Journal of clinical and diagnostic research

The Prevalence of Human Papilloma Virus (HPV) in Women using Liquid Base Pap Smear in Rasht, Northern of Iran

Seyed Mohamad Mohseni Mehran, Mandana Mansour Ghanaei, Ali Mojtehadi

Background: HPV is one of the most common sexually transmitted infections. However, little is known about its prevalence in the female population in Rasht, Northern of Iran. The aim of this study was to find the incidences of HPV viruses in high-risk women in Rasht by wet Pap smear from 2010 to 2015. Materials and Methods: This cross-sectional study investigated HPV prevalence and its genotype distribution among 103 apparently healthy and non- healthy women with abnormal cells in pap exam. DNA samples were extracted by boiling and phenol - chloroform methods, then used as template for amplifying of specific fragment of HPV genome by PCR using GP5+ / GP6+ primers. PCR products were electrophoresed in 1.5% agarose gel (Roche, Germany) containing Sybrsafe. DNA ladder (Roche Co, Germany) was used to detect the molecular weights of observed bands under UV lamp. Results: Overall, 4/98 women (4.08%) with normal cells and 1/5 women (20%) with abnormal cells were positive for at least one of the high risk HPV types in wet Pap smear. The most HPV infection was found in 26 to 39-year-old individuals. Conclusion: We evidenced a moderate prevalence of HPV infection but needs to be given more attention because in apparently healthy women also, HPV infection was observed. Health officials should conduct the study and wider screening of this infection occurring in this province. Screening for this infection must be recommended in this region.

Evaluation of Surface Roughness and Tensile Strength of Base Metal Alloys Used for Crown and Bridge on Recasting (Recycling)

Amit Agrawal, Syed W. Hashmi, Yogesh Rao, Akanksha Garg

Background: Dental casting alloys play a prominent role in the restoration of the partial dentition. Casting alloys have to survive long term in the mouth and also have the combination of structure, molecules, wear resistance and biologic compatibility. According to ADA system casting alloys were divided into three groups (wt%); high noble, Noble and predominantly base metal alloys. Aim: To evaluate the mechanical properties such as tensile strength and surface roughness of the new and recast base metal (nickel-chromium) alloys. Materials and Methods: Recasting of the base metal alloys derived from sprue and button, to make it reusable has been done. A total of 200 test specimens were fabricated using specially fabricated jig of metal and divided into two groups- 100 specimens of new alloy and 100 specimens of recast alloys, which were tested for tensile strength on universal testing machine and surface roughness on surface roughness tester. Results: Tensile strength of new alloy showed no statistically significant difference (p-value>0.05) from recast alloy whereas new alloy had statistically significant surface roughness (Maximum and Average surface roughness) difference (p-value<0.01) as compared to recast alloy. Conclusion: Within the limitations of the study it is concluded that the tensile strength will not be affected by recasting of nickel-chromium alloy whereas surface roughness increases markedly.

Study to Predict Vascular Dysfunctions in High Risk Young Adults- An Immediate Non-Invasive Investigation to Prevent Early Vascular Ageing

Introduction: Normal vascular is associated with gradual change of vascular structure and function, resulting in increased arterial stiffening and decreased arterial compliance. Arterial stiffness is a marker of vascular ageing and a predictor of cardiovascular events. Premature or early vascular ageing is measured by pulse wave velocity or the arterial augmentation index based on pulse wave analysis. Aim: To study the predictor of vascular dysfunctions in high risk young adult offsprings of type 2 diabetes mellitus and hypertensive parents. Materials and Methods: The analytical cross-sectional studies were carried out in 90 subjects (45 males and 45 females), aged 18–25 years. They were divided into three groups based on their family history, known case of type 2 DM or hypertension in their parents. Group 1- control, Group 2- DM, Group 3-Hypertensive. In all subjects, anthropometrical data, blood pressure and peripheral pulse wave velocity were measured. One-way ANOVA was applied to determine the predictor factors of pulse wave velocity within and between groups. The following parameters were included in these analyses: age, gender, body mass index, hip waist index, heart rate, blood pressure and pulse wave velocity. Results: A post-test analysis revealed that peripheral pulse wave velocity (PWV), early part of systolic phase (P1) was increased significantly than later part systolic phase (P2), p-value in both diabetic and hypertensive groups were compared with control group. (p=0.001, ANOVA) Augmentation index (P2/P1) was also increased significantly in both diabetic and hypertensive groups than control group (p=0.001, ANOVA). Conclusion: The findings of present study suggest that, although related, peripheral augmentation index AIx and PWV provide early identification of high risk groups. Implication of life style modification is the first intervention to consider in adults followed by drug therapy to control risk factors. Specifically, AIx might provide a more sensitive marker of arterial aging in younger individuals.

Role of Semi-quantitative Serum Procalcitonin in Assessing Prognosis of Community Acquired Bacterial Pneumonia Compared to PORT PSI, CURB-65 and CRB-65

Lalita Fernandes, Akashdeep Singh Arora, Anthony Menezes Mesquita

Introduction: Community Acquired Pneumonia (CAP) is one of the commonest causes of patient’s visit to the Emergency Room (ER). Hospitalisation of patient depends on severity of pneumonia. Various pneumonia severity assessment scores are available to predict mortality in community acquired pneumonia but these scores are not commonly used. Procalcitonin is a biomarker which is raised in bacterial infection and is easy and quick to measure. The aim of our study was to assess the ability of baseline serum procalcitonin level to predict mortality of community acquired bacterial pneumonia compared to PSI, CURB-65 and CRB-65 and its add-on value to the simple CRB-65 score. Materials and Methods: Fifty five patients admitted with Com-munity Acquired Bacterial Pneumonia were enrolled after taking informed consent and satisfying all inclusion and exclusion criteria. PSI, CURB -65, CRB-65 and PCT scores were determined on admission. PCT was measured by semi- quantitative assay; PCT Q. Primary outcome was 30 day mortality. Sensitivity, specificity, positive and negative predictive value of PCT for assessing mortality was calculated and compared to validated pneumonia severity scores; PSI, CURB-65 and CRB-65. We also assessed the ability of the combination of PCT to each of the scores to predict 30 day pneumonia specific mortality. Results: In receiver operating characteristic analysis for mortality prediction, area under curve (95% CI) for PCT, PSI, CURB-65 and CRB-65 was 0.92 (0.85, 1.0), 0.88 (0.78, 0.98), 0.88 (0.76, 0.99), 0.9 (0.78, 1.0) respectively. Combination of PCT to each of the scores improved the prognostic ability to predict 30 day pneumonia specific mortality. Conclusion: Semi-quantitative PCT level at admission is an excellent test to predict the outcome of pneumonia. It predicts patients at low risk of mortality from community acquired bacterial pneumonia.

Open Conservative Surgical Management of Cystic Echinococcosis in a Tertiary Care Hospital, Nepal

Niranjan Kumar Hazra, Hemant Batajoo, Samikshya Ghimire, Brijesh Sathian

Background: Cystic echinococcosis (CE) or hydatid disease caused by E. granulosus in Nepal is amenable to surgical treatment. Aim: Aim of the study is to evaluate the efficacy of surgical treatment of CE, by open partial pericystectomy with albendazole as adjuvant. Materials and Methods: Material of this prospective study were the consecutive series of 33 patients operated for CE, over a period of 8 years, at a single centre. Clinical examination, ultrasonography (USG) and computed tomography (CT) were used for establishing diagnosis. Patients were prescribed perioperative albendazole. Povidone iodine 10% (betadine)was used as contact scolicidal agent during operation. Cysts were evacuated from livers, lungs, retroperitoneum by partial pericystectomy. CE of mesentery was completely excised. Descriptive statistics was obtained using EPI- info windows version soft ware. Results: A total of 33 patients were operated for CE; 24 were females and 9 males. Age ranged from 4 years to 80 years. Organs/ site involved were: liver – 24, lungs – 4, combined liver and lungs – 2, retroperitoneum - 2 and mesentery – 1. Complication – bile leak for 2 weeks in an operated CE of liver. There was no mortality. Hospital stay (in days) was – mean 14 (range 7to21). Follow up for 3 years (average 2years) showed no recurrence. Conclusion: Evacuation of CE by partial pericystectomy is an effective, safe and simple procedure, and gives excellent cure rate with perioperative albendazole therapy.

Expression of CCK Receptors in Carcinoma Gallbladder and Cholelithiasis: A Pilot Study

Mohammad Shazib Faridi, Mahabir Saran Das Jaiswal, Sudhir K. Goel

Background: Gastrin and cholecystokinin (CCK) receptors are trophic for various gastrointestinal malignancies. Their role in gallbladder cancer has not been widely studied. Objectives: To identify expression of CCK-A and CCK-B receptors in the tissue and blood of patients suffering from carcinoma (CA) gallbladder and gallstone disease and to compare expression of CCK A and B receptors in the gall bladder tissue and blood of healthy individuals and patients of CA gallbladder, and gallstone diseases. Materials and Methods: Forty nine subjects of both genders were recruited, comprising of 22 patients of CA gall bladder, 19 cases of cholelithiasis and, 8 normal gallbladders obtained from patients operated for trauma of the biliary system or Whipple’s procedure. RNA extraction and cDNA formation for CCK-A and CCK-B receptors were carried out. Real Time PCR was performed on cDNA and threshold cycle (Ct) value of each sample was obtained and ?Ct was calculated. Chi-square test for comparing two groups and ANOVA test for comparing multiple groups were applied and if p<0.05 then Dunnett-C test was performed. Observation and Results: Both CCK-A and CCK-B receptors were expressed irrespective of its origin in all tissues and blood samples studied; be it normal, Cholelithiasis or CA gallbladder and there was no difference among them (p>0.05). Conclusion: This preliminary study showed higher expression of CCK-A receptors in patients of cholelithiasis and decreased expression of CCK-A receptors in patients of CA gallbladder as compared to normal gallbladder although it did not rise to statistical significance.

Evaluation of Students’ Perceptions Towards An Innovative Teaching-Learning Method During Pharmacology Revision Classes: Autobiography of Drugs

Anuradha Joshi, Jaishree Ganjiwale

Introduction: Various studies in medical education have shown that active learning strategies should be incorporated into the teaching–learning process to make learning more effective, efficient and meaningful. Objectives: The aim of this study was to evaluate student’s perceptions on an innovative revision method conducted in Pharmacology i.e. in form of Autobiography of Drugs. The main objective of study was to help students revise the core topics in Pharmacology in an interesting way. Settings and Design: Questionnaire based survey on a newer method of pharmacology revision in two batches of second year MBBS students of a tertiary care teaching medical college. Materials and Methods: Various sessions on Autobiography of Drugs were conducted amongst two batches of second year MBBS students, during their Pharmacology revision classes. Student’s perceptions were documented with the help of a five point likert scale through a questionnaire regarding quality, content and usefulness of this method. S tatistical analysis used: Descriptive analysis. Results: Students of both the batches appreciated the innovative method taken up for revision. The median scores in most of the domains in both batches were four out of five, indicative of good response. Feedback from open-ended questions also revealed that the innovative module on “Autobiography of Drugs” was taken as a positive learning experience by students. Conclusions: Autobiography of drugs has been used to help students recall topics that they have learnt through other teachings methods. Autobiography sessions in Pharmacology during revision slots, can be one of the interesting ways in helping students revise and recall topics which have already been taught in theory classes.

Assessment of a Group Activity Based Educational Method to Teach Research Methodology to Undergraduate Medical Students of a Rural Medical College in Gujarat, India

Dinesh Kumar, Uday Shankar Singh, Rajanikant Solanki

Context: Early undergraduate exposure to research helps in producing physicians who are better equipped to meet their professional needs especially the analytical skills. Aim: To assess the effectiveness and acceptability of small group method in teaching research methodology. Setting: Sixth semester medical undergraduates (III MBBS-part1) of a self-financed rural medical college. Materials and Methods: The workshop was of two full days duration consisting of daily two sessions by faculty for 30 minutes, followed by group activity of about four hours and presentation by students at the end of the day. A simple 8 steps approach was used. These steps are Identify a Problem, Refine the Problem, Determine a Solution, Frame the Question, Develop a Protocol, Take Action, Write the Report and Share your Experience. A Pre-test and post-test assessment was carried out using a questionnaire followed by anonymous feedback at the end of the workshop. The responses were evaluated by blinded evaluator. Results: There were 95 (94.8%) valid responses out of the 99 students, who attended the workshop. The mean Pre-test and post-test scores were 4.21 and 10.37 respectively and the differences were found to be significant using Wilcoxon Sign Rank test (p<0.001). The median feedback score regarding relevance, skill learning, quality of facilitation, gain in knowledge was four and that of experience of group learning was 5 on a Likert scale of 1-5.There were no significant differences between male and female students in terms of Pre-test, post-test scores and overall gain in scores. Conclusion: Participatory research methodology workshop can play a significant role in teaching research to undergraduate students in an interesting manner. However, the long term effect of such workshops needs to be evaluated.

Screening the Drug Resistance Property Among Aerobic Pathogenic Microorganisms of Dental Caries in North-Western Indian Population: A Preliminary Study

Aims and Objectives: To evaluate the emerging drug resistance among the caries pathogens isolated from carious dentine microbiologically. Materials and Methods: Specimens from dental caries were collected from 75 patients referred to Department of Conservative Dentistry and Endodontics, Vyas Dental College. Microbiological processing of all the samples was done within three hours to isolate the caries pathogens. The samples were inoculated on agar medium (Nutrient agar, Mac-conkey’s agar) at 370C for 48 hours aerobically. The identification of strains was done by observing colony morphology and gram’s staining. The predominant isolates were subjected to antimicrobial sensitivity test (Kirby Bauer’s method). Statistical analysis of the isolates was done using paired t-test. Results: Out of 75 patients more common isolates were Staphylococcus aureus, Klebsiella, Pseudomonas aeruginosa, Yeast. The predominant were Staphylococcus and Pseudomonas species. Newer antibiotics were proved to be effective against these predominant strains after evaluating antibiotic sensitivity tests. Conclusion: Although Streptococcus mutans (S.mutans) is the most prevalent microorganism seen in dental caries, the role of other microorganisms like Staphylococcus, Pseudomonas in initiation and progression of caries is evident from this study. Further extensive and large scale studies need to be conducted for better understanding the role of these microorganisms in dental caries.

A 7-Years Retrospective Study of Gastrointestinal Cancers Incidence in the Western Iran

Introduction: In Iran, cancer is the third reason of the death and every year 500,000 new cases were detected, and 14% of all death is related to cancer. The most common system that is affected by cancer (after the skin) is gastrointestinal (GI) system. The purpose of the study is evaluation of the 7 years incidence (2002-2008) of the GI cancers in Ilam province in the west of Iran. Materials and Methods: In this retrospective cross-sectional study, total 307 record health related to the patients affected by the gastro-intestinal system cancer were evaluated after referring to the pathologic centers of the Ilam province and neighboring provinces. Patient s data were recorded from their file based on the standard questionnaire. Result: The mean age ± standard deviation of participants was 63.8+1.5. More than half of participants study was men (58.3%). The prevalence of the esophagus, stomach, small intestine and colorectal cancers was significantly higher in the men than the women (unlike liver cancer) (p<0.001). The most common site of GI cancer were esophagus (38.1%) and stomach (34.2%) but small intestine was allocated the least prevalence (1%) to itself. The most common pathology type of cancer was adenocarcinoma in the GI system (68.1%). Conclusion: According to the high prevalence of the GI cancer and also the ascending incidence of the patient with disease in the Ilam province, special measures should be considered for the reduction of the life and property load resulted from this disease. People by introduction of the warning signs of the gastrointestinal system cancer should be screened for GI cancer.

Phylogenetic Distribution of Virulence Genes Among ESBL-producing Uropathogenic Escherichia coli Isolated from Long-term Hospitalized Patients

Objectives: The present study was aimed to investigate the antibiotic resistance, virulence potential and phylogenetic grouping of ESBL-producing uropathogenic Escherichia coli (EP-UPEC) isolated from long-term hospitalized patients. Materials and Methods: EP-UPEC isolates from September 2013 to June 2014 at a tertiary care hospital of China were screened for ESBL-production by the double disk diffusion test. Isolates with ESBL-phenotype were further characterized by antibiotic resistance testing, PCR of different ESBL and virulence genes, and phylogenetic grouping. Results: One hundred and twenty EP-UPEC were isolated from long-term hospitalized patients. All EP-UPEC isolates were resistant to Ampicillin, Cefazolin, Cefuroxime, Cefotaxime, Cefoperazone and Ceftriaxone, and the majority of EP-UPEC isolates were resistant to Piperacillin (82.5%), Ciprofloxacin (81.2%), Trimethoprim-Sulfamethoxazole (72.5%). The isolates showed the highest sensitivity against Imipenem (98.4%), Piperacillin/tazobactam (96.7%), Cefoperazone/sulbactam (91.7%), Amikacin (90.8%) and Cefepime (75.8%). Nine different ESBL genotype patterns were observed and CTX-M type was the most prevalent ESBL genotype (42.5%, 51/120). Majority of EP-UPEC isolates possess more than one ESBL genes. EP-UPEC isolates belonged mainly to phylogenetic group B2(36.7%) and D(35.0%). The prevalence of traT, ompT, iss, PAI, afa, fimH and papC were 75.8%, 63.3%, 63.3%, 60.8%, 40.8%, 19.2% and 6.7%, respectively. The number of virulence genes (VGs) detected was significantly higher in group B2 than in group A (ANOVA, p<0.001), group B1(ANOVA, p= 0.012) and D (ANOVA, p<0.001). Conclusions: EP-UPEC strains showed multidrug resistance and co-resistance to other non ß-lactam antibiotics. CTX-M was the most prevalent ESBL genotype and majority of EP-UPEC strains more than one ESBL genes. EP-UPEC strains belonged mainly to phylogenetic group B2 and D, and most of the virulence genes were more prevalent in group B2.

Efficacy of New Adhesion Promoters on Compromised Hypocalcified Enamel

Introduction: The amount of technological progress occurred in the last few years has brought an add up to the benefits of bonding in Orthodontics. Research-based findings have constantly led to the development of new materials that are aimed to simplify the clinical procedures like bonding of brackets to compromised enamel surfaces. Hence, the present study is aimed to assess the bond strength of orthodontic brackets on fluorosed enamel using adhesion promoters. Aim: To evaluate the shear bond strength (SBS) of orthodontic brackets bonded on fluorosed enamel using conventional Transbond XT and new adhesion promoters such as Enhance LC and All Bond 3. Materials and Methods: The study involved 90 non carious, extracted teeth with mild to moderate fluorosis randomly divided into 3 Groups. In Group - I (control group) the teeth were bonded with conventional Transbond XT and cured with LED light. In Group - II Enhance LC was applied to fluorosed enamel before bonding and in Group - III All Bond 3 was used. Shear bond strength was tested by using Universal testing Instron machine. ANOVA and Post-Hoc Tukey’s tests were used to compare shear bond strength. Adhesive remnant on the tooth was assessed and scored using adhesive remnant index (ARI). Results: Results showed a reduced SBS values (9.43MPa ±3.03) with conventional Transbond XT on fluorosed enamel. Among the adhesion boosters used Enhance LC illustrated lesser SBS values (12.03 MPa ± 4.42) compared with All Bond 3 (14.38MPa ±4.92). ARI showed bond failure at bracket resin interface in group I & group II and at enamel resin interface in group III although statistically insignificant. Conclusion: It was concluded that using adhesion boosters on fluorosed enamel showed higher bond strength compared to the control group. Among the two adhesion promoters used All Bond 3 expressed highest bond strength compared to Enhance LC although statistically insignificant.

