Journal of clinical and diagnostic research

The Effect of Stress Management Based on Group Cognitive-Behavioural Therapy on Marital Satisfaction in Infertile Women

Kamal Solati, Lo’bat Ja’farzadeh, Ali Hasanpour-Dehkordi

Introduction: In the developed world, infertility is on rise and has become a social concern. This is considered as a serious stress in life and exerts a severe psychological impact on the couple. Aim: This study was conducted to study the efficacy of stress management based on group cognitive-behavioural therapy on marital satisfaction in infertile women. Materials and Methods: This was a quasi-experimental study with a pretest-post-test design and control group. The study sample consisted of 40 infertile women enrolled based on convenience sampling and randomly assigned to two groups: experimental and control, of 20 each. Then, the experimental group underwent 10 two-hour stress management sessions per cognitive-behavioural therapy. The instruments used in this study were marital satisfaction inventory ENRICH and a checklist of demographic characteristics. Immediately and three months after completion of the intervention, the instruments were administered to the participants. The data was analysed by analysis of covariance in SPSS 18. Results: There was a significant difference in marital satisfaction between the experimental and control groups in both post-test (p=0.001) and follow-up (p=0.001). Conclusion: The stress management based on cognitivebehavioural therapy could contribute to increasing marital satisfaction in infertile women. The effect could remain stable three months after the last interventions (follow-up).

Clinical Relevance of Single-Voxel 1H Mrs Metabolites in Discriminating Suprasellar Tumors

A Einstien, Rahul A Virani

Introduction: Spatially resolved metabolic data obtained from Proton Magnetic Resonance Spectroscopy (1H MRS) provides information which increases the diagnostic accuracy of imaging sequences in predicting the histology of suprasellar tumors. Aim: To evaluate the role of 1H MRS in the diagnosis of various suprasellar tumors. Materials and Methods: Sixty cases of various suprasellar, hypothalamic and third ventricular neoplasms were investigated with long-echo single voxel 1H -MRS using 1.5 Tesla clinical imager. Single-voxel spectroscopic examinations were guided by T1-weighted or T2-weighted images. Statistical analysis was carried out using IBM SPSS software version 19. Results: We observed that whenever brain tissue was damaged or replaced by any process, NAA was markedly reduced. Extra-axial lesions which do not infiltrate brain or contain neuroglial tissue, didn’t demonstrate any NAA resonances. Cr was used as an internal standard for semi-quantitative evaluation of metabolic changes of other brain metabolites. Increased Cho was seen in processes with elevated cell-membrane turnover. Conclusion: Spectra obtained from different tumors exhibit reproducible differences while histologically similar tumor syield characteristic spectra with only minor differences. Pituitary tumors were typically characterized by significant reduction of NAA, Cr peak and moderate elevation of Cho peak. Gliomas were typically characterized by decrease of NAA and Cr peaks and increase of Cho peak. Craniopharyngiomas were typically characterized by significant decrease of all metabolites.

Fetal Cardiodynamics by Echocardiography in Insulin Dependent Maternal Diabetes and Its Correlation with Pregnancy Outcome

Rashmi Pilania, Pooja Sikka, Manoj K. Rohit, Vanita Suri, Praveen Kumar

Introduction: Maternal diabetes mellitus is associated with an increased risk of fetal and neonatal morbidity and mortality. Usual screening tests have not proved to be good prognostic indicators of fetal distress. Fetal cardiodynamics is potentially a useful screening tool. Aim: To determine if cardiodynamics of the fetus differ in pregnancy with diabetes requiring insulin than those without and to determine whether cardiodynamics predict fetal and neonatal outcomes. Materials and Methods: This prospective case control study was carried out in 40 pregnant women with diabetes who required insulin for blood sugar control. Twenty uncomplicated pregnant women were taken as controls. Systolic and diastolic cardiac functions along with interventricular septal thickness were assessed at 26-28 weeks and again at 34-36 weeks of gestation in fetuses by echocardiography. Fetal and neonatal adverse outcomes were evaluated in terms of major and minor morbidity. Results: Among all parameters, E/A ratio across both mitral and tricuspid valves, myocardial performance index and cardiac output were significantly different in fetuses of diabetic mothers at both gestations. However, pulmonary vein pulsatility index and interventricular septal thickness were similar between the two groups. At 26-28 weeks of gestation myocardial performance index correlated with abnormal biophysical profile whereas cardiac output correlated with minor morbidity. At 34-36 weeks of gestation, cardiac output correlated with abnormal biophysical profile while both MPI and cardiac output correlated with minor morbidity. Conclusion: Echocardiographic parameters of fetuses of diabetic women significantly differed from those of uncomplicated non-diabetic women. However, only myocardial performance index and cardiac output correlated with adverse fetal and neonatal outcomes.

Angiosarcoma of Anterior Mandibular Gingiva Showing Recurrence – A Case Report with Immunohistochemistry

Santosh Hunasgi, Anila Koneru, M. Vanishree, Vardendra Manvikar

Angiosarcomas of oral cavity and salivary gland represent 1% of all cases reported in the literature and are therefore considered as extremely rare. To the best of our knowledge very few cases of angiosarcomas involving mandibular gingiva have been reported previously. Here, we report a case of angiosarcoma occurring in the gingiva with review of literature on clinical features. A 30-year-old female patient presented with a complaint of a small growing mass in relation to lower front teeth. Intraoral examination revealed a soft sessile growth arising from the labial gingiva in relation to 31 and 41 on the labial aspect extending distally to 32. The lesion was locally excised. Histolopathological analysis showed that the tumour was composed of spindle shaped to polygonal cells with hyperchromatic nuclei, conspicuous nucleoli and intracytoplasmic vacuoles, mitotic figure were also scattered. Immunohistochemical staining revealed that the tumour cells was positive for factor VIII-related antigen, CD31 and CD34. An excisional biopsy showed a diagnosis of angiosarcoma. After two months patient reported back with the same chief complaint. This present case is a 17th case report of angiosarcoma arising in anterior mandiblular gingiva.

Effect of Oral Pregabalin as Preemptive Analgesic in Patients Undergoing Lower Limb Orthopedic Surgeries under Spinal Anaesthesia

Bon Sebastian, Anand Tippanna Talikoti, Kiran Nelamangala, Dinesh Krishnamurthy

Introduction: Conquering postoperative pain which has significant impact on the surgery outcome can be challenging for the clinicians. Pregabalin is a GABA analogue used for various neuropathic pain syndromes. Very few studies are there with the use of pregabalin as a preemptive analgesic for orthopedic surgeries. Aim: To compare pregabalin 150 mg with placebo for postoperative pain control in patients undergoing elective lower limb orthopedic surgeries under spinal anaesthesia and to assess any side effects. Materials and Methods: A randomized double blinded prospective study was undertaken. Ninety patients with ASA physical status I, II, aged between 18–50 years were enrolled in the study. One hour prior to spinal anaesthesia Group C - received colour matched empty capsules, Group P – received 150mg of oral pregabalin. Spinal anaesthesia was administered in sitting position in L3-L4 space with Inj. Bupivacaine heavy (0.5%) at a dose of 0.3mg/kg body weight with 20 mg being the maximum dose using 25 gauge spinal needle. Rescue analgesia was provided with using Inj. Diclofenac 1.5 mg/kg intramuscular. Results: Time for rescue analgesia (VAS score >3) was significantly increased in Group P than in Group C. The total dose of diclofenac required in the 24 hour postoperative period was significantly lower in Group P than in Group C. The sedation scores and patient satisfaction scores were also more in Group P than in Group C. Conclusion: Preemptive pregabalin in an oral dose of 150 mg offers good postoperative analgesia in lower limb orthopedic surgeries under spinal anaesthesia.

Mastication Frequency and Postprandial Blood Sugar Levels in Normoglycaemic and Dysglycaemic Individuals: A Cross- Sectional Comparative study

Introduction: Mastication has potential to affect postprandial blood glucose levels by affecting cephalic phase of insulin release. However, limited number of studies done in this regard has yielded conflicting results. Aim: To evaluate effects of mastication on postprandial blood glucose levels. Materials and Methods: We compared routine and thorough mastication in 2 separate groups: dysglycaemic (prediabetics and diabetics) and normoglycaemic in prospective interventional study. Blood glucose levels were measured pre-prandial and postprandial (after 2 hours) on separate days after routine and thorough mastication in both groups. Results: In normoglycaemic group, thorough mastication significantly reduced postprandial blood glucose levels at 2 hours (128.25± 7.82 mg/dl on routine mastication vs 119.74±9.08 mg/dl on thorough mastication, p<0.05). Comparatively, in dysglycaemic group, thorough mastication had little effect on postprandial blood glucose levels at 2 hours (244.07±22.37 mg/dl vs. 243.55±22.87 mg/dl). Conclusion: In normoglycaemic group, postprandial blood glucose concentration upon thorough mastication was significantly lower, due to early-phase insulin secretion. This simple lifestyle modification of thorough mastication can be a useful preventive measure against diabetes in people with a strong family history and other risk factors for diabetes who have not yet developed diabetes or prediabetes.

Evaluation of p27 Expression in Salivary Gland Neoplasms; A Step Forward in Unveiling the Role of p27

Introduction: Salivary gland neoplasms are not uncommon lesions that are seen in the head and neck region. The role of cell cycle regulators as well as that of oncogenes remains unexplored in the pathogenesis of these neoplasms. Aim: Present study was conducted to evaluate the expression of p27 in the three common salivary gland neoplasms. Materials and Methods: A total of 34 cases (19 pleomorphic adenoma, 8 mucoepidermoid carcinoma and 7 adenoid cystic carcinoma) were included. The sections were subjected to p27 staining and rated for the expression. Results: Of the total 52.6% of pleomorphic adenoma cases, 25% of mucoepidermoid carcinoma cases and only 14.2% of adenoid cystic carcinoma cases showed strong expression suggesting variable p27 expression in both malignant neoplasms. Normal salivary gland tissue was stained as a positive control for the evaluation. Conclusion: The results of the study suggest an important role for p27 in pathogenesis of mucoepidermoid carcinoma as well as adenoid cystic carcinoma while its role in pathogenesis of pleomorphic adenoma remains questionable keeping in view the strong expression of p27 in the same.

Buccal Micronuclei Assay as a Tool For Biomonitoring DNA Damage in Oral Lichen Planus

Introduction: The malignant transformation rate of Oral Lichen Planus (OLP) is between 0% and 5.8%. Oral lesions of lichen planus clinically presents itself multifocally, simulating the process of field cancerization in high risk malignancies. The Buccal MicroNucleus Cytome Assay (BMN Assay) provides a platform to identify the high risk individuals by evaluating the markers of nuclear damage at an earliest micro invasive phase. Aim: To evaluate DNA damage in exfoliated buccal mucosal cells in individuals with oral lichen planus lesions and thereby to delineate the high risk group. Materials and Methods: Buccal smears from 22 OLP and 10 control samples were stained in modified Feulgen-Rossenback reaction for micronuclei assay. Cytological evaluation of number of MicroNucleated cells (CMN), Total Number of Micronuclei (TMN) in micronucleated cells was done in both groups. Results: Frequency of micronucleated cells (CMN) when compared among the study and control group, a mean value of 4.27 ± 1.80 and 0.90 ± 0.88 were obtained respectively. On comparing the total number of micronuclei in the micronucleated cells (TMN) between the study and control groups, a mean value of 5.38 ± 2.42 and 1.5 ± 0.88 were obtained respectively. Conclusion: There was a significant increase in the frequency of micronuclei and the micronucleated cells in the oral lichen planus as compared to normal individuals.

Comparison of Boric Acid and Combination Drug of Polymyxin, Neomycin and Hydrocortisone (polymyxin NH) in the Treatment of Acute Otitis Externa

Soroush Amani, Mohammad Moeini

Introduction: Acute otitis externa is an inflammation of the external auditory canal known as "swimmers ear". Direct costs including medical treatment, painkillers, antibiotics, steroids or both and indirect costs are also remarkable. Aim: The aim of this study was to compare the effect of boric acid and polymyxin, neomycin and hydrocortisone composition in the treatment of acute otitis externa. Materials and Methods: This randomized clinical trial was carried out on 80 patients aged more than 17-year-old who were referred to Kashani hospital clinic with a diagnosis of acute otitis externa by otolaryngologist. The patients were randomly allocated to two groups (A: Boric acid and B: polymyxin NH ear drops) and Painkiller was prescribed and administered orally for all patients and in the presence of fever, cellulitis around the ears and neck adenopathy, broad-spectrum systemic antibiotics were used besides topical treatment. Symptoms of patients who were evaluated by a physician includes pain, discharge from the ear, swelling of the ear canal, auricle swelling, tenderness, and ear itching. In addition, pain was evaluated in patients and was recorded by Macgill Pain Questionnaire, in the first, third, seventh and tenth days. Results: Results showed that itching on third day (p=0.007) and swelling of the ear canal in the examination of the third day (p=0.006) and the seventh day (p=0.001) in the polymyxin NH group was more than those of boric acid group. Overall mean pain based on McGill questionnaire was 11.10±1.49 in boric acid group in the examination on the first day and was 4.05±0.22 in the examination on the tenth day and in the polymyxin NH group, it was 10.9±0.99 on the first day and 4.20±0.40 on the tenth day. In both groups, pain relief was the same and there was no significant difference between two groups (p=0.075). Conclusion: The findings of this study showed slight differences in the effectiveness of the boric acid drug and combination of polymyxin, neomycin and hydrocortisone in the treatment of patients with acute otitis externa that is of clinical significance.

Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes

Introduction: Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. Aim: To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. Materials and Methods: We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. Results: Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). Conclusion: Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries.

Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap

Introduction: Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss. Aim: Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap. Materials and Methods: Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue. Results: Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation. Conclusion: Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in patients of complete urethral loss with adequate healthy vaginal tissue.

Role of Histomorphology and Chronic Inflammation Score in Chronic Dacryocystitis

Sudipta Chakrabarti, Senjuti Dasgupta, Manas Banerjee, Debashis Pal

Introduction: Diseases of lacrimal drainage system account for nearly 3% of visits to eye clinic. Chronic dacryocystitis is a frequently encountered disorder among these patients. Histomorphology of specimens obtained after Dacryocystorhinostomy (DCR) is a pertinent indicator of prognostic outcome. Aim: The aim of the study was to evaluate histopathology of specimens obtained after DCR and to elucidate patterns and score of chronic inflammation encountered. Materials and Methods: The study was conducted for a period of one year. Total of 50 patients who were clinically diagnosed as Chronic Dacryocystitis and underwent DCR were included. Following DCR, specimens of lacrimal sac, nasal mucous membrane and nasal bone were collected. Histopathological slides were examined for chronic inflammatory cell infiltration, fibrosis and capillary proliferation and were graded according to severity, in each specimen. A Chronic Inflammation Score (CIS) was recorded for each case. Results: The average age of patients was 39.04±14.22 years and their age ranged between 13 and 62 years. There were 28 (56%) females and 22 (44%) males in the study group. The nasal bone did not reveal any abnormality in any case. The nasal mucous membrane showed mild chronic inflammatory cell infiltration in 46 (92%) cases and moderate degree in 4 (8%) patients. Chronic inflammation with granulation tissue formation was noted in lacrimal sacs of all patients. The CIS revealed that 14 (28%) cases belonged to “mild” group, 26 (52%) to “moderate” group and 10 (20%) to “severe” category. Conclusion: The inclusion of CIS in histomorphological evaluation of DCR specimens is recommended since it is one of the parameters that influence course of the disease.

Prevalence of Psychiatric Morbidity in Females amongst Infertile Couples- A Hospital Based Report

Pragati Sethi, Arvind Sharma, Lajya Devi Goyal, Gurmeet Kaur

Introduction: Infertility leads to significant stress among couple and the reaction to infertility differs among males and females. Aim: To know the prevalence of psychiatric morbidity in infertile couples and compare the prevalence of various psychiatric disorders among husband and wife. Materials and Methods: A cross-sectional study was conducted on 50 couples diagnosed with infertility from outdoor clinics. Both male and female partner of couple were interviewed for detailed history and clinical examination was done. General Health Questionnaire (GHQ-12) was applied to detect any psychological strain in couples and in those with illness, final diagnosis were made on the basis of DSM -IV (TR). The data thus generated was subjected to appropriate Statistical Analysis. Results: Out of the 50 couples, 54% of females had psychiatric morbidity. The most common diagnosis amongst the female participants was MDD (Major Depressive Disorder) (18%), whereas the second most common diagnosis was GAD (Generalized Anxiety Disorder) (16%). Psychiatric morbidity was found in only 26% of males suffering with Adjustment Disorder being most common diagnosis (8%) and Dysthymia and MDD as the second most common diagnosis (6% each). Majority of patients having psychiatric morbidity were from age group 20-29 years. The difference between females and male counterparts was statistically significant. Conclusion: Psychiatric morbidity was higher among female partners than male partners. The difference was statistically significant and the situation needs further workup.

Identification of Streptococcus pyogenes – Phenotypic Tests vs Molecular Assay (spy1258PCR): A Comparative Study

Tintu Abraham, Sujatha Sistla

Introduction: Traditionally Group A Streptococcus pyogenes (GAS) is differentiated from other beta haemolytic streptococci (BHS) by certain presumptive tests such as bacitracin sensitivity and production of Pyrollidonyl Aryl Sulfatase (PYR). The phenotypic and genotypic confirmatory tests are Lancefield grouping for cell wall carbohydrate antigen and PCR for spy1258 gene respectively. Reliance on presumptive tests alone may lead to misidentification of isolates. Aim: To compare the predictive values of routine phenotypic tests with spy1258 PCR for the identification of Streptococcus pyogenes. Materials and Methods: This comparative analytical study was carried out in the Department of Microbiology, JIPMER, Puducherry, over a period of 18 months (1st November 2013 to 30th April 2015). Two hundred and six consecutive BHS isolates from various clinical samples were subjected to phenotypic tests such as bacitracin sensitivity, PYR test and Lancefield grouping. The results were compared with spy1258 PCR which was considered 95 the confirmatory test for identification. Results: The sensitivity and specificity of phenotypic tests were as follows; Susceptibility to bacitracin – 95.42%, 70.96%, PYR test – 95.42%, 77.41%, Lancefield grouping- 97.71%, 80.64%. Conclusion: Clinical laboratories should not depend on bacitracin sensitivity as a single presumptive test for the routine identification of GAS but should use supplemental tests such as PYR test or latex agglutination test and for best results use spy1258 PCR.

The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common nerve entrapment. Subjective sensory symptoms are common place in patients with CTS, but sometimes they are not supported by objective findings in the neurological examination. Electrodiagnostic (EDx) studies are a valid and reliable means of confirming the diagnosis. The amplitudes along with the conduction velocities of the sensory nerve action potential and motor nerve action potential reflect the functional state of axons, and are useful parameters and complement the clinical grading in the assessment of severity of CTS. Aim: To conduct median nerve sensory and motor conduction studies on patients with carpal tunnel syndrome and correlate the relationship between nerve conduction study parameters and the clinical severity grading. Materials and Methods: Based on clinical assessment, the study patients were divided into 03 groups with mild CTS, moderate CTS and severe CTS respectively as per Mackinnson’s classification. Median and ulnar nerve conduction studies were performed on bilateral upper limbs of 50 patients with symptoms of CTS and 50 age and sex matched healthy control subjects. The relationship between the clinical severity grade and various nerve conduction study parameters were correlated. Results: In this prospective case control study, 50 patients with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined over a 10 month period. A total of 30 patients had unilateral CTS (right upper limb in 19 and left upper limb in 11) and 20 patients had bilateral CTS. Female to male ratio was 3.54 to 1. Age ranged from 25 to 81 years. The mean age at presentation was 49.68±11.7 years. Tingling paresthesias of hand and first three fingers were the most frequent symptoms 48 (98%). Tinel’s and Phalen’s sign were positive in 36 (72%) and 44 (88%) patients respectively. The mean duration of symptoms at presentation was 52.68±99.81 weeks. 16 patients (32%) had mild CTS, 25 (50%) had moderate CTS and 9 (18%) had severe CTS clinically. Prolongation of motor latency, latency difference between median and ulnar amplitudes, motor and sensory nerve conduction velocities, sensory latency between median and ulnar nerves, sensory nerve conduction velocities showed significant changes in comparison with controls. Among them sensory latency difference between median and ulnar nerves and sensory nerve conduction velocities are the most sensitive and specific for diagnosing CTS. Conclusion: In this study, there was a graded deterioration of electrophysiological parameters along with the clinical severity grades, thus reiterating the fact that NCS provide additional, independent objective evidence in the diagnosis and severity assessment of CTS. The sensory conductions were more sensitive than motor conductions in assessing CTS.

