studies were incorporated to obtain the data.

Teneligliptin in Management of Diabetic Kidney Disease: A Review of Place in Therapy

Mohammed Abubaker, Preetesh Mishra, Onkar C. Swami

Diabetes is a global health emergency of this century. Diabetic nephropathy is the most common microvascular complication associated with Type 2 Diabetes Mellitus (T2DM). T2DM has been reported as a major etiological factor in almost 45% of patients undergoing dialysis due to kidney failure. Lifestyle modifications; cessation of smoking, optimum control of blood glucose, blood pressure and lipids are required to reduce the progression of Diabetic Kidney Disease (DKD). Presently, Dipeptidyl peptidase-4 (DPP-4) inhibitors are preferred in the management of T2DM due to their established efficacy; favorable tolerability including, low risk of hypoglycaemia; weight neutrality and convenient once-a-day dosage. Present evidence suggests that linagliptin and teneligliptin can be used safely without dose adjustments in patients with T2DM with renal impairment, including End Stage Renal Disease (ESRD). There is a limited data about teneligliptin particularly in T2DM patients with renal impairment. The objective of this review is to evaluate efficacy and safety of teneligliptin in T2DM patients with renal impairment, in order to assess the current place in therapy and future prospects of teneligliptin. Reported evidence suggests that teneligliptin has consistent pharmacokinetic in mild, moderate, severe or ESRD, without any need for dose adjustments. Limited data from small sample studies of teneligliptin in DKD patients reported significant improvements in glycaemic parameters. Additionally, there is an improvement in kidney impairment parameters like glycated albumin, urinary albumin and eGFR. There is an evidence of reduction in biomarkers of kidney impairment like P-selectin (sP-selectin), Platelet-Derived Microparticles (PDMPs) and Plasminogen Activator Inhibitor 1 (PAI-1). Clinical significance of these will be known in near future. Thus, teneligliptin has an important place of therapy in the management of T2DM with renal impairment.

Importance of Ayu Pareeksha for the Management of Diseases

Monika Agrawal, PS Byadgi, BK Dwibedy

The word Ayurveda comes from the Sanskrit root Ayu which means span of life. The purpose of examination of Ayu is to obtain knowledge regarding longevity, residual span of life in diseased person and rate of the mortality. The purpose of Dashavidha Pariksha is to obtain knowledge regarding Dosha Bala (Vyadhi Bala), Bala (Rogibala) and Ayu of the patient as described in Charak Samhita. Commonly Ayu and Vaya are regarded as synonyms but they are not similar terms. Hence, description of Vaya and Ayu is separately mentioned in Charaka as well as Sushruta Samhita. Description exclusively on Ayu Pareeksha described in Charaka Viman Sthana, Charaka Chikitsasthana, Charaka Indriya Sthana and Charaka Shareer Sthana. In Indriya Sthana, Ayu Pariksha indicates the residual life-span of the diseased person and where as in Jaatisutriya Adhyaya in Shareer Sthana mentioned the characteristic properties of the child who is going to survive for longer period of time. In Sushruta Samhita, Ayu is classified into three broad headings namely Dirghayu, Madhyamayu and Alpayu and explained the characteristic properties of all the three.

Method Comparison (Agreement) Studies: Myths and Rationale

Ajay G Phatak, Somashekhar M Nimbalkar

Unprecedented technological growth in the last quarter of twentieth century has resulted in improved health care and opened new domains of health care research. This technological leap also facilitated the paradigm shift from hospital care to home care through development of 'point of care' devices. As early diagnoses and timely referral is a key to health management, these devices play an important role in improving health. Validation of the new technology in different settings is necessary before adopting it to practice. For a binary result like pregnancy test, it is trivial to use statistical tools like sensitivity, specificity etc. For a continuous variable like blood glucose level the analysis is not straightforward. Many of us misinterpret 'association' as 'agreement'. This misinterpretation is reflected in studies which have compared two different technologies. The findings of well conducted studies do not contribute to the evidence base just because of wrong analysis strategy. We delineate on finer nuances of analysis and interpretation of method comparison studies.