Comparison of Umbilical Cord Cleansing Using Sterile Water and Povidine Iodine-Spirit During Early Neonatal Period: A Double Blind Randomized Control Trial

Gautam Chawla, K.K. Diwakar

Aim: To compare the effect of umbilical cord care with Povidine Iodine- Spirit on umbilical infection in early neonatal period. Materials and Methods: Prospective double blinded randomized controlled study was undertaken to evaluate the effect of daily cleansing of the umbilical cord of term infants with Spirit (Alcohol) –Povidine Iodine combination). This was also compared to the retrospective data obtained for the prevailing practice of keeping the umbilical cord dry. Results: 1518 infants were included in the study. (462 in the “cord care group”, 496 in the “water” placebo group, & 560 in “Dry” retrospective group). There was an overall reduction in the clinically screened and evaluated “umbilical infection” in the Povidine –Iodine group. This was attributable to a greater reduction in the mixed bacterial (Colonizer/ commensals) isolates. The Relative Risk for Staph. aureus was lesser when the cord was kept dry (RR 0.6, p<0.01) and sterile water (Placebo) group (RR 0.7, p<0.01). Conclusion: Avoiding the antiseptic cleansing increased the RR for commensal / mixed bacterial over growth that would probably facilitate umbilical cord separation.

Comparative Analysis of Linear and Angular Measurements on Digital Orthopantomogram with Calcaneus Bone Mineral Density

Background: Bone remodeling is a continuous and complex process which occurs throughout life. Radiomorphometric and radioangular indices on the orthopantomogram are the predictors of bone remodeling associated with mandible. Bone mineral density is the amount of calcified tissue in a certain volume of the bone. Materials and Methods: Fifty normal healthy individuals within the age range of 25-55 years were included in the study. Linear measurements including mandibular cortical width (MCW) and panoramic mandibular index (PMI); and angular measurements including mandibular angle (MA) and antegonial angle (AGA) were recorded. Quantitative ultrasound bone mineral density (BMD) scan of the heel bone (calcaneus) of the same patient were also performed. Results: In our study, for both males and females, antegonial angle (AGA) had highest correlation with calcaneus bone mineral density. In the age group of less than 35 years, PMI in males, and AGA in females had highest correlation. In the age range of more than 35 years, MA in males and AGA in females had highest correlation. Conclusion: There is a correlation between the mandibular bone remodelling changes and calcaneal bone mineral density in case of elder subjects and thus these parameters may be used as an inexpensive alternative screening method to assess the bone mineral density and identify individuals at risk for osteoporosis and fractures and also for dental treatment planning.

EEG Abnormalities in Children with Speech and Language Impairment

Introduction: Epilepsy, a chronic condition of recurrent seizures, affects language, but the extent and nature of the language disturbance varies widely according to the type, severity, and cause of the epilepsy. There is paucity of literature on the electroencephalographic abnormalities in children with speech and language impairment. The present study was therefore planned to find the association of epileptiform EEG abnormalities in children with speech and language impairment and if present, their localization and lateralization to the language areas of the brain that are present predominantly in the left hemisphere. Materials and Methods: The study was conducted on Paediatric patients having speech and language impairment (n=94, age-2 to 8 years) selected on the basis of detailed history and neurologic examination. Video Electroencephalography (EEG) was performed as per American Clinical Neurophysiology Society guidelines using 16 channel RMS computerized EEG machine for a minimum of 40 minutes to capture both wakefulness and sleep along with activation procedures like hyperventilation (if feasible) and photic stimulation. EEG was reviewed for any abnormal EEG background, benign variants, interictal epileptiform discharges and ictal discharges. Results: In our cohort, 19.7% boys and 22.2% girls presented with seizures in their infancy and this gender difference was found to be statistically significant (p<0.05). EEG was abnormal in 47.9% children (45 out of 94) with no significant gender difference. Epileptiform EEG was seen in 73.6% of children with history of seizures and 41.3% of children without history of seizures (p<0.05). The EEG abnormities included: abnormal background (64.5%), presence of generalized interictal epileptiform discharges (57.8%), focal epileptiform discharges (20%) exclusively from left hemisphere and multifocal interictal epileptiform discharges (33.3%), each occurring in isolation or associated with other abnormities. Conclusion: In the current study, it is definite that presence of generalized abnormalities in EEG are seen in higher frequency and focal interictal epileptiform discharges are solely seen in left hemisphere in children with speech and language impairment. Although, there is no distinct pattern of EEG abnormalities in such patients, we recommend a routine EEG in them and also brain imaging to complement the EEG findings.

Oral Mucosal Lesions Associated with Smokers and Chewers – A Case-Control Study in Chennai Population

Shyam Sundar Behura, Mahaboob Kader Masthan, Aravindha Babu Narayanasamy

Aims and Objectives: To determine the association of oral mucosal lesions in a group of Chennai population aged 15 years and above with smoking and chewing habits. To also determine the dose-response relationship of these habits associated with the risk of oral mucosal lesions. Materiala and Methods: The study was undertaken with 450 subjects with smoking and/or chewing habits aged 15 years and over gathered through random selection in Chennai, India. Subjects with alcohol intake were excluded from the study. Based on the habits the study group was categorized into smokers, chewers and mixed (smoking+chewing). One hundred and fifty subjects diagnosed with oral mucosal lesions designated as “cases” and 300 lesion-free “controls”, frequency matched for age, sex, habit and family income were assessed during the study. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. In addition, those requiring further examination, scalpel biopsies were performed to establish a definitive diagnosis. Results: Irrespective of the type of habit, 78% of cases smoked and/or chewed for more than 10 years as compared to 37.4% of the control group. Similarly, 71.3% of cases smoked and/or chewed more than 5 times per day as compared to 25.6% of the control group. Eleven habits related mucosal lesions of the oral cavity were encountered. Smoker’s melanosis was the most common oral mucosal lesion followed by Oral submucous fibrosis and Leukoplakia. Dose-response relationships were observed for both duration and frequency of habits on the risk of oral mucosal lesions. Conclusion: The result of the present study provides information on the association of oral mucosal lesions in smokers, chewers and patients with mixed habits. The mucosal lesions encountered included a few potentially malignant conditions and oral squamous cell carcinoma. Habits were more prevalent in men thus more lesions were encountered in males than in females. Moreover, increase in the duration and frequency of habits was significant predictors of risk in the case population.

An Observational Study to Evaluate the Prevalence of Erectile Dysfunction (ED) and Prescribing Pattern of Drugs in Patients with ED Visiting an Andrology Specialty Clinic, Mumbai: 2012-14

Introduction: Erectile dysfunction (ED) is a common occurrence and its incidence is expected to increase significantly along with the increase in various lifestyle diseases. The drug utilization for ED is very low. Also, studies describing the prescription pattern in ED are lacking. Materials and Methods: We conducted a retrospective cross-sectional observational study, including a drug utilization analysis, of 606 prescriptions as per the standard guidelines (WHO and STROBE). Results: Out of 606, 249 (41%) were from the age group of 30-39 years. Addictions were present in 388 (64%). Out of 606, 186 had urological, 154 had cardiovascular and 102 had psychological co-morbid disorders. Out of 348, 201 were prescribed Tadalafil (low dose) on a once daily basis. Out of 172, 121 were prescribed Sildenafil (high dose) on an ‘as and when required’ basis. Nutritional/ herbal supplements were prescribed in 126/606. The ratio of ‘Prescribed Daily Dose’ to ‘Defined Daily Dose’ of Tadalafil, Sildenafil, and Dapoxetine were 1.1, 1.3 and 1.5 respectively. Conclusion: Measures for de-addiction play an important role in the overall management of ED. The most common co-morbid disorders were urological, like BPH, LUTS, etc, followed by cardiovascular, psychological and diabetes. Overall, rational pharmacotherapy was observed. Tadalafil was the most commonly prescribed drug for ED. The main factor in the selection of a particular PDE5 inhibitor was its pharmacokinetics and cost. Udenafil, being the costliest, was the least prescribed. Dapoxetine was used in a significant number of individuals primarily for PE with ED. The combination of Papaverine, Chlorpromazine ± Alprostadil was used as intracavernosal injection in patients not responding to oral drugs.

Evaluation of an Improved Non-invasive Fetal Sex Determination in Haemophilia A Patients

Narmin Mokari-Zadeh, Seyed Alireza Mesbah-Namin

Background: Haemophilia A (HA) is the most severe sex-linked bleeding disorder that is characterized with non-controlled and often threatening Haemorrhage. Routine fetal sex determination in early pregnancy with Haemophilia is based on invasive procedures that can be dangerous to the mother and fetus. Aim: The goal of this study is to present an improved assay for the non-invasive fetal sex determination using a Real-Time duplex PCR on the free fetal DNA (ffDNA) obtained from the maternal serum of the HA carriers. Materials and Methods: Blood samples were eventually collected from 23 pregnant HA carriers between the 8th and 12th weeks of gestation, and after amplification by duplex-PCR of the single copy of Y chromosome-specific sequence (SRY), the product was then subjected to Real-Time PCR analysis. Results: Data were compared with the outcome of chorionic villus sampling (CVS) and indicated that the SRY sequence was detected in 6 of 6 serum samples from male pregnancies and that sequence was absent in 9 samples where the fetus was female. The remaining samples determined without having the CVS positive samples. Conclusion: We tried to develop a Real-Time duplex PCR for accurate diagnosis of fetal gender early in the pregnancy of HA carriers. This study has brought up two remarkable points, the first is the method’s improvement with high specificity in sex determination, especially in screening of prenatal sex-linked disorders in male gender and the second is that fresh serum samples would be a good source for this purpose, advocated by similar studies carried out in this regard.

Microtensile Bond Strength of Embrace Wetbond Hydrophilic Sealant in Different Moisture Contamination: An In-Vitro Study

Aim: Contamination of etched enamel with saliva has been shown to result in sealant failure. Recently, a hydrophilic sealant has been introduced. In absence of documented literature, this in vitro study was undertaken to ascertain the efficacy of Embrace Wet Bond without reduction of microtensile bond strength in the different moisture contamination. Materials and Methods: A 5mm block of sealant were built over prepared occlusal surface of 40 non-carious therapeutically extracted third molars which were sectioned into 1mm thick stick and tested using Zwick micro tensile tester. Obtained data were subjected to descriptive analysis, one-way ANOVA and Scheffe’s post-hoc tests. Results: Mean microtensile bond strength of Embrace sealant was not significantly lowered in different moisture contamination groups except Group 3 (air drying), which showed very highly significant (p<0.001) decrease in µTBS as compared to Group 1 (non-contaminated). Conclusion: Mean µTBS of Embrace sealant remains largely unchanged even in presence of moisture. Owing to its hydrophilic property, this sealant can be a great help in cases where maintaining isolation is difficult.

Association Between Depression and Acute Pain in Adults Attending a Tertiary Care Hospital in Bhubaneswar

Background: Recent burden on health care organization due to acute pain and simultaneous rise in the depression cases have been ringing alarms among the medical professionals. Aims: This study was taken up with a hypothesis that acute pain and depression are inter-linked and any acute painful condition leads to some behavioural and psycho-somatic effects which needs to be detected at the earliest possible. Settings and Designs: This relationship was established by designing a cross-sectional study where four most common causes of acute pain (i.e. post-labour, post-caesarean, postoperative, dental conditions) were studied in 70 subjects each and compared with 70 subjects of control group who presented to a tertiary care hospital in Bhubaneswar, without any painful condition or underlying depression. Materials and Methods: Various pain scales (Visual Analogue Scale- VAS, Verbal Rating Scale – VRS, Box Scale) were used to assess the degree of pain while Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess the level of depression in these subjects. Statistical Analysis: Using SPSS version 16 software, the correlation coefficient was determined between the depression levels and acute pain. Results: It was seen that the geriatric populations were more depressed, while the older adults perceived more pain. The females differed from males in their pain perception; they were more depressed and proved to be more tolerant to painful conditions such as post-partum acute painful conditions. Dental pain was found to be the second most reported painful condition after postoperative acute pain. A statistically significant strong correlation was established between depression and acute pain. Conclusion: Thus the psychosomatic component of pain needs to be evaluated on a priority basis by health providers.

Hirschsprung’s Disease in Neonates with Special Reference to Calretinin Immunohistochemistry

Background: Hirschsprung’s disease is a classic example of a complex genetic disease, characterized by the lack of enteric ganglia in the submucosal and myenteric plexuses, along variable portions of the distal gut. The diagnosis of Hirschsprung’s disease is based on a combination of clinical features, radiological appearance of the bowel and histological features in Haematoxylin & Eosin stained sections of intestinal biopsies. Calretinin Immunohistochemistry is emerging to be one of the newer methods. Aims and Objectives: This study was undertaken to ascertain 1) clinical profile; 2) mode of presentation; 3) to evaluate the role of Calretinin immunostain in the diagnosis of Hirschsprung’s Disease. Materials and Methods: This prospective and observational study was conducted in the Department of Pathology IPGME&R from July 2013 to September 2014. Eighty nine patients, clinically and radiologically diagnosed with Hirschsprung’s disease underwent surgery and were included in the study. The data of every patient including age, sex and presenting symptoms were recorded. Eventually, histopathological examination & immunohistochemistry were done. Results: Total number of cases studied was 89 which aged between 0 days to 28 days. Overall sensitivity in our study to diagnose presence or absence of ganglion cells by calretinin immunohistochemistry was 100% and the specificity is 97.44% with positive and negative predictive value of 84.62 % and 100 % respectively. Conclusion: Calretinin immunohistochemistry holds several advantages, and it’s simple and not doubtful; and it is either positive or negative

Visual Evoked Potentials: Normative Values and Gender Differences

Ruby Sharma, Sandeep Joshi, K.D. Singh, Avnish Kumar

Introduction: Visual evoked potentials (VEP) are used to assess the visual pathways through the optic nerves and brain. A normal VEP response to a pattern-reversal stimulus is a positive mid occipital peak that occurs at a mean latency of 100 ms. VEP may be affected by variety of physiological factors including age, sex, visual acuity and pupillary size. Aims and Objectives: The present study was performed on healthy medical students to determine the normative values and to investigate the effect of sex and anthropometric parameters on visual evoked potentials. Materials and Methods: The study was conducted on 100 healthy medical students of Government Medical College, Patiala in the age group of 17-20 years, in which there were 50 males and 50 females. The anthropometric parameters including age, height, weight, BMI, BSA and Head circumference were recorded in all the subjects. VEP was recorded with a PC based, 2 channel, RMS EMG EP mark II machine and standard silver-silver chloride disc electrodes. A VEP monitor displaying checker board was used to give the pattern reversal stimulus. The VEP parameters recorded were latencies to N70, P100 and N155 waves, and peak to peak amplitude of P100 wave. Results: Our results showed that the latencies of N70, P100 and N155 waves were significantly longer in males as compared to females. The amplitude of P100 wave was higher in females in both left and right eye as compared to males. No significant correlation was found between VEP parameters and head circumference in both male and female subjects in our study. Conclusion: Gender is an important variable affecting the VEP. The exact reason of gender difference is not clear, but it may be related to anatomical or endocrinal differences in the two sexes.

Lipodystrophy in Human Immunodeficiency Virus (HIV) Patients on Highly Active Antiretroviral Therapy (Haart)

Background: In recent years, abnormal lipid deposition (both lipoatrophy and fat redistribution) and its related complications have changed from an anecdotal issue into a major problem for HIV (Human Immunodeficiency Virus) infected patients on HAART (Highly Active Anti-Retroviral Therapy). Lipoatrophy and fat redistribution are potentially stigmatizing complications of HAART and leads to poor adherence among patients. Hence we conducted this study to determine the pattern and to assess various risk factors for maldeposition of lipids in HIV patients. Materials and Methods: A cross-sectional case series study was conducted in ART PLUS centre, Bellary over a period of 8 months from January to August 2014 in HIV patients on ART to determine risk factors associated with and epidemiological pattern of fat redistribution or atrophy. Results: A total of 50 patients with LD {lipodystrophy} (26 with fat redestribution and 24 with lipoatrophy {LA} were diagnosed in this period. Most of them belonged to younger age and was commonly seen in females (76%). Patients with LA had a significantly lower BMI (18.73 ± 7.4), {the p-value being 0.19} compared to LH group (21.54 ± 7.62). The duration of disease was comparable among both groups (6.96 years in LH and 5.79 years in LA group) {p-value is 0.29}. There was a relatively good immunity among these patients with mean CD4 count was 509.23 in LH and 545.91 in LA group {single CD4 count was taken and the p-value was 0.001}. Most of the patients were in TLN (Tenofovir, Lamivudine, Nevirapine) regimen (58%).The duration that patient was on ART before commencement of study varied from patient to patient, but the mean duration was approximately five years in fat redistribution group and 4.5 years in LA group. There were no derangements in lipid and sugar levels among them. Conclusion: This study shows the need to identify and impact of LD with respect to treatment adherence in young patients especially female patients. Early community based screening for LD by social workers and targeted annual screening might help early detection and awareness about LD. Also adopting the least toxic regimen is one of the main aspects of LD management.

Association of Herpes Viruses with Mild, Moderate and Severe Chronic Periodontitis

Mohammad Mukhit Abdul Gaffar Kazi, Renu Bharadwaj, Kishore Bhat, Daisy Happy

Introduction: Periodontal disease is an inflammatory condition of the supporting tissues of the teeth. It is a multi-factorial and multi-etiological infectious disease process. Recent evidences shows that human herpes viruses could be putative pathogens. The aim of the present study was to evaluate the association of Herpes viruses especially Herpes simplex viruses (HSV-1 and 2), Epstein-Barr virus (EBV) and Human cytomegalovirus (HCMV) in patients with chronic periodontitis. Materials and Methods: A total of 75 patients with periodontitis were included in the study (25 each with mild, moderate and severe periodontitis) with ethical approval and informed consent. Sub gingival plaque sample was collected and subjected to extraction of DNA and further analysis with multiplex Polymerase chain reaction for the presence of herpes viral DNA. The collected data was entered in the excel sheet format. It was subjected to statistical analysis using SPSS software. The Chi-Square statistical tests was applied and p-value<0.05 was taken as significant. Results: The overall association of HSV-1, HSV-2, EBV and CMV was 28%, 32%, 30.66% and 37.33% respectively in the present study from the cases of chronic periodontitis. Conclusion: Epstein Barr viruses were detected from all types of cases of chronic periodontitis in the present study. Though, EBV was not significantly associated with periodontitis; they were significantly increased in severe periodontitis. Herpes viruses were significantly associated with periodontal disease, more so with severe periodontal disease. They could thus be playing a role in increasing the severity of the disease. Therapeutic and prophylactic intervention planned against these viruses could decrease the tooth loss associated with this disease.