Comparison of the Efficiency of Posterior Intravaginal Sling (PIVS) Procedure in Older and Younger Groups

Introduction: Vaginal vault prolapsus is a challenging problem for the patients and physicians. There may be differences between young and elderly patients in terms of efficiency and safety of surgical procedures. Aim: The aim of our study was to compare the efficiency of the Posterior Intravaginal Sling (PIVS) procedure in older versus younger patient groups. Materials and Methods: A total of 40 patients who underwent the PIVS procedure were chosen. Twenty of these patients were younger than 60 years of age (Group I) while the other 20 patients were 60 years of age or older (Group II). Preoperative Pelvic Organ Prolapsed Quantification (POP-Q) reference points were compared with postoperative data at the first year following surgery. Student’s t-test was used to analyse continuous variables and the ?2 test was used to analyse categorical data. The Mann–Whitney test was used for data that were not normally distributed. Results: Anatomical cure rates were 90 percent in both groups (p=1.00). There were significantly greater improvements in POP-Q points in group I than group II. Conclusion: It could be concluded that PIVS as minimally invasive procedure for vaginal vault prolapsed and is effective in all age groups.

Morphometric Analysis of Peripapillary Thickness in Hypertensives and Normotensives using Optical Coherence Tomography (OCT)

Krishna Rao Addoor, Sulatha V. Bhandary, Lavanya G. Rao, Smita Kapoor

Introduction: Hypotension following antihypertensive treatment is associated with retinal nerve fibre loss. There are studies that have reported the changes in RNFL in hypertensives. Aim: To compare the Retinal Nerve Fibre Layer (RNFL) thickness using Optical Coherence Tomography (OCT) in hypertensive and normotensive individuals. Materials and Methods: The cross-sectional study was conducted from October 2012 to September 2014 to compare the RNFL thickness using SD OCT in hypertensive {no other ocular or systemic co-morbidity, vision better or equal to 6/9 (n=30)} and normotensive (n=30) individuals. Results: Statistically significant RNFL loss was detected in hypertensives (98.31 ± 7.01) when compared to the normotensives (102.51 ± 8.72) p=0.001. Conclusion: Significant loss of RNFL in hypertensives point towards the altered autoregulation and warrants larger studies to assess the clinical relevance.

A Prospective Study on Prevalence and Causes of Anaemia in Patients with Acute Coronary Syndrome

Introduction: Anaemia is a contributor for adverse prognosis in Acute Coronary Syndrome (ACS), but the epidemiology and causes of anaemia in such patients is not defined. Aim: To study the prevalence and aetiology of anaemia in hospitalized patients with ACS. Materials and Methods: All consecutive patients admitted with ACS from January to March, 2010 were included. Their clinical information was recorded. Results: Of 130 (87 males) consecutive admissions for ACS, 47.7% had unstable angina, 10% had Non ST-Elevation Myocardial Infarction (NSTEMI) and 42.3% had ST-Elevation Myocardial Infarction (STEMI). Overall prevalence of anaemia (haemoglobin <130 g/l in men and <120 g/l in women) was 51.5% (n=67) and was more prevalent in women (n=30, 69.8%) than men (n=37, 42.5%). Moderate to severe anaemia was more in women (34.9%) compared to men (20.8%). Anaemia was more common in unstable angina patients (58.2%) than in NSTEMI (11.9%) or STEMI (29.9%) patients (p=0.013). Aspirin (p<0.01) and/or clopidogrel intake (p<0.01) and raised serum creatinine (p<0.01) were more often in anaemic patients. Heart failure (p<0.01) and triple vessel disease (p<0.05) were associated with anaemia. Multivariate predictors of duration of hospital stay were haemoglobin (p<0.05) at admission and revascularisation procedure (p=0.01) during hospital stay. The most common cause of anaemia was iron deficiency (29.9%). Conclusion: Anaemia was common in our patients admitted with ACS. Female gender, antiplatelet drug intake and raised creatinine were associated with anaemia, which in turn was associated with adverse in-hospital outcomes. The impact of correcting anaemia on outcomes in ACS needs long term prospective study.

Study of Retinal Nerve Fibre Layer Thickness in Patients with Diabetes Mellitus Using Fourier Domain Optical Coherence Tomography

Renu Dhasmana, Sonal Sah, Neeti Gupta

Introduction: Diabetic retina undergoes degenerative changes in retinal nerve fiber layer (RNFL) in addition to vascular changes. Loss of RNFL with changes in inner retina and their association with metabolic control have been studied with varied results in diabetic patients. Aim: To compare the RNFL thickness between diabetic patients and age matched healthy controls and to correlate the thickness to metabolic control. Materials and Methods: One hundred and sixty five patients were enrolled in the study out of which 50 served as controls, 58 patients were diabetic without retinopathy and 57 patients had diabetic retinopathy. Both eyes of all patients underwent optical coherence tomography scans for RNFL and ganglion cell complex. Foveal and parafoveal thickness were also measured. All the parameters were compared to patient’s metabolic control. Results: RNFL thinning was observed in superotemporal (p-value = 0.001) and upper nasal sectors (p-value = 0.031) around the optic disc in eyes with diabetic retinopathy. Ganglion cell complex also showed statistically significant thinning in diabetic patients. Creatinine levels showed a weak negative correlation to the RNFL. Conclusion: This study positively concluded that neurodegeneration in an early component of diabetic retinopathy.

Development and Validation of Educational Leaflet for Caregivers of Preterm Infants

Introduction: Facilitation of child development is usually emphasized in the form of early intervention classes and practical demonstrations. However, non-adherence to home program for such interventions has been reported due to various reasons. Aim: To develop and validate an educational leaflet as a supplement guide for caregivers to promote better development of their child during 4-6 months of age. Materials and Methods: An in-depth literature review and focus group discussion with the experts was conducted to formulate the content of leaflet. Initial framework consisted of introduction, main text with pictorial representation and instructions about facilitation of various milestones, do’s–don’ts and disclaimer. Validation was done through a questionnaire consisting of 9 questions pertaining to completeness, understandability, legibility, clarity and utility of educational material for caregivers and a section for comments. Leaflet with enclosed questionnaire was distributed to 14 validators (2 neonatologists, 4 paediatricians and 8 physiotherapists), along with a covering letter stating the purpose and relevance of this educational material, and the importance of their participation in validation process. Scoring was done on 5 point Likert scale for each item in the material. Results: Responses from the 14 evaluators were collected and analysed. Item level content validity index (I-CVI) was calculated for individual items which ranged from 0.73 – 1. Scale level Content Validity Index (S-CVI) was calculated for complete nine items and it was found to be 0.91. Validators expressed their views to include a column on normal milestones across 4-6 months of age and also to highlight the significance of performing each activity mentioned in the leaflet. These suggestions were incorporated in consensus with the subject experts and the final draft was made. Conclusion: Educational leaflet for caregivers of 4-6 months preterm infants has been developed and validated. It can be provided as a supplement guide to the caregivers to facilitate better development of their child.

The Role of Serum Beta hCG in Early Diagnosis and Management Strategy of Ectopic Pregnancy

Kameswari Surampudi, Sirisha Rao Gundabattula

Comparsion of Intravenous Lignocaine, Tramadol and Keterolac for Attenuation of Propofol Injection Pain

Harprit Kaur Madan, Rajinder Singh, Gurdip Singh Sodhi

Introduction: Propofol possesses many characteristics of an ideal intravenous anaesthetic agent, providing a smooth induction and a rapid recovery. However, it has been reported to evoke considerable pain on injection in 10-100% of patients. The cause of pain upon intravenous injection of propofol remains a mystery. Aim: To study and compare the efficacy of Lignocaine, Tramadol and Ketorolac in minimizing the propofol injection pain. Materials and Methods: Hundred adult patients (ASA grade I and grade II) scheduled for elective surgery under general anaesthesia with propofol as an inducing agent were considered for the study. Patients were randomly divided into 4 groups of 25 patients each Group L (lignocaine) Group T (tramadol) Group K (ketorolac) and Group N (normal saline). Pain scores were measured by the investigator immediately following injection of propofol. All patients’ responses were graded by a verbal pain score. Results: All the results were tabulated and analysed using the one-way ANOVA and z-test. There was no statistically significant difference among group L (24%), T (28%) and K (28%) for pain on injection, but significant difference of all 3 groups was there when compared with group N. Conclusion: Intravenous lignocaine, tramadol and ketorolac all 3 drugs significantly reduce propofol injection pain. However, lignocaine appears to be more acceptable cause of less pain and fewer side effects as compared to tramadol and ketorolac.

The Impact of Evidence-Based Practices on Postoperative Pain in Patients undergoing Gastrointestinal Surgery in Amiralmomenin Hospital in Zabol During 2014-2015

Introduction: The Evidence-Based Practices (EBP), have gained considerable ground in treatment and care, increases the quality of nurses’ clinical care. Yet EBP is less frequently employed despite its efficiency and importance. Pain management is an important component of nursing care and sufficient pain control has still remained as a challenge despite routine nursing practices that are already provided. Aim: The present study intended to define the impact of evidence-based nursing practices on postoperative pain in patients undergoing gastrointestinal surgery. Materials and Methods: The present study was a single group quasi-experimental study with before/after design. The study was conducted in the General Surgery Departments of the Amiralmomenin Hospital in Zabol during 2014-2015. A purposive sampling method was used to study 55 patients undergoing abdominal surgery. The data collection tool was a questionnaire. The patients pain severity was defined before and after implementing evidence-based practices. The collected data were analysed in SPSS using descriptive statistics and inferential statistics. Results: The results showed that 61.8% of patients experienced severe postoperative pain. The mean perceived pain ratings in women and men were 7.88±1.78 and 9.42±0.81, respectively. The mean pain intensity was 8.48±1.66 before the intervention and reached 7.16±1.71 after the intervention, which was significant based on Kruskal-Wallis test (p=0.003). The mean postoperative pain experienced by the patients (p<0.01) and pain-relief following the intervention (p=0.002) was significant for gender. Conclusion: This study suggests that a high percentage of patients experienced acute postoperative pain despite routine nursing care, while evidence-based nursing practices could significantly alleviate pain.

The Effects of Diclofenac Suppository and Intravenous Acetaminophen and their Combination on the Severity of Postoperative Pain in Patients Undergoing Spinal Anaesthesia During Cesarean Section

Introduction: The main tasks of postoperative care are postoperative pain and complications control which play an important role in accelerating the recovery of patient’s general condition. Aim: This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods: This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. Results: The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen – diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. Conclusion: Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia.

Valproic Acid versus Lamotrigine as First–line Monotherapy in Newly Diagnosed Idiopathic Generalized Tonic –Clonic Seizures in Adults – A Randomized Controlled Trial

Introduction: Idiopathic Generalized Tonic-Clonic Seizures (GTCS) are frequently encountered in adults. Their successful control is necessary to improve the quality of life of these patients. Valproic acid is a simple branched-chain carboxylic acid and lamotrigine is a phenyltriazine derivative. Opinions differ in regards to their effectiveness in idiopathic GTCS. Aim: To compare the effectiveness of valproic acid and lamotrigine in newly diagnosed adults with idiopathic generalized tonic-clonic seizures. Materials and Methods: The present prospective randomized study was conducted on 60 patients suffering from idiopathic GTCS. Thirty patients received valproic acid and rest 30 patients received lamotrigine. All patients were followed regularly monthly for one year for treatment response and adverse effects. Results: After 12 months follow-up, 76.67% patients taking valproic acid and 56.67% patients taking lamotrigine were seizure-free. Common adverse effects recorded were nausea, dyspepsia, headache and skin rash. Conclusion: Valproic acid is more effective than lamotrigine as first-line drug in the treatment of adults with newly diagnosed idiopathic generalized tonic-clonic seizures.

Comparative Analysis of Crack Propagation in Roots with Hand and Rotary Instrumentation of the Root Canal -An Ex-vivo Study

Manju Raj Kumari, Manjunath Mysore Krishna Swamy

Introduction: Success of any endodontic treatment depends on strict adherence to ‘endodontic triad’. Preparation of root canal system is recognized as being one of the most important stages in root canal treatment. At times, we inevitably end up damaging root dentin which becomes a Gateway for infections like perforation, zipping, dentinal cracks and minute intricate fractures or even vertical root fractures, thereby resulting in failure of treatment. Several factors may be responsible for the formation of dentinal cracks like high concentration of sodium hypochlorite, compaction methods and various canal shaping methods. Aim: To compare and evaluate the effects of root canal preparation techniques and instrumentation length on the development of apical root cracks. Materials and Methods: Seventy extracted premolars with straight roots were mounted on resin blocks with simulated periodontal ligaments, exposing 1-2 mm of the apex followed by sectioning of 1mm of root tip for better visualization under stereomicroscope. The teeth were divided into seven groups of 10 teeth each – a control group and six experimental groups. Subgroup A & B were instrumented with: Stainless Steel hand files (SS) up to Root Canal Length (RCL) & (RCL –1 mm) respectively; sub group C & D were instrumented using ProTaper Universal (PTU) up to RCL and (RCL -1mm) respectively; subgroup E & F were instrumented using ProTaper Next (PTN) up to RCL & (RCL -1 mm) respectively. Stereomicroscopic images of the instrumentation sequence were compared for each tooth. The data was analyzed statistically using descriptive analysis by ‘Phi’ and ‘Cramers’ test to find out statistical significance between the groups. The level of significance was set at p< 0.05 using SPSS software. Results: Stainless steel hand file group showed most cracks followed by ProTaper Universal & ProTaper Next though statistically not significant. Samples instrumented up to 1mm short of working length (RCL-1mm) showed lesser number of cracks. Conclusion: All groups showed cracks formation, the stainless steel group being the highest. Working 1mm short of apex reduces the incidence of crack formation.

Analgesic Efficacy of Ultrasound Guided FICB in Patients with Hip Fracture

Devender Kumar, Sarla Hooda, Shashi Kiran, Jyoti Devi

Introduction: Hip fractures are often encountered in the elderly and present special problems to the anaesthesiologist. Fascia iliaca compartment block is another technique with the intent to block all the three nerves like 3-in-1 nerve block. Aim: To evaluate the analgesic efficacy of ultrasound guided fascia iliaca compartment block to facilitate positioning of patients with hip fracture for spinal anaesthesia. Materials and Methods: This prospective study was conducted in 50 patients aged between 40-80 years, belonging to American Society of Anesthesiologists (ASA) physical status I-III undergoing surgery for hip fracture. All 50 patients received an ultrasound guided Fascia Iliaca Compartment Block (FICB) in the premedication room with 30 mL of 0.5% ropivacaine by 23G spinal needle. Sensory blockade was evaluated 5, 10 and 20 minutes after ropivacaine administration using loss of perception to cold in the lateral, anterior and medial part of the thigh. Visual analogue scale scores were noted before the block, 20 minutes after block and during positioning for spinal anaesthesia. Patient’s acceptance for FICB was evaluated 24 hour after arriving back to the orthopaedics ward using a two-point score. Any episode of hypotension or bradycardia was noted and managed accordingly. Results: In lateral part of thigh, at 5 minutes sensory blockade was present in 33 patients (66%) and at 10 minutes sensory blockade was present in 45 cases (90%). In anterior part of thigh, sensory blockade was present in 34 cases (68%) at 5 minutes time interval and at 10 minutes sensory blockade was present in 48 cases (96%). In medial part of thigh, 28 cases (56%) had sensory blockade at 5 minutes and at 10 minutes in 43 cases (86%). Sensory blockage was same at 20 minutes as on 10 minutes interval in all thigh parts. Before FIC block average VAS was 7.5 which was decreased to average of 2.94 at 20 minutes after block which was statistically significant (p<0.01). During positioning for spinal anaesthesia, 46 patients had VAS less than 4. Positioning during spinal anaesthesia was assessed unsatisfactory (0) in 2 cases (4%), satisfactory (1) in 5 cases (10%), good (2) in 25 cases (50%) and excellent (3) in 18 cases (36%). Conclusion: Ultrasound guided FICB can be performed safely without complications in controlling pain for patients with hip fracture. Performing an FICB before positioning for spinal anaesthesia provides good pain management and facilitates spinal performance with wide patient acceptance, hence improving overall quality and efficiency of care.

Definitive Management of Open Tibia Fractures Using Limb Reconstruction System

Introduction: Open fractures are treated as surgical emergency and early administration of intravenous antibiotic coupled with early irrigation and debridement decreases the infection rate dramatically. Limb Reconstruction System (LRS) is a unilateral rail system which consists of Shanz pins, rail rods and sliding clamps. It is specifically designed to enable the surgeon to perform simple and effective surgery as it offers rigid fixation of fracture fragments, allowing early weight bearing and reduces economic burden. Aim: To determine the efficacy of Limb Reconstruction System for treatment of compound tibia fractures. Materials and Methods: A prospective study was carried out where in 54 cases out of 412 compound tibia fractures having Modified Gustilo Anderson Type IIIA and IIIB with a mean age of 42±5 years were treated using LRS over a period of 26 months. Limb reconstruction system was used in acute docking mode or with corticotomy and bone transport was done depending upon the bone loss. The soft tissue condition was assessed and split thickness skin grafting and flap repairs were done as per the need. Clinical and radiological assessment was done at every follow-up. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Results: Among 54 patients, bony results as per ASAMI score were excellent in 36, good in 14, fair in 2 and poor in 2 patients. Functional results were excellent in 43, good in 7, fair in 4 patients. The average fracture union time was 8 months. Post-surgery patient satisfaction was excellent since fixation allowed weight bearing immediately. Average hospital stay was 7 days and financial burden was reduced by 40% as compared to multi staged surgery. The average time of return to work was 20 days. Conclusion: LRS is an easy, simple and definitive surgical procedure that allows immediate full weight bearing walking. It reduces hospital stay, is cost effective with excellent patient compliance and can also be used for bone lengthening/transportation.

Imaging More Imagining less: An Insight into Knowledge, Attitude and Practice Regarding Radiation Risk on Pregnant Women among Dentists of Ghaziabad – A Cross Sectional Study

Introduction: The safety of diagnostic imaging during pregnancy is an important aspect for all clinicians. Pregnant women often do not receive proper dental care as the dentists are not aware of low diagnostic radiation doses involved in dental radiation. Aim: To assess awareness of radiation risks on pregnant women among dentists of Ghaziabad city. Materials and Methods: A total of 268 practicing dentists in Ghaziabad were selected for a questionnaire based cross-sectional study. Data consisted of 18 questions which assessed the knowledge, attitude and practice of dental professionals regarding radiation risks on pregnant women. The questionnaire was distributed and collected personally by the principal investigator. Data was analyzed by Mann Whitney U test and chi-square test. The level of significance was set at p = 0.05. Results: The results showed that the dentists who had attended continuing dental education program had increased level of knowledge regarding radiation effects among pregnant women as compared to the dentists who had not attended continuing dental education programs (p<0.05). Among them who had attended continuing dental education programs 93.3% were aware of the safe dose of radiation and 62% were aware of threshold radiation doses of pregnancy termination. On the contrary there was no significant difference in the knowledge, attitude and practice scores regarding radiation risks on pregnant women based on their academic qualification (p=0.05). Conclusion: The level of knowledge among dentists was found to be satisfactory, this outcome shows that continuing dental education regarding radiation protection principles and its risks on pregnant women is required to ensure maximum safety both for clinician as well as pregnant women.

Cisplatin Concentrations in Long and Short Duration Infusion: Implications for the Optimal Time of Radiation Delivery

Introduction: Cisplatin has radiosensitizing properties and the best sensitization to radiotherapy occurs with a higher plasma concentration of cisplatin. To our knowledge the optimal time sequence between chemotherapy and administration of radiation therapy, to obtain maximum effect from concurrent chemoradiation is unclear. Aim: The aim of this study was to measure the two cisplatin infusion regimens in order to determine the total and free cisplatin post infusion concentration changes over time. These changes may have clinical implications on the optimum time of administration of post infusion radiation therapy. Materials and Methods: Two cohorts of patients were recruited and both, total and free plasma concentration of cisplatin following long and short durations of intravenous infusion was determined. Blood samples were collected at 0.5, 1, 1.5, 2, 3 and 5 hours from the start of the infusion in the 1hour infusion group and at 2, 3, 3.5, 4, 6 and 24 hours from the start of the infusion, in the 3 hour infusion group. Total and free cisplatin concentrations were measured using a validated HPLC-UV method. Results: The highest concentration of total and free cisplatin was achieved at the end of the infusion in both regimens. Total cisplatin concentration declined 30 minutes after the end of infusion in both the groups. After 1hour of discontinuing cisplatin, the free cisplatin concentration also declined significantly. Conclusion: We conclude that radiation should be administered within 30 minutes of completion of the infusion irrespective of the duration of infusion.