Co-infection of Candida parapsilosis in a Patient of Pulmonary Actinomycosis-A Rare Case Report

Purbasha Ghosh, Indrajit Gupta, Mousumi Kar, Poulami Nandi, Prosenjit Naskar

The diagnosis of pulmonary actinomycosis is difficult and less than 10% of cases are diagnosed at the initial presentation. Actinomycosis is always poly-microbial flora infection in human. On the other hand, Candida parapsilosis is an emerging fungal pathogen especially in immuno-compromised patients. Combined bacterial-fungal infection increases frequency and severity of the disease. This report is a case of a Candida parapsilosis co-infection in a 23-year-old male patient having pulmonary actinomycosis. This thereby could guide the clinicians towards an appropriate therapy

Intracoronal Radiolucency in An Unerupted Premolar: A Rare Occurrence

Neil De Souza, Anna Vaz, Paul Chalakkal

Pre-eruptive Intracoronal Resorption (PIR) is a lesion that mostly occurs within the dentin in the occlusal part of the crown, next to the dentin-enamel junction. Such lesions are usually detected accidentally, on routine intraoral radiographs. This case report highlights a case of PIR detected in the mandibular second premolar of a 10 year old boy. The radiographic finding, size, position and restoration of the defect have been mentioned.

Anaphylaxis Complicated by Acute Respiratory Distress and Fatal Outcome in A Nigerian Family

Reports on hypersensitivity diseases in Nigerians are rare. We report the incidence of anaphylaxis in three siblings following fatal outcome in their mother. Urticarial rashes were noticed in three siblings’ resident in a South Western Nigerian town, one week before presentation at our facility. All the three siblings developed respiratory distress four days after the rash was noticed. Onset of respiratory distress made the family seek care at a private hospital, where they were admitted and treated with intravenous aminophylline and ceftriaxone. The mother of the children had experienced the same symptoms earlier also. She took treatment and died in the same private hospital, where her children received care. Death of the mother and worsening respiratory distress in the children made the father effect transfer of the children to the paediatric emergency unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo. The three children made a slow but uneventful recovery after instituting appropriate management for anaphylaxis and acute respiratory distress syndrome. The cases are discussed with a view to create awareness amongst health practitioners about the occurrence of anaphylaxis in our society. The need for prompt recognition and appropriate management, when confronted with this disease is also underscored.

Trichoadenoma of Nikolowski- A Rare Tumour with Unusual Presentation Over Vulva

Ashok Sangwaiya, Shilpa Bairwa, Shivani Kalhan, Puja Sharma, Rahul N Satarkar

Trichoadenoma is a rare benign, slowly growing, cutaneous tumour of the hair follicle first described by Nikolowski in 1958. It presents as a non-specific nodule over the face or buttocks. However, unusual sites such as the neck, upper arm, thigh, shoulder, and shaft of the penis may also be affected. The tumour is less mature than a trichofolliculoma and is more differentiated than a trichoepithelioma with a differentiation towards the infundibular portion of the pilosebaceous canal. Histologically, it consists of numerous infundibulocystic structures present throughout the dermis, few of which are lined by eosinophilic epidermal cells with attempted glandular formation and contain laminated keratin, without evidence of hair follicle formation. We report a case of trichoadenoma over the vulva of 25-year-old female showing typical histological features.

Correspondence: Evaluation of Risk Factors Associated with First Episode of Febrile Seizure

Anirban Mandal, Puneet Kaur Sahi

Correction: 2014 Dec:8(8): ZC08-ZC11

Hanspal Singh, Pushparaja Shetty, Sreelatha S.V., Madvikha Patidar, Analysis of Salivary Antioxidant Levels in Different Clinical Staging and Histological Grading of Oral Squamous Cell Carcinoma: Noninvasive Technique in Dentistry. (Published in Journal of Cilinical and Diagnostic Research. 2014 August : 8(8)): ZC08-ZC11 In this article, a typo error in name of fourth author Madvikha Patidar is corrected as Madhvika Patidar.