Molecular Methods for Identification of Acinetobacter Species by Partial Sequencing of the rpoB and 16S rRNA Genes

Background: Acinetobacter spp. is a diverse group of Gram-negative bacteria which are ubiquitous in soil and water, and an important cause of nosocomial infections. The purpose of this study was to identify a collection of Acinetobacter spp. clinical isolates accurately and to investigate their antibiotic susceptibility patterns. Materials and Methods: A total of 197 non-duplicate clinical isolates of Acinetobacter spp. isolates identified using conventional biochemical tests. The molecular technique of PCR-RFLP and sequence analysis of rpoB and 16S rRNA genes was applied for species identification. Antimicrobial susceptibility test was performed with a disk diffusion assay. Results: Based on 16S rRNA and rpoB genes analysis separately, most of clinical isolates can be identified with high bootstrap values. However, the identity of the isolate 555T was uncertain due to high similarity of A. grimontii and A. junii. Identification by concatenation of 16S rRNA and rpoB confirmed the identity of clinical isolates of Acenitobacer to species level confidently. Accordingly, the isolate 555T assigned as A. grimontii due to 100% similarity to A. grimontii. Moreover, this isolate showed 98.64% to A. junii. Besides, the identity of the isolates 218T and 364T was confirmed as Genomic species 3 and A. calcoaceticus respectively. So, the majority of Acinetobacter spp. isolates, were identified as: A. baumannii (131 isolates, 66%), A. calcoaceticus (9 isolates, 4.5%), and A. genomosp 16 (8 isolates, 4%). The rest of identified species showed the lower frequencies. In susceptibility test, 105 isolates (53%), presented high antibiotic resistance of 90% to ceftriaxone, piperacillin, piperacillin tazobactam, amikacin, and 81% to ciprofloxacin. Conclusion: Sequence analysis of the 16S rRNA and rpoB spacer simultaneously was able to do identification of Acinetobacter spp. to species level. A.baumannii was identified as the most prevalent species with high antibiotic resistance. Other species showed lower frequencies ranged from 4 to 9 strains.

Effect of Camphylobacter rectus on Serum Iron and Transferrin– In–Vivo Findings

Background and Aim: Periodontopathogens require iron constituents for their growth and metabolism in subgingival crevice. In this study, C.rectus was detected and quantified by using 16s rDNA based PCR in chronic periodontitis and compared with the levels of serum iron, total iron binding capacity and transferrin in chronic periodontitis and healthy sites. Materials and Methods: One hundred twenty subjects divided into chronic periodontitis and healthy controls. Deep subgingival plaque was collected and genomic DNA was extracted from each sample analysed for C.rectus using 16s rRNA based PCR analysis. Blood samples were collected from both groups for estimation of serum iron, serum total iron binding capacity and serum transferrin levels. The quantified bacterial count was compared with blood samples. C. rectus was detected in both groups. Results: There was significant increase in bacterial count in chronic periodontitis (p<0.05). Serum iron level was significantly raised in healthy group. TIBC and transferrin levels were elevated in periodontitis. Although these differences were non-significant. Regression analysis showed significant linear relationship between C.rectus counts and decreasing iron levels and consequently increasing serum transferrin and TIBC (p<0.05). Conclusion: The preliminary in vivo findings suggests C.rectus requires iron as a significant source of nutrition for its survival and growth form its hosts in deeper subgingival sites.

A Study on The Incidence of Neural Tube Defects in A Tertiary Care Hospital Over A Period of Five Years

Introduction: Several congenital malformations affect developing fetuses, among which Neural tube defect (NTD) is most common. Folic acid supplementation brought decline in the incidence of NTDs. The present study aims at finding the incidence of NTDs in a tertiary care hospital and compares the results with the similar Indian studies published earlier. Materials and Methods: The study was done at Chettinad Hospital & Research Institute (CHRI), Kelambakkam. The total number of deliveries was recorded for a period of five years from 2009 to 2013. Fetuses which were still born with neural defect were collected and observed in detail externally for the sex, type of NTD and other associated anomalies. Indian studies published between 1987 and 2014 reporting the incidence of NTDs among the births occurred were retrieved from the Internet and their various observations were used for comparison. Results: The number of deliveries conducted between 2009 and 2013 at CHRI was 3220. Of these, babies born with NTDs were nine (5 males and 4 females). The incidence of fetuses with meroanencephaly, holoanencephaly, craniorachischisis, encephalocele and myelocele were 0.62, 0.62, 0.93, 0.31 and 0.31 per 1000 births respectively. Overall incidence of NTDs in the present study was 2.79/1000 births. Fetuses with NTDs also had the following anomalies – Club foot, cleft lip and palate and exomphalos. Conclusion: Comparing the results with the previous studies it is clearly evident that the incidence of NTDs have significantly reduced from 11.42/1000 births to 2.79/1000 births. In most of the previous studies NTDs had a female preponderance whereas present study has a male preponderance.In older studies, spina bifida was the most common NTDs followed by anencephaly. But in the present study anencephaly was the common NTD than spina bifida. Incidence of NTDs has reduced due to various reasons like prenatal screening for fetal anomalies and folic acid supplementation.

To Study the Incidence, Predictive Factors and Clinical Outcome of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis with Ascites

Kavita Paul, Jasmine Kaur, Harbans Lal Kazal

Objective: To study the prevalence and predictive factors of spontaneous bacterial peritonitis (SBP) in patients of cirrhosis with ascites and to study the clinical characteristics and prognosis of patients with SBP. Materials and Methods: The present study was conducted on 122 cases admitted in Department of Medicine, through emergency, in Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. Cases of cirrhosis (irrespective of aetiology) with ascites between the ages of 18-75 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures, before initiation of antibiotic therapy and was sent for biochemical analysis, culture and cytological analysis. Results: Mean age of patients enrolled was 50.30± 10.98 years. 85% were male and 15% were female. Alcohol (73.8%) was the leading cause of cirrhosis followed by HCV (37.7%) and HBV (4.9%). Of the 122 patients studied, 27 (20.4%) patients were diagnosed as having SBP and its variants. Monomicrobial Bacterascites (BA) was present in 5 patients and Culture Negative Neutrocytic Ascites (CNNA) was present in 22 patients. Escherichia coli were the most common isolated organism followed by Klebsiella. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score and high MELD score. Conclusion: Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Bedside inoculation of 10-20ml of ascitic fluid into culture bottle at patient bedside will yield better results. Early diagnosis and treatment will reduce the mortality rate in these patients.

Evaluation of Probability of Survival using APACHE II & TRISS Method in Orthopaedic Polytrauma Patients in a Tertiary Care Centre

Archit Agarwal, Atul Agrawal, Rajesh Maheshwari

Aim: The aim of the study was to assess the ability of Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and Trauma and Injury Severity Score (TRISS) method to evaluate chances of survival of orthopaedic polytrauma patients. Materials and Methods: It is a retrospective study carried out at a tertiary care teaching hospital situated in a hilly terrain. The medical records of 535 polytrauma patients admitted to ICU from January 2012 to April 2015 were examined of which only 95 were included into the study. The APACHE II scores were calculated from data at the time of admission, on day 1 after admission and on day 5. Data from casualty department was used to calculate TRISS. For each patient APACHE II and TRISS was used to calculate their probability of death. Receiver operating characteristic curve analysis was used to assess the ability of APACHE II and TRISS to predict mortality. Results: In the receiver operating characteristic curve analysis, the areas under the curve for TRISS, APACHE II on admission and APACHE II on day one of admission scoring system was 0.831, 0.706, 0.885 respectively. Sensitivity and specificity for TRISS was 83.64 and 77.50 respectively while for APACHE II score on day one of admission was 90.91 and 72.50. Conclusion: The results from the present study showed that APACHE II score on day one of admission was relatively a better predictor than TRISS score and a far better predictor than APACHE II on admission in evaluating probability of survival of a patient.

Evaluation of the Efficacy of Caries Removal Using Polymer Bur, Stainless Steel Bur, Carisolv, Papacarie – An Invitro Comparative Study

Context: Dental caries continues to affect a significant portion of the world population and treatment of the decay is associated with pain by many patients. Intervention and application of rotary instruments for treatment of carious lesions has often resulted in considerable removal of tooth structure. Chemo-mechanical method, a minimal invasive technique for caries removal was developed to overcome these shortcomings. This innovative method seems to be efficient in removing infected dentine without altering the healthy dental tissue or harming the adjacent oral mucosa. Aim: To evaluate the efficacy and efficiency of Caries removal Using Polymer Bur, Stainless Steel Bur, Carisolv and Papacarie. Materials and Methods: A total of 120 sectioned specimens were obtained from 60 extracted teeth. Each tooth was sectioned mesiodistally in the center of the carious lesion so that two halves (buccal and lingual or palatal) having equal sized carious lesions are compared. The sectioned specimens were subdivided into four groups (Polymer Bur, Stainless Steel Bur, Carisolv, Papacarie) allotting 30 specimens to each for caries excavation. Results: One-way ANOVA, Chi-square test analysis was done for comparison between groups which showed significant results with Stainless Steel Bur excavation taking less mean time when compared to other agents and Polymer Bur showed more amount of bacterial remnants after excavation whereas Carisolv and Papacarie were efficient with less dentinal tubule destruction and bacterial remnants after excavation. Further inter comparison between groups was done using Paired t-test and Fischer’s Exact-test. Conclusion: The Mean time taken by Stainless Steel Bur excavation was found to be less and caused more amount of dentinal tubule destruction when compared to Polymer Bur, Carisolv and Papacarie. Chemo-mechanical methods found to be more efficient with lesser amount of bacterial remnants and dentinal tubule destruction after caries excavation when compared to conventional methods.

Salivary Thiocyanate, Uric Acid and pH as Biomarkers of Periodontal Disease in Tobacco Users and Non-Users- An In-Vitro Study

Fawaz Pullishery, Ganesh Shenoy Panchmal, Sabin Siddique

Introduction: Biomarkers of tobacco exposure are used to confirm the absorption of specific smoke constituents in a quantitative manner. Materials and Methods: Periodontal status was measured by Community periodontal Index (WHO). Salivary thiocyanate was determined using spectrophotometric analysis, Salivary uric acid concentration was determined using the enzymatic uric acid assay reagent. pH was measured using pH strips. Results: Proportion of participants with periodontal pockets of 4-5mm was highest among tobacco smokers (80.0%) and periodontal pockets of 6mm or more were observed to be higher among tobacco chewers (26.67%). When LOA scores among tobacco chewers were recorded 26.7% of them presented with attachment loss of 0-3mm. 46.7% of them were affected with loss of attachment of 4-5mm and loss of attachment 6-8mm was found in 16.7%. 6.7% of them were found to be having loss of attachment of 9-11mm. 3.3% of them were found to be having loss of attachment of 12mm or more. The LOA scores in non- tobacco users showed 46.7% of 0-3mm, 50.0% of 4-5mm and 3.33% of 6-8mm attachment loss. The mean level of thiocyanate level detected in saliva of tobacco smokers was 172 ± 54.7 µg/ml and 203.70± 45.7 µg/ml in tobacco chewers. The mean uric acid levels was found to be 2.54 ±0.63 (µg/dl) in smokers and 2.65 ± 0.37(µg/dl) in chewers and in non tobacco users it was 2.33 ± 0.47 µg/dl. Conclusion: Tobacco users had significantly higher concentration of SCN levels than non-users.

Comparative Analysis of Visual Field Plotting by Octopus Interzeag 1-2-3, Humphrey Field Analyser II and Frequency Doubling Perimetry in Glaucoma Patients in South Indian Population

AR Rajalakshmi, Elangovan Suma, D Ranjit Prabhu

Purpose: Standard achromatic perimetry tests the differential light sensitivity whereas the frequency doubling technology tests the contrast sensitivity. The aim of this study was to compare and correlate the visual field indices with three different types of perimeters namely frequency doubling perimetry (FDP), Humphrey field analyser (HFA) and Octopus Interzeag 1-2-3 (OI) for detecting glaucomatous field defects. Design: Prospective cross-sectional observational study. Materials and Methods: Hundred eyes of 50 glaucoma patients were studied. All the patients underwent visual field examinations by Octopus Interzeag 1-2-3, Humphrey field Analyser II and Frequency Doubling perimetry (FDP). The correlations of the global indices were compared. The time taken to perform the test with the three perimeters was analysed. Results: The visual field plotting by the perimeters were comparable and significant positive correlation was observed. The time taken to perform visual field test by Octopus Interzeag 1-2-3 was shorter than the other two methods. Conclusion: The visual field plotting by Octopus Interzeag 1-2-3, Humphrey field analyser and frequency doubling technology perimetry were comparable and Octopus field plotting takes lesser time than the rest two methods.

An Invitro Comparative Evaluation of Compressive Strength and Antibacterial Activity of Conventional GIC and Hydroxyapatite Reinforced GIC in Different Storage Media

Praveen Bali, Attigupperamasetty Prabhakar, Nadig Basappa

Background: GIC is the most commonly used restorative material in pediatric dentistry since it has got various advantages like fluoride release, anticariogenic property and chemical adhesion to tooth but a major disadvantage is its contraindication in posterior teeth because of poor mechanical properties. Aim: The purpose of this study is a modest attempt to explore the influence of the addition of 8% hydroxyapatite to conventional GIC on its compressive strength when immersed in different storage media and antibacterial activity. Materials and Methods: One hundred and twenty six pellets of the specific dimension of 6 x 4 mm were prepared and divided into 6 groups and were immersed in deionized water, artificial saliva, lactic acid solution respectively for three hours everyday over 30 days test period. The compressive strength was measured by using a universal testing machine (AG-50kNG) at cross head of 1mm2/min and strength was determined after 1 day, 7 days, 30 days respectively and the antibacterial activity evaluated against Streptococcus mutans strain in brain heart infusion broth using serial dilution method. Statistical Analysis: Group wise comparisons were made by one-way ANOVA followed by post-hoc Tukey’s test, Intergroup comparison was done with Mann-Whitney test. R esults: GIC+HAp showed significantly greater antibacterial activity against Streptococcus mutans when compared to GIC group. There was no statistically significant change in the compressive strength among the groups except for group 3 and group 6 when immersed in lactic acid had shown significant difference at the end of 24 hours. Conclusion: The addition of 8% hydroxyapatite to GIC showed marked increased in the antibacterial activity of the conventional GIC against caries initiating organism without much increase in the compressive strength of the GIC when immersed in the different storage media.

In vitro Evaluation of the Accuracy of Seating Cast Metal Fixed Partial Denture on the Abutment Teeth with Varying Degree of Convergence Angle

Background: The prime goal of a diligent prosthodontist is to obtain adequate marginal fit while restoring lost tooth structure. The marginal fit of the restoration, in turn depends upon the geometrical morphology of the tooth preparation. Objective: To determine the effect of varying degree of convergence angle on the marginal seating of the single crown, three-unit fixed partial denture and multiple-unit fixed partial denture with pier abutment. Materials and Methods: Three dies, of same convergence angle, were placed in an arch form on a base. In this way, four arch forms were prepared for four different convergence angles i.e. 00, 60, 120, and 200. Five castings each were made for single crown, 3-unit fixed partial denture and multiple-unit fixed partial denture (FPD) with pier abutment for each convergence angle. The castings were seated on their respective dies and vertical marginal discrepancy was measured at four points for each casting with the help of an optical microscope. Results: The results showed that 200 convergence angle showed better marginal seating of the single crown, 3-unit FPD as well as for the multiple unit FPD. Conclusion: There was a possibility that the retention and resistance may be compromised with 200 taper. Hence 120 taper is suggested for crowns and fixed partial denture retainers as the marginal discrepancy is reasonable and retention and resistance is optimum. There was a high statistical significant difference in the values obtained for the different convergence angles.

Evaluation of Potential Drug-Drug Interactions with Antidepressants in Two Tertiary Care Hospitals

Background: Limited resources of healthcare system and high use of antidepressants have raised some serious concerns regarding proper surveillance system of prescribed medicines. Not much literature is available from Pakistan regarding the potential drug-drug interactions (pDDIs) associated with antidepressants. Objective: The objective of this study was to assess the frequency of pDDIs associated with antidepressants, their severity, significance and their association with patient characteristics. Materials and Methods: A prospective, observational study was conducted in two major hospitals of Karachi for the period of three months. Patient profiles, medication charts, and physician notes were thoroughly reviewed to gather all the relevant information. Inclusion and exclusion criteria were set prior to data collection. The collected data was then analysed using Micromedex Drug-REAX System. Descriptive and binomial logistic regression analysis was used to express results. Results: Of 245 prescriptions reviewed, 141 prescriptions had at least one pDDI (57.5%). A total of 181 pDDIs were identified in prescription containing antidepressant. The ratio of pDDI per prescriptions was 0.78. 42.5% interactions were moderate in severity, 30% of interactions were rapid in onset, and 43% were considered as significant interactions. Polypharmacy (OR=3.41, p<0.001) and presence of chronic problems (OR=2.14, p=0.002) were significantly associated with the occurrence of pDDIs. Citalopram and diclofenac (11.6%) was commonly prescribed interacting pair in this study. Conclusion: The findings of this study recorded high frequency of antidepressants associated pDDIs. Our results confirm the significant association of polypharmacy with the occurrence of pDDIs with antidepressants. Future studies are warranted to establish these results by including hospitals in different parts of the country.

Candida tropicalis as a Predominant Isolate from Clinical Specimens and its Antifungal Susceptibility Pattern in a Tertiary Care Hospital in Southern India

Binesh Lal Yesudhason, Kalylyani Mohanram

Background: The incidence of infections caused by Candida species has increased considerably over the past three decades mainly due to the rise of the AIDS epidemic, an increasingly aged population, higher numbers of immunocompromised patients and the more widespread use of indwelling medical devices. Candida tropicalis is emerging pathogenic yeast among non-albicans species. Recently drug-resistant C.tropicalis was also reported in hospitals. Aim and Objective: The present study aimed to isolate and speciate C. tropicalis from various clinical samples and to determine its antifungal susceptibility profile. Materials and Methods: Clinical samples such as urine, blood, exudates and vaginal swab which were submitted to the Microbiology laboratory during the year 2013 were screened for the growth of Candidia species, which then identified as C.tropicalis by the routine microbiological procedures such as germ tube formation, assimilation and fermentation of sugars and colony color on HICHROM Candida agar. Antifungal susceptibility was performed by disc diffusion method with the drugs Amphotericin-B, Itraconazole, Ketaconazole and Fluconazole on C. tropicalis isolates. Results: A total number of 112 Candida isolates were isolated during the year 2012 from various clinical specimens. Among them 61 (54.3%) were identified as C.tropicalis. All the C. tropicalis isolates were sensitive to Amphotericin-B (100%) but 23 isolates (37.7%) were resistant to Fluconazole. Conclusion: We conclude that identification of Candida species is important to know the prevalent species in the clinical setup and routine antifungal susceptibility should be performed to avoid inappropriate treatment.

Effect of 10% Sodium Ascorbate on Shear Bond Strength of Bleached Teeth - An in-vitro Study

Background: Patient often requires some additional interventions such as replacement of old restorations, laminates and veneers after bleaching, for aesthetic purposes. The residual oxygen inhibits polymerization of resin based materials which results in reduced bond strength of the restorations. Some techniques are available to solve the clinical problems related to the post bleach compromised bond strength. Objectives: The purpose of this study is to evaluate, the role of 10% sodium ascorbate on reversing the compromised bond strength and compare enamel shear bond strength of 5th and 6th generation dentine bonding agents on bleached and unbleached teeth. Materials and Methods: Eighty freshly extracted human anterior teeth were assigned in to Group A and Group B of 40 teeth each. Samples in both groups were subdivided in to 4 subgroups of 10 teeth each. In Group A composite resins was bonded using 5th generation dentine bonding agent (3M Single Bond) and Group B was bonded using 6th generation (3M ESPE Adper SE Plus). Subgroups were subjected to the procedure as, A1;B1 etching and bonding (control), A2; B2 bleaching, etching and immediate bonding, A3; B3 bleaching,10% ascorbic acid treatment for 10 minutes after that etching and bonding immediately, A4; B4 bleaching, storage in artificial saliva for 4 days and then etching and bonding. Pola office, in office bleach (SDI (082216) was used for bleaching. The specimens were subjected to shear load in a Universal testing machine to evaluate bond strength. Results: A decrease in bond strength was seen with 6th generation adhesive system compared to 5th generation bonding system, which is statistically significant, p<0.001. Conclusion: Treating the bleached enamel surfaces when treated with 10% sodium ascorbate, which reverses the compromised bond strength and is a good alternative to delayed bonding.