Efficacy of Epidural Steroid Injection in Management of Lumbar Prolapsed Intervertebral Disc: A Comparison of Caudal, Transforaminal and Interlaminar Routes

Ritesh Arvind Pandey

Introduction: Epidural steroid is an important modality in the conservative management of prolapsed lumbar disc and is being used for over 50 years. However, controversy still persists regarding their effectiveness in reducing the pain and improving the function with literature both supporting and opposing them are available. Aim: To study the efficacy of epidural steroid injection in the management of pain due to prolapsed lumbar intervertebral disc and to compare the effectiveness between caudal, transforaminal and interlaminar routes of injection. Materials and Methods: A total of 152 patients with back pain with or without radiculopathy with a lumbar disc prolapse confirmed on MRI, were included in the study and their pre injection Japanese Orthopaedic Association (JOA) Score was calculated. By simple randomization method (picking a card), patients were enrolled into one of the three groups and then injected methyl prednisone in the epidural space by one of the techniques of injection i.e. caudal, transforaminal and interlaminar. Twelve patients didn’t turn up for the treatment and hence were excluded from the study. Remaining 140 patients were treated and were included for the analysis of the results. Eighty two patients received injection by caudal route, 40 by transforaminal route and 18 by interlaminar route. Post injection JOA Score was calculated at six month and one year and effectiveness of the medication was calculated for each route. The data was compared by LSD and ANOVA method to prove the significance. Average follow-up was one year. Results: At one year after injecting the steroid, all three routes were found to be effective in improving the JOA Score (Caudal route in 74.3%, transforaminal in 90% and interlaminar in 77.7%). Transforaminal route was significantly more effective than caudal (p=0.00) and interlaminar route (p=0.03) at both 6 months and one year after injection. No significant difference was seen between the caudal and interlaminar route (p=0.36). Conclusion: The management of low back pain and radicular pain due to a prolapsed lumbar intervertebral disc by injecting methyl prednisone in epidural space is satisfactory in the current study. All three injection techniques are effective with the best result obtained by transforaminal route.

Colour Preference to Emotions in Relation to the Anxiety Level among School Children in Puducherry – A Cross–Sectional Study

Introduction: Dental setting plays an important role in child’s behavior and cooperation to the planned dental treatment. Adding attractive colours to the dental environment and by incorporating colourful equipments can make the child feel good and be at ease. This study tries to convey the relationship between colours and dental anxiety among children. Aim: To evaluate the colour preference to emotions in relation to children’s age, gender and anxiety level. Materials and Methods: A total of 382 children aged 6-12 years were randomly selected from schools in and around Puducherry. Modified dental anxiety scale was recorded by a calibrated examiner. Each question was scored from one (not anxious) to five (extremely anxious); such that the total score ranges from 5 to 25, wherein a score of 15 or more was considered to be anxious. Based on this, children were divided into anxious and non-anxious groups. All the children were provided with eight different coloured crayon pencils and were asked to shade two cartoon emoticons indicating happiness and sadness with their preferred colour. Values were tabulated and statistically analyzed to evaluate the association between the variables using Z test, Chi-square, Chi-square goodness of fit and odds ratio. (p=0.05 was considered statistically significant). Results: Among 382 children, 77% (294) were graded as anxious and 23% (88) as non- anxious. For positive emotion (happiness), 31.2% (119) children preferred blue followed by pink 29.3% (112). For negative emotion (sadness), 52.1% (199) of children preferred black and 46.9% (179) preferred red. Association between colour and emotion was highly significant (p= 0.005). Conclusion: From the colours preferred by the children in our study, it can be concluded that colours like blue and pink in the dental set-up could enhance a positive attitude while black and red could develop a negative outlook in their mind.

Ultrastructural Analysis of Incinerated Teeth by Scanning Electron Microscope – A Short Study

Sugunakar Raju Godishala Swamy, Shyam Prasad Reddy Dorankula, Keerthi Muddana

Introduction: In forensic context precise knowledge on physical and histological changes of teeth subjected to high temperatures is of great importance. Preserving fragile incinerated teeth for physical, histological and ultra structural examinations is essential in fire investigations involving the origin of fire, its cause as well as the identification of victims which relies on a thorough understanding of the structural changes in dental tissues subjected to heat. Aim: The study was conducted to evaluate the physical and ultrastructural changes seen in freshly extracted teeth when subjected to gradual heating at different temperatures using Scanning Electron Microscope (SEM). Settings and Design: Freshly extracted teeth collected from subjects of different age groups were subjected to different temperatures using laboratory furnace and findings were correlated to the temperature. Materials and Methods: The study was conducted on 60 healthy freshly extracted teeth belonging to age group between 20-30 years. Group A comprised of control group which included teeth that were not subjected to heat whereas Group B, C and D comprised of teeth that were subjected to different temperatures i.e., 100oC, 300oC and 600oC respectively for a time of fifteen minutes in laboratory furnace, after which they were processed for SEM examination. Each group included 15 teeth; 5 anteriors, 5 premolars and 5 molars. Results: Examination under SEM revealed definite ultra structural changes which were explicitly seen at particular temperatures (100oC, 300oC and 600oC). The samples showed cracks and charring of the tooth structure with ultra structural findings such as pebbles, granules, dots on enamel surface; and soap bubble pattern, honey comb pattern and snail track pattern on cementum surface. Conclusion: Because of the consistency of morphological changes and the ultra structural patterns at various temperatures, evaluation of incinerated dental remains using SEM can provide additional investigative avenues in victim identification and in the areas of forensic fire investigations.

Effects of a Dietary Beetroot Juice Treatment on Systemic and Cerebral Haemodynamics– A Pilot Study

Introduction: Beetroot Juice (BJ) contains dietary nitrates that increase the blood Nitric Oxide (NO) level, decrease Blood Pressure (BP), increase athletic performance and improve cognitive functions but the mechanism remains unclear. Ultrasonographic measurement of middle cerebral artery blood flow velocity with computation of Cerebral Augmentation Index (CAIx) is a measure of the reflected flow signal, modulated by changes in cerebrovascular resistance and compliance. Aim: This pilot study tests the hypothesis that ingestion of an amount of BJ sufficient to raise the blood NO level two-to three-fold, decreases Transcranial Doppler (TCD) measured CAIx. Materials and Methods: Ten healthy young-adult African-American women were studied at two levels of submaximal exercise, 40% and 80% of their predetermined peak oxygen consumptions.The subjects ingested nitrate-free orange juice (OJ, control) and an isocaloric BJ beverage (1.5 mg/mL nitrate, 220 Cal), on different days, 1-2 weeks apart. Results: The BJ treatment increased blood NO and decreased systolic BP at rest and at the two levels of exercise. The BJ treatment decreased CAIx only at the two levels of exercise (from 79 ± 2% to 62 ± 2% and from 80 ± 2% to 60 ± 3%, p<0.05). Exercise increased TCD-measured resistance and pulsatility indices (RIx, PIx) without changing AIx. The BJ treatment had no effect on RIx and PIx. Conclusion: These findings suggest that decreased CAIx associated with aerobic exercise reflects the change in cerebral haemodynamics resulting from dietary nitrate supplementation. Future studies should determine whether the BJ-induced decrement in CAIx is correlated with an improvement in brain function.

Minor Salivary Gland Changes in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma - A Histopathological Study

Introduction: The most common etiology for Oral Squamous Cell Carcinoma (OSCC) is tobacco and tobacco related products which cause nuclear damage to the keratinocytes. The chemical carcinogens not only affect the lining of oral epithelium but also affect the lining epithelium of the excretory ducts of the salivary glands. Thus, there is a possibility of epithelial dysplasia of the salivary duct epithelium which may lead to potential malignant transformation. Aim: The study was performed to see the changes in the minor salivary glands and excretory ducts in cases of oral epithelial dysplasia and OSCC. Materials and Methods: A total of 278 archival cases of mild, moderate and severe epithelial dysplasia, carcinoma in situ, OSCC including verrucous carcinoma were histopathologically evaluated to observe changes in the excretory ducts and the minor salivary glands. Results: In the study there were 56.5% males and 43.5% females. The age group that was most commonly affected in both the sexes was 50-60 yr old. Buccal mucosa was the most common site of involvement. Ductal changes observed in the excretory duct include simple hyperplasia, metaplastic changes such as mucous, oncocytic & squamous, and infiltration of inflammatory cells and malignant cells. Acinar changes observed were degeneration, squamous metaplasia, myoepithelial cell proliferation and inflammatory cell infiltration. Both the excretory ducts and ducts within the gland showed dysplasia. Conclusion: According to observations in our study it is suggested that histopathological interpretation for oral mucosal lesions especially oral epithelial dysplasias and OSCC should also include changes related to salivary gland tissue to provide a better treatment plan and prevent recurrence of the malignant tumours.

Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children

Introduction: Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). Aim: Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. Materials and Methods: From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score =9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. Results: Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. Conclusion: The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.

Comparative Evaluation of Arimedadi Oil with 0.2% Chlorhexidine Gluconate in Prevention of Plaque and Gingivitis: A Randomized Clinical Trial

Introduction: Chemical plaque control measures are advocated to maintain proper oral hygiene. Ayurvedic medicines are alternatives considered with minimal side effects to treat systemic diseases and dental diseases. So the present study was conducted to assess the anti-plaque efficacy of Arimedadi (herbal) oil against 0.2% Chlorhexidine gluconate mouthwash. Aim: To assess the anti-plaque efficacy of Arimedadi (herbal) oil against 0.2% Chlorhexidine gluconate mouthwash. Materials and Methods: A total of 45 patients aged 18 to 21 years, with mild to moderate gingivitis were recruited and were divided randomly into three groups with 15 subjects in each group. After baseline data, scaling and polishing was performed. Group A, as Control, Group B, Chlorhexidine gluconate mouthwash and Group C used experimental Arimedadi oil mouthwash. Instructions were given to use 10 ml mouthwash twice daily after 30 min of tooth brushing for 1 min till 21 days. Plaque Index (PI) and Gingival Index (GI) were taken to assess Plaque and Gingival health on 7th day, 14th day and at 21st day. The statistical analysis was done using Paired t-test and analysis of variance (ANOVA) followed by Post Hoc test. Results: There was similar improvement in gingival health among both groups compared to control group up to 21 days (p<0.001). However from 14th day to 21st day there was no difference in gingival health between Chlorhexidine and Arimedadi group (p>0.05). Conclusion: Arimedadi oil is equally effective to Chlorhexidine gluconate as an adjunct to mechanical plaque control in prevention of plaque accumulation and gingivitis. Arimedadi oil could be an effective and safe alternative to 2% Chlorhexidine gluconate mouthwash due to its prophylactic and therapeutic benefits.

An Increase Incidence in Uric Acid Nephrolithiasis: Changing Patterns

Introduction: Nephrolithiasis is a complex disease affecting all age groups globally. As the causative factors for nephrolithiasis rises significantly, its incidence, prevalence and recurrence continues to baffle clinicians and patients. Aim: To study the prevalence of different types of renal stones extracted by Percutaneous Nephrolithotomy (PCNL) and open surgical procedures. Materials and Methods: Renal stones from 50 patients were retrieved by Percutaneous Nephrolithotomy (PCNL), Ureterorenoscopy (URS) and open surgical techniques for qualitative tests for detection of calcium, oxalate, uric acid, phosphate, ammonium ion, carbonate, cystine and xanthine. Results: Three patients had stone removed by open surgery and rest had undergone PCNL. Nine of the stones were pure of calcium oxalate, 9 were of pure uric acid and 32 were mixed stones. Forty one stones had calcium. Among the mixed stones, oxalate was present in 25 samples (39 of total), uric acid was seen in 17 (25 of total stones), phosphate was present in 23 (23 of total) and carbonate was present in 4 stones (4 of total). Only 1 patient had triple phosphate stone. 12 were of staghorn appearance of which 6 were of struvite type, 6 were pure uric acid and remaining were mixed oxalate-phosphate stones. Conclusion: Our study, though in a small number of hospital based patients, found much higher prevalence of uric acid stones and mixed stones than reported by previous hospital based studies in north India (oxalate stones~90%, uric acid~1% and mixed stones~3%). Biochemical analysis of renal stones is warranted in all cases.

Identification of HIV Mutation as Diagnostic Biomarker through Next Generation Sequencing

Introduction: Current clinical detection of Human immunodeficiency virus 1 (HIV-1) is used to target viral genes and proteins. However, the immunoassay, such as viral culture or Polymerase Chain Reaction (PCR), lacks accuracy in the diagnosis, as these conventional assays rely on the stable genome and HIV-1 is a highly-mutated virus. Next generation sequencing (NGS) promises to be transformative for the practice of infectious disease, and the rapidly reducing cost and processing time mean that this will become a feasible technology in diagnostic and research laboratories in the near future. The technology offers the superior sensitivity to detect the pathogenic viruses, including unknown and unexpected strains. Aim: To leverage the NGS technology in order to improve current HIV-1 diagnosis and genotyping methods. Materials and Methods: Ten blood samples were collected from HIV-1 infected patients which were diagnosed by RT PCR at Singapore Communicable Disease Centre, Tan Tock Seng Hospital from October 2014 to March 2015. Viral RNAs were extracted from blood plasma and reversed into cDNA. The HIV-1 cDNA samples were cleaned up using a PCR purification kit and the sequencing library was prepared and identified through MiSeq. Results: Two common mutations were observed in all ten samples. The common mutations were identified at genome locations 1908 and 2104 as missense and silent mutations respectively, conferring S37N and S3S found on aspartic protease and reverse transcriptase subunits. Conclusion: The common mutations identified in this study were not previously reported, therefore suggesting the potential for them to be used for identification of viral infection, disease transmission and drug resistance. This was especially the case for, missense mutation S37N which could cause an amino acid change in viral proteases thus reducing the binding affinity of some protease inhibitors. Thus, the unique common mutations identified in this study could be used as diagnostic biomarkers to indicate the origin of infection as being from Singapore.

Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

Murali G Rao, Dalbir Singh, Rakesh Kumar Vashista, Suresh Kumar Sharma

Introduction: Microscopic study of the organization of the Subdural Haemorrhage (SDH) verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature. Aim: This study was conducted for dating the early subdural haemorrhage by routine histopathological stains. Materials and Methods: A prospective analytical study was conducted during July 2009 to December 2010. A total of 100 cases (50 males and 50 females) fulfilling the inclusion and exclusion criteria were included in this study. Routine histopathological staining of the subdural haematoma was done. Results: Correlation between the frequency of a given histomorphological phenomenon and the length of the Post-Traumatic Interval (PTI) was evidential. All the histomorphological features, when correlated with PTI groups, were found to be statistically significant, except for Polymorphonuclear Leukocytes (PMN). Conclusion: We concluded that routine histopathology was reliable in the dating of early subdural haemorrhages.

A Study of Haemostatic Parameters in Patients of Chronic Myeloid Leukaemia

Ankur Jain, Naresh Gupta, Tejinder Singh, Sunita Agarwal

Introduction: Chronic Myeloid Leukaemia (CML) is characterized by derangement of various components of the haemostatic system resulting in thrombo-haemorrhagic complications. Although less common than other myeloproliferative neoplasms, derangement of various components of the haemostatic system is observed in CML. Haemostatic abnormalities have been described in relation to hyperleucostasis and drugs used to treat CML. However, the correlation between haemostatic derangements and phase of CML is unclear in the literature. Aim: The purpose of this cross-sectional study was to assay various haemostatic parameters in patients of CML receiving Imatinib and to determine any correlation between them and phases of disease as well as the status of remission. Materials and Methods: The study included 30 patients with CML (17 males, 13 females, mean age of 35.53 ± 8.92 years) receiving imatinib mesylate. Haemostatic parameters including platelet counts, Prothrombin Time (PT), activated Partial Thromboplastin Time (APTT), fibrinogen, D-dimers and Factor VIII levels were assayed for all patients using standard methods. Bcr-abl gene product (quantitative) was determined on the peripheral blood by reverse transcriptase polymerase chain reaction (RT-PCR). Patients were grouped into phases of disease (chronic, accelerated and blast) and their response to imatinib was determined in the form of remission (clinical, haematological and molecular). Correlations were drawn between them using spearman’s coefficient. Results: A significant positive correlation was found between PT (p=0.002), fibrinogen (p=0.011), D-dimers (p=0.050), Factor VIII levels (p=0.006) with the phase of CML and a significant negative correlation was observed between PT (p=0.003, 0.006), fibrinogen (p=0.010, 0.005), D-dimers (p=0.035, 0.017), Factor VIII levels (p=0.005, 0.001) and clinical and haematological remission respectively. No significant correlation of platelet counts and APTT was seen with the phase of CML or remission status. Conclusion: Haemostatic system is significantly disturbed in CML and correlate positively with the progression of the disease. Imatinib treatment leads to improvement in some of these parameters.

Evaluation of Mechanical and Physical Properties of Clinically Used and Recycled Superelastic NiTi Wires

Introduction: The initial leveling and aligning phase has been simplified with the introduction of superelastic nickel-titanium archwires. The relatively high cost of these wires has prompted some of the clinicians to reuse them after sterilization. The quantitative changes in the surface properties of superelastic ‘NiTi’ wires after clinical application and recycling by autoclave method have not been established in earlier studies. Aim: To quantify the changes in mechanical and physical properties of four different commercially available superelastic nitinol (NiTi) archwires after clinical usage and recycling. Materials and Methods: The superelastic ‘NiTi archwires obtained from four different manufacturers: Group I-GAC (McMinnville, USA); Group II- 3M Company (California, USA); Group III- G&H Company(Franklin, USA) and Group IV- American Orthodontics (AO) (Sheboygan, USA) were selected for the study. Each of the four groups comprised of 20 samples of wire with 10 of them selected randomly as control and remaining 10 as test specimen in each group. The experimental archwires were placed on selected patients for a period of three months followed by Standard Autoclave sterilization at 121°C and 15 to 20 psi pressure for 20 minutes and were retrieved. The tensile strength was evaluated by Instron-Universal Testing Machine. The quantification of changes in surface roughness was investigated by grid method using Scanning Electron Microscope (SEM). The Control Wires (C) were evaluated at initial time “T1” where as the Experimental sample of wires (T) were subjected to testing at an initial time ‘T1’ and after clinical usage and sterilization at ‘T2’ Statistical Analysis: Paired t-test was used for intra-group comparison and one way ANOVA and Post Hoc Tukey tests were used for inter-group comparison. Results: There was significant decrease in tensile strength (p = 0.0015 to 0.001) and surface roughness (p< 0.001) between control and experimental arch wires within each group when properties at T1 and T2 were compared. Conclusion: The study suggests discouraging the use of clinically used and sterilized superelastic NiTi archwires.

A Study on Dosimetric Outcomes and Acute Toxicity of Post Mastectomy Adjuvant Hypofractionated Radiotherapy for Breast Cancer

Introduction: Hypofractionated External Beam Radiotherapy (HFRT) is a relatively new adjuvant Radiotherapy (RT) schedule for breast cancers following breast conservation surgery and less commonly, following mastectomy. Here we report our experience on normal tissue exposure and acute toxicity of HFRT after mastectomy. Aim: To assess the dosimetric outcomes and acute toxicity profile of adjuvant HFRT following mastectomy for breast cancer. Materials and Materials: This prospective observational study considered consecutive patients planned for adjuvant HFRT (42.5 Gy in 16 sessions delivered over 3 weeks) to the chest wall with/without regional nodes between October 2014 and June 2015. The dosimetric parameters including dose homogeneity to the target volume and exposure to heart and lung were analyzed. Acute haematological and dermatological toxicity was recorded until upto three months after completion of RT. Results: Among the 56 patients treated with HFRT, the mean age was 49 years (range: 28-69 years). Pathologically positive nodes and =pT3 primary was observed in 44 (78.6%) and 12 (21.4%) patients, respectively. Majority (87.5%) received prior adjunct chemotherapy. RT to the supraclavicular fossa was delivered for 39 (69.6%) patients. The mean V90 and V95 to the Planning Target Volume (PTV) were 95% (± 3.3%) and 93% (± 4%), respectively. The maximum dose received was on average 47.7 Gy (112%; range: 46.2-48.5 Gy). The mean lung dose was 10.2 Gy (± 3.5 Gy) and V20 was 20.9% (± 6%). The mean V25 to heart was 6.6% (± 4.8%) for left sided and 0% for right sided tumours (p=0.001). Acute skin toxicity peaked at completion of RT and was tolerable (grade 0, I, II and III reactions were 75%, 16% and 1.8%, respectively). No patient had = grade III haematological toxicity, and treatment was not interrupted for any patient. Conclusion: Adjuvant HFRT could be planned while meeting the dose constraints to normal tissues in all patients and was well tolerated, with mild to moderate acute adverse effects that did not warrant any therapeutic intervention or treatment interruption.