Biochemical and Cytological Comparison of Keratocystic Odontogenic Tumours to Nonkeratinising Odontogenic Cysts Fluid

Aim: To evaluate the levels of albumin, prealbumin, total protein, inorganic phosphate and presence of keratinocytes in the cystic fluid for the diagnosis and appropriate treatment planning of keratocystic odontogenic tumours and other non keratinizing odontogenic cysts. Materials and Methods: Fifteen keratocystic odontogenic tumour and 15 controls were studied. The cystic fluid was aspirated and analysed to determine the levels of albumin, prealbumin, total protein, inorganic phosphate and the presence of keratinocytes. The data collected was statistically evaluated using Mann Whitney U-Test and Student’s t-test. Results: A highly significant difference (p<0.0001) was seen when a comparison of Prealbumin, total protein, inorganic phosphate and presence of keratinocytes was made between keratocystic odontogenic tumour and non keratinizing odontogenic cysts. The presence of albumin also showed a significant difference (p<0.01). Conclusion: A combined analysis of total protein, albumin, prealbumin, inorganic phosphorous and detection of epithelial squames may be used as a diagnostic adjunct in the preoperative diagnosis of keratocystic odontogenic tumour in a minimally invasive and highly accurate fashion.

Langerhans Cell Expression in Oral Submucous Fibrosis: An Immunohistochemical Analysis

Bharghavi Narayanan, Malathi Narasimhan

Background: Langerhans cells (LCs), are dendritic cells of the epithelium which play a role in an array of oral lesions from gingivitis to oral cancer. Oral Submucous Fibrosis (OSMF), a potentially malignant disorder (PMD), is an insidious chronic disease with juxta-epithelial inflammatory changes leading to fibrosis. Langerhans cells (LCs) may play a part in the ongoing inflammatory dysregulation of OSMF. Objective: The study was aimed at elucidating the distribution of LCs in varying grades of OSMF. Materials and Methods: A retrospective study using 39 cases of OSMF, graded using Haematoxylin and Eosin (H&E) stained section. Immunohistochemistry was performed using polyclonal anti- CD1a antibodies to identify LCs in 5 cases of normal tissue and 39 samples of OSMF. The distribution of LCs among the various grades and normal mucosa analysed using Mann-Whitney U test. Results: LC population in the OSMF was significantly higher when compared to the normal epithelium (p<0.001). Within the grades the advanced stage had more LCs than the other stages. Conclusion: The increase in LCs might indicate the role of antigenic exposure in turn leading to cell mediated immunity in OSMF. Thus the fibrosis in OSMF might have a direct link to LCs.

Assessment of Under Nutrition Using Composite Index of Anthropometric Failure (CIAF) amongst Toddlers Residing in Urban Slums of Raipur City, Chhattisgarh, India

GS Boregowda, G.P. Soni, Kamlesh Jain, Shubhra Agrawal

Introduction: Several indicators have been used for measurement of under nutrition in the past. They are overlapping and none individually provide a comprehensive number of under nourished in the community. The effort has been to discuss the use of an alternative indicator of malnutrition – the composite index of anthropometric failure (CIAF). Aim: To study the prevalence of under nutrition of Toddlers using CIAF and compare the prevalence of under nutrition obtained by primitive indicators and CIAF. Materials and Methods: Cross-sectional community based study was carried out in urban slums of Raipur (C.G) during Jan 01,2014 to Sept 30, 2014 using sample size of 602. Slums were selected by multistage random sampling and the subjects were selected by convenient sampling, i.e. starting from a random point house to house survey was carried out until desired number of subjects (According to PPS) were covered assuming that slum population is evenly distributed. Attendant of Toddlers were interviewed with semi structured proforma and Height and Weight were measured by measuring tape and Salter’s weighing machine respectively. Informed consent was obtained. MS excel was used for data analysis after compilation. Results: Girls and boys were 50% each. By CIAF the prevalence of under nutrition was found to be 62.1% while, Underweight, Stunting and Wasting showed it to be 45.2%, 46.6% and 17.8% respectively. Conclusion: Primitive indices under estimate the burden of under nutrition and CIAF should be used a screening tool for assessing under nutrition.

Radiation Pneumonitis After Conventional Radiotherapy For Breast Cancer: A Prospective Study

Background: Loco-regional radiotherapy is an important treatment modality in breast cancer and radiation pneumonitis (RP) is one of the early toxicities. Aim: To study the occurrence, correlation of RP with patient and radiotherapy related factors and the effects on pulmonary function following conventional radiotherapy in breast cancer. Settings and Design: Prospective study, from a tertiary hospital in a developing country. Materials and Methods: Prospective analysis of clinical symptoms, pulmonary function and radiologic changes was done prior to and 12 weeks after adjuvant radiotherapy (n=46). Statistical analysis was done using SPSS version 10 software. Results: Radiological and clinical RP was seen in 45.65% (n=21) and 19.56% (n=9) respectively. RP was significantly higher with age >50 years (OR 4.4), chest wall irradiation with electrons, (electrons 83.3% vs cobalt60 32.4%, p=0.02) and supraclavicular field treatment with 6 MV photons (p= 0.011). There was significant relationship between Inferior Lung Distance (ILD) and RP (p=0.013). The fall in Total Lung Capacity (TLC) was significantly more in those with RP (p=0.02). Conclusion: Clinical RP occurs in almost one-fifth of breast cancer patients treated with conventional radiotherapy. Chest wall irradiation with electrons, supraclavicular field irradiation with 6 MV photons, higher ILD and age >50 years was associated with increased RP. The pulmonary function parameter most affected was TLC. The factors associated with increased RP should be considered when adjuvant radiotherapy is planned to minimize its likelihood and intervene appropriately.

Comparison of Local Injection of Platelet Rich Plasma and Corticosteroids in the Treatment of Lateral Epicondylitis of Humerus

Raman Yadav, S Y Kothari, Diganta Borah

Introduction: Lateral epicondylitis or Tennis Elbow is one of the most common causes of upper extremity pain with various treatment options. Platelet-rich plasma (PRP) offers a new option for the treatment of lateral epicondylitis. This study was conducted with an aim to compare the efficacy of PRP versus methyl-prednisolone local injection in patients with lateral epicondylitis. Materials and Methods: Sixty five patients with lateral epicondylitis were included in the study and randomized into two groups. Group A was treated with single injection of 1ml PRP with absolute platelet count of at least 1 million platelets/ mm3. Group B was treated with single injection of 1ml (40mg) methyl-prednisolone. Pain, grip strength and functional improvements were assessed using visual analogue scale, dynamometer and quick Disabilities of the Arm, Shoulder and Hand scale respectively at baseline, 15 days, 1 month and 3 months. Results: Sixty patients completed the follow up. All assessment parameters improved significantly in both the Groups at each follow up compared to baseline. At the end of three months group A showed significantly better improvement as compared to Group B. Conclusion: PRP and methyl-prenisolone both are effective in the treatment of lateral epicondylitis. However, PRP is a superior treatment option for longer duration efficacy.

Quality of Diabetic Care among Patients in a Tertiary Care Hospital in Bangalore, South India: A Cross-sectional Study

Carolin Elizabeth George, Sapna Mathew, Gift Norman, Devashri Mukherjee

Background: Despite high prevalence of diabetes, translation of practice recommendations to care is still deficient in Asian and developed countries. The objective of this study is to assess the quality of care provided to diabetic patients and extent of knowledge transfer by the provider to these patients as a measure of the quality of service. Materials and Methods: A cross sectional study was done among 190 diabetic patients over a period of 6 months. All type II diabetic patients, 30 years and above, who were diagnosed at least 1 year back without any other co-morbidity satisfied the inclusion criteria. They were interviewed based on an audit checklist formulated by National Diabetes Quality Improvement Alliance. Results: The results revealed that blood pressure is the only parameter which is regularly monitored in majority (93%) of the diabetics. Hb1AC, LDL cholesterol and eye check up were less common and done only in 40%, 52.6% and 56.8% of diabetics respectively. Only 33(17.37%) had at least 5 of the 7 essential parameters monitored at least once in the last year. The knowledge questionnaire showed that more than 70% of the diabetic patients know that their condition requires lifelong management, diet modifications and exercises. There was no difference in the knowledge scores between the people who had no essential tests done and those diabetics who got 5 essential tests done. Gender, education, occupation and duration of diabetes were associated with knowledge score. Conclusion: There is a need to formulate the local standards of care and clinical practice guidelines for the management of diabetes that are easily affordable and available to the health care providers and applicable to our country at the national level. Continuing audit of patients with diabetes is a feasible and a very useful method of promoting and helping to achieve the management goals of a good quality care.

Taboos Related to Dog Bite in an Urban Area of Kancheepuram District of Tamil Nadu, India

Background: India is known for its diverse social and cultural backgrounds with wide range of myths and misconceptions related to diseases/illnesses. One such belief is certain food taboos and diet restrictions practiced following dog bite, which is widely prevalent. Materials and Methods: This is a community based cross- sectional study conducted among adults population in Anakaputhur area of Kancheepuram district. The sample size was estimated to be 275 based on previous study data and simple random sampling method was used for data collection. Data collected was analysed using SPSS version 16 and results described using descriptive statistics and Chi-square test was used for finding statistical association. Results: About 84.4% of the study participants said that some kind of restrictions should be followed in case of dog bite, among them 68.7% said non vegetarian foods should be avoided. About 81 % of those bitten by dogs followed some form of food restrictions. Nearly 93.6% of those bitten did follow certain restrictions, based on advice of family members/relatives while about 6.4% of the study group followed restrictions based on advice by ‘medical personnel’. Illiterates and those educated up to high school; participants with no history of animal bite in their family, were more at risk of having misconceptions (p<0.05). Pet owners have more misconceptions compared to non pet owners. Conclusion: This study reveals the existence of certain food taboos in case of dog bite among the study population. These practices and taboos are of no use and can be harmful at times. It is important to clear these misconceptions through appropriate health education measures for better health seeking behaviour and management.

Effectiveness of Intensive Interactive Classes and Hands on Practice to Increase Awareness about Sharps Injuries and Splashes among Health Care Workers

Nonika Rajkumari, Purva Mathur, Jacinta Gunjiyal, Mahesh Chandra Misra

Background: Occupational exposure to sharps and splashes pose a major hazard among health care workers (HCWs); so knowledge and awareness regarding sharps/splashes by blood and potentially infectious body fluids (BBF) is a must. Hence, the study was done to assess the extent of knowledge of the staff and using awareness classes and hands on practice as a model to increase awareness as well as prevention. Materials and Methods: This prospective interventional cohort study, using before – after trial, was conducted in a Level I trauma care centre. All cadres of HCWs were enrolled randomly into 5 different groups of 15 each. This study was conducted in 2 phases – interactive classes and hands on practice (Phase I) and questionnaire assessment and work area observation (phase II). This was repeated twice and the final outcome was analysed. A systematic level of grading was used to assess the improvement. Results: It was observed that Group 1 (doctors) and group 2 (nurses) had the maximum knowledge about such exposures and its prevention compared to the other groups (groups 3, 4 and 5) during the initial assessment (Phase I). The remaining groups showed a major improvement after the 2nd assessment, though their knowledge was poor in the beginning. Groups 1and 2 showed 32% and remaining groups showed a 25% improvement in voluntary reporting after the second assessment (Phase II). Conclusion: Awareness classes and hands on practice are indeed useful in generating knowledge about sharps/ splashes. Certain incentives given at right time can improve it further.

The Knowledge of the Physicians about Sepsis Bundles is Suboptimal: A Multicenter Survey

Objectives: Sepsis is a severe condition with possible high mortality outcomes. A multicentre-survey to detect the knowledge of the physicians who are involved in sepsis management in daily work was conducted. Materials and Methods: The study was held in October 2013. A questionnaire consisting of questions about sepsis bundles was prepared. Eight centers from different regions of the country were invited to join the survey. The questionnaires were introduced to physicians from infectious diseases, internal diseases, emergency (ER) and anaesthesiology departments. Results: Two-hundred-and-twenty-three physicians from eight different centers were included. Of total 112 (50%) were male, median age was 30 years (24-59 years). Median working duration of participants was 5 years; 153 (69%) were residents, 70 (31%) were consultants. Of total 131 (59%) declared that they have enough knowledge on sepsis management. About the most important approach in sepsis, 151 (68%) voted for fluid replacement while 59 (26%) and 13 (6%) said early antibiotic use and inotropic support are the most important approaches respectively. Physicians from ER (56.5%) and anaesthesiology departments (55.4%) were more aware of the fluid replacement element of the bundle (30ml/kg, 3-hours bundle) in severe sepsis. The ID physicians, who routinely follow sepsis patients, were not aware of the fluid resuscitation (only 20% replied the element correctly) but almost all of them answered the question on early antibiotic use and blood culture sampling correctly. The knowledge of target CVP and MAP in severe sepsis were also below expectant among ID physicians. The overall knowledge of sepsis bundles of internal medicine physicians was poor. Almost all of the ER physicians knew that they have to measure lactate level upon admission but they were not aware of the threshold of the lactate level. Conclusion: The knowledge of the sepsis bundles of the physicians, who are in charge of sepsis patients in routine work, was suboptimal. Most of the participants were unaware of SSC and new bundles. Training of the physicians of all centers about sepsis bundles is suggested according to these results.

An in vitro Evaluation of Microleakage of Posterior Teeth Restored with Amalgam, Composite and Zirconomer – A Stereomicroscopic Study

Background: Numerous restorative materials are being used in dentistry to achieve adequate strength and restore aesthetics. However, a perfect ideal restorative material has still eluded dentist. Dental amalgam is versatile material with self-sealing property, but is unaesthetic. Other restorative materials like, composites require conservative preparation, but exhibits polymerisation shrinkage resulting in microleakage. To overcome these drawbacks a high strength restorative material reinforced with ceramic and zirconia fillers known as zirconomer has been introduced. The aim of this study was to evaluate the micro-leakage of these three different restorative materials. Materials and Methods: Thirty non-carious human permanent first and second molars were utilized in this study. Class I cavities were prepared on the occlusal surface; cavities were then restored with amalgam, composite and zirconomer as per manufacture’s instruction. All samples were stored for 24 hours in distilled water followed by thermocycling. The entire tooth surface was painted with two coats of varnish to within 1mm of the restoration margins. The teeth were immersed in dye. Teeth were sectioned and observed under stereomicroscope. Result: In this study the zirconomer exhibited the highest micro leakage as compared to composite and amalgam but composite having higher micro leakage as compared to amalgam and lower micro leakage as compared to zirconomer. Conclusion: Even though composite and amalgam are being marketed aggressively and new material like zirconomer are on origin, amalgam still proves to be one of the best materials.

Pigmented Pre-malignant and Malignant Lesions of Skin with Special Reference to Atypical Presentations

Nadia Shirazi, Rashmi Jindal, Sneha Singh, Meena Harsh, Sohaib Ahmad

Background: Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions. Aim: To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings. Materials and Methods: A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated. Results: A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry. Conclusion: All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.

Evaluation of Effect of Cigarette Smoking on Vital Seminal Parameters which Influence Fertility

Introduction: Cigarette smoke contains many compounds which are proven carcinogens having detrimental effect on various organs. The free radicals and other carcinogens have a harmful effect on testicular function which may affect male fertility directly. Aim: Although many studies have been conducted to establish the relationship between cigarette smoking and male infertility, their conclusions have been highly controversial. This evoked our interest to investigate this intriguing research question. Materials and Methods: One hundred and twenty three subjects were included in the present study amongst which 20 were non smokers, 42 with smoking history of less than 5 years and 61 with more than 5 years. Results: Cigarette smoking was found to have a detrimental effect on both the sperm motility and the sperm count, but the effect on sperm motility was greater than that of sperm count. Conclusion: This study throws light on the detrimental effect of cigarette smoking on male fertility as reflected by decreased vital parameters of semen like sperm motility and sperm count.

Emerging Role of Myeloperoxidase in the Prognosis of Nephrotic Syndrome Patients Before and After Steroid Therapy

Background: Myeloperoxidase (MPO) is a myelocyte derived iron containing enzyme particularly involved in host defense by destroying foreign micro organisms invading the body. Numerous evidences suggest that MPO is involved in the pathogenesis of many inflammatory diseases, especially atherosclerosis. Aim: Present study deals with the role of MPO in the renal function and progression of disease in Nephrotic syndrome patients. Study Design and Settings: Case- Control Study carried out in Kasturba Medical College Hospital, Mangalore, India. Materials and Methods: Forty newly diagnosed Nephrotic syndrome cases, 40 age and sex matched healthy controls and 15 subjects in Nephrotic syndrome remission, were included in the study. Myeloperoxidase enzyme was assayed by 4 amino antipyrine methods in all the subjects. Other renal parameters like urea, creatinine, Blood Urea Nitrogen (BUN), BUN- Creatinine ratio (BUN/Cr) total protein, albumin, globulin, albumin – globulin ratio (A/G ratio) and estimated Glomerular Filtration Rate (eGFR) were also analysed. 24 hour urine protein-creatinine ratio was estimated in Nephrotic syndrome cases and remission group by turbidimetric assay. Statistical Analysis: Students paired t-test and Wilcoxon Signed Rank test were used for the comparison of the data. Pearson and Spearman analyses were used for correlation of the parameters. Results: MPO levels were found to be high in Nephrotic syndrome cases when compared to healthy controls. Urea, creatinine, BUN, BUN/Cr ratio and eGFR were high in Nephrotic syndrome cases while total protein, albumin, globulin and A/G ratio showed decreased levels. MPO had a positive correlation with creatinine and urine protein-creatinine ratio in Nephrotic syndrome. During remission, MPO levels decreased significantly while total protein and albumin levels increased. Conclusion: Myeloperoxidase enzyme is found to be elevated and it strongly correlated with the severity of disease in Nephrotic syndrome. Further studies can be done to use MPO as a therapeutic target in Nephrotic syndrome to ameliorate the symptoms.

Cd34 and Mast Cell Analysis in Normal Oral Mucosa and Different Grades of Oral Squamous Cell Carcinoma: A Comparative Study

Background: Oral Squamous Cell Carcinoma (OSCC) remains a serious health problem worldwide. Prognosis of OSCC is poor and long term survival rate still remains below 50%. Angiogenesis or neovascularisation plays an important role in tumour progression and metastasis. Mast cells have been implicated in promoting tumour angiogenesis, especially of digestive tract, little is known in OSCC. Aim & Objective: To study the correlation between blood vessel density (BVD) and mast cell density (MCD) in different grades of OSCC. Materials and Methods: Thirty eight paraffin blocks of different grades of OSCC were retrieved from the department and sections were stained with CD34 followed by counterstaining with toluidine blue. The slides were then analysed using Leica Software (Version 4.5). Results: Mean BVD and MCD were found to be increased in OSCC as compared to normal mucosa. Increase in BVD with co-current increase in MCD was also observed in different grades of OSCC Conclusion: From our study, it was concluded that, mast cells play a major role in promoting tumour angiogenesis. But, as the grade of the tumour increases, other angiogenic factors may play a more significant role than mast cells in tumour progression.

Prevalence of Psychiatric Morbidity Among Undergraduate Students of a Dental College in West Bengal

Background: Stresses of medical course affects the academic performance as well as physical and psychological health of the students negatively. In the present day scenario every one of us has vulnerability to have psychiatric morbidity. Like other young adults, undergraduate dental students are similarly vulnerable to turmoil due to academic and social stresses, which often hamper the educational achievement. Early detection and treatment of psychological morbidities shorten the suffering leading to less social impairment in long term. Aim: The aim of this study was to assess the psychiatric morbidity of dental students and the factors affecting their mental health. Settings and Design: This cross sectional, descriptive and correlation study was conducted in North Bengal Dental College, a rural dental college of West Bengal, India. Materials and Methods: The study sample consisted of a total of 89 dental students. The student enrollment was done by “simple random sampling method”. The semi-structured proforma and the General Health Questionnaire (GHQ)-28 were used to collect data and to assess the psychiatric morbidity. Statistical Analysis: Pearson’s correlation followed by multivariate linear regression analysis was done to assess the effect of academic achievement, positive and negative event on the GHQ total score. Results: The overall mean GHQ total score in the study population was 5.33, with a SD of 4.85 which was above the cutoff (>4) score. Karl Pearson correlation co-efficient r-values for GHQ total score with ‘academic achievement’ and ‘negative events’ score were 0.718 and 0.628 respectively and p-values were 0.001 and 0.001. Conclusion: The poor academic performance and negative events had strong impact on psychological morbidity of dental students. The findings of our study can’t be generalized for all undergraduate dental student due to small sample size and non inclusion of many other variables.

Class II Division 1 in New Dimension: Role of Posterior Transverse Interarch Discrepancy in Class II Division 1 Malocclusion During the Mixed Dentition Period

Introduction: Posterior transverse discrepancy as seen in some cases of Class II Division 1 malocclusion in mixed dentition period can be related to typical skeletofacial characteristics. These features when studied early in the mixed dentition period give a clear view of the desired appropriate treatment plan in a particular case. Aim: The purpose of this study was to establish a simple method to determine the posterior (intermolar) transverse discrepancy and craniofacial skeletal features between the dental arches during the mixed dentition in a sample of Class II Division 1 patients to provide diagnostic and therapeutic guidance in the early approach. Materials and Methods: A sample of 60 Class II Division 1 patients in mixed dention that were divided into 30 Class II Division 1 patients with posterior transverse interarch discrepancy {Class II (I) PTID group} and 30 Class II Division 1 patients without posterior transverse interarch discrepancy {Class II (I) NPTID group}. Thirty Class I subjects in mixed dentition were included as control. Results: The skeletal features of the Class II group without PTID are those of the skeletal Class II associated with ‘anatomic’ mandibular retrusion (due to a micrognathic mandible) and those of the Class II group with PTID as skeletal Class II associated with only a ‘functional’ mandibular retrusion (due to a posteriorly displaced mandible of normal size). Conclusion: This study confirmed the role of occlusion in the control of maxillomandibular skeletal relationships.The treatment strategies could be planned on the basis of the transverse component of Class II Division 1 groups in the mixed dentition period.

Lifestyle in Iranian Patients with Breast Cancer

Robabeh Khalili, Masoumeh Bagheri-Nesami, Ghasem Janbabai, Attieh Nikkhah

Background: One of the most commonly diagnosed cancers is breast cancer that leads to mortality and morbidity among Iranian women. Behavioural risk factors, such as common lifestyle patterns are often associated with risk of breast cancer incidence. Aim: This study aimed to investigate lifestyle of breast cancer patients admitted to Cancer Research Center of Mazandaran University of Medical Sciences. Materials and Methods: This descriptive cross-sectional study was conducted using convenient sampling method. Sample size consisted of 150 cancer patients, and data collection tool included a researcher-made questionnaire on dimensions of lifestyle containing four dimensions of self-care, exercise and physical activity, diet and coping with stress. Maximum score in different dimensions, based on 100% of marks earned, was evaluated in three categories of undesirable, relatively desirable and desirable. Data were analysed with SPSS-19 software using descriptive statistics (relative and absolute frequencies, mean and standard deviation). Results: In total of 150 women, the mean age of patients was 51.9 ± 1.04 (27-78). The majority of participants were married, housewives, with high school education. Among the four parts of healthy lifestyle, desirable level of physical activity and exercise had the least participants, and in the dimensions of physical activity and exercise, the lowest level related to walking, followed by daily exercise. Most of the participants had undesirable level of self-care and lowest frequency related to mammography after 40-year-old, followed by annual check-up and Pap-smear. With regard to nutrition, most of them were at desirable level. Conclusion: The results indicated undesirable levels in two lifestyle dimensions (self-care and physical activity and exercise) in the majority of participants for a year before contracting breast cancer. Primary prevention programs should be implemented with a comprehensive approach, thus, effective strategies are required to modify lifestyle.

Right Dorsolateral Frontal Lobe N-Acetyl Aspartate and Myoinositol Concentration Estimation in Type 2 Diabetes with Magnetic Resonance Spectroscopy

Rajani Santhakumari Nagothu, Yogananda Reddy Indla, Archana R, Ravi Varma

A Comparative Immunohistochemical Analysis of Langerhans Cells in Oral Mucosa, Oral Lichen Planus and Oral Squamous Cell Carcinoma

Background: Langerhans cells (LCs) are immunocompetent cells resident within oral mucosa which, together with intraepithelial lymphocytes, play a role in mucosal defence. LCs play a role in the pathogenesis of Oral lichen planus (OLP), a chronic mucocutaneous disorder thought to result from cell-mediated immune damage. In oral squamous cell carcinoma (OSCC), LCs are thought to present tumour antigens to the lymphocytes. Aim: To assess and compare LCs immuno-histochemically in normal mucosa, oral lichen planus and oral squamous cell carcinoma using anti S100 antibody and to know whether LCs play any role in local immune response to these diseases. Materials and Methods: The study was carried out in 65 cases (study group), 30 oral lichen planus and 35 oral squamous cell carcinoma (15 well differentiated, 14 moderately differentiated and 6 poorly differentiated), that were randomly selected from the archives of department of oral pathology and along with control group consisting of 30 normal healthy mucosa. The tissue sections were stained immunohisto-chemically by using anti S100 antibody in each group for detection of LCs. Results: There was significant change in mean value of number of LCs in the study groups i.e. OLP and OSCC when compared to that of control group. The results of our study also revealed that there was decrease in the mean value of langerhans cells as the tumour progressed from well differentiated squamous cell carcinoma to poorly differentiated LCs carcinoma. Conclusion: A better understanding and clarity of LCs is pivotal for designing novel or improved therapeutic approaches that will allow proper functioning of LC’s in patients with OLP and OSCC, thus significantly reducing the morbidity of OLP and OSCC patients.

Analysis of Information, Impact and Control of HIV amongst Dental Professionals of Central India

Jatin Agarwal, Rolly Shrivastava Agarwal, Asha Shrivastava, Sudha Shrivastava

Background: Dental health care providers may be exposed to a variety of microorganisms via blood, oral or respiratory secretions. Though the risk of transmission of Human Immunodeficiency Virus (HIV) in dental settings is low, the consequences of being infected are life threatening. Therefore, high standards in infection control and waste management are required in controlling occupational contagion and cross infection. Aim: To obtain comprehensive information about the HIV related information, its impact on the health care provider’s attitude towards treating patients living with HIV/AIDS (PLWHA), infection control & waste disposal practices among dental professionals of Malwa region of Madhya Pradesh; situated in Central India. Materials and Methods: A cross-sectional survey was conducted among 320 private dental practitioners. Data was collected using a pretested, self administered 40 item questionnaire and statistically analysed. Results: The response rate was 81.25%. Over all 50.76% dentists were graded as having good knowledge of HIV. Unfortunately, their willingness to treat these patients remained low. In all 39.23% dentist were willing to render care to PLWHA. Junior dentists expressed less hesitation with regard to acceptance of risk patients than other dentists. Over 65% of the respondents reported adherence to universal precautions. The most alarming observation was that dentists were not following safe waste management practices. Conclusion: Dental professionals continue to indicate a reluctance to treat patients with HIV/AIDS or those in high- risk groups. The results suggest need to have a comprehensive motivational program and implementing ways to ensure access and availability of safe dental care for PLWHA. The desire to get training on how to handle PLWHA illustrates that receptiveness to change exists.

Comparative Evaluation of Antimicrobial Efficacy of Resin–Modified Glass Ionomers, Compomers and Giomers – An Invitro Study

P.Tarasingh, J.Sharada Reddy, K.Suhasini, I.Hemachandrika

Background: Dental restorative materials, especially those applied in direct contact with the contaminated substrate, should have appropriate antibacterial activity in order to prevent residual bacteria from continuing their metabolic activity in addition to impairing new bacteria from reaching the tooth-restoration interface. Aim: To determine the antibacterial efficacy of three different restorative materials against the common cariogenic microorganism i.e., Streptococcus mutans. Materials and Methods: Three different restorative materials were evaluated in this study: Giomer (Beautifil), Compomer (F2000) & Resin modified Glass ionomer (Fuji II LC) for their anti microbial efficacy against Streptococcus mutans by standard agar diffusion method and zones of inhibition for each restorative material were calculated. Statistical Analysis: Inhibition zones around each restorative material were measured and values were subjected to one-way ANOVA with least square difference (LSD) Post-hoc test. Results: The mean inhibitory zones for Resin modified glass ionomers, Giomers & Compomers ranged from 10.1 – 6.90mm. Fuji II LC exhibited the highest mean inhibitory zone of 10.1 ± 1.97 for S.mutans. Beautifil exhibited mean inhibitory zone of 8.20 ± 1.62, whereas F2000 showed the least mean inhibitory zone of 6.90 ± 1.29. Conclusion: Based on the inhibitory zones of three restorative materials, Fuji II LC is recommended as the best restorative material among the three tested restorative materials.

Prevalence of Oral Trichomonas tenax in Periodontal Lesions of Down Syndrome in Tabriz, Iran

AtabakKashefi Mehr, Ali Zarandi, keivan Anush

Background: It was presented that Trichomonas tenax is one of the parasites which is responsible for oral infection. This study was considered to estimate the prevalence of this parasite in oral cavity of Down syndrome patients with periodontal lesions and in healthy population from welfare organization in Tabriz, Iran. Materials and Methods: In the case-control study, 52 patients with periodontal disease (case group) and 52 individuals with healthy gingiva (control group) selected for the study. Examination was done by dental mirror and periodontal probe. After using plaque detector tablets, sampling was done by entering sterile paper into periodontal pocket for 20 seconds. The amount of plaque was measured by plaque index. Finally samples sent to laboratory for prepared PCR reaction. Results: In the case group, 14 patients were infected and in the control group 5 individuals. Percentage of infection in case group was 18.8% and in the control group was 3% that difference was statically significant. Plaque index in the case group was 72 ± 10.2 and in the control group was 68 ± 11.4 and difference between two groups was not significant. Conclusion: Parasitic infections in Down syndrome were higher than healthy children while plaque index was not significantly different between the two groups. Therefore follow-up of orders are necessary in control of parasitic infection in Down syndrome that have intrinsic defect of immune systems.

Alcohol and Drug Use in Injured Drivers – An Emergency Room Study in a Regional Tertiary Care Centre of North West India

Senthil Kumar, Yogender singh bansal, Dalbir Singh, Bikash Medhi

Introduction: Chronic hyperglycaemia in type 2 diabetes, effects the central nervous system by altering the concentrations of brain metabolites like N-acetyl aspartate (NAA) and myoinositol (mI), which are indicators of neuronal integrity and glial cell damage respectively. Dorsolateral frontal lobe is associated with aspects of cognition especially right frontal lobe is involved in episodic memory retrieval, ninety percent of the diabetic cases are type 2 in nature globally and yoga is very effective in stabilizing the brain metabolites by bringing the blood glucose levels to near or within the physiological range in type 2 diabetes. Aim and Objectives: The aim of the study was to observe the effects of yogasana and pranayama on glycosilated haemoglobin (HbA1c) levels and right dorsolateral frontal cortical NAA and mI concentration in type 2 diabetic subjects. Materials and Methods: It’s a case control study. Sixty eight type 2 diabetic subjects of both the sex, aged between 35-65 years are included in the study, subjects are divided in to test and control group 34 each. Test group subjects did the yogasana and pranayama for a period of 6 months, 6 days in a week, 45-60 minutes daily under the supervision of a qualified yoga teacher. Control group subjects are not on any specific exercise regimen. Both the group subjects are taking oral hypoglycaemic agents. HbA1c levels are measured using the Bio-Rad D-10™ haemoglobin A1c program and Magnetic Resonance Spectroscopy (MRS) is used in assessing the metabolite concentrations. Statistical analysis: Analysis of data was done by using unpaired t-test. P-value for HbA1c level is <0.001, which is highly significant statistically. P-value for NAA was < 0.02 and for myoinositol was < 0.01, which are statistically significant. Results : HbA1c levels in control and test group subjects are 7.7 ± 1.84 and 6.02 ± 0.46 respectively. NAA concentrations in the right dorsolateral frontal lobe of control and test group are 1.44 ± 0.15 and 1.54 ± 0.19 respectively. The mI concentrations in the right dorsolateral frontal lobe of control and test group are 0.61 ± 0.22 and 0.47 ± 0.24 respectively. Conclusion: Yogasana and pranayama minimized the neuronal and glial cellular damage in test group, which is evident by minimal changes in right dorsolateral frontal lobe NAA and mI levels in type 2 diabetic subjects.

A Study on Atherogenic Indices of Pregnancy Induced Hypertension Patients as Compared to Normal Pregnant Women

Meenakshi Singh, Mauchumi Saikia Pathak, Anindita Paul

Introduction: Pregnancy induced hypertension (PIH) includes Gestational hypertension, Pre-eclampsia and Eclampsia and is one of the most common obstetric complication. Worldwide about 76,000 pregnant women die each year from pre-eclampsia and related hypertensive disorders. The aetiology of Pre-eclampsia is unknown but it is thought to be related to abnormal development of placenta. Several studies have shown the presence of reduced endothelial function in pre-eclamptic pregnancy. Endothelial dysfunction is also a feature of atherosclerosis. Aim: To assess fasting lipid profile and atherogenic indices in women diagnosed with pre-eclampsia as well as in women with normal pregnancy and to correlate the findings of pre-eclamptic women with that of normal pregnant women, in an attempt to utilize the data for the development of a new clinical approach for early recognition and prevention of risk of future cardiovascular diseases in women with PIH. Materials and Methods: This case-control study was conducted on 50 pre-eclampsia patients who were in third trimester of pregnancy (Case group). A control group of 50 age and gestational age matched normal pregnant women was taken. Strict inclusion and exclusion criteria were followed. Fasting Lipid profile parameters were assessed and used to calculate the atherogenic indices namely Atherogenic index of plasma (AIP), Cardiac risk ratio (CRR) and Atherogenic coefficient (AC). Statistical Analysis was done by using student’s t-test. Mann-Whitney U-test was used wherever applicable and correlations between the variables were estimated by Pearson’s correlation coefficients. Results: There was an extremely significant (p<0.0001) increase in Atherogenic indices (AIP, CRR and AC) in case group as compared to the control group. A positive and significant correlation of systolic blood pressure with AIP (r=0.3583), CRR (r=0.3137), AC (r=0.3193) was found in cases. There was a positive and significant correlation between gestational age and atherogenic indices in the case group. Conclusion: Women with pre-eclampsia present abnormalities in lipid profile and these lipids turn out to be a risk factor for cardiovascular complications. Evaluation of the atherogenic indices during pregnancy may help prevent this risk.

Is Endoscopy Really Necessary in My Case? A Four Year Retrospective Study

HN Dinesh, CD Jagadish Kumar, HM Sanjay, V Sachin, Basavaraju

Introduction: About 40% of the general population report dyspepsia at some time in their life making it a fairly common disease. Uncomplicated dyspepsia refers to patients whose dyspepsia is not accompanied by alarm features or associated with NSAIDS usage. Aim: To assess the need for UGI Endoscopy and find out the patterns of different endoscopic presentations in patients presenting with uncomplicated dyspepsia. Materials and Methods: Our study conducted in KR Hospital, Mysore, Department of General Surgery is a retrospective endoscopic study of 1450 patients with uncomplicated dysepsia. Results: A significant 64% of the patients presenting with uncomplicated dyspepsia were found to have findings on endoscopy. The most common age range for positive endoscopic findings was 40-50 years in our hospital. Malignancy was diagnosed in 2.5% patients. Conclusion: We recommend upper GI endoscopy in patients presenting with uncomplicated dyspepsia for patients above 40 years of age in our hospital.

Structure of Clavicle In Relation to Weight Transmission

Vipra Maulikkumar Shah, Rohini V. Routatal

Aims and Objectives: It is a known fact that weight of upper limb is transmitted to the axial skeleton through clavicle. The present study is an attempt to correlate pattern of compact and trabecular bone of clavicle as a weight transmitting bone. Materials and Methods: Sixty clavicles were studied from right and left sides of 30 cadavers donated to the Anatomy department, Pramukhswami Medical College, Karamsad, India. The study was focused on the thickness of compact bone of clavicle and trabecular pattern of this bone. Results: Cancellous bone: Cancellous bone near both ends of clavicle presented meshwork of thin bony plates. Between the conoid tubercle and area for attachment of costo-clavicular ligament, cancellous bone showed a definite pattern. Thickness of compact bone: The compact bone was thicker between conoid tubercle and area for attachment of costo-clavicular ligament. At midshaft point thickness of compact bone was maximum. Conclusion: The structure of clavicle between conoid tubercle and area for costoclavicular ligament showed thick compact bone and definite pattern of cancellous bone. This structure of clavicle between conoid tubercle and area for attachment of costo-clavicular ligament transmits weight from lateral to medial direction and this knowledge of clavicular structure will also be useful to orthopedic surgeons to deal with clavicular fractures and other abnormalities.

Serum Ferritin as A Marker for Preterm Premature Rupture of Membranes –A Study From A Tertiary Centre in Central Kerala

Background: Preterm birth is the leading cause of newborn deaths and also the leading cause of death in children under 5 years of age. There is wide spread suspicion that subclinical infection is a common accompaniment and cause of preterm labour. Ferritin is an acute phase reactant and it increases during inflammation.This study aims to determine whether serum ferritin levels which may be raised in the setting of any infective process could be used as a marker of spontaneous preterm labour or PPROM (Preterm premature rupture of membranes). Aim: To determine whether serum ferritin levels, which may be raised in the setting of any infective process, could be used as a marker of spontaneous preterm labour or PPROM. Study Setting: Department of Obstetrics and Department of Biochemistry. Study design: Descriptive comparative design. Materials and Methods: The study involved 3 groups. 50 patients of PPROM, 50 patients of spontaneous preterm labour and 50 pregnant women matching with haemoglobin and same gestational age Serum ferritin were analysed in all the 3 groups. Statistical analysis: Significance of difference in the means of serum ferritin levels between the pregnant women (preterm) in the 3 groups were found out using ANOVA and also using a post hoc test (Tukey test). A p-value of < 0.05 was considered significant. Results: There was a significant increase in serum ferritin in PPROM cases as compared to the control group. But no significant increase in spontaneous preterm labour cases as compared to the control group. Conclusion: Serum ferittin can be used as a marker of PPROM but cannot be used as a marker for spontaneous preterm labour. A cut off value of 35.5 mg/l of serum ferritin may be used for predicting PPROM cases.