Intense Pulsed light Versus 1,064 Long–Pulsed Neodymium: Yttrium–Aluminum– Garnet Laser in the Treatment of Facial Acne Vulgaris

Essam Elden Mohamed, Khaled Tawfik, Mohamed Elsaie

Introduction: Laser and light-based procedures provide a good and safe modality for treatment of active acne lesions when used properly. Aim: To compare the clinical efficacy of intense pulsed light (IPL) versus 1,064 long-pulsed Neodymium:Yttrium–Aluminum– Garnet (Nd: YAG) in treatment of facial acne vulgaris. Materials and Methods: Seventy four patients recruited between June 2013 and August 2014 was enrolled in this controlled, single-blind, split-face clinical trial. All participants received 3 sessions of IPL on the right side of the face and 1,064-nm Nd:YAG on the left side of the face at 4-weeks intervals. Final assessment was made by comparison of the changes in the count of inflammatory acne lesions (inflammatory papules, pustules, nodules and cyst) and non-inflammatory acne lesions (Comedones) and the acne severity score between both therapies, based on standardized photography. Results: At the final visit, the inflammatory acne lesions were reduced on the IPL and 1,064-nm Nd:YAG treated sides by 67.1% and 70.2% respectively (p<0.05 for each), while non inflammatory acne lesions were reduced by 18.3% and 19.3% respectively (p>0.05 for each). For both therapies, there was significant difference in the improvement on inflammatory acne lesions in comparison to non-inflammatory lesions (p<0.05 for each). There was no significant difference in the efficacy of the two therapies in reducing the percentage of both types of acne lesions count from baseline to the end of the study (p>0.05 for each). Conclusion: Both IPL and 1,064-nm Nd:YAG laser are effective in treatment of inflammatory facial acne vulgaris. There is no significant difference between the effects of both therapies on facial acne lesions.

Effect of Normal Saline on Cleaning Uterine Cavity During Cesarean Delivery

Lobat Jafarzadeh, Hajar Hojjati

Introduction: Cesarean delivery is the most common and costly gynaecologic surgery, with an increase in rate all over the world. Aim: The present study aimed to estimate the effect of uterine cavity cleansing with normal saline solution during cesarean delivery on the rate of infection, fever, bleeding and postoperative gastrointestinal complications. Materials and Methods: This study was a clinical trial carried out on 90 pregnant women who underwent elective cesarean delivery. The subjects were randomly assigned into two groups of 45 individuals, including rinsing in 500ml of normal saline solution during cesarean delivery (intervention group) and non-rinsed (control group). Postoperative complications include bleeding, fever, wound infection were examined. The data related to postoperative gastrointestinal complications and endometritis at the second day and one and six weeks after surgery were collected and data were analysed through SPSS 17. Results: There was no significant difference between two groups regarding febrile morbidity two days after the surgery. The rate of one-week postoperative febrile morbidity was higher in the control group but not statistically significant. The difference in the incidence of fever, wound infection and endometritis on the second day and on the first week was not statistically significant but the incidence of endometritis on the sixth week after surgery was significant in the intervention group than control group and was less in the intervention group, the wound infection at sixth week after surgery was fewer in the intervention group but not statistically significant. There was no significant difference between two groups in terms of gastrointestinal complications. Conclusion: Uterine cavity cleansing with normal saline solution during cesarean delivery may decrease postoperative complication, although the reduction is not statistically significant.

A Pilot Study on Carbapenemase Detection: Do We See the Same Level of Agreement as with the CLSI Observations

Introduction: Rapid identification of carbapenemase producing organisms is of great importance for timely detection, treatment and implementation of control measures to prevent the spread. The Modified Hodge Test (MHT) and Carba NP test is recommended by CLSI for the detection of carbapenemases in Enterobacteriaceae. However, MHT may give false positive results or fail to detect metallo ß-lactamases (MBLs). In the US, MHT is the most widely used test for detection of carbapenemases and has been found to have a sensitivity and specificity of >90% for blaKPC producers. However, in India, the prevalence of blaNDM is higher than blaKPC producers. Aim: To evaluate the usefulness of CarbaNP in an Indian setting. Materials and Methods: A total of 260 isolates of carbapenem resistant E.coli (n=57), Klebsiella spp. (n=85), Pseudomonas aeruginosa (n=60), and Acinetobacter baumannii (58) isolated from clinical specimens between 2012-2014 at the Christian Medical College, Vellore were included in the study. All the carbapenem resistant isolates were subjected to CarbaNP, MHT and multiplex PCR for detection of carbapenemase genes. Results: CarbaNP was found to be positive in 88% (n=50/57), 81% (n=69/51), 38% (n=23/60) and 81% (n=47/58) for E.coli, Klebsiella spp., P. aeruginosa, and A. baumannii respectively. While in MHT it showed, 89% (n=51/57) and 81 % (n=69/85) for E.coli and Klebsiella spp. respectively. In P.aeruginosa, synergy testing of imipenem plus cloxacillin showed that, 65% of CarbaNP negatives were ampC producers. Overall, the sensitivity and specificity of CarbaNP was found to be 94% and 100 for blaNDM; 77% and 100 % for blaOXA-48 like producers and 81% and 100% for CarbAcinetoNP respectively. Conclusion: This observation was more than what was reported in CLSI guidelines. Therefore, it is advisable to evaluate an assay for better laboratory diagnosis at respective regions.

GyrA ser83 and ParC trp106 Mutations in Salmonella enterica Serovar Typhi Isolated from Typhoid Fever Patients in Tertiary Care Hospital

Introduction: Typhoid fever is endemic in India and other developing countries, causing major public health problems with high morbidity and mortality. The resistance of Salmonella enterica serovar Typhi (S. Typhi) towards commonly prescribed antimicrobials is increasing in developing countries. However, there have been several reports of the therapeutic failure of fluoroquinolones in patients with Salmonella infection. Resistance to quinolones/ fluoroquinolones commonly arises due to target site mutation. Aim: The present study was planned to analyze mutation in Quinolone Resistance Determining Region (QRDR) of quinolone resistant Salmonella isolates. Materials and Methods: A total of 133 S. Typhi isolates (blood (n = 131), stool (n=1) and bone marrow aspirate (n=1)) from tertiary care hospitals in Chennai and Puducherry, were included in this study. Minimum Inhibitory Concentrations (MIC) were carried out according to the Clinical Laboratory Standard Institute (CLSI)guidelines 2014. Mutations in gyrA and parC genes were analyzed by PCR-RFLP (Restriction Fragment Length Polymorphism) method followed by DNA sequencing. Results: Of the 133 S. Typhi, 99.2% were resistant to nalidixic acid and 21% were resistant to ciprofloxacin by MIC method. 94% of isolates showed Ser 83 mutation in gyrA and 21.8% of isolates showed Trp106-Gly mutation in parC. Conclusion: Mutations in gyrA and parC genes are highly prevalent among Salmonella species. Irrational use of fluoroquinolones may increase the accumulation of mutations in the DNA gyrase and topoisomerase encoding genes, which lead to the emergence of high level fluoroquinolone-resistant Salmonella strains in future.

Simple Molecular Methods for Early Detection of Chloroquine Drug Resistance in Plasmodium Vivax and Plasmodium Falciparum

Gurjeet Singh, Raksha Singh, Anant Dattatraya Urhehar

Introduction: Malaria is a human disease of which causes high morbidity and mortality. In Plasmodium falciparum malaria, the resistance to antimalarial drugs, especially chloroquine (CQ) is one of the paramount factors contributing to the global increase in morbidity and mortality, due to malaria. Hence, there is a need for detection of chloroquine drug resistance genes i.e., pfcrt-o (Plasmodium falciparum chloroquine resistance transporter-o) and pfmdr-1 (Plasmodium falciparum multidrug resistance-1) of P. falciparum and pvcrt-o (Plasmodium vivax chloroquine resistance transporter-o) and pvmdr-1 (Plasmodium vivax multidrug resistance-1) of P. vivax by using molecular methods to prevent mortality in malarial cases. Aim: To standardize chloroquine drug sensitivity testing by molecular method so as to provide reports of chloroquine within 6-8 hours to physicians for better treatment. Materials and Methods: This study was conducted over a period of one year from January to December 2014. A Total of 300 blood samples were collected from malaria suspected patient attending MGM Hospital, Kamothe, Navi Mumbai, India. Out of 300 blood samples, 44 were malaria positive as assessed by Thick and Thin blood smear stained, by Leishman’s method and examination with light microscope. Chloroquine drug sensitivity testing was performed using WHO III plate method (micro test). Nested PCR was done for detection of pfcrt-o and pfmdr-1 for P. falciparum and pvcrt-o, pvmdr-1 genes for P. vivax. Results: Total 44 samples were included in this study, out of which 22 samples confirmed for Plasmodium falciparum and 22 samples confirmed for Plasmodium vivax. Out of 22 P. falciparum 15 (68.18%) samples were chloroquine resistant. P. vivax showed chloroquine resistance to 5 samples (22.73%) by method similar to WHO III plate method (micro test) and nested PCR. Conclusion: Drug resistance testing by molecular methods is useful for early detection of antimalarial drug resistance. pfmdr-1 along with pfcrt-o can be used as biomarker for chloroquine drug resistance in P. falciparum and pvmdr-1 along with pvcrt-o for P. vivax.

Microbiology of Non-Tunnelled Catheter-Related Infections

Shefali Gupta, Shrikara P. Mallya, Ashok Bhat, Shrikala Baliga

Introduction: Aerobic bacterial infections often complicate vascular access in patients receiving haemodialysis, leading to Catheter-Related Blood Stream Infections (CRBSI). Various studies report Gram - positive bacteria, Staphylococcus aureus (S. aureus) in particular, as the most common aetiologic agent. Studies on microbiological analysis in this subset of population from India are very few. Aim: To examine clinical and bacteriological profiles of haemodialysis patients developing CRBSI, the antibiotic susceptibility of the bacteria isolated from these patients and determine nasal carriage of S. aureus in the study subjects. Materials and Methods: Using a prospective observational design 127 patients receiving haemodialysis (84 males; 43 females) from October 2011 to March 2013 were enrolled in this study. At each dialysis session, catheters were examined for any evidence of infection. In case of suspicion for infection, pus swab, blood culture and the catheter tips were sent to microbiology laboratory for site specific investigations. Vancomycin injection was empirically administered to these patients pending culture results. Data obtained was examined for relationship of CRBSI with clinical and socio-demographic risk factors. Results: Out of 127 patients, 19 developed CRBSI, 10 developed exit-site infections and 33 patients were noted to have colonization of their catheters. The most common organisms included S. aureus in 24 (45.2%) catheter tips, followed by Pseudomonas aeruginosa in 9 (17%), Acinetobacter spp. in 5 (9%), Enterobacter spp. in 4 (7.5%) and Klebsiella pneumoniae in 3 (5.6%) catheter tips. Bacteraemia was found in 19 (20.7%) patients and P. aeruginosa was the most commonly isolated organism amongst them (38.8%). Staphylococcal nasal carriage was seen in 60 (69%) patients and 36 (41.4%) of these isolates were methicillin-resistant. Significant factors associated with CRBSI included history of bacteraemia, presence of diabetes mellitus, long duration (>15 days) of catheterization and antibiotic use within three months (p<0.05 for all). Conclusion: Although S. aureus was the most common colonizer of non-tunnelled central access catheters among haemodialysis patients, CRBSI was most frequently caused by P. aeruginosa, which may have a bearing on our current antibiotic policy.

Expression of p63 and Bcl-2 in Malignant Thyroid Tumors and their Correlation with other Diagnostic Immunocytochemical Markers

Ashumi Gupta, Shyama Jain, Nita Khurana, Arun Kumar Kakar

Introduction: Bcl-2 is a marker recently studied in thyroid tumours and proposed to have prognostic significance. p63 is expressed in a proportion of papillary thyroid carcinoma cases and may have a role in tumour progression. Aim: To study expression of Bcl2 and p63 in thyroid tumours and correlation of Bcl-2 with diagnostic markers including Thyroglobulin, Calcitonin and Carcinoembryonic antigen. Materials and Methods: Cytology smears of 35 cases of thyroid cancer were studied over a period of 18 months. In 20 cases histopathology was available. Immunocytochemistry for Bcl-2 and p63 was done, and diagnostic markers were applied as and when required. Results: p63 showed focal nuclear expression in 46.1% of papillary thyroid carcinoma cases, and was negative in all other tumours. Bcl-2 was positive in 88.9% of follicular carcinomas, 100% of papillary carcinomas and 83.3% of medullary carcinoma cases, and showed focal weak expression in 40% of Anaplastic Carcinoma (ATC) cases, thereby signifying down regulation (p-value = 0.001). There was significant down regulation of Thyroglobulin (Tg) in ATC vs well differentiated follicular derived tumours (p-value = 0.016). Positive correlation was noted between expression of Bcl-2 and Calcitonin (0.93) and Bcl-2 and Carcinoembryonic Antigen (CEA) (0.89), and weak positive correlation (0.65) between Tg and Bcl-2. Conclusion: Bcl-2 is downregulated in anaplastic carcinomas as compared to well differentiated thyroid tumours, and shows correlation with differentiation associated tumour antigens. Thus, loss of Bcl-2 was associated with loss of differentiation in thyroid tumours. Anaplastic carcinoma as such is associated with worse prognosis and loss of Bcl-2 may be partly responsible for the same. p63 is specific but less sensitive marker for PTC. Further studies are required to determine the role of Bcl-2 and p63 in thyroid tumours.

Reconstructive Surgery Camp for Leprosy Deformities in a Tertiary Hospital: An Example of Service Delivery at Low Costs

Nikita R. Bhatt, Gaurav A. Kakked, Kinnari Vyas, Rajiv Merchant

Introduction: Seventy percent of all cases of leprosy in the world occur in India. 8,462 new cases of disability were reported in India between 2010-11. Reconstructive Surgery Camps (RSC) provide free of cost plastic surgical expertise to patients of leprosy with deformity. Aim: The aim of this article was to report the outcomes of a RSC in a tertiary level university hospital in India. We also described the types of deformities in the patient group and the cost of conducting such a camp. Materials and Methods: The RSC involved 130 patients with leprosy related deformities operated by a team of plastic surgeons in a tertiary university hospital over 5 days. Health workers of the National Leprosy Elimination Program identified patients at community level. The camp was funded by the central government of India and the patients were provided incentives for undergoing treatment. Results: Plantar ulcer was the commonest deformity (51.5%) while lagopthalmos (9.2%) was the least common deformity in the patient group. The overall complication rate in our study was around 10.6% (n=11). The total cost of this camp was 730,000 rupees (£7029.9). Conclusion: Reconstructive surgery in a camp setup is a low cost alternative of correcting leprosy related deformity. It also provides valuable practical experience in reconstructive surgery to surgical trainees. Tertiary hospital based camps for conducting large-scale surgeries may be a cost effective alternative to reduce waiting lists in public health sectors. Long-term studies monitoring patients operated in a camp setting would be worthwhile.

To Evaluate the Efficacy of Combination Antioxidant Therapy on Oxidative Stress Parameters in Seminal Plasma in the Male Infertility

Alpana Singh, Nusrat Jahan, Gita Radhakrishnan, B.D. Banerjee

Introduction: Infertility is defined as inability to conceive after 1 year of unprotected intercourse and it affects 7% of male population and 8–10% of couples. According to estimates WHO, 13-19 million couples in India are infertile. Oxidative stress is the causative factor in 25% of infertile males. Aim: To study the efficacy of antioxidant therapy on oxidative stress parameters in seminal plasma of infertile male. Materials and Methods: Forty patients of male infertility were enrolled in study after two abnormal semen analyses reports at 2-3 weeks interval, of oligozoospermia and/or asthenozoospermia, as per WHO guide line 1999. First semen sample was collected at a time of enrollment of study and second semen sample was collected three months after combined antioxidant therapy. Semen samples from the infertile male (the second confirmatory sample of oligoasthenozoospermia) were taken and after liquefaction semen sample were utilized for various analyses, 0.5 ml of sample for standard semen analysis, 1.2 ml sample for separation of seminal plasma to evaluate Oxidative stress (OS) parameters like Malondialdehyde (MDA), Protein Carbonyl (PC) and antioxidant capacity by Glutathione (GSH). We followed the patient for three months after completion of the treatment. Results: Semen parameters – Out of 40 patients recruited in the study group 7 patients had only oligospermia (1 to 20 million/ml) and 31 patients had oligoasthenozoospermia (motility range 0-50%) and 2 patients had oligoasthenoteratozoospermia. There was no patient with asthenospermia alone as abnormal semen parameters. After the three months treatment with combined antioxidants the semen parameters like count (mean SD = -1.70±1.44) and motility (mean +SD= -9.56±9.05) were significantly increased (p-value=0.000). Oxidative Stress Assessment – The level of MDA which is a marker of oxidative stress was significantly lower after the three months therapy of antioxidants (p-value=0.002) whereas another marker which is denoted by PC was also lower after the treatment but not statistically significant (p-value=0.584). The level of antioxidants GSH also significantly increased after the treatment (p-value=0.000). After the treatment out of 40, five patients conceived (16.7%). Conclusion: As we have seen through this study antioxidant dramatically reduced the oxidative stress markers and enhancing the antioxidant enzymes. They should be used on routine basis in case of male infertility.

Comparative Evaluation of Efficacy of Physics Forceps versus Conventional Forceps in Orthodontic Extractions: A Prospective Randomized Split Mouth Study

Introduction: Tooth extraction is one of the most commonly performed procedures in dentistry. It is usually a traumatic procedure often resulting in immediate destruction and loss of alveolar bone and surrounding soft tissues. Various instruments have been described to perform atraumatic extractions which can prevent damage to the paradental structures. Recently developed physics forceps is one of the instruments which is claimed to perform atraumatic extractions. Aim: The aim of the present study was to compare the efficacy of physics forceps with conventional forceps in terms of operating time, prevention of marginal bone loss & soft tissue loss, postoperative pain and postoperative complications following bilateral premolar extractions for orthodontic purpose. Materials and Methods: In this prospective split-mouth study, outcomes of the 2 groups (n = 42 premolars) requiring extraction of premolars for orthodontic treatment purpose using Physics forceps and Conventional forceps were compared. Clinical outcomes in form of time taken, loss of buccal soft tissue and buccal cortical plate based on extraction defect classification system, postoperative pain and other complication associated with extraction were recorded and compared. Results: Statistically significant reduction in the operating time was noted in physics forceps group. Marginal bone loss and soft tissue loss was also significantly lesser in physics forceps group when compared to conventional forceps group. However, there was no statistically significant difference in severity of postoperative pain between both groups. Conclusion: The results of the present study suggest that physics forceps was more efficient in reducing operating time and prevention of marginal bone loss & soft tissue loss when compared to conventional forceps in orthodontically indicated premolar extractions.

Pro-Activeness of Parents in Accepting Behavior Management Techniques: A Cross-Sectional Evaluative Study

Prevalence of Autoantibodies and HLA DR, DQ in Type 1 Diabetes Mellitus

Introduction: Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of ß-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). Aim: Aim was to study the prevalence of Anti-TTG IgA, Anti-TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM. Materials and Methods: Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method. Result: The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls. HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies. Conclusion: Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone.