Cardiorespiratory Fitness of University Volleyball Players and Sedentary Young People in Marathwada Region of Maharashtra Province in India

Afshan Kausar, Syed Mudassir, Khaled Mohsin Badaam, A.N. Shete, Shoeb Khan

Background: Volleyball is considered a physically demanding athletic sport; characterized by rapid acceleration, deceleration, and sudden changes of direction. It has been highlighted that aerobic capacity (VO2 max) which indicates cardiorespiratory fitness has a significant effect on the performance of athletes and is an important element of success in sports. Aim and Objective: The objective of this study was to compare aerobic capacity of university volleyball players from the region with that of matched sedentary controls. The secondary objective was to compare the findings with the aerobic capacity data reported in literature for the volleyball players and sedentary population. Materials and Methods: Sample size was calculated for detecting a large effect size (Cohen’s d = 0.8) with a as 0.05 and power of study as 80% for two tailed hypothesis testing. By using Queen’s college step test, VO2 max was measured in 30 male volleyball players in the age group of 20 to25 years and was compared with 30 age and socio-economic status matched controls with sedentary lifestyle. Results: The mean predicted VO2 max was 52.99 ± 5.13 ml/kg/min in volleyball players and 37.01 ± 3.94 ml/kg/min in controls. The difference in mean values of VO2 max (ml/kg/min) in volleyball players and controls was statistically highly significant with p-value less than 0.001. Conclusion: The volleyball players showed a superior aerobic capacity compared with age and socio-economic status matched controls with sedentary lifestyle.

Chromosomal Abnormalities in Infertile Men from Southern India

Background and Objective: Male infertility has been associated with aneuploidies and structural chromosomal abnormalities, Yq microdeletions and specific gene mutations and/or polymorphisms. Besides genetic factors, any block in sperm delivery, endocrine disorders, testicular tumours, infectious diseases, medications, lifestyle factors and environmental toxins can also play a causative role. This study aimed to determine the constitutional karyotype in infertile males having normal female partners in a south Indian population. Materials and Methods: A total of 180 men with a complaint of primary infertility ranging from 1 to 25 years were screened for chromosomal abnormalities through conventional analysis of GTG-banded metaphases from cultured lymphocytes. Results: Four individuals were diagnosed to have Klinefelter syndrome. Two cases exhibited reciprocal translocations and one showed a maternally inherited insertion. Polymorphisms were seen in sixty-seven patients (37.2%). Conclusion: The occurrence of chromosomal abnormalities in 4.6% and variants involving the heterochromatic regions of Y, chromosome 9 and the acrocentric chromosomes in 38.2% of the infertile men with an abnormal seminogram strongly reiterates the inclusion of routine cytogenetic testing and counselling in the diagnostic work-up prior to the use of assisted reproduction technologies.

Chronic Liver Diseases in Children: Clinical Profile and Histology

Sachin Devidas Dhole, Archana S. Kher, Radha G. Ghildiyal, Manjusha P. Tambse

Aim: The main aim of the study is to study the clinical profile of disorders of the liver and hepatobiliary system in paediatric patients and to correlate the histopathology findings of liver biopsy in chronic liver disease. Another aim being to assess the prognosis and to know the outcome and the effects of treatment in chronic liver diseases in paediatric age group. Materials and Methods: It was a prospective study, included the clinical profile of Chronic Liver Diseases (CLD) in children and the histopathological correlation. A total of 55 children were thoroughly investigated by doing relevant investigations and liver biopsy. Observations and Results: A male predominance (60%) was noted with maximum incidence in the age group of 6-12 years. The incidence of CLD was 1.1% of total admissions. The most common presenting complaint was jaundice and abdominal distension. Hepatic encephalopathy was noted in 29% patients. Hepatomegaly was seen in 63% patients and spleenomegaly was seen in 60% patients. The incidence of cirrhosis on liver biopsy was 42% (23cases) in CLD patients. The most common diagnosis on histopathology was Wilson’s disease (22%), followed by hepatitis and autoimmune hepatitis. The predominant spectrum of CLD was metabolic liver disease and also the predominant cause of death. Conclusion: As the incidence of CLD is quite low, a very high index of suspicion is required for its diagnosis. Some uncommon causes of CLD in children were seen in our study like neutral lipid storage disease, a1-Antitrypsin deficiency disease, lupus hepatitis, Alagille syndrome and Budd-Chiari syndrome. A patient of CLD with jaundice and hepatomegaly should be treated aggressively as those are the poor prognostic indicators of the disease. Hepatic encephalopathy and cirrhosis are also associated with poor outcome in patients with CLD. Liver biopsy histopathology by an expert and its correlation with laboratory investigations plays an important role in the diagnosis of CLD. The major cause of deaths in patients with CLD is due to end stage liver disease and fulminant hepatic failure and the only way to prevent and treat these patients is by liver transplantation.

Effect of Saliva on the Tensile Bond Strength of Different Generation Adhesive Systems: An In-Vitro Study

Nimisha Gupta, Abhay Mani Tripathi, Sonali Saha, Kavita Dhinsa, Aarti Garg

Background: Newer development of bonding agents have gained a better understanding of factors affecting adhesion of interface between composite and dentin surface to improve longevity of restorations. Objective: The present study evaluated the influence of salivary contamination on the tensile bond strength of different generation adhesive systems (two-step etch-and-rinse, two-step self-etch and one-step self-etch) during different bonding stages to dentin where isolation is not maintained. Materials and Methods: Superficial dentin surfaces of 90 extracted human molars were randomly divided into three study Groups (Group A: Two-step etch-and-rinse adhesive system; Group B: Two-step self-etch adhesive system and Group C: One-step self-etch adhesive system) according to the different generation of adhesives used. According to treatment conditions in different bonding steps, each Group was further divided into three Subgroups containing ten teeth in each. After adhesive application, resin composite blocks were built on dentin and light cured subsequently. The teeth were then stored in water for 24 hours before sending for testing of tensile bond strength by Universal Testing Machine. The collected data were then statistically analysed using one-way ANOVA and Tukey HSD test. Results: One-step self-etch adhesive system revealed maximum mean tensile bond strength followed in descending order by Two-step self-etch adhesive system and Two-step etch-and-rinse adhesive system both in uncontaminated and saliva contaminated conditions respectively. Conclusion: Unlike One-step self-etch adhesive system, saliva contamination could reduce tensile bond strength of the two-step self-etch and two-step etch-and-rinse adhesive system. Furthermore, the step of bonding procedures and the type of adhesive seems to be effective on the bond strength of adhesives contaminated with saliva.

Comparison Between Dexmedetomidine and Propofol with Validation of Bispectral Index For Sedation in Mechanically Ventilated Intensive Care Patients

Background and Aim: Sedation plays a pivotal role in the care of the critically ill patient. It is equally important to assess depth of sedation. The present study had been designed to compare dexmedetomidine and propofol for sedation in mechanically ventilated intensive care patients. It also intended to verify the clinical validity, reliability and applicability of objective assessment tool bispectral index (BIS) for monitoring sedation and observe for correlation with the commonly used subjective scale, Ramsay sedation score (RSS). Materials and Methods: This prospective randomized study was carried out in 60 haemodynamically stable patients, aged between 18 to 80 years, requiring sedation and mechanical ventilation. These were divided equally into two groups. Group A received dexmedetomidine loading dose (1µg/kg) over 10 min followed by maintenance infusion of 0.5µg/kg/hr (0.2-0.7 µg/kg/hr). Group B received propofol loading dose (1mg/kg) over 5 min followed by infusion of 2mg/kg/hr (1-3mg/kg/hr). All patients received fentanyl 1 µg/kg prior to the study drugs. Vital parameters and sedation levels (using RSS and BIS) were monitored for the study period of 12 hours with level 4 or 5 of RSS as target for sedation. Ramsay score was compared with the average of BIS values. Statistical analysis was done using SPSS VERSION 17 software. Results: The study revealed statistically significant lower heart rates during sedation in dexmedetomidine group whereas fall in mean arterial pressure (MAP) following loading dose in propofol group. Patients sedated with dexmedetomidine were easily arousable. Need for rescue drug for achieving the desired RSS as well as incidence of bradycardia was more in dexmedetomidine group than other. Good correlation exists between Ramsay score and BIS values. Conclusion: Dexmedetomidine reduces heart rate while propofol transiently affects MAP. However, adequate sedation is achieved with both the drugs. The data obtained from the study validate BIS monitoring for ICU sedation.

Significance of Diagnosing Parasitic Infestation in Evaluation of Unexplained Eosinophilia

Vinay Khanna, Kriti Tilak, Chiranjay Mukhopadhyay, Ruchee Khanna

Background: The evaluation of unexplained eosinophilia in an asymptomatic individual has always been a diagnostic challenge and requires understanding about a wide range of probable causative agents. Helminthic infestation and schistosomiasis are the main parasitic causes of eosinophilia. Therefore, the availability of simple and accurate diagnostic tests for detection of parasitic infections can prove to be valuable in early diagnosis and solving the mystery of unexplained eosinophilia. Materials and Methods: In the present study we attempt to find an association between relative eosinophilia and parasitic infections and also to find the parasites responsible for eosinophilia in a substantial number of cases. A retrospective study for the presence of eosinophilia was done on 621 cases positive for parasitic infestation. Results: Among a total of 621 cases of parasitic infestation only 66 (10.6%) cases were found to have relative eosinophilia. The parasites found to be responsible for eosinophilia were Trichuris trichiura, Ascaris lumbricoides, Strongyloides stercoralis, filarial worm and hook worm. Conclusion: From the study it is concluded that eosinophilia is not a universal finding in cases with parasitic infestation. Although presence of eosinophilia can serve as one of the many diagnostic clues to look for the presence of helminthic infestation if other non-infectious causes of eosinophilia are ruled out.

Diagnostic Accuracy on Magnetic Resonance Imaging for the Diagnosis of Osteoarthritis of the Temporomandibular Joint

Shinya Yura, Saori Harada, Kazuhiko Kobayashi

Objectives: Osteoarthritis, which is also called degenerative arthritis or degenerative joint disease, is primarily a disease that results from the breakdown and loss of cartilage in joints. The purpose of this study was to investigate the diagnostic accuracy of magnetic resonance images for the diagnosis of osteoarthritis of the temporomandibular joint. Materials and Methods: Fifty patients (50 joints) with closed locking of the temporomandibular joint were examined with magnetic resonance imaging and then underwent arthroscopic surgery. The agreement of osteoarthritis between magnetic resonance images and arthroscopic findings was studied using the ? coefficient. Results: The incidence of osteoarthritis on magnetic resonance images (38%) was significantly lower than that in arthroscopic findings (78%). There was no significant agreement between these two findings (p=.108). The ? coefficient was 0.154. Conclusion: The diagnostic accuracy of magnetic resonance images for osteoarthritis of the temporomandibular joint was low; early osteoarthritis could not be diagnosed from magnetic resonance images. Clinicians should understand that the diagnostic accuracy of osteoarthritis without arthroscopy is not always high.

Pattern of Antibiotic Resistance Among Community Derived Isolates of Enterobacteriaceae Using Urine Sample: A Study From Northern India

Background: Despite world-wide evidence of increased antibiotic resistance, there is scarce data on antibiotic resistance in community settings. One of the reason being difficulty in collection of biological specimen (traditionally stool) in community from apparently healthy individuals. Hence, finding an alternative specimen that is easier to obtain in a community setting or in large scale surveys for the purpose, is crucial. We conducted this study to explore the feasibility of using urine samples for deriving community based estimates of antibiotic resistance and to estimate the magnitude of resistance among urinary isolates of Escherichia coli and Klebsiella pneumonia against multiple antibiotics in apparently healthy individuals residing in a rural community of Haryana, North India. Materials and Methods: Eligible individuals were apparently healthy, aged 18 years or older. Using the health management information system (HMIS) of Ballabgarh Health Demographic Surveillance System (HDSS), sampling frame was prepared. Potential individuals were identified using simple random sampling. Random urine sample was collected in a sterile container and transported to laboratory under ambient condition. Species identification and antibiotic susceptibility testing for Enterobacteriaceae was done using Clinical Laboratory and Standards Institute (CLSI) 2012 guidelines. Multi-drug resistant (MDR) Enterobacteriaceae, Extended Spectrum Beta Lactamase (ESBL) producing Enterobacteriaceae, and Carbapenem producing Enterobacteriaceae (CRE) were identified from the urine samples. Results: A total of 433 individuals participated in the study (non-response rate – 13.4%), out of which 58 (13.4%) were positive for Enterobacteriaceae, 8.1% for E. coli and 5.3% for K. pneumoniae. Resistance against penicillin (amoxicillin/ampicillin) for E. coli and K. pneumoniae was 62.8% and 100.0% respectively. Isolates resistant to co-trimoxazole were 5.7% and 0.0% respectively. None of the isolates were resistant to imipenem, and meropenem. Conclusion and recommendations: It is feasible to use urine sample to study magnitude of antibiotic resistance in population based surveys. At community level, resistance to amoxicillin was considerable, negligible for co-trimoxazole, and to higher antibiotics including carbapenems.

The Effect of Increased Temperatures of QMix and EDTA on the Push-out Bond Strength of an Epoxy-resin Based Sealer

Emel Uzunoglu, Sevinc Aktemur Turker, Sevilay Karahan

Background: Bond strength of root canal sealers is mainly influenced by the surface tension of the root canal wall. Heat, or the use of a surfactant might reduce surface tension and it is known that surface tension of an EDTA solution significantly affected from temperature rise. QMix is a novel endodontic irrigant for smear layer removal containing EDTA, chlorhexidine and a detergent. There is no data regarding the influence of the temperature of the EDTA and QMix on the push-out bond strength of root canal sealers. Aim: To evaluate effect of temperatures of QMix and EDTA on the bond-strength of AH Plus. Materials and Methods: Sixty premolars were prepared with ProTaper F4. During preparation 3% NaOCl was performed. Specimens were divided into 4 groups as follows: 5-mL 17% EDTA at 22°C and 37°C; 5-mL QMix at 22°C and 37°C. Three specimens from each group were prepared for observation using SEM. Remaining roots were obturated and prepared for a push-out test. Data was analysed using Anova and Bonferroni tests (p<0.05). Results: Samples irrigated with QMix had higher push-out bond strength values than those irrigated with EDTA (p=0.01), regardless of temperature. Samples irrigated with 37°C EDTA resulted in higher bond-strength values than those irrigated with 22°C EDTA (p<0.001). Conclusion: Temperature of the final irrigant does affect the bond strength values of AH plus to root dentin irrigated with EDTA. Bond strength of AH Plus sealer to root canal dentin may improve with QMix.

A Study of Eclampsia Cases Associated with Posterior Reversible Encephalopathy Syndrome

Shobha Bembalgi, Vishal Kamate, K.R. Shruthi

Objectives: Incidence of eclampsia is 1 in 2000 to 3250 deliveries in developed countries and 1 to 5% in India. Posterior reversible encephalopathy syndrome (PRES) is a constellation of symptoms caused by reversible ischaemia mostly of the posterior cerebral vasculature. PRES has been associated with preeclampsia-eclampsia and acute renal injury. We present a study of patients in whom eclampsia was complicated with PRES. Our aim was to study the clinico-radiological profile, associated complications and outcome of patients who had eclampsia with PRES. Materials and Methods: A retrospective study was done of all pregnancies diagnosed as eclampsia with PRES syndrome over a four year period from August 2010 to July 2014 managed at Karnataka institute of medical sciences, Hubli, India. Results: Eleven patients had eclampsia with PRES syndrome of the 36,094 patients delivered in the institution over the study period. Nine of these were primigravidas, 8 were of 20-25 years age group, 10 presented with multiple seizure episodes. In eight patients seizures were controlled only with MgSo4. Perinatal mortality was seen in three patients. There were no maternal deaths in these cases. Conclusion: Incidence of eclampsia with PRES syndrome was 0.03% amongst the patients delivered in Karnataka institute of medical sciences. The incidence of PRES was more amongst cases of postpartum eclampsias as compared to antepartum eclampsias. PRES was more common in primigravidas and younger age group (20 to 25 years). Signs of imminent eclampsia like headache, epigastric pain and blurring vision were uncommon in these patients. In the majority of the patients seizures were controlled with MgSo4 alone. Prognosis of eclamptic patients with PRES was favourable.

The Effect of Fenestration of Lamina Terminalis on the Vasospasm and Shunt-Dependent Hydrocephalus in Patients Following Subarachnoid Haemorrhage

Background and Aims: SAH (Sub Arachnoid Haemorrhage) is a life threatening that is associated with complications such as vasospasm and shunt-dependent hydrocephalus. The purpose of this study was to assess the effect of FLT (Fenestration of Lamina Terminalis) on the incidence of vasospasm and shunt-dependent hydrocephalus in ACoA (Anterior Communicating Artery) aneurismal in SAH. Materials and Methods: The data of 50 ruptured ACoA aneurism patients were selected during the year 2001-2009 admitted to Imam Hussein hospital, Tehran, IR. In a randomized double-blind trial patients assigned in two group {with fenestration (FLT, n=25), without fenestration (No FLT, n=25)}. All patients underwent craniotomy by a single neurosurgeon. Patient’s age, sex, Hunt-Hess grade, Fisher grade, vasospasm, presence of hydrocephalus and incidences of shunt-dependent hydrocephalus were compared between groups. Results: There were no significant differences among groups in relation to demographic characteristics, neurological scale scores (Hunt-Hess grade) and the severity of the SAH (Fisher grade) (p>0.05). The rate of hydrocephalus on admission, were 24% and 16% in FLT and no FLT group respectively (p>0.05). The shunt placement postoperatively in FLT and no FLT group were 16% and 12% respectively (p>0.05). The clinical vasospasm was 20% and 24% in FLT and no FLT group respectively (p>0.05). Conclusion: Despite FLT can be a safe method there were not significant differences of FLT on the incidence of vasospasm and shunt-dependent hydrocephalus. A systematic evaluation with multisurgeon, multicentre and with greater sample size to disclose reality is suggested.

Prevalence and Clinical Characteristics of Primary Epstein–Barr Virus Infection Among Children Presented with Cervical Lymphadenopathy

Jalal Ali Bilal

Introduction: Epstein-Barr virus is a known cause of childhood cervical lymphadenopathy. In practice this infection is not sought as a cause in low-resources settings. The virus among children with cervical lymphadenopathy was not studied before in this country. The aims of this study were to estimate the prevalence of primary EBV infection and to describe clinical characteristics of children presenting with cervical lymphadenopathy. Materials and Methods: A cross-sectional study was conducted among children presented with cervical lymphadenopathy to Khartoum Children Emergency Hospital during the period from February 2009 to January 2010. Eighty-two children were randomly selected. Demographic and clinical data were recorded. Routine laboratory values were determined and children’s sera were analysed for anti- viral capsid antigens IgM Epstein–Barr virus ELISA tests. Mean and SD were calculated. Regression analysis was to identify association between demographic, clinical and laboratory variables and IgM seropositivity of EBV. Results: Epstein-Barr virus infection was diagnosed in 13 (15.9%) children with cervical adenopathy (n=82). The average age of these children was 7.5 (SD±3.3) years. The male to female ratio was 1.6. The most frequent symptoms were fever, loss of appetite and cough. The anterior cervical group of lymph nodes was most commonly implicated. All affected patients had mobile lymph nodes and the majority, 12 (92.3%), of patient had firm nodes. The lymph node number ranged from 2-6 nodes; with a mean of 3.5 nodes and average size of 3.6 cm. Splenomegaly and pharyngo-tonsillitis were found in 30.8% and 23.1% of patients respectively and leukocytosis was noted in 3 (23.1%). The odds of IgM seropositivity decreased with age = 9 years (OR 0.15, 95% CI 0.03-0.78, p=0.023). Conclusion: EBV infection is not an uncommon cause of childhood cervical lymphadenopathy. The commonest symptoms are fever, loss of appetite and cough. Anterior cervical nodes are the most affected. Younger children (age = 9 years) are less likely to be sero-positive.

A Successful Strategy for Surgical Treatment of Boerhaave’s Syndrome Sans Thoracotomy

Boerhaave’s syndrome is a rare life threatening condition that is often misdiagnosed and fatal if not treated promptly. While the gold standard is early surgical intervention, recent studies have showed success with conservative management. We report a case of Boerhaave’s syndrome that was managed conservatively by decompressive gastrostomy, feeding jejunostomy, bilateral intercostal drainage tubes with added proximal diverting cervical esophagostomy. The patient recovered completely and stoma closure was done two months later.

“Rare or Underdiagnosed?” - Solitary Circumscribed Neuroma of the Lip

Veerendranath Reddy Panthula

Solitary circumscribed neuroma, also known as palisaded encapsulated neuroma is a benign neural tissue tumour. This is usually an asymptomatic and often misdiagnosed pathology in the head and neck region. Lip lesions have a broad differential diagnosis. Clinician’s awareness and accurate diagnosis are vital for their appropriate management. Here, we present a case report of solitary circumscribed neuroma of the lip, with a one year follow-up.

Blue Rubber Bleb Nevus Syndrome in a Child

Sahana M Srinivas, R. Premalatha

Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder with multiple haemangiomas in the skin, gastrointestinal tract and other visceral organs often associated with fatal bleeding and anaemia. We report a 13-year-old female child with multiple haemangiomas on skin and gastrointestinal tract with refractory anaemia. Awareness of this entity is necessary to prevent complications.

Two Common Trunks Arising From Arch of Aorta: Case Report and Literature Review of A Very Rare Variation

C.S. Ramesh Babu, Vinay Sharma

Arch of aorta normally gives off three branches, the brachiocephalic trunk, left common carotid artery and left subclavian artery. Due to its complex development, variations in the branching pattern are not infrequent and since many such variants remain asymptomatic, they are detected incidentally at diagnostic imaging, autopsy and surgery. The classical branching pattern is reported to be present in 63.5%–89.4% cases and the most common variant observed is the presence of common trunk of brachiocephalic and left common carotid arteries. Direct aortic arch origin of left vertebral artery is the second most common pattern observed. We report here an extremely rare branching pattern of two common trunks arising from the arch, the first common trunk of brachiocephalic and left common carotid arteries and the second designated as vertebro-subclavian trunk, the common trunk of origin of left subclavian and left vertebral arteries. To the best of our knowledge this is the second such case to be reported.

Ameloblastic Carcinoma: A Case Report

Mallika Kishore, Sunil R Panat, Ashish Aggarwal, Nitin Upadhyay, Nupur Agarwal

Ameloblastic carcinoma is a rare malignant lesion with characteristic histologic features and behavior that dictates more aggressive surgical approach than that of a simple ameloblastoma. Here we present a case of ameloblastic carcinoma of the mandible in a 30-year-old male patient with a clinical course of typical aggressiveness and extensive local destruction.

Cervicofacial Actinomycosis Mimicking Osseous Neoplasm: A Rare Case

Actinomycosis is a rare chronic infectious disease caused primarily by Actinomyces israelli. Although they are normal inhabitants of the oral cavity, infection occurs when there is a breach in the mucosa allowing them access to the subcutaneous tissues. Poor oral hygiene, dental caries, recent dental extraction, oromaxillofacial trauma have been implicated as risk factors for actinomycosis. Cervicofacial actinomycosis is the most common form of this rare disease. Here, we are presenting a rare case of actinomycosis involving the parotid gland and coronoid process of mandible in a young child where diagnosis was made based on histopathological findings since the classical clinical manifestations of actinomycosis, were absent in the case.

Stevens Johnson Syndrome-Toxic Epidermal Necrolysis Overlap Secondary to Interaction Between Methotrexate and Etoricoxib: A Case Report

P.R Rachana, HV Anuradha, Reddy Mounika

Rheumatoid arthritis (RA) is an autoimmune disease affecting about 1% of people, with the highest incidence between 40 and 70 years. Methotrexate is an anti-folate analogue that has good efficacy and safety in the treatment of RA. Methotrexate (MTX) and non-steroidal anti inflammatory drugs are often concomitantly administered in clinical practice for the treatment of RA. In this case report, a 57-year-old female was treated with oral methotrexate 7.5 mg per week for a diagnosed case of RA. Since her pain persisted after completing six weeks of treatment with methotrexate, oral etoricoxib 60 mg once daily was added to the treatment regimen. Six weeks later, the patient complained of oral ulcerations and blisters on all fours limbs and trunk. The patient was re-evaluated and was diagnosed with Stevens-Johnson syndrome-Toxic epidermal necrolysis (SJS-TEN) overlap. This case highlights the possible pharmacokinetic interaction between methotrexate and etoricoxib that has a significant clinical implication.

Disseminated Cutaneous Herpes Zoster in a Patient with Uncontrolled Diabetes Mellitus

Shashikant Malkud, Santosh M Patil

Herpes zoster is a clinical manifestation which results from reactivation of latent VZV (Varicella zoster virus) present in the sensory root ganglia. Disseminated herpes zoster has been reported in immune-compromised patients such as patient on cancer chemotherapy, HIV (Human immune deficiency virus) infection, systemic corticosteroid therapy. However, we report a case of disseminated herpes zoster infection in an uncontrolled diabetic patient. A brief review of literature on this topic has been bestowed.

Malignant Cylindroma of Post Aural Region Involving the Temporal Bone

Dermal eccrine cylindroma is a benign adnexal tumour commonly affecting the neck, scalp and skin of elderly individuals. These are poorly circumscribed dermal or subcutaneous lesions consisting of numerous rounded ovoid or cord shaped dermal island that fit together to form a jigsaw pattern. Malignant transformation is not commonly seen. This case highlights malignant transformation of a dermal eccrine cylindroma in the post aural region extending to involve the underlying mastoid bone.

Secondary Metastasis to the Mandible From Breast Carcinoma –A Rare Case Report

Amit Thorawat, Venkatesh G Naikmasur, Preeti Patil, Priya Perumal

Regardless of the rare occurrence of metastatic lesions to the jaw, it should be taken into consideration in the individuals with a history of malignancy. Early detection requires accurate examination, and microscopic evaluation is essential. In this paper we report a case of breast carcinoma to the mandible as female breast cancer is the most frequent metastatic lesion to the mandible and its metastasis is well documented. The patient’s medical history revealed that she had undergone mastectomy on the left breast three years ago. As this condition is infrequently described, documentation of new cases will augment the existing knowledge.

Condiments Costing High. . . ! A Case Report of Erythema Multiforme

Adverse drug associated mucocutaneous reactions having a preponderance to occur above 1% include urticaria, angioedema, photosensitivity, fixed drug eruptions and Erythema Multiforme (EM). EM is an acute inflammatory disease of the skin and mucous membranes that causes a variety of skin lesions-hence named ‘multiforme’. The aetiological spectrum of EM is wide and is attributed to infectious agents, drugs and food additives. EM is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries least significance. We report a case of a 38-year-old male who presented with a complaint of severe oral & cutaneous lesions making him difficult to eat & drink. History revealed the usage of clove to get rid of tooth pain following which he developed ulcers in the mouth which made him to visit a general physician where he was administered gentamycin. Later on oral lesions worsened along with the emergence of dermal lesions. In the present case, based on the patient history, clove was found to be a probable aetiological agent and the condition was further precipitated owing to the administration of gentamycin. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in a year follow up.

Multicentric Metaplastic Breast Carcinoma with Squamous Differentiation

Metaplastic breast carcinoma is a rare primary breast malignancy. A 45-year-old female patient presented with multicentric lumps in left breast of 6 months duration and history of axillary lymphadenopathy of 2 months duration. Mammography revealed two high density masses with ill defined margins. Fine needle aspiration cytology was positive for duct carcinoma cells. Histo pathologic examination, reported as “Multicentric infiltrating duct carcinoma with squamous differentiation left breast”, grade 2. Immunohistochemistry revealed negativity for ER, PR and positivity for HER-2neu. We are presenting this rare case for clinical, radiological, histopathological and immunohistochemical study.

Intussusception in Children with a Pathological Appendix Acting as a "Lead Point" - A Series of 3 Cases

Meckel’s diverticulum is commonest lead point for intussusception in children. Appendix is part of the intusssusception of the commonest ileocolic type but appendix as lead point for intussusception is rare. We report a series of 3 cases of intussusception in children, wherein a pathological appendix was the lead point. We would like to propose that more likely a pathological appendix, acts as a lead point leading to an appendico-caeco-colic intussusception rather than a normal appendix.

Isolated Tuberculous Peroneal Tenosynovitis: A Case Report

S.M. Ajoy, Bheemsingh Samorekar, Sharath Soman, Mohan Jadhav

Tuberculosis (TB) of osteoarticular sites constitutes less than 3% of total patients with tuberculosis. Involvement of the foot and ankle is less than 0.3% of total disease. Even in a country like India, where the incidence of TB is not uncommon, we do not encounter isolated tenosynovitis. We present a young man with bilateral tubercular peroneal tenosynovitis who was evaluated with relevant investigations and operated upon and started on antitubercular treatment (ATT) in consultation with the pulmonologist. After tenosynovectomy and commencement of ATT, the patient’s symptoms improved.

Emphysematous Cholecystitis in 24-Year-old Male Without Predisposing Factors

Asli Tanrivermis Sayit, Hediye Pinar Gunbey

Emphysematous cholecystitis (EC) is a life threatening condition characterized by gangrene of the gallbladder due to an infection with gas-forming organisms. It is more common in elderly men and has been associated with systemic disease, especially diabetes and vascular disease. Computed tomography is the most important and accurate imaging modality for the diagnosis of EC. EC should be thought of when the radiographic presence of gas is detected within the gallbladder wall or lumen. Emergency surgical intervention and antibiotic treatment for the gas-forming organism should be initiated after the diagnosis of the EC. Here, we present the imaging and pathologic findings of a 24-year-old male with EC without any predisposing factors, successfully treated with laparoscopic cholecystectomy.

Subdural Effusion in Dengue Patient as A Late Neurological Complication: A Rare Case Report

Praveen Bharti, Kiran Bala

Dengue is the most common and widespread arthropod borne arboviral infection in the world today. Recent observations indicate that the clinical profile of dengue fever is changing with neurological manifestations being reported more frequently. A 50-year-old male patient was admitted with fever and thrombocytopenia. He was diagnosed as dengue fever with positive IgM dengue serology. Patient was managed medically in the ward for seven days and observed for any complications. Fever subsided since third day of admission and platelet count started to improve; he had no complication of dengue fever and was discharged in stable condition. However, patient again came back to emergency with two episodes of generalized tonic clonic seizures followed by altered sensorium. Emergency NCCT head and later MRI brain revealed bilateral subdural effusion. Patient was managed with antiepileptic drugs and anti-oedema measures were taken. Patient showed improvement in sensorium after 48 hours of admission. Later after six weeks NCCT and MRI brain revealed complete resolution of subdural effusion.

Production of a Fixed Provisional Restoration Using an Acrylic Denture: Technique and Case Report

Hasan Kocaagaoglu

The damage or loss of anterior teeth causes a negative impact on the patient in many ways. In adolescents and young patients, the provisional replacement with artificial teeth may minimize this impact. Many approaches have been described for provisional restorations. This article discusses about a chairside fixed provisional restoration technique that was adjusted into the edentulous area of a 15-year-old girl.

Psammomatoid Juvenile Ossifying Fibroma Involving Upper Jaw: A Rare Case Report

Juvenile ossifying fibroma (JOF) is a fibro-osseous neoplasm, rare in occurrence and usually seen in young children. JOF is locally aggressive spreads quickly and is defined as a variant of ossifying fibroma. There are two types of ossifying fibroma depending on histopathology and classified as Psammomatoid juvenile ossifying fibroma (PJOF), Trabecular juvenile ossifying fibroma (TJOF). Both the types affect skull bones with the trabecular type being more common in the jaws- maxillofacial region and the psammomatoid type being more common in the paranasal sinuses, ethmoid sinuses- craniofacial region. Complete excision is mandatory because JOF’s have an extremely high rate of recurrence. A rare case of PJOF involving right maxilla sparing paranasal sinuses in a 15-year-old male patient with clinical, radiographic and histopathological features is discussed.

A Surgical Technique for the Management of Suction Cup-Induced Palatal Perforation: A Technical Note

Amin Rahpeyma, Saeedeh khajehahmadi

Suction cap-induced palatal perforation is uncommon today. In the surgical management of such a complication, the surgeon should consider the large bony defect hidden behind the small slit in the palatal mucosa. In this article a case is presented,in which a combination of anteriorly based inferior turbinate flap and posteriorly based palatal submucosal flap solved the problem properly. The advantages of this technique are two-layer closure and predictability of the technique.

Chondromyxoid Fibroma: An Unusual Tumour at An Atypical Location

Rib tumours are mostly secondaries arising from breast or prostrate malignancies. Among primary rib tumours, osteochondromas are reported as the commonest cause. Chondromyxoid fibromas are primary benign rib tumours that are seldom seen, occurring almost exclusively at the metaphyseal ends of large tubular bones. Here a case of chondromyxoid fibroma of rib, its clinical and radiological features, management and prognosis, is discussed which has only an occasional mention in literature.

A Rare Case of Urachal Sinus

Abnormalities in the closure of the intraembryonic portion of the allatoic lumen result in urachal abnormalities. Urachal remnant diseases are rare in adults. Malignant urachal neoplasms, like adenocarcinoma which may probably occur due to metaplasia of the transitional epithelium of the urachal remnant are very rare. Surgical excision of the urachus is needed. The imaging features of the urachal abnormalities are important for correct diagnosis and surgical management.

Mucinous Cystadenocarcinoma Co-Existing with Mature Cystic Teratoma : A Rare Case Report

Co-existence of mucinous cystadenocarcinoma with mature cystic teratoma in the same ovary is very rare. We report a case in a 48-year-old female who presented with left abdominal mass. CT scan revealed a heterogeneous enhancing left ovarian mass lesion. Clinical diagnosis of complex ovarian cyst was made, later underwent laparotomy and histologically diagnosed as mucinous cystadenocarcinoma (grade 2) co-existing with benign cystic teratoma, stage Ia (FIGO) of the left ovary. Six months after surgery, the patient is doing well without any recurrence or metastasis. Hence, histopathological examination plays a significant role in accurate diagnosis and management of the patient. So, we should be aware of these rare co-existent tumours and meticulous dissection should be done to look for any synchronous tumours or malignant areas; since management and prognosis will vary significantly depending upon the microscopic type and stage.

Intra Oral Fibrosarcoma with Various Histopathological Patterns: A Rare Case Report

Fibrosarcoma has been defined as a malignant mesenchymal tumour, the cells of which recapitulate the appearance of the normal fibroblast, with variable collagen production. Fibrosarcoma is a very uncommon tumour in the head and neck regions constituting only 0.05% of all the fibrosarcomas presenting in humans. They cause no characteristic symptoms and pose difficulty in clinical diagnosis. They have been classified histologically based on their distinct features into myxoid fibrosarcoma, low grade fibromyxoid fibrosarcoma and sclerosing epitheloid sarcoma. Here we present a rare case report of a 45-year-old male patient presenting with a maxillary fibrosarcoma, which histologically presented with different patterns.

Unicystic Ameloblastoma of Mandible Treated with an Innovative Approach: A Clinical Case Report

Narendra Babu, NSC Charles, Raj Rai, Smita Mathur, Sameer Hemant Runwal

Ameloblastoma is a true benign neoplasm with its origin from remnants of odontogenic epithelium. Unicystic ameloblastoma presents as a cystic lesion which clinically, radiographically, and macroscopically mimics a mandibular cyst, but microscopically exhibits ameloblastic epithelium lining part of the cyst cavity, with or without intraluminal growth and tumour infiltration into the fibrous connective tissue wall. An important and perplexing aspect associated with ameloblastoma is its management. We hereby present a case of unicystic ameloblastoma in a 63-year-old female and report an innovative technique of treating the case with split iliac crest graft.

Peripheral Calcifying Cystic Odontogenic Tumour - A Rare Case Report

Odontogenic lesions are derived from remnants of the components of the developing tooth germ. The calcifying cystic odontogenic tumour (CCOT) is a benign cystic neoplasm of odontogenic origin that is characterized by ameloblastoma-like epithelial cells and ghost cells. Most peripheral CCOTs are located in the anterior gingiva of the mandible or maxilla. This is a rare case report of CCOT. The rare feature in our case was its peripheral nature of existence and its location in the left buccal vestibule and retromolar region. Based on the radiological, cytological and histopathological findings the lesion was surgically excised.

Spontaneous Soft Tissue Haematomas A Rare Presentation of Chronic Myeloid Leukemia (CML)

Spontaneous soft tissue haematomas are rarely found in haematological malignancies. Chronic myeloid leukemia (CML) is a myeloproliferative disorder which rarely present with thrombo-haemorrhagic phenomenon. It is a malignant clonal disorder of pleuripotent stem cells that results in increase in myeloid, erythroid and platelets cells in peripheral blood and marked myeloid hyperplasia in bone marrow. It is characterized by the presence of Philadelphia chromosome (Ph) with BCR – ABL 1 fusion gene. This gene is responsible for the formation of 210 KDa chimeric proteins with enhanced tyrosine kinase activity which leads to the abnormal bone marrow cell proliferation and to the clinical and morphologic manifestations of leukemia. Cutaneous and mucous membrane bleeding is common in CML whereas bleeding in deep soft tissue is rarely found because of qualitative and quantitative platelet abnormalities. Here, we report a case of CML (BCR-ABL rearrangement positive) who presented with large haematoma in the anterior as well as posterior compartment of left thigh and treated successfully with hydroxyurea and imatinib.

Very Large Inflammatory Odontogenic Cyst with Origin on a Single Long Time Traumatized Lower Incisor

Jorge N.R. Martins, Filipe Freitas, Saudade André, André Moreira, João Caramês

One of the consequences of traumatic injuries is the chance of aseptic pulp necrosis to occur which in time may became infected and give origin to periapical pathosis. Although the apical granulomas and cysts are a common condition, there appearance as an extremely large radiolucent image is a rare finding. Differential diagnosis with other radiographic-like pathologies, such as keratocystic odontogenic tumour or unicystic ameloblastoma, is mandatory. The purpose of this paper is to report a very large radicular cyst caused by a single mandibular incisor traumatized long back, in a 60-year-old male. Medical and clinical histories were obtained, radiographic and cone beam CT examinations performed and an initial incisional biopsy was done. The final decision was to perform a surgical enucleation of a lesion, 51.4 mm in length. The enucleated tissue biopsy analysis was able to render the diagnosis as an inflammatory odontogenic cyst. A 2 year follow-up showed complete bone recovery.

A Case Report of Adenoid Cystic Carcinoma of Breast– So Close Yet So Far from Triple Negative Breast Cancer

Barath Raj Kumar, Naveen Padmanabhan, Gajasaraj Bose, Venkat Paneer

Adenoid cystic carcinoma (ACC) of breast is a rare tumour with a low malignant potential. Though negative for oestrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (Her2/neu), it is different from triple negative breast cancer (TNBC); ACC has an indolent course with a good prognosis.We present a case of a 40 year old premenopausal female initially diagnosed with ductal carcinoma in situ (DCIS) on core needle biopsy. She underwent breast-conserving surgery (BCS) and her final histopathological diagnosis was ACC. She subsequently underwent adjuvant external beam radiotherapy. The patient is on follow-up for more than a year with no recurrence till date.