Evaluation of Vinegar as a Disinfectant for Extracted Human Teeth - An in-Vitro Study

Biologics Use in Asian Indian Patients with Ankylosing Spondylitis: A Physician’s Perspective

Anuj Singhal, Darshan Bhakuni, Vishal Marwaha, Vivek Hande, Garvit Bagga

Introduction: Ankylosing Spondylitis (AS) with non-steroidal anti-inflammatory drug (NSAID) therapeutic failure is treated with biologics. Aim: To compare the clinical outcomes of different biologics for Asian Indian patients with AS who have NSAID therapeutic failure. Materials and Methods: Thirty-five AS patients with NSAID failure were administered Etanercept (n=15) (50mg SQ, weekly) or Infliximab (n=20) (5mg/kg IV every 2nd month) based on patient convenience or physician discretion as per 2015 ACR/SAA/SPARTAN recommendations. Baseline demographic details, time to diagnosis, disease duration, presence of low backache, early morning stiffness, peripheral joint and extraarticular involvement, ESR, CRP values and HLA-B27 score were obtained. Baseline values of scores of BASMI-3 and MASES were calculated. To monitor the disease activity, BASDAI and ASDAS-ESR scores were recorded at baseline, and after 6 months and 12 months of therapy initiation. Statistical Analysis: Comparison of means: independent samples t-test; comparison of parameters over time: repeated measures ANOVA. Results: Both groups were comparable in all parameters at therapy initiation except in the baseline BASMI-3 score which was significantly higher in patients who received Etanercept. Over 12 months of treatment, the reduction in disease activity, as evidenced by reduction in the mean BASDAI and ASDAS-ESR scores was statistically significant for all patients when considered together, as well as when Etanercept and Infliximab were considered separately (p<0.0001 in all cases). However, there was no statistically significant difference in the magnitude of reduction in the mean BASDAI and ASDAS-ESR scores between patients who received Etanercept and those who received infliximab (p=0.696 and 0.618 respectively). Conclusion: Etanercept and Infliximab offer statistically similar reduction in disease severity in Asian Indian AS patients with NSAID failure. Further studies with larger sample size are warranted.

Comparative Evaluation of Two Different Ultrasonic Liquid Coolants on Dental Aerosols

Introduction: Dentists are more prone for developing infectious diseases especially related to respiratory system. The ultrasonic scaler which is a major source of dental aerosol production is most frequently used contrivance in a dental set up. Aim: The aim of this study was to evaluate the effect of povidone iodine and chlorhexidine gluconate as an ultrasonic liquid coolant on aerosols in comparison with distilled water. The objectives of this study were to compare the potency of povidone iodine and chlorhexidine gluconate on reducing dental aerosols and quantitative assessment of microbial content of dental aerosols at right, left and behind the dental chair. Materials and Methods: In this study 30 subjects were selected who fulfilled the inclusion criteria and were divided into three groups. Group 1 (Control group): Ultrasonic scaling with distilled water (10 subjects), Group 2 (Test group): Ultrasonic scaling with 2% povidone iodine (10 subjects), Group 3 (Test group): Ultrasonic scaling with 0.12% chlorhexidine (10 subjects). At the baseline one blood agar plate was kept for 10 minutes in the fumigated chamber before ultrasonic scaling, thereafter three blood agar plates were kept at a distance of 0.4 meters away on either side of the patient and 2 meters behind the patient’s mouth during ultrasonic scaling. Blood agar plates were kept for gravitometric settling of dental aerosols. Results: At baseline, no significant numbers of Colony-Forming Units (CFU) were detected. It is found that Group 3 (chlorhexidine gluconate) showed effective CFU reduction (27.17 ±12.5 CFU) when compared to distilled water (124.5 ± 30.08 CFU) and povidone iodine (60.43 ± 33.33 CFU). More CFU were found on blood agar plates which were kept on right side in all the three groups. The results obtained were statistically significant (p< 0.001). Conclusion: Chlorhexidine gluconate is more effective in reducing dental aerosols when compared to povidone iodine and distilled water. Povidone iodine showed better CFU reduction when compared with distilled water. Hence, chlorhexidine or povidone iodine can also be used as an ultrasonic liquid coolant for reducing the number of dental aerosols during ultrasonic scaling.

Neuropsychiatric Profile in Malaria: An Overview

Introduction: Malaria is the most important parasitic disease of humans causes clinical illness over 300-500 million people globally and over one million death every year globally. The involvement of the nervous system in malaria is studied in this paper, to help formulate a strategy for better malaria management. Aim: To study the Neuropsychiatric manifestation in malaria. Materials and Methods: This was a prospective observational study in 170 patients with a clinical diagnosis of malaria admitted in various medical wards of medicine department of PBM Hospital, Bikaner during epidemic of malaria. It included both sexes of all age groups except the paediatric range. The diagnosis of malaria was confirmed by examination of thick and thin smear/optimal test/strip test. Only those cases that had asexual form of parasite of malaria in the blood by smear examination or optimal test were included in the study. Results: Out of total 170 patients 104 (62%) reported Plasmodium falciparum (PF), Plasmodium vivax (PV) were 57 (33.5%) followed by mixed (PF+PV) 9 (5.3%) cases. The total PBF-MP test positivity was 84.5%. Maximum patients were belonging to the age range of 21-40 year with male predominance. Neuropsychiatric manifestation seen in falciparum malaria (n=111) as follow: altered consciousness 20 (18.01%), headache 17 (15.32%), neck rigidity 5 (4.5%), convulsion 5 (4.55%), extra pyramidal rigidity 2 (1.8%), decorticate rigidity 1 (0.90%), decerebrate rigidity 1 (0.90%), cerebellar ataxia 3 (2.7%), subarachnoid haemorrhage 1 (0.90%), aphasia 2 (1.8%), subconjunctival haemorrhage 1 (0.90%), conjugate deviation of eye 1 (0.90%) and psychosis 6 (5.40%). Twenty one patients presented with cerebral malaria out of 111 patients. Most patients of cerebral malaria presented with altered level of consciousness followed by headache and psychosis. Acute confusional state with clouding of consciousness was the most common presentation of psychosis (50%). Conclusion: Neuropsychiatric manifestations are not an uncommon presentation of malaria. Most commonly caused by PF malaria. Malaria should be thought as a differential diagnosis in pyrexia with neuropsychiatric manifestation. Observation obtained in the study will be highly useful for the diagnosis and management of patients suffering from malaria.

Correlation of Strain Elastography with Conventional Sonography and FNAC/Biopsy

Ramona Menezes, Sanjay Sardessai, Renny Furtado, Mahesh Sardessai

Introduction: Elastography is a new promising technique that can be especially helpful when used as an adjunct to conventional B-mode ultrasound in evaluating breast lesions. Aim: To evaluate the diagnostic performance of four interpretation criteria for elastography and to compare the diagnostic performance of sonoelastography with that of conventional sonography in characterising breast lesions as benign or malignant with FNAC/biopsy correlation. Materials and Methods: One hundred breast lesions were prospectively evaluated by ultrasound as well as by strain elastography followed by FNAC/ biopsy correlation. The criteria used were Elastography Score, Strain Ratio, Distance Ratio and Area Ratio. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality. The best cut-off point was calculated for each of the interpretation criteria using the MedCalc version 10.1 software. The diagnostic performance of the interpretation criteria was compared with that of conventional sonography by the area under the receiver operating characteristic curve using SPSS software. Results: The elastography score was found to have the best performance among the 4 criteria used with a sensitivity and specificity of 100% and 82.66%, respectively at the best cut-off point between 3 and 4. At a best cut-off point for conventional sonography between BI-RADS categories 4A and 4B, the sensitivity and specificity were found to be 96% and 92% respectively. The area under the curve value was slightly greater for conventional sonography (0.980) than for the elastography score (0.913) using receiver operating characteristic curve analysis. Conclusion: While all interpretation criteria were able to differentiate benign and malignant lesions with statistical significance, the elastography score was found to be the most accurate. While conventional ultrasound remains the primary modality for the characterization of breast masses, elastography was found to have a role in low suspicion lesions (BI-RADS 3 and 4A) where it’s greater specificity could justify avoiding unnecessary biopsy.

A Clinicopathological Study of Benign Phyllodes Tumour of Breast with Emphasis on Unusual Features

Kishori Moni Panda, Reena Naik

Introduction: Benign Phyllodes Tumours (PTs) are rare fibroepithelial neoplasms that resemble fibroadenoma. But unlike fibroadenoma, benign PT can recur and both stromal & epithelial components can progress to malignancy. Contrary to earlier belief that benign PT is a stromal neoplasm and possibly arises from fibroadenoma, more recent molecular studies have suggested that both stroma and epithelium can become neoplastic. Sometimes, benign PT can occur synchronously with fibroadenoma. Here histomorphologic analysis of eleven cases of benign PT are presented including some unusual features. Materials and Methods: Eleven cases of benign PT diagnosed between Dec 2014 and Jan 2016 in the Department of Pathology were studied. The demographic and clinicopathological features were analysed. Results: The most common age group affected was 20-30 years (range: 13-45). Clinical features included pain, lump and bleeding from nipple. The tumour size varied from 2.5-18 cm in diameter. H&E stained sections showed secondary changes (haemorrhage, myxoid, change, cystic degeneration), epithelial hyperplasia (8), squamous & columnar metaplasia (1), benign tubular adenoma like areas (1), Ductal Carcinoma In Situ (DCIS) (1), Invasive Ductal Carcinoma (IDC) (1), Pseudoangiomatous Stromal Hyperplasia (PASH) (1), histologic infarction (2), tumour necrosis (1) and synchronous fibroadenoma (1). Unusual histologic features included atypical ductal hyperplasia, DCIS, IDC, synchronous fibroadenoma and tubular adenoma like areas arising within benign PT. Conclusion: This study shows a spectrum of hyperplastic, metaplastic, dysplastic, benign, in-situ-malignancy and even invasive ductal malignancy occurring in benign PT. Therefore adequate and extensive sampling is recommended for accurate diagnosis.

Lipid Profile in Cardiac Syndrome X: Association with Helicobacter pylori

Introduction: Chronic inflammation caused by Helicobacter pylori (H.pylori) infection has a pathogenic role in Cardiac Syndrome X (CSX). In addition, it has shown that bacterial infection may affect blood lipids. Aim: To assess if H.pylori affects the level of lipid profile in CSX. Materials and Methods: Eighty-eight CSX patients and 97 healthy controls were enrolled. The Total Cholesterol (TC), Triglyceride (TG), Lipoprotein A (LP{A}), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Apoprotein A1 (APOA1), and Apoprotein B (APOB) was estimated colorimetrically. In addition, the presence of IgG antibody to H.pylori was tested in plasma samples by using enzyme linked immunosorbent assay method. Results: TC, LP{A}, LDL, APOA1 and APOB levels in CSX group were significantly higher than those of the control group (p<0.05). But, these parameters in H.pylori positive and H.pylori negative, among CSX and control groups were not significant. Conclusion: Increased plasma level of lipid profile and H.pylori infection were associated with CSX; it seems that plasma l

Effect of Chlorhexidine with Fluoride Mouthrinse on Plaque Accumulation, Plaque pH - A Double Blind Parallel Randomized Clinical Trial

Neha Shukla, Sabyasachi Saha, Sanjay Singh

Introduction: Mouthwashes are important means used in chemical control of dental plaque. There is strong evidence suggestive of better effectiveness, when fluoride is added to chlorhexidine mouthwash. Aim: To assess the anti-plaque efficacy of Chlorhexidine combined with Fluoride mouthwash and to measure its impact on plaque accumulation and on plaque pH. Materials and Methods: Initially 100 subjects were screened. A double blind, parallel randomized clinical trial was conducted on 30 subjects after applying inclusion and exclusion criteria. Other independent variables were matched before randomly allocating them in three groups: Group A-Chlorhexidine as positive control, Group B-Chlorhexidine + Fluoride as test group and Group C- Distilled water as negative control. Oral prophylaxis of participants was done before onset of the study. Plaque pH was assessed before and immediately after rinsing at 0, 5 and 10 minutes interval and after 7 days with digital pH electrode (pHepR pH meter, Hanna Instruments R10285) and accumulation of plaque was recorded by Turesky et al., modification of Quigley Hein Plaque Index (1970). ANOVA test was used for statistical analysis. Results: Although there was a statistically significant reduction in mean plaque scores from baseline to seven days in both Groups A and B, Group B showed better anti-plaque efficacy. Almost equal drop in plaque pH was seen for both the groups at 5 and 10 minutes. Conclusion: Better anti-plaque efficacy was observed in Group B (Chlorhexidine and Fluoride combination) with minimum variation of plaque pH.

Quantitative Gene Expression of ERG9 in Model Saccharomyces cerevisiae: Chamomile Extract For Human Cancer Treatment

Maryam Hosseinpour, Mohsen Mobini-Dehkordi, Hossein Teimori

Introduction: Over expression of squalene synthase gene causes induction of growth tumour and reduction of apoptosis. This gene which is conserved between Saccharomyces cerevisiae yeast and humans, is named (ERG9). Aim: In this work, we studied the effect of Matricaria recutita extract on ERG9 gene (squalene synthase) expression in S.cerevisiae which was used as organism model in cancer therapy. Materials and Methods: S. cerevisiae was cultured in YPD medium plus 0,250, 1000 and 3000 µg/ml of Matricaria recutita extract and we evaluated the (ERG9) gene expression by Real-time RT-PCR method after 24 hours. Statistical analysis used: At least 3 independent experiments were done. Data were analyzed using One-way ANOVA and Dunnett’s test. A p-value of less than 0.01 was considered as significant. Results: We found that 250, 1000 and 3000 µg/ml of Matricaria recutita extract could reduce expression of ERG9 gene significantly (p<0.01). Interestingly, the expression of this gene was completely inhibited in 1000 and 3000 µg/ml concentrations. Conclusion: This study predicted that Matricaria recutita extract produced anti-cancer effects in humans, because it could inhibit the expression of an analogue key gene in this malignant disease. Further investigations should be made, to study its molecular mechanism of action at the mammal cell level.

Comparative Morphologic Evaluation and Occluding Effectiveness of Nd: YAG, CO2 and Diode Lasers on Exposed Human Dentinal Tubules: An Invitro SEM Study

Mini Saluja, Harpreet Singh Grover, Pankaj Choudhary

Introduction: Dentinal hypersensitivity is one of the most common problem, encountered in dental practice but has least predictable treatment outcome. The advent of lasers in dentistry has provided an additional therapeutic option for treating dentinal hypersensitivity. Although various lasers have been tried over a period of time to treat dentinal hypersensitivity, but still the doubt persist as to which laser leads to maximum dentinal tubular occlusion and is most suitable with minimal hazardous effects. Aim: To compare the effects of Nd: YAG, CO2 and 810-nm diode lasers on width of exposed dentinal tubule orifices and to evaluate the morphologic changes on dentinal surface of human tooth after laser irradiation by scanning electron microscope (SEM). Materials and Methods: Forty root specimens were obtained from ten freshly extracted human premolars, which were randomly divided into four groups of ten each. Group I: control group treated with only saline, Group II: Nd:YAG laser, Group III: CO2 laser and Group IV: 810-nm diode laser. The specimens were examined using SEM. After calculating mean tubular diameter for each group, the values were compared statistically using parametric one-way ANOVA test and Turkey’s post hoc multiple comparison test. Results: All the three lased groups showed a highly statistical significant result with p-value of <0.001 as compared to non-lased group. On intergroup comparison within the lased groups, all the three groups showed statistically significant difference in the reduction of dentinal tubular diameter (p-value < 0.001). Conclusion: Nd: YAG laser was found to be most effective, followed by the CO2 laser and 810-nm diode laser was found to be least effective. The morphologic changes like craters, cracks and charring effect of the dentine were seen maximum by the use of CO2 laser.

The Role of Socioeconomic Status on Health-Related Quality of Life in the West of Iran

Introduction: The quality of life involves different dimensions of people’s social mental, physical welfare and health. Aim: This study aimed to determine the effects of economic- social factors on quality of life in 2013 in the west of Iran. Materials and Methods: In this cross-sectional study, we selected cases among different counties of Ilam province by multi-stage cluster sampling. Data collection tools were general economic questionnaires and the quality of life questionnaire SF-36. Data analysed using multiple regression models. Results: Nine hundred and eighteen participants were selected mean±sd age for the studied participant was 32.97±9.5 years and mean±sd scores for their quality of life were 61.74± 12.31. Based on results of logistic regression, the good quality of life among women was 1.2 times more than men and among married was 1.47 times more than single. After adjustments on other covariates, the odds of good quality of life for people with good and median economic condition was respectively 1.8 and 3.4 times more than groups with bad economic condition. Conclusion: Therefore, the general improvement of people’s quality of life can be influenced by increasing social cooperation, improving health care services and providing counseling services about obtained policies by health care.

A Cross-sectional Study of the Pattern of Body Image Perception among Female Students of BBM College in Vijayapur, North Karnataka

Introduction: Body image is an essential aspect of young girls’ self-definition and individual identity which is influenced by various biological, psychological and social factors. Excessive concern about body image, body image misconception are leading to dissatisfaction, disturbed eating patterns, affecting the nutritional status and also leading to depression and anxiety disorders. This concept of body image has been less explored in Indian context, especially among young girls. Aims: The objectives of the study were to assess the body image perception among young college going girls, using a visual analog scale and to compare body image perception and satisfaction with their BMI levels and weight changing methods adopted. Materials and Methods: An exploratory cross-sectional study was conducted among 63 female students studying BBM course at a private commerce institution in Vijayapur city. Data was collected using a self administered questionnaire containing details of basic socio-demographic information and a validated visual analogue scale. Height was measured by Seca Stadiometer, weight was measured using Digital weighing machine and Body Mass Index levels were calculated. Percentages were calculated for descriptive variables. Chi-square test was applied for analysing categorical variables. Spearman Rank correlation test was applied for analysing ordinal data. Results: A 39.7% of participants were underweight and 15.9% were overweight/obese. Majority of underweight and overweight girls (72% and 89%, respectively) perceived themselves as normal weight. Body image satisfaction of participants was found to be significantly associated with their body image perception, mothers’ educational status and also with relatives’ and peer group’s opinions about their body weight. Unhealthy weight changing patterns like skipping meals (13%), increasing quantity and frequency of meals (17%) were reported among study participants. Conclusion: This exploratory study highlights the gap between young girls’ body image perception and their BMI levels, indicating body image misconception. Lower literacy level of mothers and opinions of relatives and friends significantly influenced body image satisfaction among study participants. Higher percentage of underweight (39.7%) coupled with unhealthy weight changing patterns reportedly adopted by participants (30%) indicates need for further research on this issue, to help inform public health nutrition programmes.

Serum γ-Glutamyltransferase, Alanine Aminotransferase and Aspartate Aminotransferase Activity in Healthy Blood Donor of Different Ethnic Groups in Gorgan

Abdoljalal Marjani, Masoumeh Mehrpouya, Zeinab Pourhashem

Introduction: Measure of liver enzymes may help to increase safety of blood donation for both blood donor and recipient. Determination of liver enzymes may prepare valuable clinical information. Aim: To assess serum ?-Glutamyltransferase (GGT), Alanine Aminotransferase (ALT), and Aspartate Aminotransferase (AST) activities in healthy blood donors in different ethnic groups in Gorgan. Materials and Methods: This study was performed in 450 healthy male blood donors, in three ethnic groups (Fars, Sistanee and Turkman) who attended Gorgan blood transfusion center. Liver enzymes (GGT, ALT and AST) were determined. Results: Serum AST and ALT in three ethnic groups were significant except for serum GGT levels. There was significant correlation between family histories of liver disease and systolic blood pressure and AST in Fars, and GGT in Sistanee ethnic groups. Conclusion: Several factors, such as age, family history of diabetes mellitus, family history of liver disease and smoking habit had no effect on some liver enzymes in different ethnic groups in this area. Variation of AST, ALT, and GGT enzyme activities in healthy subjects was associated with some subjects in our study groups. According to our study, it suggests that screening of AST and GGT enzymes in subjects with family history of liver disease is necessary in different ethnic groups.

Estimation and Comparison of Salivary Calcium, Phosphorous, Alkaline Phosphatase and pH Levels in Periodontal Health and Disease: A Cross-sectional Biochemical Study

Rufi Murad Patel, Sidd hartha Varma, Girish Suragimath, Sameer Zope

Introduction: In oral diagnostics there is a great challenge to determine biomarkers for screening and evaluating the disease activity. Biomarkers can also serve as a useful tool to measure the efficacy of the therapy. Aim: To evaluate and compare the levels of salivary calcium, phosphorous, alkaline phosphatase and pH levels in periodontally healthy subjects and patients with gingivitis and periodontitis. Materials and Methods: The present study consisted of 150 subjects aged between 20-45 years who were divided into three groups; periodontally healthy, gingivitis and chronic periodontitis. Prior to the clinical examination the demographic details, relevant information of the subject, gingival index, plaque index, Oral Hygiene Index (OHI) and pH were recorded. Biochemical assay of saliva i.e., inorganic calcium, phosphorous and alkaline phosphatase were estimated by colorimetric method. ANOVA and Tukey’s test were applied for statistical analysis. Results: The mean levels of biomarkers studied were; inorganic calcium (12.55µg/dl), phosphorous (14.50µg/dl), alkaline phosphatase (49.62µg/dl) and pH (11.65). There was a gradual increase in these levels as the condition progressed from health to gingivitis or periodontitis which was statistically significant at p<0.001. Conclusion: Based on these results, it can be concluded that, the biomarkers like salivary calcium, phosphorous, alkaline phosphatase and pH can be considered for evaluating the diagnosis and prognosis of periodontal tissues in disease and health.

Bacterial Viability within Dental Calculus: An Untrodden, Inquisitive Clinico-Patho- Microbiological Research

Introduction: Chronic inflammatory periodontal diseases i.e. gingivitis and periodontitis are one of the most common afflictions faced by human beings. Dental plaque, which is a pool of pathogenic microorganisms, remains to be current mainstay in etiopathogenesis. Dental calculus, which is a mineralized product of this plaque remains ignored and is considered merely as an ash heap of minor significance. However, the intriguing array in disease etiopathogenesis bulldozed researchers to suspect the role of calculus in disease chrysalis but still the viability of bacteria inside calculus and thus its pathogenicity remains an intricacy; the answer to which lies in the Pandora’s Box. Aim: The present study was undertaken to investigate the viability of bacteria within dental calculus along with their identification. Also, to classify dental calculus on the basis of mineralization and to observe the variation of viable microflora found in dental calculus with the extent of mineralization and disease severity. Materials and Methods: A total of 60 samples were obtained, by harvesting two samples of supragingival calculus from each patient having chronic inflammatory periodontal disease. These samples were divided into two groups (Group A and Group B). Samples of Group A were kept non-irradiated and samples of Group B were exposed to UV radiation. The samples were categorized into less, moderately and highly mineralized according to the force required for crushing them. All the crushed calculus samples were then divided into three parts. These were used for dark-field microscopy, gram staining and bacterial cultures. Bacterial identification of the cultures obtained was also carried out by performing various biochemical assays. Results: The present study revealed the presence of motile spirochaetes within the samples under dark-field microscope. Gram staining revealed presence of numerous gram positive cocci and gram negative bacilli. Bacterial cultures showed growth of variety of aerobic and capnophilic microorganisms. Conclusion: The present study concludes the presence of viable aerobic and capnophilic bacteria inside dental calculus which may reside within the lacunae and channels in the calculus.

A Comparative Evaluation of Sealing Ability of New MTA Based Sealers with Conventional Resin Based Sealer: An In-vitro Study

Introduction: Root canal obturation is the most important step in the root canal treatment that aims to obtain a complete hermetic seal and to prevent the re-growth of microorganisms in the root canal system. To accomplish this, many endodontic obturation materials and sealers are being used. Aim: To evaluate and compare the apical microleakage of a resin based sealer; Adseal with Mineral Trioxide Aggregate (MTA) based sealers; Pro root MTA and MTA Fillapex. Materials and Methods: Total 75 extracted human single rooted teeth were taken and decoronated at cemento-enamel junction. The access cavities and biomechanical preparation were performed using endodontic rotary system. The teeth were randomly divided into five groups with n=15; Group I - Gutta-percha and Adseal sealer; Group II - Gutta-percha and MTA Fillapex; Group III- Gutta-percha and Pro root MTA; Group IV- Gutta-percha without sealer (positive control group); Group V- Root canal remained empty (negative control). All the specimens were stored at 370C with 100% humidity for one week. All root surfaces except the apical 2mm were covered with two layers of nail varnish and then immersed in an aqueous solution of 2% methylene blue dye for 72 hours. Roots were longitudinally split using a diamond disk. Linear apical dye penetration was measured under Stereomicroscope at 40X magnification. Statistical Analysis: The data obtained was subjected to statistical analysis using paried t-test, ANOVA for interclass comparison, with SPSS statistical software (version 20.0). Results: The intraobserver reliability was found to be insignificant in each of the triplicate study of all the three study samples. MTA Fillapex group showed maxmium apical microleakage followed by Pro root MTA and Adseal sealer. Conclusion: The results concluded that Adseal sealer showed minimal dye penetration followed by Pro root MTA and MTA Fillapex. Thus, concluding that Adseal sealer is better in apical sealing than Pro root MTA and MTA Fillapex.

Breaking the Chain of Infection: Dental Unit Water Quality Control

Amrita Pawar, Sandeep Garg, Sonia Mehta, Rajat Dang

Introduction: The air–water syringes, ultrasonic scalers, high speed air turbine handpieces are connected to dental units by a network of small-bore plastic tubes through which water and air travel to activate or cool the instruments and it had been shown that this system is extensively contaminated with microbial biofilms and pose a potential risk of infection for patients as well as dental professionals. Aim: To evaluate and compare the efficacy of various disinfectants in reducing the microbial colony count in water derived from Dental Unit Waterlines. Materials and Methods: Five random dental units were selected and samples were collected before and after intervention with 5 disinfectants (0.02% H2O2 continuously, 0.02% H2O2 continuously with shock treatment with 0.25% H2O2 weekly, 0.12% Chlorohexidine and 12% Ethanol overnight, 1:50 Original Listerine overnight, 2% Sodium Perborate and 2% EDTA 5 minutes in morning) using different disinfection methods for 4 weeks. Samples were cultured on Reasoner’s 2A (R2A) agar for microbial counting. Results: Results were recorded as Colony forming units/ml (cfu/ml) and were evaluated statistically. Results showed that all the dental unit waterlines were heavily contaminated with microbes before any intervention. After 1 day of disinfection regime the counts reduced significantly and showed progressive reduction in consecutive weeks. Goals set by ADA & CDC were ultimately achieved at the end of 4 weeks. Conclusion: All the disinfectants were equally effective in reducing the microbial colony count of DUWLs, irrespective of their concentration and method of disinfection.

Quality of Basic Life Support – A Comparison between Medical Students and Paramedics

Maria Isabel Körber, Thomas Köhler, Verena WeiSS, Roman Pfister, Guido Michels

Introduction: Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals. Aim: This study aimed to assess quality of basic life support in medical students and paramedics. Materials and Methods: We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth =50mm) were assessed as quality parameters of CPR. Results: In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups. Conclusion: Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.

Morphometric Study on Bicipital Groove among South Indian Population

Yamini Soundara rajan, Senthil Kumar Sampath Kumar

Introduction: The Bicipital Groove (BG) is an indentation between the lesser and greater tubercles of the proximal part of the humerus. It conveys biceps tendon, its synovial sheath and ascending branch of anterior circumflex humeral artery. The knowledge of the morphometry is important for the understanding of the functional aspect of the shoulder region. Aim: To study the morphometry of bicipital groove of humerus in south Indian population. Materials and Methods: In the present study, 100 adult humeri (50 right and 50 left) were examined. The length of the medial wall, lateral wall, width and depth were measured by using vernier calliper. The humeri were examined for the presence of supratubercular ridge. All the parameters were accurately measured and the data were analysed. Results: The mean length of BG on right side was 84.79±5.84 mm and 87.33±6.40mm on the left side. The mean width of BG on right side was 6.84±1.01mm and 7.74±1.96mm on the left side. The mean depth of BG on right side was 4.21±0.58 mm and 5.01±1.05mm on the left side. The mean length of the medial and lateral walls on the right side was 24.22±1.02mm and 32.05±2.21mm respectively and that on the left side was 23.31±2.21mm and 31.12±0.24mm respectively. 17% of humeri on the right side and 14% on the left side showed the presence of supratubercular ridge of Meyer in the present study. Conclusion: Bicipital groove is present in the shoulder region where wide range of movements occurs. Osseous spurs and supratubercular ridge may predispose dislocation of tendon of biceps brachii. Hence morphometric knowledge is obligatory and is significant functionally and clinically for better understanding of this region.

Comparison of Vaginal versus Oral Estradiol Administration in Improving the Visualization of Transformation Zone (TZ) during Colposcopy

Introduction: Colposcopy is an important diagnostic tool in the evaluation of patients with abnormal pap smears. However, in 10-20% transformation zone (TZ)/squamo-columnar junction is not completely visualized and these patients are deemed to have an incomplete colposcopy examination. Such patients usually require conization, a procedure associated with significant morbidity. Various agents like misoprostol, estrogens and laminaria tents have been used in the past to overcome the non-visualization of TZ. Aim: The present study was conducted with the aim to compare the efficacy of vaginal versus oral estradiol administration in overcoming incomplete colposcopy. Materials and Methods: Forty patients with non/partially visualized TZ during colposcopy were recruited for the study. These patients were randomly distributed into two groups: In Group I, 25µg estradiol was administered intravaginally daily for seven consecutive days followed by a repeat colposcopy on day 8. In Group II, a seven day course of 25µg oral estradiol was followed by a repeat colposcopy on day 8. The efficacy of the two regimens in improving visualization of the TZ on colposcopy and their adverse effect profile was compared. Results: Vaginal estradiol had an overall efficacy of 70% in improving visualization of the TZ as compared to oral estradiol which was effective in 50% of patients (p-value-0.19). Major adverse effects in both the group of patients were nausea and vaginal discharge with no significant differences among the two groups. Conclusion: Both vaginal and oral estrogens had comparable efficacy and similar adverse effect profile in improving visualization of the TZ.

Comparison of Cell Preparations between Commercially Available Filter Cards of the Cytospin with Custom Made Filter Cards

Introduction: Cytological evaluation of body fluids is an important diagnostic technique. Cytocentrifuge has contributed immensely to improve the diagnostic yield of the body fluids. Cytocentrifuge requires a filter card for absorbing the cell free fluid. This is the only consumable which needs to be purchased from the manufacturer at a significant cost. Aim: To compare the cell density in cytocentrifuge preparations made from commercially available filter cards with custom made filter cards. Materials and Methods: This was a prospective analytical study undertaken in department of pathology of a tertiary care centre. A 300 GSM handmade paper with the absorbability similar to the conventional card was obtained and fashioned to suit the filter card slot of the cytospin. Thirty seven body fluids were centrifuged using both conventional and custom made filter card. The cell density was measured as number of cells per 10 high power fields. The median cell density was compared using Mann-Whitney U test. The agreement between the values was analysed using Bland Altman analysis. Results: The median cell count per 10 High power field (HPF) with conventional card was 386 and that with custom made card was 408. The difference was not statistically significant (p = 0.66). There was no significant difference in the cell density and alteration in the morphology between the cell preparations using both the cards. Conclusion: Custom made filter card can be used for cytospin cell preparations of body fluids without loss of cell density or alteration in the cell morphology and at a very low cost.

A Comparative Analysis of Cytokeratin 18 and 19 Expressions in Odontogenic Keratocyst, Dentigerous Cyst and Radicular Cyst with a Review of Literature

Introduction: Odontogenic cysts viz Odontogenic Keratocyst (OKC), Dentigerous Cyst (DC) and Radicular Cyst (RC) occur commonly in the oral and maxillofacial region. Cytokeratin (CK) expression studies have been done to evaluate diagnostic accuracy, role in pathogenesis, elucidate behaviour and role in treatment protocols. However, variations have been reported in the expression of Ck patterns in these odontogenic cysts, which could be due to the lack of standardization of laboratory techniques. The present study has tried to shed light on CK 18 and 19 expression in odontogenic cysts and offer the brief review of previous studies on these cK. Aim: The aim of the present study was to evaluate the intensity and expression patterns of CK 18 and 19 in OKCs, DCs and RCs. Materials and Methods: A total of 60 cases, 20 each of OKC, DC and RC were confirmed histologically and evaluated for immunohistochemical expression pattern and intensity of CK 18 and 19. Results: A focal and variable expression of CK 18 was observed in 25% of OKCs, 15% of DCs and 10% of RCs. ck 19 was expressed in 75% of OKCs and 100% in DCs as well as RCs. Conclusion: The intensity and expression of Cytokeratin 19 was more in all three cysts compared to Cytokeratin 18.

Knowledge and Attitude among General Dental Practitioners towards Minimally Invasive Dentistry in Riyadh and AlKharj

Introduction: Minimally Invasive Dentistry (MID) emphasizes conservative caries management strategies resulting in less destruction of tooth structure, a deviation of the traditional GV Black’s restorative principles. However, there seems to be either deficiency in knowledge or little intention by general dental practitioners to adopt these principles. Aim: The aim of this study was to assess the knowledge and attitude among general dental practitioners towards minimally invasive dentistry in Riyadh and AlKharj cities of Saudi Arabia. Materials and Methods: Self-administered structured questionnaires were handed to general dental practitioners (GDPs) in the cities of Riyadh and AlKharj in Saudi Arabia. Several questions, including Likert-type scale response categories (1–5), were used. The questions assessed the respondents’ levels of agreement regarding diagnostic, preventive and restorative techniques such as use of caries risk assessment, use of high fluoride tooth paste, Atraumatic Restorative Treatment and tunnel preparations. Results: Out of 200 respondents, 161 GDPs with overall response rate of 80.5% completed the questionnaires. The GDPs showed significantly different approach with regards to the use of sharp explorer for caries detection (p = 0.014). Almost 60% of the participants had received no special education regarding minimally invasive procedures. Moreover, GDPs who had received MID training showed significantly better knowledge and attitude in adopting minimally invasive techniques for both diagnosis and treatment of dental caries. Conclusion: Although GDPs possess knowledge about the benefits of MID; however, study showed deficiencies in their attitudes towards caries detection methods and application of minimally invasive dentistry procedures.

Knowledge, Awareness and Attitude towards Emergency Management of Dental Trauma among the Parents of Kolkata-An Institutional Study

Introduction: Traumatic dental injuries are one of the commonly encountered dental emergencies. Missing anterior tooth in children due to any injury can be a source of considerable physical and psychological discomfort for the child. The prognosis of some dental injuries depends to a great extent on parents’ knowledge of correct and prompt emergency measures. Aim: The purpose of this cross-sectional study was to assess the knowledge, attitude and awareness level of parents regarding the emergency management of dental trauma and to find out the relation of the responses to social variables. Materials and Methods: A total of 2000 parents were surveyed over a period of three months using a pretested close ended questionnaire prepared in English, Hindi as well as in the regional language which was divided into three parts: Part 1 contained questions on personal information, Part 2 on an imaginary case of trauma to assess their knowledge regarding trauma management and Part 3 related to their attitude towards dental trauma management education. The data was statistically analysed using descriptive and chi-square statistics. Results: The overall knowledge of parents regarding emergency management of trauma was not satisfactory. Although most of the people were in favour of taking professional consultation for emergency management of trauma but most of them were unaware of the steps that need to be taken on their part so as to minimize complications and improve prognosis. Conclusion: Educational campaigns are the need of the day to increase the knowledge of parents regarding emergency management of dental trauma.

Nanoleakage Evaluation of Posterior Teeth Restored with Low Shrinkable Resin Composite- An invitro Study

Labib Mohamed Labib, Sameh Mahmoud Nabih, Kusai Baroudi

Introduction: The effect of nanoleakage on the integrity of resin–dentin bond has been in interest for long-term adhesion. Aim: This study evaluated the nanoleakage in premolar teeth restored with low shrinkable resin composite. Materials and Methods: A total of 40 human premolars were used for nanoleakage evaluation in this study. Each group was divided into four equal groups; Group A: using silorane with its adhesive system. Group B: using silorane with G-bond. Group C: using Filtek supreme composite with G-bond. Group D: using Filtek supreme composite with AdheSE adhesive. Nanoleakage analysed using Scaning Electron Microscope (SEM) and Energy Dispersive X-Ray Spectrometery (EDX). Results: The amount of silver present in hybrid layer depend on the adhesive used; this indicated different nanoleakage expressions in different adhesive systems. Filtek Z350 composite with G-bond showed clear silver uptake in both the adhesive and hybrid layer. Low shrinkable resin composite (silorane) with its adhesive system showed less silver penetration and slight silver peak on the elemental energy spectroscopy of energy dispersive X-Ray spectrometry (EDS) as compared to other samples. Conclusion: Adhesives used between different groups, influence the location and degree of nanoleakage. There is difference in nanoleakage patterns between two-step and one-step adhesives and also among the one-step adhesives themselves.

Effectiveness of Pooled Platelet Transfusion in Concordant and Discordant Groups among Dengue Patients

Amoolya Bhat, Vijaya Chowdappaappa, Smita Surendra Masamatti

Introduction: Dengue affects more than 50 million people per year and is one of the most common causes of severe thrombocytopaenia. Thrombocytopaenia is a common complication of dengue and other viral fevers apart from malaria, typhoid, leptospirosis, leukaemia and megaloblastic anaemia. A platelet count of <20,000/µl is characteristically seen in dengue haemorrhagic fever and dengue fever. It results from immune complex mediated platelet destruction or bone marrow suppression. Severe thrombocytopaenia <10,000/µl is one of the indications for prophylactic platelet transfusion therapy to prevent haemorrhage. Aim: To evaluate the effectiveness of transfusion of ABO compatible and ABO incompatible pooled platelet units in severe thrombocytopaenia cases. Materials and Methods: In this study ABO compatible and incompatible pooled platelet units were transfused to serologically confirmed dengue cases having thrombocytopaenia with or without bleeding manifestations. Each of the adult patients received 4-6 units of pooled platelet concentrates prepared from random donor whole blood suspended in plasma for severe thrombocytopaenia. Pre and post transfusion platelet counts were compared. Children aged less than 12 years, pregnant women and patients with splenomegaly those on ayurvedic and homeopathic therapy, recipients of packed red cells on the same day of platelet transfusion and recipients of multiple platelet transfusions within 24 hours were excluded from the study. Results: The median post transfusion platelet increments (PPI) and corrected count increments (CCI) at 4hour post transfusion were 25,000/µL (5,000-80,000/µL) and 18,000/µL (range 8,000/µL- 47,500/µL) respectively among the responders. Median PPI and CCI at 24 hours were 45,000/µL and 28,863/µL among the responders. The median CCI at 4 hour post transfusion among the non-responders was 850/µL and at 24hours was 1,425/µL. At 24 hours responders showed significantly higher PPI as compared to non responders. The average platelets transfused were 4units in case of responders and 8 units in case of non-responders. Conclusion: ABO identical and compatible pooled platelet transfusions were more successful in increasing the post transfusion platelet counts as compared to ABO incompatible pooled platelets.

Evaluating the Relationship of Dental Fear with Dental Health Status and Awareness

Tuba Talo Yildirim

Introduction: Dental fear is one of the most common problems in dentistry, for both the patient and for the dentist. This issue can have an important effect on an individual’s dental health. Aim: The aim of this paper was to report on the prevalence of dental anxiety and to explore if high levels of anxiety are associated with sociodemographic factors, oral health status, and level of oral health awareness. Materials and Methods: The sample for this cross-sectional study included 294 patients (154 males and 140 females). All participants filled out a Dental Fear Survey (DFS) to evaluate their level of dental fear. Gender, age, education level, socioeconomic status and oral health awareness were also noted. Oral health behaviors and oral health awareness levels were investigated using seven questions. Also, the periodontal status of all participants was evaluated using the Community Periodontal Index of Treatment Needs (CPITN). Differences between different subgroups were tested using the chi-square test. Results: There was a statistically significant difference between the DFS groups with regard to sociodemographic data. Women had significantly higher scores than men, and young patients had significantly higher scores than others. Patients with low education levels and low socioeconomic status had high DFS scores. Periodontal status was better in groups that had scores in the low and moderate ranges compared to groups that had high scores on the DFS. There was a statistically significant difference between the groups of DFS and CPITN (p<0.05). Patients with low and moderate levels of DFS answered the oral health knowledge questions correctly. There was a statistically significant difference between the DFS groups based on correct answers to the oral health knowledge questions (p<0.05). Conclusion: The elimination of dental fear is very important and should be treated according to a patient-centered assessment. These individuals were informed about the dental treatment procedure so their prejudices were eliminated. Patients with a high level of dental fear may be given psychiatric support for comfortable treatment procedure.

Correction:2014 Nov, Vol-8(11): HF05-HF07

Suhani Sumalatha, K Shridhar R Pai, Nitesh Kumar, Kumar MR Bhat, Hepatoprotective Role of Caesalpinia bonduc: A Histopathological and Biochemical Study. (Published in Journal of Cilinical and Diagnostic Research. 2014 Nov, Vol-8(11): HF05-HF07 In this article spelling error had occurred at few places previously, which has now been corrected. In this file, word Caesalpenia has been replaced by Caesalpinia.