A Precise Method of Measuring Simultaneous Intrusion and Uprighting of Mandibular Molar Using Denta Scan – A Case Report

A commonly encountered problem in prosthetic dentistry is the supra eruption of teeth due to absence of opposing teeth. Consequently, replacement of the missing teeth with prosthesis becomes difficult due to lack of vertical dimension of the edentulous area. This article describes the space regaining procedure in a 14-year-old female patient who wanted a fixed prosthesis for her missing maxillary 1st molar. On examination, it was observed that mandibular 1st molar had supraerupted and tipped lingually. After considering the various treatment modalities it was decided to simultaneously intrude and upright the mandibular molar using a mini-implant. The precise measurements of intrusion and uprighting were done using Dentascan software. Intrusion of 1.8mm and buccolingual uprighting of 2.3mm was achieved in 45 days. The mini-implant is an efficient non-compliance device to intrude and upright the tooth simultaneously. Dentascan is an accurate and very precise method of measuring the intrusion and uprighting of teeth.

Prenatal Diagnosis of A Case with Frontoethmoidal Encephalocele and the Neonatal Outcome

Ebru Hacer Biberoglu, Ayse Kirbas, Korkut Daglar, Nuri Danisman

Encephalocele is a rare congenital defect characterized by a sac-like protrusion of the neural tissue and/or meninges through a defect in the skull. We reported a case with a naso-frontal anterior encephalocele which was diagnosed by prenatally and confirmed by postnatal evaluation and complications such as hypoadrenalism, diabetes insipidus and arterial thrombosis in the lower limbs were diagnosed in the neonatal period.

Bilateral Osseous Interclinoid Bridges Associated with Foramina of Vesalius: A Case Report

George Paraskevas, Zoi Nitsa, Konstan tinos Koutsouflianiotis

The current study displays a very rare combination of ossified interclinoid ligaments at the sella turcica region associated with bilateral foramina of Vesalius. In a macerated skull four osseous bars interconnecting the clinoid processes bilaterally were detected. Specifically, two bilateral osseous bars were observed bridging the gap between the anterior and middle clinoid processes forming the so called caroticoclinoid foramen on each side and two additional osseous bridges linked the anterior and posterior clinoid processes, bilaterally. Furthermore, two distinct bilateral foramina of Vesalius were documented just anterior and medial to the foramen ovale. The awareness of the osseous sellar bridges is crucial for the physician and especially the neurosurgeon since their presence may complicate the removal of clinoid processes and induce damage of the internal carotid artery and oculomotor nerves. Furthermore, the likely existence of the foramen of Vesalius may lead to transfer of an infected thrombus into the cranial cavity and complicate a percutaneous trigeminal rhizotomy.

Ovarian Sertoli-Leydig Cell Tumour with Heterologus Elements Masquerading as Mucinous Tumour on Frozen Section: A Case Report

Swati Sharma, Manna Valiathan, Sandeep Kumar, Sukriti Kapoor

Sertoli-Leydig cell tumour (SLCT) is an extremely rare ovarian neoplasm. This tumour is characterized by excessive proliferation of normal testicular structures sertoli and leydig cells. These cells are seen in varying proportions and exhibit varying degrees of differentiation. We report a case of primary ovarian SLCT with heterologus elements in a 17-year-old girl which was misdiagnosed on frozen section as mucinous cystic neoplasm. We discuss the clinicopathologic features of SLCT along with the unusual features seen in this case.

Successful Term Pregnancy in a Second Trimester Female with Urosepsis: A Case Report

Urolithiasis means calculus in urinary system. It is a rare condition in pregnancy which can have devastating results for the mother in the form of pyonephrosis and septicaemia and to the foetus in the form of IUGR and prematurity. This is a rare case report of a 27-year old female patient who presented with perinephric abscess and hydronephrosis at 22 weeks of pregnancy. With proper evaluation and management, pregnancy continued till term with good perinatal outcome.

Dual Cystic Arteries in Association with Caterpillar Hump of Right Hepatic Artery- A Case Report and its Surgical Relevance

Kavitha Kamath. B

A rare variation was seen in the arterial supply of liver and gall bladder during dissection of an adult female cadaver. The right hepatic artery was having a tortuous course with double loops and cystic artery was arising from the distal loop within the hepatobiliary triangle. There was an accessory cystic artery arising from the superior pancreaticoduodenal artery outside the hepatobiliary triangle which ascended anterior to the common bile duct and cystic duct towards the gall bladder. The knowledge of these vascular variations is very much essential owing to increase in surgical interventions involving the biliary tract. Recognition of such vascular variations is essential for laparoscopic surgeons to reduce complications like uncontrolled intraoperative bleeding, iatrogenic extrahepatic biliary injuries and conversion to open cholecystectomy. This report emphasizes the necessity of all surgeons being well aware of vascular variations and anomalies to be able to accomplish safe and uneventful hepatobiliary surgeries.

Carbapenem Resistant Organisms: An Unusual Aetiology for Puerperal Sepsis

Puerperal infection is a common complication of labour. It occurs universally and is usually responsive to first line antibiotics. However, resistance to first line antibiotics and even second line antibiotics is becoming more wide spread. We report a case of puerperal infection caused by carbapenem resistant organisms leading to prolonged fever and hospitalisation. A 28-year-old primigravida, following caesarean section done elsewhere, for elevated blood pressure presented with high grade fever. The patient was treated with antibiotic to which she failed to respond. She underwent laparotomy twice and only improved after Colistin was combined with Meropenam, based on urine and pus culture reports.

Anesthesia for a Rare Case of Uncorrected Pentalogy of Fallot Undergoing Craniotomy and Drainage of Brain Abscess

Vinay Marulasiddappa, B.S. Raghavavendra

Children with uncorrected cyanotic congenital heart diseases can present for non cardiac surgeries. They pose several challenges to the Anaesthesiologist, especially when they are posted for emergency surgery, due to the complex haemodynamic changes secondary to the heart disease. Pentalogy of Fallot (POF) is a rare form of congenital heart disease characterized by the association of Tetralogy of Fallot (TOF) with an atrial septal defect (ASD). TOF is the leading cause of intracardiac right to left shunt and is the commonest type of cyanotic congenital heart disease to cause a brain abscess. Children with POF presenting with brain abscess pose several challenges to the anaesthesiologist due to the altered haemodynamics and warrant a meticulous anaesthetic plan. There are very few case reports of Anaesthesia management of a child with Pentalogy of Fallot (POF) presenting for non cardiac surgery. We report the anaesthetic management of a rare case of a 5-year-old child with uncorrected POF, who presented to our Superspeciality hospital with a brain abscess and underwent an emergency craniotomy with drainage of the brain abscess successfully.

Serendipity: A Rare Discovery of Haemoglobin D-Iran in An Indian Female During Routine Antenatal Screening for ß-Thalassemia

Rittu Surjit Chandel, Abhishek Roy, Leela Gul Abichandani

Haemoglobin D is a rare form of haemoglobinopathy in homozygous form. However, the heterozygous form of the disease is clinically silent and relatively easier to find in North-West India, Pakistan and Iran. Haemoglobin D is sometimes found to be coexistent with Haemoglobin S and/or Thalassaemia leading to clinically significant conditions like sickle cell anaemia with mild to moderate splenomegaly. In India the more prevalent form is Haemoglobin D-Punjab (also known as Hb D- Los Angeles) which has a prevalence of 2% in Punjab and around 1% in Gujarat. However, the variant, Haemoglobin D- Iran is very rare in India in heterozygous as well as homozygous forms. This report is of a 36-year-old female, who visited for an antenatal check up. On analysing the blood sample using Agarose Gel Electrophoresis in Alkaline media, the migration of abnormal haemoglobin to haemoglobin S/D/G region was observed. Sickle cell solubility test was negative. On capillary electrophoresis, peak in the Haemoglobin D Zone was seen.

Dental Caries Scenario Among 5, 12 and 15-Year-old Children in India- A Retrospective Analysis

Objectives: Dental caries is the most prevalent dental disease and children are one of the most affected groups. Thus, the present study was conducted to assess the average dental caries prevalence across different WHO index age groups (5, 12 & 15 years) for the past fifteen years. Materials and Methods: Literature search was performed electronically in various search engines like google scholar, PubMed, Copernicus, etc. using Dental caries and India as MeSH terms. Articles from the past 15 years reporting on dental caries prevalence and experience in India were searched and this online searching strategy collected and listed 781 articles. After evaluating their titles and abstracts, only 30 articles fulfilled the inclusion and exclusion criteria & were finally selected for complete review and data collection. Five articles which were hand searched were also included. Pooled estimates were calculated for different index age groups and different regions (Northern and Southern) separately with a confidence interval of 95% both for prevalence and experience of dental caries. Results: The pooled prevalence of dental caries was found to be highest in 15 year olds followed by 5 and 12 years (62.02%, 48.11% & 43.34% respectively). Weighted mean was also found to be highest for 15 years, followed by 5 and 12 years (2.56±6.508, 2.49±7.78, 1.48±3.292 respectively). Pooled prevalence and weighted mean for the Northernern India region was found to be more in all the index age groups as compared to the Southernern India region. Conclusion: More than 40% of the children in India have shown dental caries in both primary and permanent teeth in the past 15 years. Also, Northernern region was found to be more affected by dental caries than Southern region. Since children are seen as the future of the nation, this data could be helpful in the planning of oral health care services by the concerned authorities in the community.

Non Pharmacological Cognitive Enhancers – Current Perspectives

Ankur Sachdeva, Kuldip Kumar, Kuljeet Singh Anand

Cognition refers to the mental processes involved in thinking, knowing, remembering, judging, and problem solving. Cognitive dysfunctions are an integral part of neuropsychiatric disorders as well as in healthy ageing. Cognitive Enhancers are molecules that help improve aspects of cognition like memory, intelligence, motivation, attention and concentration. Recently, Non Pharmacological Cognitive Enhancers have gained popularity as effective and safe alternative to various established drugs. Many of these Non Pharmacological Cognitive Enhancers seem to be more efficacious compared to currently available Pharmacological Cognitive Enhancers. This review describes and summarizes evidence on various Non Pharmacological Cognitive Enhancers such as physical exercise, sleep, meditation and yoga, spirituality, nutrients, computer training, brain stimulation, and music. We also discuss their role in ageing and different neuro-psychiatric disorders, and current status of Cochrane database recommendations. We searched the Pubmed database for the articles and reviews having the terms ‘non pharmacological and cognitive’ in the title, published from 2000 till 2014. A total of 11 results displayed, out of which 10 were relevant to the review. These were selected and reviewed. Appropriate cross-references within the articles along with Cochrane reviews were also considered and studied.

Effectiveness of Subgingival Irrigation as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review

Aim: Subgingival applications of various chemotherapeutic agents have been used as an adjunct to nonsurgical periodontal treatment and preventive periodontal therapy. Their use in regular clinical practice, however, is less, perhaps due to concerns about clinical success or probably due to a lack of knowledge of their effectiveness or cost. The aim of this systematic review is to obtain overall quantitative estimate of effectiveness of subgingival irrigation (SI) in the treatment of chronic periodontitis. Materials and Methods: A literature search of electronic database was performed for articles published through December 31, 2014, followed by manual search of dental journals. Randomized controlled trails (RCTs) assessing the effect of SI as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis evaluated by changes in the clinical and microbiological outcomes were included. Results: This literature search yielded only two randomized, placebo-controlled studies that evaluated the efficacy of SI as an adjunct to SRP in patients with chronic periodontitis. The studies were methodologically not perfect (in terms of mediocre quality) with a risk of bias to come to any final conclusions to be reached. These studies didn’t clearly mention about randomization, allocation concealment, blinding, dosage and formulation of irrigants, severity of periodontal disease, patient-centered outcomes and results data. Conclusion: Due to insufficient evidence supporting the efficacy of SI as an adjunct to SRP in treating chronic periodontitis, more rigorous scientific research is required to assess the efficacy of SI as an adjunct to SRP in the treatment of periodontal diseases.

Evaluation of Analgesic and Anti-Inflammatory Activity of Extract of Holoptelea Integrifolia and Argyreia Speciosa in Animal Models

Bhavesh K. Lalan, R. S. Hiray, B. B. Ghongane

Background: Long term use of NSAIDs, opioids and corticosteroids was associated with serious adverse effects. Hence, the search for a safer analgesic and anti-inflammatory agent was always going on. It was considered worthwhile to evaluate analgesic and anti-inflammatory activities of Holoptelea integrifolia and Argyreia speciosa. Aim: To evaluate analgesic and anti-inflammatory activities of aqueous extract of leaves of Holoptelea Integrifolia and methanolic extract of Argyreia Speciosa root powder in mice and rats. Materials and Methods: After obtaining permission from animal ethics committee, the animals were divided into 7 groups of 6 animals each {control, standard – ibuprofen 100mg/kg, Holoptelea integrifolia (250 and 500 mg/kg), Argyreia speciosa (100 and 300 mg/kg) and combination of Holoptelea integrifolia (250 mg/kg) and Argyreia speciosa (100 mg/kg)}. The analgesic activity of the extracts was evaluated using tail-flick with radiant heat and acetic acid induced writhing method and the anti-inflammatory activity was evaluated using carrageenan induced paw oedema method. Statistical Analysis: One-way ANOVA followed by post-hoc test. p < 0.05 was considered to be significant. Results: In tail-flick method, both Holoptelea integrifolia and Argyreia speciosa produced significant (p<0.05) increase in latency as compared to control, their combination showed a significant increase in latency as compared to control as well as to the standard – ibuprofen. In writhing method, Holoptelea integrifolia and Argyreia speciosa, alone and in combination, significantly decreased the number of writhes as compared to control. In paw oedema method, both Holoptelea integrifolia and Argyreia speciosa showed significant inhibition of paw oedema as compared to control and the activity was comparable to ibuprofen. Conclusion: Extracts of Holoptelea integrifolia and Argyreia speciosa exhibits significant central and peripheral analgesic and anti-inflammatory activity.

Role of Cytochrome Modulators in Altering the Occurrence of Cataract in Rats

Kanchan Gupta, Shivani Juneja, G S Bajwa, Sandeep Kaushal

Background: Cataract is one of the primary causes of blindness all over the world. It indicates the onset of secondary complications of diabetes. The only treatment available is surgery as there are no satisfactory drugs which can prevent or retard the initiation and maturation of cataract. It was hypothesized that cytochrome P 450 (CYP) inducers or inhibitors can modify the cataract occurrence by accelerating or delaying the occurrence of cataract respectively. Objective: To study the effect of two commonly used drugs, phenytoin (CYP inducer) and ciprofloxacin (CYP inhibitor) on the initiation and maturation of cataract with the galactose- induced cataract model. Materials and Methods: The experiment was conducted in 24 new born male Wistar rats. Cataract formation was induced with a 50% galactose diet. The rats were randomized into four groups of 6 rats each: Group 1 rats received a normal diet; Group 2, 3 and 4 rats received 50% galactose diet day 23 onwards. In addition, Group 3 rats were pre-treated with ciprofloxacin (20mg/kg) and Group 4 rats were pre-treated with phenytoin (50mg/kg) day 18 onwards once a day orally. The appearance of cataract was checked daily with an ophthalmoscope. The maturation pattern was examined using Fundus Fluorsen Angiographer (FFA). The cataract was graded according to Sippel s classification. The experimental and control groups were compared by chi square test and the results were considered significant at p< 0.05. Results: The initiation of cataract was significantly delayed with ciprofloxacin as compared to galactose; however, there was no difference in the maturation pattern of cataract in both the groups. In spite of being a CYP inducer, the initiation of cataract was not accelerated in phenytoin group. Rather, it was significantly delayed and the cataract did not progress to stage 5 even on 30th day of galactose administration Conclusion: CYP450 modulators have a significant effect on the initiation of cataract without significantly altering the maturation pattern. It is not reasonable to extrapolate the results of one enzyme inhibitor or inducer to other CYP modulators. Hence, further studies are needed to identify the pharmacological profile of various CYP modulators on the occurrence of cataractogenesis.

A Wildfire in the Abdomen: Asymptomatically Flourishing Extensive Inferior Vena Caval Thrombus

Jagadesh madireddi, Rohith reddy, Ranjan shetty, Ananthakrishna Shastry

Necrotizing Sarcoid Granulomatosis (NSG): A Diagnostic Pitfall to Watch Out For!

Stephan Schiekofer, Christina Zirngibl, Jochen G. Schneider

Early and Rarely – A Unique Case of Calcification in Stage 2 Chronic Kidney Disease

Top of Basilar Artery Syndrome

Pokhraj P. Suthar, Prakash J. Rana, Chetan Mehta, Narottam A. Patel

Endovascular Repair of a Popliteal Artery Pseudoaneurysm Following Total Knee Arthroplasty

Oguz Karaca, Evren Akpinar, Onur Omaygenc, Beytullah Cakal, Bilal Boztosun

A Constellation of Nail Changes in A Child with Kawasaki Disease

Vijayasekharan Kalasekhar, Chandrasekaran Venkatesh

Atypical Presentation of Childhood Leukemia

Pratibha Dhiman, Priyanka Saxena

Osteochondroma of the Proximal Fibula-Revisited

Vivek Machhindra Morey , Anupam Das, Mohammed Tahir Ansari, Kiran Kumar Gowda

Retracted Article: Prevalance of Obesity in Children with Cerebral Palsy

Ankita Bansal, Shraddha Diwan, Jasmin Diwan, Neeta Vyas, Prevalance of Obesity in Children with Cerebral Palsy (Published in Journal of Cilinical and Diagnostic Research. 2014 August: 8(8):). BC08–BC11 It was brought to the editorial notice, that this article has contents which are plagiarized. It was later confirmed that most of the Introduction and Discussion were taken from other sources verbatim. Authors were communicated; they acknowledged and agreed that it was an honest error by a junior researcher. Hence the article has been retracted. Date of Retraction: 02.07.15

Correction: 2014 Oct: 7(10):). 2247-2249

Ashraf Direkvand-Moghadam, Afra Khosravi, Effect of Acupressure on Post–Operative Nausea and Vomiting in Cesarean Section: A Randomised Controlled Trial (Published in Journal of Clinical and Diagnostic Research. 2013 October: 7(10):). 2247-2249 In this article changes have been done in the Authors' name. Surnames of authors have been expanded for correct citation.

Correction:2014 November: 8(11):). XC01-XC04

Ashraf Direkvand-Moghadam, Ataollah Hashemian, Ali Delpisheh, Farnaz Sohili, Kourosh Sayehmiri, Effective Factors on Patients‘ Satisfaction with Emergency Care Services using Factor Analysis: A Cross Sectional Study (Journal of Clinical and Diagnostic Research. 2014 November: 8(11):). XC01-XC04 In this article changes have been done in the Authors' name. Surnames of authors have been expanded for correct citation.

Correction:2014 Feb: 8(2):). 106-109

Ashraf Direkvand-Moghadam, Kourosh Sayehmiri, Ali Delpisheh, Sattar Kaikhavandi, Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. (Published in Journal of Clinical and Diagnostic Research. 2014 Feb: 8(2):). 106-109 In this article changes have been done in the Authors name. Surnames of authors have been expanded for correct citation.

Retracted Article: A Prevalence of Thyroid Disorder in Western Part of Nepal

Raj Kumar Yadav, Namrata Thapa Magar, Bibek Poudel, Naval Kishor Yadav, Binod Yadav, A Prevalence of Thyroid Disorder in Western Part of Nepal (Published in Journal of Cilinical and Diagnostic Research. 2013 Feb: 7(2):). 193-196 It was brought to the editorial notice, that this article has contents which are plagiarized from an earlier published article. This was confirmed and Authors were communicated; they acknowledged and agreed that this has been done by mistake. To avoid misleading the scientific community the article has been retracted. Date of Retraction: 13.7.15