Pregnancy with Pemphigoid Gestationis: A Rare Entity

Anshuja Singla, Sneha Shree, Sumita Mehta

Pemphigoid Gestationis (PG) is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies with earlier onset and a more severe course. Direct Immunofluorescence (DIF) staining is confirmatory on skin biopsy specimen. A 24-year-old female presented at 6 months period of gestation with increased blood pressure records. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs. Termination of pregnancy was done due to high BP. Patient delivered a fresh still birth weighing 750 gm. No postpartum flare ups were seen and she was discharged on prednisolone in a satisfactory condition.

Primary Inadequate Management of Dental Trauma

Tooth fractures are common complications due to trauma in the oral cavity. Tooth fragments and foreign bodies may be embedded in soft tissues as a result of dentofacial trauma and go unnoticed in emergency situations. The inadequate management of such cases may lead to complications, such as foreign-body reaction and scarring. This report describes two cases with dental fragments embedded in the lower lip, which went unnoticed until the patients presented later for completely different treatments and emphasizes the importance of clinical and radiographic examination of soft tissues, even in cases that present late for dental trauma management.

The Earliest Presenting Umbilical Port Site Hernia Following Laparoscopic Cholecystectomy: A Case Report

Rajeev Sharma, Deeksha Mehta, Manav Goyal, Sanjay Gupta

Port site hernia after laparoscopic surgery is a rare complication. Here we present a case of a 55-year-old female, diagnosed with an anterior abdominal wall hernia through the 10mm umbilical port, just two days after her laparoscopic cholecystectomy. The uniqueness of this case is its extremely early presentation. Patient presented with features of acute intestinal obstruction and due to prompt diagnosis and timely intervention, she underwent a successful reduction of hernia and an anatomical repair of the fascial and peritoneal defect through the midline laparotomy incision.

Mediastinal Mass with Hyper-eosinophilia in a Young Boy -A Diagnostic Dilemma

Mediastinal masses in children comprises of a heterogeneous group of tumours. In such cases, biopsy and histological analysis are mandatory for planning of treatment. We have reported an unusual aetiology for a mediastinal mass in a young boy presenting with features of Superior Vena Caval Obstruction (SVCO) who also had marked blood and marrow eosinophilia mimicking Chronic Eosinophilic Leukaemia (CEL). We have also discussed the differential diagnoses of mediastinal tumours with hyper-eosinophilia and possible therapeutic implications.

Osseous Consolidation of an Aseptic Delayed Union of a Lower Leg Fracture after Parathyroid Hormone Therapy – A Case Report

Ilko Kastirr, Sebastian Radmer, Reimer Andresen, Hans-Christof Schober

The absence of osseous consolidation of a fracture within the normal time period is defined as delayed union or non-union. Both for the patient and from a socio-economic point of view, impaired fracture healing represents a major problem. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces, interposition of soft tissue in the fracture gap, as well as circulation disturbances, metabolic disease, smoking and infections. In animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. Few cases with the empiric off-label use of PTH that showed a tendency to support delayed or non-union fractures have been published. We report about a patient with a fracture of the lower leg and no osseous consolidation after 7 months. Four Months after therapy with 20 µg teriparatide per day for 8 weeks the fracture was consolidated and the patient had regained full and pain free weight bearing capacity of the leg with no reported side effects.

Gas Bubbles in the Bone: A Case Report

Intraosseous pneumatocysts are benign gas-filled cavities within bones which are most commonly found in ilium, sacrum and vertebrae. The lesions are asymptomatic and found incidentally while evaluating for other injuries. Here, we present an intraosseous pneumatocyst of ilium in a 23-year-old male patient. Although once thought to be rare, intraossseous pneumatocyst are now believed to be more common. Thus, familiarity with their appearance is essential to avoid unnecessary workup. Intraosseous pneumatocysts are differentiated from more clinically significant differential diagnoses like osteonecrosis and osteomyelitis by their characteristic appearance of intraosseous air collections with sclerotic rim.

Biodentine Pulpotomy in Mature Permanent Molar: A Case Report

Harleen Kaur Soni

Irreversible pulpitis is the most common reason for endodontic treatment in primary and permanent teeth. Root canal therapy and extraction are the two viable and most documented treatment options for the same. Studies with regards to management of mature permanent teeth with carious exposure and treatment with vital pulp therapies such as adult permanent tooth pulpotomy are scarce. However, permanent tooth pulpotomy with the new calcium-silicate based cements (Mineral Trioxide Aggregate and Biodentine) can help preserve the tooth pulp vitality and promote healing and repair foregoing the more invasive root canal therapy procedure. A 12-year old male patient with irreversible pulpitis in right mandibular first permanent molar was treated with complete coronal pulpotomy with placement of Biodentine in the pulp chamber and a full coronal coverage using stainless steel crown. Clinical and radiographic examinations were performed at three, six, twelve and eighteen months. At the end of 18 months, the patient was completely asymptomatic and the tooth was free of any clinical and radiographic signs of inflammation and infection.

Acquired Solitary Glomangiomyoma on the Forearm: A Rare Case Report

Glomus tumours are benign lesions which are frequently seen on hand (particularly subungual region). In this report a 52-year-old male patient with glomangiomyoma on the left forearm has been presented. With a preliminary diagnosis of haemangioma, a subcutaneous well-circumscribed nodular lesion of the patient was excised. On histomorphological examination glomus cells, vascular structures and spindle-shaped smooth muscle cells were seen around it. Immunohistochemistry of smooth muscle cells and glomus cells showed positivity for smooth muscle actin. By means of these findings, the patient was diagnosed with glomangiomyoma. Glomus tumours are rare in the forearm (In the literatüre there are two cases). Moreover, glomangiomyomas are the least common histomorphological type of glomus tumour and are generally seen in the lower extremity.In the literature, a few cases of glomangioma and solitary glomus tumour has been described on the forearm histologically and only a few glomangiomyoma cases on forearm location. We have presented the glomangiomyoma on the forearm as a rarely-seen case. Early diagnosis of the glomangiomyoma on the forearm is of importance for the prevention of morbidity.

Chronic Giardiasis in a Case of Common Variable Immunodeficiency (CVID): A Case Report

Supriya M. Paranjpe, Avani Koticha, Preeti R Mehta

Common Variable Immunodeficiency (CVID) is a primary immunodeficiency characterized by low antibody levels and recurrent infections. This makes an individual more prone to recurrent respiratory and gastrointestinal tract infections. In cases where there is persistent positive finding of intestinal parasites in stool, a high index of suspicion should be raised to rule out immunodeficiency state. Early diagnosis of such cases will help in reducing the morbidity and better management of the patient. A case of CVID in 18-year-old male with recurrent lower respiratory tract infection and chronic diarrhoea due to Giardia lamblia is reported herewith.

Penile Sarcoma: Report of a Rare Malignancy

Shiv Rajan, Vijay Kumar, Arun Chaturvedi, Jeevan Ram Vishnoi, Prashant Dontula

Penile cancer is an uncommon malignancy. Squamous cell carcinoma constitutes approximately 95% of all histology. Non-squamous malignancies are rare in penis. Sarcomas of penis are rarer among them. Spindle cell sarcoma is one of the extremely rare sarcoma of penis. To best of our knowledge, only two cases have been reported so far, one in English literature and other in Japanese. We are presenting this uncommon case of spindle cell sarcoma of penis, which was diagnosed with microscopy with its characteristic immunohistochemistry. The disease had an aggressive course with multiple recurrences in a short duration despite margin negative resection. Disease responded poorly with the chemotherapy and patient succumbed to the disease.

Cortical Clefts and Cortical Bumps: A Continuous Spectrum

Asthik Biswas, Farha Furruqh, Suresh Thirunavukarasu, Ravichandran Vivekandan

Cortical ‘clefts’ (schizencephaly) and cortical ‘bumps’ (polymicrogyria) are malformations arising due to defects in postmigrational development of neurons. They are frequently encountered together, with schizencephalic clefts being lined by polymicrogyria. We present the case of an eight-year-old boy who presented with seizures. Imaging revealed closed lip schizencephaly, polymicrogyria and a deep ‘incomplete’ cleft lined by polymicrogyria not communicating with the lateral ventricle. We speculate that hypoperfusion or ischaemic cortical injury during neuronal development may lead to a spectrum of malformations ranging from polymicrogyria to incomplete cortical clefts to schizencephaly.

Communicating (Open) Renal Hydatid Cyst Managed Successfully with Renal Sparing Approach

Priyank Yadav, Alpana, Vijay Sharma, Devarshi Srivastava, Hiralal

Renal hydatid disease accounts for 2% of all cases of hydatid cysts. With the majority of isolated renal hydatid disease patients being asymptomatic, hydatid cysts grow slowly for several years. They may be associated with pressure symptoms or flank pain, depending on their size and location. Hydatiduria occurs in less than one-fifth of the patients. In the absence of hydatiduria, diagnosis is usually radiological. Surgery is the mainstay of treatment which is usually renal sparing surgery as most cysts are non-communicating. In cases of cyst communicating with the collecting system, nephrectomy remains the mainstay of treatment. We report a case of hydatiduria due to a communicating hydatid cyst diagnosed on CT urography, where a renal sparing approach was followed and the patient was managed with cystopericystectomy, closure of Pelvicalyceal System (PCS) and double J (DJ) stenting with an excellent result.

Paediatric Extracranial Spinal Accessory Nerve Schwannoma: An Extremely Rare Case Report

Arunabha Chakravarti, Sunil Garg, Rahul Bhargava

Schwannoma in head and neck region are quiet common and generally arise from last four cranial nerves. Spinal accessory nerve involvement is very rare. We are hereby presenting an extremely rare case of paediatric XI nerve schwannoma hitherto unreported in English medical literature till date.

Anatomic Variant of Liver, Gall Bladder and Inferior Vena Cava

Yogesh Ashok Sontakke, V. Gladwin, Parkash Chand

The morphology and relations of liver, gall bladder and inferior vena cava are cardinal. Their anatomical variations may be a reason for the adverse surgical outcome. During routine anatomy dissection of an abdomen, we noticed a variant liver, gall bladder and inferior vena cava in a 63-year-old male cadaver. In the specimen, a retrohepatic segment of inferior vena cava was found to be intrahepatic. On dissection, it was observed that inferior vena cava was covered entirely by a liver tissue on its dorsal aspect. In the same specimen, the gall bladder had undulated inferior surface. On dissection of the gall bladder, numerous mucosal folds were present in the interior. A band of fibrous tissue was found, which was extending from the right side of the gall bladder to the falciform ligament. Hence, preoperative scanning of congenital variations of the liver, gall bladder and inferior vena cava may be compassionate in planning safe surgeries and interventional abdominal procedures.

A Rare Case of Fatal Endocarditis and Sepsis Caused by Pseudomonas aeruginosa in a Patient with Chronic Renal Failure

Manav Aggarwal, Vikrant Vijan, Anjith Vupputuri, Sandya Nandakumar, Navin Mathew

Nosocomial catheter-related and Arteriovenous fistula (AV)-related infections are significant concern in patients undergoing haemodialysis. These infections are associated with multiple complications as well as mortality and demands immediate and appropriate management. While coagulase-negative staphylococci, S.aureus, and Escherichia coli are the most common causes of catheter-related infections in haemodialysis patients, such infections caused by Pseudomonas aeruginosa are relatively rare. Here, we present an unusual case of 36-year-old male patient with chronic renal failure, who developed endocarditis and sepsis from Pseudomonas aeruginosa infection of the left hand arteriovenous fistula. The bacteraemia in the present case caused multiple complications including dry gangrene of bilateral lower limbs, stroke, endophthalmitis, left brachial artery thrombosis and vegetations on the interventricular septum and aortic wall. Despite antibiotic treatment, the patient suffered a cardiac arrest and could not be revived.

All That Glitters is Not Gold: All Unilateral Oedema is Not DVT

Innominate vein stenosis or thrombotic occlusion can occur in dialysis patients. Central vein stenosis is a common problem in patients on dialysis. Placement of a central vein catheter for dialysis access increases the risk of central vein stenosis. Central vein stenosis sometimes can jeopardize the arteriovenous fistula and arteriovenous graft in the ipsilateral extremity unless recognized early and treated. We describe three patients with left innominate vein stenosis who were known case of chronic kidney disease on haemodialysis and had a left brachio-cephalic fistula and presented with unilateral facial and upper limb oedema.

Rare Case of Unilateral Hypoplasia of Lung with Associated Ventricular Mass in an Adult

Lavina Vishnu Mirchandani, Azad Alam, Aparna Iyer, Jayalakshmi Thelapurath Kutty

Hypoplasia of the lung is a rare congenital condition which can be: a) primary i.e. no apparent cause is found; or b) secondary i.e. associated with other congenital anomalies that are implicated in its pathogenesis. These anomalies may involve the diaphragm, cardiovascular, central nervous, urogenital and musculoskeletal system. Patients usually present in neonatal, infancy or childhood period and very rarely in adulthood. Our patient was an adult having a unilateral hypoplastic lung associated with a ventricular mass and to our knowledge this rare combination has never been reported in the English literature; though there are reports of prenatal or newborns with hypoplastic lung and rhabdomyoma of ventricle who did not survive.

Endogenous Panophthalmitis in a case of Multiple Myeloma and Diabetes Mellitus

Madhurima K. Nayak, Neha Singh

Multiple myeloma cripples the human body in many ways, one of them being decreased immunity. Infections occurring spontaneously can increase the morbidity. We report a case of an elderly lady with multiple myeloma on treatment and uncontrolled diabetes, who developed loss of vision, swelling and redness of left eye of 4 days duration. There was no history of injury or entry of a foreign body. She also had left arm cellulitis. Ocular examination revealed visual acuity of 6/36 in right eye and no perception of light in left eye. Anterior segment of the right eye was insignificant while the left eye showed features suggestive of panophthalmitis. B scan revealed choroidal detachment and confirmed panophthalmitis. She underwent evisceration of the left eye. The cause of spontaneous infections is an immunocompromised state due to multiple myeloma and uncontrolled diabetes. This case report highlights the propensity of multiple myeloma to cause infections of the eye debilitating enough to cause severe visual morbidity.

Salmonella typhi Splenic Abscess Following Blunt Abdominal Injury: A Case Report

Splenic abscess as a complication of enteric fever due to Salmonella typhi is a rare entity. Here, we are presenting a case of splenic abscess caused by Salmonella typhi with a blunt injury to the abdomen as the predisposing factor. The patient underwent total splenectomy due to failure of conservative management. Splenic abscess is a potential life threatening disease if left untreated. In spite of its rarity, Salmonella typhi has to be considered as a possible pathogen causing the disease.

Native Triple Valve Endocarditis as Complication of Post-Abortal Sepsis

Mohan Venkata Sumedha Maturu, Tom Devasia, Mugula Sudhakar Rao, Hashir Kareem

Infective endocarditis (IE) is a highly morbid condition in pregnancy which poses both maternal and fetal risk. In majority of cases, endocarditis occurs only on single valve and usually occurs on valve with structural disease or prosthetic valve. Multi-valvular involvement is not common and so we report a case of native triple valve endocarditis as a complication of post abortal sepsis which was successfully treated medically.

Tracheobronchial Injury caused by Blunt Trauma: Case Report and Review of Literature

Vandana Pandey, Dharam S Meena, Swati Choraria, Sushil Guria

Tracheobronchial injuries are rare cases requiring skillful airway management. We report a challenging case of tracheobronchial injury in a young adult who was run over by a tractor and was referred to us from a peripheral hospital with endotracheal tube in situ. He was severely hypoxaemic on initial presentation. Diagnostic work up showed high suspicion for right bronchial transection along with left lung upper lobe contusion. Due to deteriorating clinical condition of the patient and despite immediate unavailability of fibreoptic bronchoscope, patient was immediately taken up for right posterolateral thoracotomy and double lumen tube was inserted. The position of the tube was confirmed clinically. As soon as the fibreoptic bronchoscope arrived, it was again used to confirm the position of double lumen tube. Patient’s clinical condition improved after repair of the injured right bronchus and he was later extubated the next day.

Broad Ligament Pregnancy – Success Story of a Laparoscopically Managed Case

Jayashree Nayar, Sobha S. Nair

Abdominal pregnancies constitute 1% of ectopic pregnancies, among which broad ligament pregnancy is a rare form. The maternal mortality rate has been reported to be as high as 20%. The diagnosis is seldom established before surgery. Laparoscopic management of broad ligament ectopic pregnancy is the ideal form of treatment in appropriately selected patients. We present the case report of successful laparoscopic treatment of a 3x3.5cm broad ligament pregnancy. A search of literature shows that ours is the 6th case report of such a rare ectopic pregnancy managed endoscopically successfully.

A Giant Retroperitoneal Lymphangioma: A Case Report

Prabhu Hubli, Muddasetty Rohith, Basavaraju M Sachin

Lymphangioma is a congenital lesion of childhood. They usually present in head and neck region. Intra-abdominal lymphangioma in an adult is a rare lesion which poses diagnostic difficulty. Although asymptomatic, they may present with an acute abdomen.Here, we report a rare case of huge asymptomatic retro-peritoneal lymphangioma who underwent complete surgical excision with an uneventful postoperative period.

Penile Circular Fasciocutaneous (McAninch) Flap as an Option for Complex Anterior Urethral Stricture in Case of Non-Viable Buccal Mucosal Graft

The penile circular fasciocutaneous flap (FCF) is employed in the successful single stage reconstruction of long segment complex anterior urethral strictures especially when buccal mucosa is unavailable due to various reasons. A 65-year-old gentleman, chronic smoker and tobacco chewer, hypertensive on treatment, presented with obstructive lower urinary tract symptoms for 8 months. He had no prior urethral catheterization. On examination, he had circumcised penis, with stenosis of the external urethral meatus. Glans had no changes suggesting balanitis xerotica obliterans. Suprapubic cystostomy was done as he developed acute urinary retention during evaluation. Retrograde urethrogram (RGU) showed pan-anterior urethral stricture. He was planned for substitution urethroplasty. On oral cavity examination, he had moderate trismus with oral submucous fibrosis. As buccal mucosal graft was unavailable, he was planned for FCF. A ventral onlay tubularization FCF urethroplasty from meatus to bulbar urethra based on dartos dorsal pedicle was done. His postoperative recovery was uneventful. Pericatheter RGU did not show extravastion and he voided well with Qmax 14 ml/second. He is doing well at follow-up.

Hydrosalpinx as a Rare Presentation of Synchronous Ovarian and Endometrial Carcinoma – A Case Report

Hydrosalpinx in postmenopausal woman is rare. Most commonly it is due to primary ovarian malignancy with fallopian tube involvement or primary fallopian tube carcinoma. But hydrosalpinx with no malignancy in the fallopian tube, associated with synchronous malignancy of ovary and endometrium is rare. In a postmenopausal women, hydrosalpinx is commonly due to fallopian tube malignancy or rarely pelvic inflammatory disease. We present a rare and very interesting case of 65-year-old nulliparous postmenopausal women with bilateral hydrosalpinx and pyometra who was found to have papillary serous adenocarcinoma of the ovary and endometroid adenocarcinoma of endomertrium with normal fallopian tube. One should always suspect genital malignancy with this presentation, especially in this age group.

Unilateral Existence of Chondro-epitrochlearis: Its Embryological Perspectives and Clinical Implications

Abhinitha Padavinangadi, Naveen Kumar, Mohandas KG Rao, Satheesha B Nayak

Chondroepitrochlearis (CET) is an anomalous muscular slip that originates from the pectoralis major muscle and inserts into epicondyle of the humerus. The morphology of this variant form of pectoralis major can vary from slender to strong musculo-tendinous. In its course, it usually crosses the neurovascular structures of arm; their compression is a major complication that could be manifested by its persistence. In the present case, potentially anomalous CET muscle with the slender slip of origin, but strong tendinous insertion to the medial epicondyle of the humerus was found unilaterally. This musculo-tendinous structure was found to be compressing the brachial artery and median nerve in the arm. Detailed embryological and clinical perspective of such variant muscular slip helps the physiotherapists, orthopaedicians in their treatment strategy in complain of restricted shoulder movement. It may also help the neurologists, radiologists in their diagnostic approach of ulnar neuropathy.

Signet Ring Cell Carcinoma of Urachal Origin Presenting as Irritative Lower Urinary Tract Symptoms and Pain Abdomen: A Rare Case Report

Amit Verma, Vinay Tomar

Signet ring cell carcinoma of urachus is a very rare tumour. It generally presents as a high grade, high stage tumour and in most of the cases it has regional or distant metastasis at the time of presentation. It is known to have a uniformly poor prognosis. We present here a very interesting and rare case report of signet ring cell carcinoma of urachus in a 61-year-old male who presented with irritative lower urinary tract symptoms and pain abdomen. High index of suspicion led to the early diagnosis and timely surgical intervention. The patient is doing well on follow-up.

An Innovative Technique for Columellar Reconstruction using ‘Flip-Over’ Buccal Mucosa Flap

Kapil S. Agrawal, Raghav Shrotriya, Mansi Pabari

Loss of columella is a significant deformity and its reconstruction proves to be quite difficult. An 18-year-old lady had loss of columella due to burn while steam inhalation at a young age and required reconstruction for the same. Labial mucosa has been used as a source of tissue for columellar reconstruction since long. We describe a modification of the buccal mucosal flap to manage a difficult case of columellar deficiency. The buccal mucosa flap was used to cover the columellar defect in the usual manner in the first stage and in second stage, along with division of the base, the residual length of the mucosal flap was used to add to the thickness of columella by doubling it on itself.

Angioleiomyoma of the Plantar-Medial Arch: A Case Report

Omar Baarini, Mark Gilheany

An angioleiomyoma is a benign soft tissue tumour that arises from smooth muscle layer of blood vessels. The true aetiology of these masses is largely unknown and quite often may not be associated with pain. This paper illustrates the occurrence of an angioleiomyoma in the medial arch of the foot, a previously unreported location. Significant delay occurred in the patient being referred for specialist consultation, after attending numerous general practitioners for management. This highlighted the need for ongoing publication for case reports of this nature. The patient underwent excision with no recurrence of the lesion reported at 12 months. Often masses of this type may be left alone. However, when symptomatic simple excision will suffice where no other surrounding complication exists and where the mass is well encapsulated in the sub cutaneous area.

Fallacious Carcinoma- Spindle Cell Variant of Squamous Cell Carcinoma

Spindle cell carcinoma is a unique, rare and peculiar biphasic tumour of head and neck which is not frequently observed in the oral cavity. This variant of squamous cell carcinoma although of monophasic epithelial origin, simulates a sarcoma and is an aggressive carcinoma with high frequency of recurrence and metastasis. A correct and timely diagnosis is of paramount importance. Most of the tumours require an Immunohistochemistry (IHC) panel for confirmation or diagnosis. We report a case of spindle cell carcinoma with varied histopathological morphology and clinical presentation in a middle aged female with a brief review of literature.

A Rare Case of Solitary Peutz Jeghers Type Hamartomatous Duodenal Polyp with Dysplasia!

Solitary Peutz Jeghers (SPJ) type hamartomatous polyp is a rare and separate entity from classic Peutz Jeghers syndrome (PJS). A hamartomatous polyp without associated mucocutaneous pigmentations, any other gastrointestinal polyp or a family history of PJS is diagnosed as a SPJ type polyp. We described a case of 22-year-old young man in whom solitary duodenal polyp was incidentally detected and resected. Histopathological examination revealed PJ type hamartomatous polyp with foci of adenomatous and moderate dysplastic change. Very few cases of solitary duodenal PJ type hamartomatous polyps with malignant transformation have been reported. They can be treated with endoscopic or surgical resection. Endoscopic ultrasound can give an idea about the depth of involvement. This is a rare case of duodenal solitary PJ polyp with dysplasia in a young patient.

An Unusual Case of Extensive Lattice Degeneration and Retinal Detachment

David J. Mathew, Saurabh Kumar Sarma, Jennifer V. Basaiawmoit

Lattice degeneration of the retina is not infrequently encountered on a dilated retinal examination and many of them do not need any intervention. We report a case of atypical lattice degeneration variant with peripheral retinal detachment. An asymptomatic 35-year-old lady with minimal refractive error was found to have extensive lattice degeneration, peripheral retinal detachment and fibrotic changes peripherally with elevation of retinal vessels on dilated retinal examination. There were also areas of white without pressure, chorioretinal scarring and retinal breaks. All the changes were limited to beyond the equator but were found to span 360 degrees. She was treated with barrage laser all around to prevent extension of the retinal detachment posteriorly. She remained stable till her latest follow-up two years after the barrage laser. This case is reported for its rarity with a discussion of the probable differential diagnoses. To the best of our knowledge, this is the first report of such findings in lattice degeneration.

Esthesioneuroblastomas: Reservations and Recommendations

Rajesh Nair, Bhavna Nayal, Vinod Kumar, Padmapriya Jaiprakash

Neuroectodermal tumour has a wide range of biological activity that ranges from an indolent course to local recurrence and rapid widespread metastasis. We describe, herewith, 2 patients with Esthesioneuroblastomas (ENB) who had varied atypical clinical presentation. The first case presented with Intracranial Pressure (ICP) headache and acute visual deterioration with radiology revealing an extra axial lesion with extension into the nasal cavity while the second case presented with nasal congestion and progressive headache of long duration. We review the unusual characteristics that may uncommonly occur in ENBs and elaborate regarding which of these must be considered when evaluating patients with this malignancy.

Facial Diplegia with Paresthesia: An Uncommon Variant of Guillain–Barre Syndrome

Prabhat kumar, Riyaz Charaniya, Anish Bahl, Anindya Ghosh, Juhi Dixit

Facial nerve palsy (FNP) is a common medical problem and can be unilateral or bilateral. Unilateral facial palsy has an incidence of 25 per 100,000 population and most of them are idiopathic. However, facial diplegia or bilateral facial nerve palsy (B-FNP) is rare with an incidence of just 1 per 5,000,000 population and only 20 percent cases are idiopathic. Facial diplegia is said to be simultaneous if the other side is affected within 30 days of involvement of first side. Guillain-Barre Syndrome (GBS) is a common cause of facial diplegia and almost half of these patients have facial nerve involvement during their illness. Facial Diplegia with Paresthesias (FDP) is a rare localized variant of GBS which is characterized by simultaneous facial diplegia, distal paresthesias and minimal or no motor weakness. We had a patient who presented with simultaneous weakness of bilateral facial nerve and paresthesias. A diagnosis of GBS was made after diligent clinical examination and relevant investigations. Patient responded to IVIG therapy and symptoms resolved within two weeks of therapy.

Unusually Aggressive Primary Testicular Diffuse Large B Cell Lymphoma with Post Therapy Extensive Metastasis

Shalini Goel, Ritesh Sachdev, Ishani Mohapatra, Smeeta Gajendra, Sunil Gupta

Primary Testicular Lymphoma (PTL) is a rare intermediate to high grade tumour, diffuse large cell being the most common type. Unlike nodal Diffuse Large B-Cell Lymphoma (DLBCL), testicular DLBCL has a less aggressive course and better prognosis. Metastasis is uncommon in testicular DLBCL. Commonly involved sites are contralateral testes, Waldeyers ring, skin, lung, Central Nervous System (CNS) and prostate, however the kidneys, liver, bone marrow, pleura and bones are more rarely involved. We report a case of testicular DLBCL which has metastasized to skin and bone marrow with an aggressive clinical course in a year, in-spite of combined modality of therapy given to the patient. Bone marrow infiltration is common and well documented with nodal DLBCL, however there is no published literature for simultaneous bone marrow and skin infiltration in testicular DLBCL till date. Other large studies done in the west have shown that distinct metastasis is usually common but the median progression-free survival is usually in years. This case stresses on shorter period of progression after standard treatment protocol in this part of the world, thus highlighting the need for other extensive studies to define specific treatment protocol for testicular DLBCL.

Congenital Giant Teratoma Arising from the Hard Palate: A Rare Clinical Presentation

Kandukuri Mahesh Kumar, Indira Veligandla, A.R.Vijaya Lakshmi, Vanita Pandey

Teratomas are rare tumours which originate from all 3 germs cell layers namely endoderm, mesoderm and ectoderm, with varying proportions of each component. The most common site of teratoma is in the sacro-coccygeal region. Teratomas are generally benign and have well appreciable clinical and histopathological features. Incidence of congenital teratoma is 1 in 4000. In head and neck region congenital teratomas usually associated with other anomalies like cystic hygroma and cleft palate with an incidence of 1 in 400. The approximately reported incidence of palatal teratoma is 1 in 35000 to 40000 live-births. Upper airway difficulty causes anticipated functional problems at hypopharynx. The prognosis of palatal teratoma mostly depends on the risk and extent of neonatal respiratory distress. We present a rare case of congenital teratoma arising from the hard palate in a new born girl. The outcome in this case was bad due to the large mass causing respiratory difficulty and bleeding from the ruptured cystic areas leading to hypovolemic shock. After two hours of delivery, baby expired.

Wuchereria bancrofti: Unusual Presentation as Pancytopenia

Mili Jain, Ayush Shukla, Ashutosh Kumar, Rashmi Kushwaha, Uma Shankar Singh

Wuchereria bancrofti is an endemic filarial nematode spread by a mosquito vector. The clinical manifestations vary from asymptomatic microfilaremeia to lymhoedema. We report two cases of microfilaria of Wuchereria bancrofti in bone marrow presenting as peripheral pancytopenia. The patient did not have any classical features of lymphoedema or elephantiasis. The diagnostic demonstration of microfilaria with unusual presentations has been done in cytology specimens from various sites. Microfilaria infection in association with peripheral blood pancytopenia has been rarely reported. An aetiopathological co-relation of these haematological manifestations of microfilaria needs further investigation.

Splenic Epidermoid Cyst in a Five-Year-Old Child

Sumit Grover, Bhavna Garg, Neena Sood, Satpal Singh

Splenic epidermoid cysts are rare non-parasitic true cysts affecting the spleen. We report a five-year-old child who presented with an abdominal lump associated with pain of 15 days. Ultrasonography of the abdomen showed a huge cystic lesion of obscure origin. At laprotomy a huge unilocular cyst involving upper part of spleen containing pultaceous fluid was seen and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. Thus histopathology helped in elucidating the aetiology and diagnosis.

Efficacy of Azithromycin as an Adjunctive Therapy to Non-Surgical Periodontal Treatment of Periodontitis: A Systematic Review and Meta-Analysis

Introduction: Over the years, numerous trials have sufficiently documented benefits of adjuvant administration of antibiotics in combination to Scaling and Root Planing (SRP) in treatment of periodontitis. Nevertheless there are justified doubts in respect to antibiotics administration with regard to increasing development of resistances. Aim: The aim of this review study and meta-analysis was to verify a possible benefit of Azithromycin (AZM) as an alternative adjuvant antibiotic in combination with SRP. Materials and Methods: Electronic databases (Pubmed) were searched from the earliest point of record until May 2015. A hand search was also conducted. The variables considered in this respect were Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and SRP. A meta-analysis containing trials comparing SRP as a sole therapy with SRP and administration of AZM was produced once all of the data obtained had been reviewed. Results: Six randomised clinical trials were accepted into the review and the meta-analysis following the process of trial selection. Meta-analysis revealed larger overall effects by the systemic administration of AZM compared with SRP on their own in terms of PD, CAL, BOP, Plaque-Index and total bacterial load reduction after three and six months. Conclusion: The data used in this study revealed that the systemic administration of AZM is beneficial compared with SRP on its own for the treatment of chronic periodontitis

Ultrasound: A Revenant Therapeutic Modality in Dentistry

An ultrasound (US) gives a visible image of the organs that are present inside the body. In medicine it serves for diagnosing and also its therapeutic benefits are well established for bone healing, osteointegration and soft tissue healing. In dentistry it is widely used for diagnostic purposes. When it was discovered it was introduced for therapeutic purposes, but due to lack of clinical studies its use as therapy was remittent in dentistry. The aim of the present paper was to establish the efficiency of therapeutic US in maxillofacial region for alleviating the pain and to see the other applications. Our search included the English terms like ultrasonography, applications, dentistry in Google search engine, PubMed and Medline from 1980 to 2015. We found very few articles showing the effects of therapeutic Ultrasound (US) in treatment of pain and healing in dentistry. We concluded that clinical benefits of in vivo studies were very little and demands further rigorous research to strive for the therapeutic success of US.

Vascular Disease in Young Indians (20-40 years): Role of Dyslipidemia

Dyslipidemia is an established risk factor for cardiovascular disease (CVD). Atherosclerosis begins early in life as suggested by “fatty streaks” observed in coronaries of healthy organ donors aged 20-29 years. Premature occurrence of coronary heart disease (CHD) in Indians increases the risk for young individuals. Management of Dyslipidemia in the young Indian, poses several challenges. In this article we provide in-depth review of prevalence, guidelines’ perspective and expert comments on management of Dyslipidemia in the young (20-40 years) Indian.

Exploring Biomarkers for Alzheimer’s Disease

Neeti Sharma, Anshika Nikita Singh

Alzheimer’s Disease (AD) is one of the most common form of dementia occurring in elderly population worldwide. Currently Aß42, tau and p-tau in the cerebrospinal fluid is estimated for confirmation of AD. CSF which is being used as the potent source for biomarker screening is obtained by invasive lumbar punctures. Thus, there is an urgent need of minimal invasive methods for identification of diagnostic markers for early detection of AD. Blood serum and plasma serves as an appropriate source, due to minimal discomfort to the patients, promoting frequent testing, better follow-up and better consent to clinical trials. Hence, the need of the hour demands discovery of diagnostic and prognostic patient specific signature biomarkers by using emerging technologies of mass spectrometry, microarrays and peptidomics. In this review we summarize the present scenario of AD biomarkers such as circulatory biomarkers, blood based amyloid markers, inflammatory markers and oxidative stress markers being investigated and also some of the potent biomarkers which might be able to predict early onset of Alzheimer’s and delay cognitive impairment.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part III: Cyanotic Heart Diseases and Complex Congenital Anomalies

Venkatraman Bhat, Vinay Belaval, Karthik Gadabanahalli, Vimal Raj, Sejal Shah

From the stand point of radiographic analysis most of the complex cyanotic congenital heart diseases (CHD), can be divided into those associated with decreased or increased pulmonary vascularity. Combination of a specific cardiac configuration and status of lung vasculature in a clinical context allows plain film diagnosis to be predicted in some CHD. Correlation of the position of the cardiac apex in relation to the visceral situs is an important information that can be obtained from the plain film. This information helps in gathering information about the atrio-ventricular, ventricular arterial concordance or discordance. Categorization of the cyanotic heart disease based on vascularity is presented below. Thorough understanding of cardiac anatomy by different imaging methods is essential in understanding and interpreting complex cardiac disease. Basic anatomical details and background for interpretation are provided in the previous parts of this presentation.

Modified Wrap-Around Retainer: A Quick Tip To Enhance the Retention of the Appliance

Kanhu Charan Sahoo, Snigdha Pattanaik

As the teeth are in an inherently unstable position after the completion of the orthodontic treatment, a little pressure even from the soft tissues may create a relapse tendency. So there is always a need for a retention period until the gingival and periodontal reorganization is completed around the new position of the tooth. Removable appliances can be used effectively for the retention purpose of which Begg's wrap around retainers are most commonly used. This article presents a new modification in the design of the appliance which will help us to use the retainer more efficiently.

Unusual Presentation of Pigmented Basal Cell Carcinoma of Face: Surgical Challenge

Ravleen Nagi, Shashikant Sahu, Nitin Agarwal

Actinomycotic Osteomyelitis of the Maxilla – A Delusive Presentation

Colloidion Baby: A Rare Clinical Entity

Rakesh Kumar, Gulnaz Nadri, Vineeta Wadhwa, Rajlaxmi Mundhra

Endodontic Management of Type III Dens Invaginatus with an Open Apex

Kinjal Mahesh Gathani, Srinidhi Surya Raghavendra, Swati Wadekar

Panoramic Radiographic Appearance of Giant Bilateral Tonsilloliths

Gold Tooth Tattoos: Identifying Features in Forensic Odontology

Roma Yadav, Abhishek Yadav, Radhika Rai, Meetika Pahuja, Savita Solanki

Congenital Aniridia with Ectopia Lentis

Rakhi Kusumesh, Anita Ambastha

Comments on “Alternate Nostril Breathing at Different Rates and Its Influence on Heart Rate Variability in Non Practitioners of Yoga”

Sriloy Mohanty, Apar Avinash Saoji

Mobile Cam Lap Endotrainer

Shankar Ram, Aby Madan, Nazar Musthafa, Soumya Kasturi

No Benefit of BCR-ABL1 Screening in Polycythemia

Stephen E. Langabeer

Open Defecation in India: A Major Health Hazard and Hurdle in Infection Control

Paurush Ambesh, Sushil Prakash Ambesh

Bilateral Xanthogranulomatous Orchiepididymitis in a Diabetic Patient

Asmita Parihar, Sonal Sharma

Consider Differentials of MRI Myocarditis in Noncompaction

Josef Finsterer, Claudia Stöllberger

Delta-Beta Thalassaemia Screening

Beuy Joob, Viroj Wiwanitkit

Bilateral Multi-Focal Sporadic Papillary Renal Cell Carcinoma: A Unique Surgical Challenge

The Role of Human Epidermal Growth Factor Receptor 2 (HER2/neu) in Mucoepidermoid Carcinomas

Shirin Saravani

Zika Virus: An Emergence of a New Arbovirus

Sankalp Yadav, Gautam Rawal, Mudit Baxi

The world is facing a new pandemic in progress due to a mosquito-borne flavivirus popularly known as Zika virus. The emergence of this new virus is really alarming with the sudden increment in the cases of microcephaly reported from Brazil. The findings attributing the involvement of Zika virus as the reason for congenital deformations in the babies born in afflicted areas have really shocked the world. The present knowledge about this virus is very limited and in the absence of further studies the precautions seems to be the best way of protection from this virus. The present article is a short review about this new virus.

Recent Outbreaks of Diphtheria in Dibrugarh District, Assam, India

Partha Pratim Das, Saurav Jyoti Patgiri, Lahari Saikia, Debosmita Paul

Diphtheria is still a significant child health problem in countries with low immunization coverage. Reports of diphtheria in adult population are also increasing. Here we describe three recent outbreaks of diphtheria in Dibrugarh district, Assam in two consecutive years. The study was undertaken in Assam Medical College & Hospital, Dibrugarh after the diagnosis of two Diphtheria cases in the month of September and October 2015 and another in January 2016. Outbreak investigation was done after defining operational definition and throat swabs were collected from thirty three (33) individuals including three (3) index cases and thirty (30) close contacts. Diagnosis was done by clinical findings, direct microscopy, bacteriological culture and in-house designed multiplex Polymerase Chain Reaction (PCR) of the isolates for the expression of Corynebacterium diphtheriae specific rpoB gene and tox gene. Out of the 10 confirmed cases, 2 and 7 were in the first two outbreaks while only one in the third outbreak respectively. All the cases were of age > 10 years, unimmunized or partially immunized. The overall mortality was 20%. PCR results revealed all the culture positive isolates to be tox gene positive. Diphtheria is a resurgent problem in our region with a significant age shift towards adult.

Spectrum of Radiological Manifestations in Lymphoproliferative Malignancies with Unusual Extra Nodal Soft Tissue Involvement

Shantiranjan Sanyal, Akhila Prasad, Lalendra Upreti, Umesh Chandra Garga

Lymphoproliferative malignancies constitute a wide spectrum of haematological malignancies and their prevalence is widely increasing. Non-Hodgkin lymphomas and Hodgkin disease, frequently involve extranodal soft tissue structures in the head and neck, thorax and abdomen. These malignancies may involve virtually any type of soft tissues to any extent; hence many different imaging manifestations are possible which may mimic other disorders. The imaging characteristics of extranodal lymphomatous soft tissue involvement are described and classified here according to the site of involvement in 6 cases (primary diseases with orbital, muscle, extra testicular, scalp, sinonasal and pachymeningeal/dural involvement). In majority of these cases at presentation we found a predominantly homogeneous soft tissue mass with mildly high attenuation on CT and a T2 intermediate signal on MRI at these sites without any manifestation of disease elsewhere but on follow-up two out of these six cases developed systemic disease elsewhere. Few consistent patterns were noticed on CT and MRI which might help to include lymphomas as an important differential diagnosis of soft tissue masses. Though a definitive diagnosis requires a biopsy (bone marrow, lymph node, or mass), and other laboratory tests, imaging primarily aims at staging of the disease and identification of new or recurrent disease.

Rare Mimickers of Exostosis: A Case Series

Phani Chakravarty Mutnuru, Lakshmi Manasa Perubhotla

Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora’s lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas.