Journal of clinical and diagnostic research

Syringocystadenocarcinoma Papilliferum- An Uncommon Malignant Adnexal Neoplasm at an Unusual Location

Saranya Shankar, BN Kumarguru, CA Arathi, AS Ramaswamy, R Prashanth

Syringocystadenocarcinoma Papilliferum (SCACP) is a rare adnexal malignant neoplasm. Most of the cases present with a long standing mass with a sudden progression in size. A 60-year-old female presented with history of swelling over the antero-lateral aspect of left thigh since three years. The lesion was associated with history of pain and ulceration. Grossly, the external surface showed three ulcerated areas. The largest ulcer measured 4×5.5 cm. On cut section, the tumour showed variegated appearance consisting of grey-white to pink areas, multiple cysts, focal necrosis and hemorrhagic areas. Microscopically, tumour cells were arranged in papillary configuration, solid sheets, tubular and acinar pattern. Individual tumour cells showed pleomorphic vesicular nucleus and mitotic figures. The intervening connective tissue showed dense chronic inflammatory cell infiltrate composed of lymphocytes, plasma cells and eosinophils. Also seen were areas of necrosis and Gamna-Gandy body. Based on histological features, a diagnosis of malignant appendageal tumour of the skin with apocrine differentiation, favouring SCACP was offered. By Immunohistochemistry (IHC), tumour cells showed focal positivity for CEA and negative for GCDFP-15. IHC may be helpful, but a pathologist has to primarily depend on the histopathological characteristics of the lesion for diagnosing the condition.

Asymmetric Skeletal Open Bite Treated with Unilateral Sagittal Split Osteotomy and Tongue Reduction

Treatment of mandibular asymmetry with skeletal open bite poses big challenge for orthodontists. Presence of macroglossia is another aggravating factor that makes open bite worse. Masticatory function is highly compromised in cases where anterior open bite extends to posterior regions. Treatment of mandibular asymmetry with complete anterior and posterior open bite with occlusal canting has not been described in the past. There are very few case reports which describe treatment of severe open bite with contact only in second molar regions. Bilateral Sagittal Split Osteotomy is preferred surgical option for most mandibular asymmetries but unilateral sagittal split osteotomy has been attempted by very few. This case report describes treatment of Asymmetric Skeletal Openbite with customised surgical procedure in combination with orthodontics. Here, anterior and posterior open bite was treated with Unilateral Sagittal Split Osteotomy (USSO), paramedian ostectomy and partial glossectomy. After the treatment, the patient’s masticatory function was enhanced in addition to improvement in aesthetics.

Plasma Cell Osteomyelitis: A Rare Entity

Shruti Gupta, Arvind Kumar Gupta, Tarun Goyal, Pratima Gupta, Shalinee Rao

Plasma cell osteomyelitis, characterised by abundance of plasma cells in the lesional bone is a rare entity. We report a case of chronic plasma cell osteomyelitis in a 14-year-old male child who presented with complaints of pain in right leg and fever. The X-ray AP view of right leg revealed a cavitary lytic lesion with a sclerotic border in proximal one third of right tibia. A clinical diagnosis of Brodie’s abscess was favoured. Histopathological examination revealed sheets of plasma cells, many neutrophils and lymphocytes, areas of fibrosis and spicules of dead bone. Immunohistochemistry revealed polyclonal population of plasma cells which were both Kappa and Lambda light chain positive. We recommend diligent histopathological examination and correlation with clinico-radiological profile for a correct diagnosis and in order to avoid an over diagnosis of neoplastic plasma cell lesion.

Endodontic Management of Maxillary First Molar Teeth with Double Canal System in Each Root: A Case Series

Sana Farooq, Mousumi Goswami, Tanu Nangia, Bushra Rahman, Shriyam Sharan

The root canal aberrations and variations in maxillary first permanent molars is a constant challenge and successful endodontic management with latest adjuncts decreases the failure of missing a canal. We present a series of three cases of maxillary first permanent molar with six canals wherein it was noted an unusual morphology of double canal system in each root using recent adjuncts like Cone Beam Computed Tomography, endodontic microscope and magnifying loupes.

Diagnosis of a Fatal Rickettsial Infection in a 44-Year-Old Male

Yogesh Velaskar, Aparna Kotekar

Rickettsial infections are an emerging public health concern in many parts of India with several undiagnosed or misdiagnosed cases. Despite its widespread prevalence in India, lack of suspicion, nonspecific signs and symptoms, and absence of widely available sensitive and specific diagnostic test contributes to a high fatality rate. This is a case study of a 44-year-old male patient with a severe Rickettsial infection that turned fatal. Aim of this case study is to highlight the importance of timely diagnosis of Rickettsial infections which in this case could have saved the patient’s life.

Six Mesh Hernia Repairs in a Single Patient Done Simultaneously- A Case Report

JS Rajkumar, Aanchal Kothari, JR Anirudh, Akbar Syed, Aluru Jaykrishna Reddy

Bilateral hernias being done simultaneously is quite a common procedure. Sometimes, a para umbilical hernia is fixed at the same time as well. However, it is rare to fix more than three hernias of the abdominal wall simultaneously. This case report presents a 73-year-old gentleman who underwent mesh hernioplasty of the hiatus, an epigastric hernia, a paraumbilical hernia, a Spigelian hernia, and bilateral inguinal hernia repair as well, all done in a single session. On follow-up at one year, he was asymptomatic, with no complications attributable to the multiple hernia meshplasty. This case report is being published to reiterate that multiple abdominal wall deficiencies can be corrected in a single sitting, which is advantageous in terms of cost and the need for multiple admissions, especially for patients from remote areas.

A Fatal Case of Acute Gastroenteritis with Sepsis due to Salmonella enterica Serovar Kentucky in an Immunocompetent Patient: A Case Report

Sumana Mahadevaiah Neelambike, Sowmya Govindanahalli Shivappa

Non Typhoidal Salmonella are the common agents causing bacterial food borne gastroenteritis. They are the leading cause of bacterial food borne disease outbreaks and human gastroenteritis in developed countries and also a worry to public health in developing countries. A fatal case of acute gastroenteritis with septic shock due to S. Kentucky bacteraemia in an immunocompetent patient is reported in this article. The S. Kentucky isolate in this case was susceptible to all classes of antibiotics in contrast to the multidrug resistance pattern observed globally. Awareness of various Non Typhoidal Salmonella causing human infections is of utmost importance, because delayed identification, serotyping and susceptibility testing may delay the administration of antibiotics leading to worsening outcomes. Hence identification of Salmonella to species and subspecies level is necessary.

Osteoplastic Flap Approach for Posterior Table Leak: A Case Report

Rishikesh Thakur, David Victor Kumar Irugu, Hitesh Verma

Frontal sinus Cerebrospinal Fluid (CSF) leak is relatively uncommon. Surgical treatment is indicated when conservative management fails. Here we present a case report of 19-year-old male who presented with delayed CSF rhinorrhea after trauma with one episode of meningitis. On evaluation, frontal sinus posterior vault leak was seen. The repair was done by osteoplastic flap raising approach. Follow-up clinico-radiological assessment showed no evidence of leak or defect. Although endoscopic approach is used most commonly now-a-days, defect in posterior vault may not be adequately dealt especially if defect is laterally or superiorly located as seen in this case. This case is reported to highlight the indication of open approach in endoscopic era.

Hyperpigmentation Induced by Hydroxychloroquine: A Case Report

Bhanukumar Muthaiah, George Mathew Panachiyil, Tirin Babu

Hydroxychloroquine is an antimalarial drug which is widely used in the treatment of rheumatoid arthritis, owing to its immunosuppressive and anti-inflammatory properties. Mucocutaneous hyperpigmentation induced by hydroxychloroquine is rarely reported. The time temporal relationship between the starting of hydroxychloroquine therapy and the onset of hyperpigmentation of the skin ranges from three months to 22 years. This report presents a case of 48-year-old female with rheumatoid arthritis who developed hyperpigmentation on the face and skin during the treatment with hydroxychloroquine. She was treated with hydroxychloroquine for one year. Hyperpigmentation on the face and skin started after nine months of initiation of hydroxychloroquine therapy and skin biopsy showed skin with epidermis displaying increased basal melanin. The superficial dermis showed increased collagenisation. Perls stain was done, which did not stain the pigment. This presentation of melanin deposition alone is rare as previous reports of hyperpigmentation indicate the presence of both melanin and haemosiderin in patients being treated with antimalarial medication. The patient was advised to stop hydroxychloroquine and as an alternate drug, methotrexate 7.5 mg (two times per week) was started for her. Stoppage of hydroxychloroquine resulted in the decline of the pigmentation over the course of several months.

Pyramidal Lobe and its Clinical Significance- Case Report and Review of Literature

Rajani Singh, Pooja Bhadoria

Thyroid gland normally consists of two lobes, one in right and another in left side, connected by isthmus, is the largest endocrine gland with numerous variations pertaining to number of lobes, absence of isthmus, its size and location. One of the variations of thyroid gland is occurrence of pyramidal lobe which may arise from lobes or isthmus of the gland. A review of literature coupled with reporting of two cases of pyramidal lobe has been carried out in the department of Anatomy, AIIMS, Rishikesh. Two pyramidal lobes were detected in two female cadavers out of six cadavers fixed in 10% formalin during dissection of head and neck. Mean age of cadavers was 70 years. Mean lengths and widths of pyramidal lobes in two cadavers were 48.02 mm, 28 mm and 52.99 mm, 18.1 mm, respectively. Pyramidal lobe if not removed may cause recurrences after total thyroidectomy and also it may be site of certain cancers or metastases for some tumours. Hence, knowledge of pyramidal lobe is very important to clinicians.

Myositis Ossificans Masquerading as Soft Tissue Giant Cell Tumour in Fine Needle Aspiration Cytology- A Case Report with Brief Review

J Priyadharisini, Pammy Sinha, Khowsalya Subrajaa

Myositis ossificans (MO) is a reactive condition that is sometimes mistaken microscopically for extraosseous osteosarcoma. Cytological features of MO are quite confusing because of various patterns of presentation in fine needle aspiration smears due to differences in phases of MO and thereby poses a diagnostic challenge to cytopathologist. Hence clinico-radiological correlation along with histopathology is useful for definitive diagnosis. As per the literature search, none of the cases of MO presented cytologically with extensive giant cells component leading to the diagnosis of Giant cell tumour of soft tissue. This case report aims to explore diagnostic dilemma in cytomorphology of MO which we experienced recently and rarity of occurrence of non-traumatic MO.

Case of Extreme Trichotillomania in a Child with Comorbidities

Tanushree Sahoo, Krishna Mohan Gulla, Nuthan Kumar, Prahbhjot Malhi

Trichotillomania is an uncommon paediatric psycho-dermatological condition in children. Contrary to the prevalence reported in western literature, it is relatively uncommon in paediatric clinics of Indian subcontinent: mostly due to under reporting because of parental ignorance and associated social stigma. Here, authors report a 10-year-old girl who presented with extreme trichotillomania and other psychological comorbidities like intellectual disability, learning disorders and nocturnal enuresis leading to school absenteeism. She responded well to behavioural therapy without pharmacotherapy. In follow-up at two months, there were no relapses. This case emphasises the recognition of trichotillomania in children and importance of active family participation in successful therapy.

Struma Ovarii: A Rare Unpredictable Ovarian Teratoma Case Series and Review of Literature

Struma ovarii is a rare ovarian teratoma of monodermal variant constituting 1-4% of all benign ovarian teratoma. Any ovarian teratoma is called struma ovarii only when it consists of at least 50% thyroid tissue. Only about 8% of struma ovarii cases present with clinical and biochemical features of thyrotoxicosis which is presumed to be due to ectopic production of thyroid hormone and only 0.5 to 5% undergo malignant transformation. We report seven cases of varied clinical presentations of struma ovarii operated at a single centre over four years duration, from January 2014 to December 2017, and endeavor to define the clinical features of this neoplasm as regards to ultrasonographic findings, histological features and ideal management. The clinical presentation, laboratory findings and imaging of these patients are very diverse. Pathologic findings confirm the diagnosis. Due to its rarity, there is no consensus on the best management of Struma ovarii and each case must be individualised. A review of the literature finds that most authors recommend surgical treatment. For malignant struma ovarii, surgery should be followed by postoperative total-body scinti-scanning with I131 to evaluate for residual disease. Many studies recommend adjunct thyroidectomy with I131 therapy to be considered first line management following surgery.

Naive or Caper: Author Behavior

Sunanda Das, Hemant Jain

Immunohistochemical Study of Metalloproteinases (MMP-2 and MMP-9) Expression in Laryngeal Squamous Cell Carcinoma

Introduction: Laryngeal squamous cell carcinoma (LSCC) is the second most common head and neck Squamous cell carcinoma (SCC). Among more than 24 members of the Matrix metalloproteinases (MMPs) family, MMP-2 and MMP-9 are proved to have the capacity to degrade the most important elements of Extracellular matrix (ECM) and basement membrane, thus contributing to the invasion and metastases of the malignant tumours. Aim: To evaluate and compare Immunohistochemistry (IHC) stained sections of MMP-2 and MMP-9 in both in situ and invasive LSCC and to study its relation with other clinicial and pathological features. Materials and Methods: This was a retrospective cross-sectional study conducted in Pathology department, Facutly of Medicine, Cairo University. A total of 60 specimens LSCC were studied obtained from laryngsopyic biopsies, partial and total laryngectomy specimens with selective neck dissection over one year duration. Both Haematoxylin and Eosin (H&E) and IHC (MMP-2 and MMP-9) stained sections were evaluated. IHC results of MMP-2 and MMP-9 were correlated with clinicopathological parameters. Data was analysed using SPSS software version 17.0. The p-value <0.05 was considered as statistically significant. Results: Thirty five (35) cases (58.3%) were considered MMP-2 expressors and 36 cases (60%) were considered MMP-9 expressors. A significant relations were detected between MMP-2 and MMP-9 expressions on one hand and tumour grading, tumour site, infiltration of thyroid cartilage, infiltration of resected margins, lymph node metastasis and tumour staging on the other hand (p-value <0.05). Conclusion: MMP-2 and MMP-9 overexpression could be a useful prognostic marker for predicting LSCC with a potential for metastatic behaviour. This allows easier identification of patients who are at higher risk of metastatic carcinoma and should be controlled more frequently. Larger studies on a wider scale of patients are needed based on long term follow-up.

The Potential Curative and Prophylactic Effects of Grape Seed Extract on Aspirin Induced Gastric Ulcer in Adult Male Albino Rats

Basma S Abdelatif, Fatma El-Nabawia A El-Safty, Ahmed S Zolfakar, Asmaa S Essawy

Introduction: Aspirin {Acetyl Salicylic Acid (ASA)} is a potent Nonsteroidal Anti-Inflammatory Drug (NSAID). Gastric ulcer associated with the use of aspirin is a major problem. Grape Seed Extract (GSE), has been shown to produce effective antioxidant effects. Aim: To evaluate the effect of grape seed extract on gastric ulcer induced by aspirin. Materials and Methods: Fifty adult rats were classified into: Group I (control group); Group II (GSE group), which received a single dose of GSE (250 mg/kg/day) by gavage for 10 days; Group III (Gastric ulcer group), which received (300 mg/kg) of aspirin by gavage, Group IV (Prophylactic group), which received GSE (250 mg/kg/day) by gavage for 10 days, one hour after administration of the last dose each rat received a single dose of aspirin (300 mg/kg) by gavage and Group V (Curative group), which received a single oral dose (300 mg/kg) of aspirin, five hours after administration of aspirin each rat received an oral dose (250 mg/kg) of GSE for 10 days. At the end of the study, the rats were anaesthetized and the stomach from all groups were extracted and examined. ANOVA test followed by a post-hoc test (LSD) were employed to compare the results of studied animal groups. Results: The gastric tissue of group III revealed extensive mucosal erosions and sloughing of gastric glands. GSE administration in the prophylactic group resulted in intact mucosa with minimal inflammatory infiltration while sloughing of gastric glands was still observed in some areas in the curative group. Significant increase in the percentage of iNOS and MDA level was found in Group III compared to control group, while significant decrease of iNOS and MDA level was noticed in Group IV and Group V as compared to Group III. Conclusion: Results of the current study revealed that administration of GSE before induction of gastric ulcer could greatly ameliorate the condition than after the induction of the ulcer.

Chronic Ingestion of Bisphenol A and Bisphenol S Attenuated Contractile Activity of Rat Stomach and Small Intestine In-vitro

Parul Sharma, Maloy B Mandal

Introduction: Bisphenol A (BPA) is a chemical used in synthesis of plastic. BPA seeps into food from the plastic containers used to store food items. Exposure to BPA is implicated as a causative factor for detrimental effects on fetal development and various body systems like endocrine, reproductive and immune. Few studies report that BPA ingestion impair small intestinal contractility in-vitro. Government organisations of many countries have probed into the matter and imposed regulations on marketing of BPA. To meet the terms with regulations on BPA, manufacturers are increasingly replacing BPA with Bisphenol S (BPS). BPS has been advertised as a safer substitute to BPA. The various ill effects on BPS are being explored but the effect on gut motility is less clear. Aim: To examine the effect of chronic ingestion of BPA and BPS on rat gut contractions in-vitro. Materials and Methods: Healthy male adult albino rats (175- 225 g) were fed BPA (50 mg/kg/day) or BPS (50 mg/kg/day) or vehicle (Dimethyl sulphoxide) for four weeks by oral gavage. The animals were gently restrained so that the head is immobilised by retaining the animal in an upright position. Gavage needle was passed along the side of the mouth and moved into the esophagus and towards the stomach. After four weeks, they were sacrificed and isometric contractions of gut muscle strips were recorded in an organ bath (maintained at 37±0.5°C) using force transducer, computerised polygraph (power lab 4ST) and chart-5 for Windows, ADI, Sydney, Australia. Results: Acetylcholine (Ach) (0.1-100 µM) evoked gut contractions in-vitro and the basal tone and maximum contractile tension increased in a concentration-dependent manner. However, in both the treated groups, the Ach induced contractions were significantly (p<0.05, two-way ANOVA) attenuated as compared to control (vehicle) group. When both the treated groups were mutually compared, the Ach response was found to be similar. The spontaneous intestinal contractions were significantly less (p<0.05, one-way ANOVA) as compared to control in both the treated groups, where as in gastric tissue, only BPA treatment could significantly diminish the spontaneous contractility. Conclusion: Chronic ingestion of both BPA and BPS may impair gut contractility indicating that BPS might not be a harmless substitute for BPA.

Letter to Editor- Oligodontia in Non-syndromic Children: Series of Three Cases

Evaluation of the Diagnostic Accuracy of the Most Commonly used Equations for Calculation of Osmolarity in Paediatric Population

Neha Uppal, Vibha Uppal

Introduction: Serum osmolality is an essential laboratory parameter to understand various clinical disorders including dehydration status, electrolyte disturbances and exogenous intoxication. The measured serum osmolarity by using basic plasma components such as glucose, urea and electrolytes is an indirect indicator of serum osmolality. While several equations are available for calculation of serum osmolarity, their diagnostic predictive accuracy for estimation of serum osmolality remains debatable. Aim: To determine the most accurate equation for calculation of serum osmolarity in Paediatric population. Materials and Methods: The present retrospective study was conducted on 50 apparently healthy children (aged =12 years) at Chacha Nehru Bal Chikitsalya, Paediatric Government Hospital, Delhi. Serum urea, sodium, potassium, glucose (Glu) and osmolality values were obtained from the January 2016- December 2016 laboratory records. Osmolarity was calculated using most commonly used nine prediction-equations. Students’ paired t test was used to assess the statistical differences between measured and calculated osmolarity by different equations. Pearson correlation coefficient test was used to analyse the correlation between the calculated osmolarity and measured osmolality. The Bland Altman method and Regression analysis were used to determine the agreement and differential bias between calculated osmolarity and measured osmolality. Results: The mean of measured osmolality was 293.86±10.89 mOsm/kg. The equation for calculating serum osmolarity by Smithline Gardner: 2(Na)+Glu+Urea, (all components were measured in mmol/L) with statistical insignificant difference between the measured osmolality (p-value>0.05), osmolal gap close to zero and maximum r squared value along with the lowest standard error, was best able to predict measured serum osmolality. Conclusion: Assessment of panel of serum osmolarity equations showed that Smithline Gardner equation had best diagnostic accuracy in Paediatric population and therefore we recommend that the equation should be adopted at different clinical and analytical laboratories platforms.

The Prognostic Value of Different Molecular Subtypes of Breast Cancer in Relation to Enhancer-of-Zeste Homologue 2 Expression

Zohreh Sanaat, Ashraf Fakhrjou, Faris Farassati, Roya Dolatkhah

Introduction: The role of Enhancer-of-zeste homologue 2 (EZH2) in breast cancer invasion and progression may be attributed to EZH2-mediated epigenetic repression of tumour cells. Aim: The study aimed to assess the prognostic value of different luminal subtypes of breast cancer in association with EZH2 protein expression. Materials and Methods: A cross-sectional analytical research study on breast cancer women was performed. The four major molecular subtypes of breast cancer were defined, as follows: luminal A, luminal B, HER2-type, and Triple-Negative/Basal-like (TNBC). Log Rank (Mantel-Cox) test of equality of survival function was then performed to assess statistical significance between groups. The effects of variables on Overall Survival (OS) and Event Free Survival (EFS), was then assessed to give adjusted Hazard Ratios (HRs) with 95% Confidence intervals (CIs). Results: Samples were collected for women with breast cancers, with follow-up data collected over a 5-year period, with the age range of 34-75 years. TNBC subgroup was twice as likely to have high EZH2 expression compared with the luminal A subgroup (as the reference group) (OR=2.06; 95% CI=0.22 to19.09), and the luminal B subgroup had a 35% reduced likelihood (OR=0.66; 95% CI=0.26 to1.70). Cox’s Regression analysis showed that the hazard of mortality was about 3 times more in HER2 subtype breast cancers than in the luminal A subgroup (HR=3.16; 95% CI: 1.30-15.45, P<0.005), while the Log Rank (Mantel-Cox) test showed a statistically significant difference in OS by molecular subtype at all-time points (p=0.05). Conclusion: The results provide some interesting insights, confirming the prognostic differences by molecular subtypes, in relation to EZH2 protein expression. However, there remains controversy about the prognostic value of different molecular subtypes.

Ex Vivo Evaluation of the Erosive Potential of Typical Fruit Juices from Brazilian Tropical Forests

Introduction: Dental erosion is defined as an irreversible loss of hard tissue caused by intrinsic and extrinsic acidic sources, non-bacterial dissolution not directly associated with traumatic factors or tooth decay. Aim: The aim of this study was to analyse the ex-vivo pH, titratable acidity and erosive potential of following juices: iTheobroma grandiflorum, Annona muricata, Spondias mombin and Spondias tuberosa,which are commonly found and widely used fruits by the population of the northern and north-eastern regions of Brazil. Materials and Methods: Fifteen human third molars, extracted for clinical reasons and obtained from Human Teeth Bank of the Dental School (Federal University of Juiz de Fora), were selected to be immersed in the juices and in 1% citric acid (positive control group) and perform erosive cycles. The samples were immersed in the solutions for 2 minute, five times a day, at intervals of two hour, for four days. Between the erosive cycles, the specimens remained in artificial saliva. Before the beginning of the erosive cycles and at the end of the cycle sequence, specimens were analysed for roughness and for micro-hardness. Statistical analyses were performed using the IBM SPSS Statistics 22.0 software. The results were expressed as a mean±standard error of the mean, and analysed using variance analysis (ANOVA), followed by post-hoc Tukey’s test. The significance accepted was p<0.05. Results: The pH of all juices analysed was acidic, within a narrow range of pH values from 2.41 to 3.28 and titratable acidity values suggest that the beverages tested have pH lower than the critical pH for dental enamel. Conclusion: The data analysis allows one to conclude that all the juices presented acid pH and promoted significant loss of superficial enamel hardness. Regarding the surface roughness of the samples from this study, only 1% citric acid and the juice of Theobroma grandiflorum reached values close to or greater than the critical surface roughness. Therefore, one must be aware of the great erosive potential of these juices when drinking them.

Depression and Physical Activity Impairment in COPD Subjects

Introduction: Obstructive airway disease and psychological comorbidities share some common clinical outcomes, such as impaired physical activity and quality of life. Aim: To evaluate levels of depression and the determinants of impaired physical activity in Chronic Obstructive Pulmonary Disease (COPD) subjects. Materials and Methods: This study included 120 adults (aged between 40-80 years) with diagnosis of COPD, who were evaluated for perception of dyspnea {St. George Respiratory Questionnaire (SGRQ)} and Hamilton depression scale. The level of physical activity was assessed by the modified Baecke questionnaire (mBQ) and Quality of Life by Short Form-36 Questionnaire (SF 36). The Student’s t-test, as well as multivariate linear regression analysis, was used for the statistical analysis. Results: The prevalence of depression was 80%, with female sex predilection. Depression was predominant in the age group of 46-55 years. Mean scores (±SD) of depression of total participants and the physically impaired ones were 14.22±7.56 and 19.04±5.37, respectively. The level of physical activity (mean modified Baecke questionnaire score±SD) of total participants and the physically impaired ones were 4.22±0.72 and 3.7±0.36 respectively. The determinants of impaired physical activity were CAT Score, BMI, Six-minute walk distance (6MWD), Depression, Quality of life (PCS SF36) and the length of stay in ward in the regression analysis. Conclusion: The present study found that depression, quality of life and physical activity of life are important entities for the management of COPD subjects.

Innovative Practice of Involving Medical Student in Community Based Research Projects and Scientific Writing

Timsi Jain, Yogesh Mohan, Ruma Dutta, Gomathy Parasuraman

Introduction: The present MBBS curriculum does not provide an adequate platform for promoting research aptitude among under-graduates in India. To overcome this limitation an innovative approach was introduced, to involve each student in the 6th semester in planning and conducting a research project. Aim: To teach medical students how to identify research questions, plan and conduct a research study. Materials and Methods: In the month of January 2017, a two days Research Methodology workshop was organised for the 6th semester MBBS students (n=141) by the Department of Community Medicine. During the workshop, sessions were taken on need for research, framing a research question, steps in conducting research studies, sample size calculation, sampling methods, data collection methods and tools, data analysis, data presentation, interpretation and writing a report. Plenary sessions were followed by group formation. The students were divided into groups of three each. Each group was guided by a faculty from Community Medicine Department. By the end of workshop all the groups finalised their research topics, framed objectives and decided on basic methodology like type of study design and estimated sample size. Each research project underwent Institutional ethical clearance. All the projects were completed by 30th May 2017 and on June 15th 2017 the Department organised and conducted a Poster competition for all the 47 projects. Individual student in the research group was assessed by his/her group facilitator and was awarded marks out of 5. Results: A total of 47 research projects were completed. The mean score of internal assessment marks of students for research projects was 4.02 out of 5. Students presented 51 posters and three papers in various Local, State, National and International conferences. They won five outstanding awards and eight project reports were converted into publications. Conclusion: This innovation has successfully involved 6th semester MBBS students in planning and conducting community based research projects. Students could understand the various steps involved in conducting scientific research and writing and presenting a research report. This study empirically demonstrated that with some extra effort from teachers, undergraduate medical students can be exposed to a handson learning experience in population-based research, without using additional resources.

Measurement of Health Related Quality of Life in Malaria Patients in Indonesia using EQ-5D-5L

Introduction: Indonesia is one of the countries with high malaria cases. In 2017 there were at least 261,167 malaria cases nationally. West Papua is included in the 3 major provinces with the highest incidence of malaria. Malaria disease alters patient’s Quality of Life (QoL). Thus, measurement of Health Related Quality of Life (HRQOL) is gaining importance. Aim: This study was aimed at measuring HRQOL in malaria patients and examining the relationship between socio-demographics and HRQOL. Materials and Methods: Data were collected from 110 patients with malaria visiting primary healthcare centres. It was a cross-sectional study conducted from October to December 2018. Measurement of HRQOL was done using the European Quality of Life-Five Dimension-Five Level (EQ-5D-5L) instrument. Descriptive analysis was used to analyse patients HRQOL in terms of EQ-5D-5L descriptive system, EQ-5D-5L index scores (utility), and European Quality-Visual Analog Scale (EQ-VAS). Relationships between socio-demographics and HRQOL were examined using multivariate regression analyses. Results: Almost all of the respondents reported problems in all domains. There were no responses of “extreme problems” for any of the domains. “Pain/discomfort” (99%) and “usual activities” (95.4%) domains were the most reported problems among malaria patients. The mean EQ-5D-5L and VAS score was 0.490±0.470 and 50.9±0.5, respectively. Utility score in patients with severe malaria (0.349) was lower compared to patients with mild malaria (0.571). Patients with health insurance had a better QoL. Sociodemographic factors, particularly the type (severity) of malaria and health insurance, contributed 36.9% to the HRQOL. Conclusion: Malaria was associated with poor HRQOL and particularly affected “Pain/discomfort” and “usual activities” domains.

Impact of Hyperthyroidism on Biochemical Markers of Bone Metabolism

Introduction: Hyperthyroidism is a common endocrine disorder associated with multi-systemic effects, a rarely reported of which is bone loss in newly diagnosed hyperthyroid cases. Elevated thyroid hormones directly stimulate bone cells and accelerate bone turnover. Increased serum Osteocalcin (OSC) levels can be used as a bone biomarker in hyperthyroidism disorder. Aim: To elucidate the effect of excess thyroid hormone on the serum OSC, alkaline phosphatase, calcium and phosphorus levels in newly diagnosed hyperthyroidism patients. Materials and Methods: The study was conducted at the National Center of Teaching Laboratories of Medical City Institute, Baghdad, Iraq. Newly diagnosed 50 patients with hyperthyroidism (19 males, 31 females), and 30 age and sex-matched healthy controls (9 males, 21 females) were included in the study. The detailed history of the participants were recorded and thyroid profile including Thyroid Stimulating Hormone (TSH), Total tri-iodothyronine (T3) and Total tetra-iodothyronine (T4) levels, and biochemical markers of bone metabolism-serum OSC, Alkaline Phosphatase (ALP), calcium and phosphorus were analysed. Normality was calculated using Shapiro-Wilk test. Mann-Whitney test was used to determine association among non-parametric data. Independent t-test was used to compare the difference between age groups. Receiver Operating Characteristic curve (ROC curve) was used to identify the validity of markers as an indicator of infection, and the markers were compared according to the area under the curve. Results: In hyperthyroidism patients, the serum total T4 levels, and T3 levels were significantly elevated (p-value <0.0001), while TSH (p-value <0.0001) were lowered as compared to the control group. Significant difference was observed in serum levels of OSC (p-value <0.0001), ALP (p-value <0.0001) and calcium (p-value=0.0004) levels in hyperthyroidism patients and control group, while no significant (p-value=0.17) difference was observed in serum phosphorus levels. Elevated serum OSC, ALP and calcium were significantly associated with the elevated thyroid hormones (total T3 and total T4). Conclusion: Association of elevated OSC, ALP and calcium levels with elevated levels of thyroid hormones in hyperthyroid patients indicates that hyperthyroidism influences the bone mineral homeostasis. OSC serves as a better biomarker than the ALP in the risk assessment of bone loss in newly diagnosed hyperthyroidism patients.

Effects of Gestational Diabetes Mellitus on Umbilical Cord Morphology: A Comparative Study

Introduction: Gestational Diabetes Mellitus (GDM) has great effects on umbilical cord gross morphology. Antenatal detection of altered morphology would be helpful to identify the impact of GDM on umbilical cord to reduce fetomaternal complications. Aim: To assess and compare the morphological features of umbilical cord among gestational diabetic and normal subjects. Materials and Methods: The study was conducted in the Department of Anatomy, PK Das Institute of Medical Sciences Palakkad, Kerala, India. The subjects included in this present study were divided into two groups. Group I consisted of normal non-diabetic pregnant women (n=52) and group II consisted of mothers with GDM (n=59). A total of 111 placentas along with the umbilical cord were collected and morphological parameters of umbilical cord such as length, diameter, circumference, coiling index, insertion, knots and number of vessels were noted. Descriptive statistical analysis was done using the statistical software SPSS version 23.0. Results: Mean diameter (1.303±0.1884) and circumference (4.073±0.595) were found more in GDM mothers than normal (1.163±0.1815 and 3.648±0.5952) which was statistically significant (p-value 0.0001). No significant changes were observed in length, coiling index, mode of insertion and false knots among GDM and normal. The number of umbilical cord vessels was same in both the groups and true knots were absent. Conclusion: Knowledge about the variation in the morphometric measurements of umbilical cord is important for the early detection of the maternal complications and to prevent the adverse fetal outcome.

Food Intake Evaluation in a Group of Elite Track and Field Athletes

Introduction: Eating behaviours and nutritional status are key factors related to individuals’ health. In athletes, diet optimisation has a key role in training adaptation achievement, injury prevention and good health status maintenance. However, nowadays it is still common to find diet behaviours not optimised with an increased risk of energy/nutrients deficiencies that can result not only in performance impairment but also in increased injury frequencies and malnutrition. Aim: To evaluate food intakes of elite track and field athletes to evaluate the adequacy of their diet. Materials and Methods: A total of 24 healthy elite track and field athletes, aged 18-30 years participated in the study. Anthropometric measurements were performed (weight, height, body circumferences, skinfold thickness) and Food Habits were evaluated using a seven days-food diary. Data were analysed through the WinFood® software, to obtain information about the basal metabolic rate and the energy expenditure of subjects. Moreover, information about macro and micro-nutrients were obtained both as percentage and grams. Statistical analysis was carried out in order to evaluate difference between male and female and between studied group’s intakes and international nutritional guidelines (The International Society of Sport Nutrition (ISSN)’s guidelines and the Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine (ACSM) on Nutrition and Athletic Performance). Results: From the analysis, it was observed that energy expenditure resulted higher than the caloric intake. On average, there was a difference of about 30% between the energy expenditure and the caloric intake. The amount of macronutrients daily assumed by athletes was lower than values suggested by the major international society of sport in case of carbohydrates especially in female. Proteins intake resulted to be adequate, on the other hand, lipids intake were higher than recommendations above all in female. Furthermore, athletes did not assume adequate intakes of the most important micronutrients respect to the values suggested by guidelines especially for Calcium both in male and female and Iron in female. Conclusion: These results underline the importance of nutritional education programs and of nutritional practitioner in order to optimise the diet with proper intakes of macro and micro-nutrients.

Efficacy of Core Musculature Strengthening on Postural Sway

Sweeta Priyadarshini, AD Gopalswami

Introduction: Low Back Pain (LBP) is the most frequent cause of activity limitation among younger population. Among Indian population, 23% of the working adults, majority of whom are blue collar job holders, experience LBP. One of the numerous negative impacts of it is decreased postural control and hence sways of static posture. This may occur due to weak core musculature, an associated phenomenon in LBP. Increased postural sway is believed to be an attributor for higher risk of falls and injury. Aim: To analyse the effect of core muscle strengthening on minimising postural sway and thereby preventing risk of falls, averting unnecessary energy expenditure and subsequent injury. Materials and Methods: Thirty subjects of both genders, age: 20-50 years, experiencing LBP with or without radicular symptoms of more than three months’ duration of non-traumatic aetiology were recruited for the study. Subjects were allocated to intervention and control groups with (n=15) in each group. Both the groups had closely age matched individuals and those belonging to control group were asymptomatic. Initial evaluation was performed to obtain baseline measures of the variables: postural sway, lumbar lordosis and core strength. Both groups had undergone supervised core muscle strengthening program which included lower abdominal series, semi sit-ups, sit-ups with rotation, lateral bridge for one-week duration. Following which, post-intervention measures of variables were obtained and data was subjected to statistical analysis using Wilcoxon signed rank test which was used to compare the variables within the groups before and after exercise program. Mann-Whitney test was utilised to analyse variations following exercises between the cases and controls. Results:,/b> Subjects belonging to intervention group did not achieve significant reduction in postural sway after stabilisation program. Although, their stability improved due to increased core muscle strength. The controls demonstrated significant reduction of postural sway in the Medio-Lateral direction, but did not impact on core strength. Conclusion: No significant difference was observed in postural sway between symptomatic and control subjects. Although, there is a good scope for future studies with larger sample size and increased duration of intervention.

Seroprevalence of Rubella Immunity (IgG Antibody) among Female Health Care Workers in a Hospital in Southern India
Introduction: Rubella is a mild exanthematous illness caused by Rubella virus which belongs to the family Togaviridae. Rubella is considered of public health importance for the teratogenic potential of the virus, this lead to disastrous consequences in pregnant women if contracted during first trimester. An effective and safe vaccine against rubella is available, yet according to estimation, over 100,000 infants are born with Congenital Rubella Syndrome (CRS) annually worldwide. Rubella is endemic in India and CRS contributes in morbidity and mortality among the live birth. As rubella vaccine has been incorporated in their immunisation schedule, the incidence of rubella has been reduced drastically. But still seronegative population has been noted in various studies in India. Aim: To evaluate the immune status (Rubella specific IgG antibody) of Rubella among Health Care Workers (HCW) of our hospital. Materials and Methods: A prospective, cross-sectional study was conducted among female health care students and workers (n=145) in a tertiary care teaching hospital in South Chennai from January to February 2017. Blood samples were collected after getting informed consent and serum was separated. A rubella specific IgG antibody was detected by ELISA using the commercially available kit as per the manufacturer’s instruction. Samples showing IgG antibody titre >10 IU/mL were taken as positive and =10 IU/mL as negative. The results were analysed statistically using Epi Info version 7.2. Results: A total n=145 samples were analysed and among which 124 (85.5%) workers had adequate titre and 21 (14.48%) were negative for rubella IgG antibody. The mean age of the participants was 19.65. The participants were MBBS students (n=75), BDS students (n=48), Laboratory technicians (n=12), Staff nurses (n=9) and Doctor (n=1). None of them was remembering their vaccination status. Conclusion: The study concludes that immunisation of HCWs against rubella is an important target regardless of their vaccination status. There is a more chance of exposure to infection and also in transmission of infection in the hospital environment. Hence, maintenance of immunity is an essential part of prevention and infection control scheme.

A Prospective Study on PPIUCD Insertion between Vaginal Delivery and Caesarean Section
Introduction: Postpartum Intrauterine Contraceptive Device (PPIUCD) has great potential of being the modern, reliable contraceptive that can serve the unmet need for a large number of women. The program of PPIUCD suffered a setback when it was introduced earlier due to lack of trained personnel and subsequently a poor result in terms of efficacy and side effects were observed. Aim: To find out the acceptability, expulsion rate and other complications of PPIUCD in both vaginal and caesarean delivery groups. Materials and Methods: A prospective study was conducted from 3^rd September 2017 to 2^nd December 2017 in which 2287 women were counselled during the antenatal visit, after admission to the Hospital and in the immediate post-partum period. Overall 1345 patients had PPIUCD insertion in the study period. Out of these patients first 127 mothers who delivered vaginally and the first 127 mothers who underwent caesarean section were regarded as study groups and were followed up for three months. The collected data was entered in MS Excel 2016, and was analysed by Student’s t-test, Pearson’s Chi-square test, on IBM SPSS® software, version 20.0. The p-value =0.05 was considered statistically significant. Results: In the caesarean group the mean age was 25.1 years and in vaginal delivery group it was 23.6 years and the difference was statistically insignificant (p=0.27). Expulsion rate at six weeks was 0.8% in caesarean section group and 3.9% in vaginal delivery group (p=0.09). At three month the expulsion rates in caesarean section group and vaginal delivery group were 3.1% and 4.7% respectively (p=0.51). At six weeks missing string was seen in 39.3% and 34.6% in caesarean section and vaginal delivery group respectively (p=0.51). At three months follow-up missing string was seen in 39.3% in caesarean section and 26.9% in vaginal delivery group which was statistically significant (p=0.04). At three months, 3.9% of women in caesarean section and 4.7% in vaginal deliveries had bleeding (0.74). At three months, 6.2% women in caesarean section group complained of pain whereas 7.1% in vaginal delivery group complained of pain (p=0.78). At three months, in caesarean section group 4.7% and in the vaginal delivery group 3.9% came with complaints of vaginal discharge (p=0.75). No case of perforation of uterus was found in either group. Client satisfaction was assessed at three months of PPIUCD use using Visual Analogue Scale (VAS 1-5) and 61.4% in intracaesarean group and 62.7% in the vaginal group gave score 3 in the 1-5 scale. Conclusion: The benefits of PPIUCD outweigh the minor risks associated with it. This study suggests that PPIUCD in caesarean section as well as in vaginal delivery group is a convenient opportunity which should not be missed in countries like ours with high rates of unplanned and short interval pregnancies with limited access to health care providers.

Evaluation of Expression of HER2/neu in Intestinal and Diffuse Type Gastric Carcinomas by Immunohistochemistry

BS Sangeetha, S Revathy, Prakash Geetha, D Manimaran, H Rajesh
Introduction: The management of gastric cancer in advanced stages, which is the second most leading cause of cancer mortality in the world, has evolved very little. Surgical resection remains the mainstay of treatment and can cure patients with early-stage cancer. The survival rate of patients with advanced resectable-gastric cancers, however, remains poor despite new treatment strategies. A better understanding of the molecular basis of cancer has contributed to the development of rationally designed molecular targeted therapies, which interfere with the signalling cascades involved in cell differentiation, proliferation and survival. Aim: To evaluate the expression of HER2 (Human epidermal growth factor receptor 2) by Immunohistochemistry (IHC) in intestinal and diffuse type gastric carcinomas, in and around Kanchipuram, Tamil Nadu, India. Materials and Methods: Fifty cases (31 males, 19 females) were selected which includes 30 cases of resected gastric carcinoma specimens and 20 cases of endoscopic guided biopsies diagnosed as gastric carcinoma in the Department of Pathology, in Meenakshi Medical College and Research Institute (MAHER), Enathur, Kanchipuram, Tamil Nadu which is a teaching medical college and hospital in southern part ofIndia from January 2012 to July 2014 for a period of two and half years. All the cases that were received during the study period that-fulfilled the inclusion and exclusion criteria were included in the study. All cases were analysed for their expression of HER 2/Neu protein antigen by Immunohistochemical staining in this study. The scoring criteria established by an international consensus panel of oncologists and pathologists was followed. Breast carcinoma tissue positively expressing HER2 was used as the positive control. We considered only those tumours expressing 3+positivity as those expressing HER2. Results: HER2 score was significantly higher in intestinal type gastric carcinomas. Of the total 26 cases expressing the HER2 protein, 81% (21/26) were of intestinal type Vs 19% (5/26) that of diffuse types (p=0.007). Also, no statistical difference was found between other variables like age and gender (p=0.098 and p=0.985). Conclusion: This study assessed the expression of HER2 in gastric carcinomas and we found a statistically significant expression in intestinal type gastric carcinomas than the diffuse type gastric carcinomas. There was no significant overexpression of HER2 protein regarding the clinicopathological variables like age and gender.

Receiver Operator Characteristics (ROC) Analyses of Complete Blood Count (CBC) Delta

S Balamurugan, V Rohith
Introduction: Delta check is a quality control tool that involves comparison of lab test result of current sample with that of previous sample from the same patient based on specified criteria. Though chemical analytes have been studied extensively for delta checking, literature is limited for haematology tests. Aim: In this ‘simulation’ study, we aimed to evaluate the performance characteristics of Complete Blood Count (CBC) tests in delta checking of specimen mix-ups/mis-identification using Receiver Operator Characteristics (ROC) analyses. Materials and Methods: Retrospective data from hospital patients (aged >18 years) for whom CBC tests were done within 14 days of primary testing were collected. Two groups were created: actual delta and simulated pseudo delta, the latter group simulating the real-time misidentified or mislabeled specimens. Performance characteristics of CBC analytes in detecting specimen mix-ups were evaluated by ROC curves and Areas Under Curves (AUC) using MedCalc statistical software. Results: AUC values observed for CBC analytes were: MCV (0.90), MCH (0.87) and RDW (0.82), Haematocrit (0.76), Haemoglobin (0.75), RBC count (0.75), Platelet count (0.72), MCHC (0.61) and Total leucocyte count (0.64). Indices of individuality (II) for CBC analytes were: MCH (0.27) Conclusion: MCV and MCH are the most ideal CBC analytes for delta checking of specimen mix-ups/mis-identification as they have low indices of individuality/Reference change values (RCV) and high AUC values. Integration of delta check in the Lab Information System (LIS) is an effective quality practice that can monitor release of erroneous lab results.

A Study of Serosal Covering of the Appendix

S Swayam Jothi, Sreelekha Dorairaj, N Sujatha

Introduction: Vermiform Appendix is a part of caecum and hence a part of large intestine. Normally, it does not present with a true mesentery. However, sometimes a peritoneal fold called mesenteriole or mesentery of the appendix may be present. The characteristic features of large intestine namely the appendices epiploicae is not seen in caecum, appendix and rectum. During our routine cadaveric dissection, we came across a few specimens of appendix with appendices epiploicae. Aim: To study the mesentery of the appendix and the presence of small Appendices Epiploicae in appendix macroscopically and microscopically. Materials and Methods: During our routine cadaveric dissection, over a period of 5 years, we observed the appendix of 75 cadavers macroscopically for the presence of mesentery and appendices epiploicae. Simultaneously, during the same period 116 post-appendicectomy specimens that came to pathology department for reporting was studied macroscopically and microscopically for the same. The post-appendicectomy specimens were obtained from our institute Shri Sathya Sai Medical College and Research Institute, Kancheepuram. Results: Appendices Epiploicae was observed macroscopically in 7 out of 75 cadaveric specimens and only microscopically in 76 out of 116 Appendix specimens removed at surgery. Conclusion: This less reported finding is presented for its clinical importance, wherein presence of Appendices Epiploicae of Appendix can lead to torsion and inflammation of Appendix and can be considered in the differential diagnosis of acute abdomen.

Developing and Implementing Structured Viva Voce Examination as a Valid and Reliable Assessment Tool in Biochemistry for First Year BDS Students

Sufia Naseem, Mehjbeen Javed, Ummul Baneen

Introduction: Traditional viva voce lacks objectivity, reliability and validity. Structured viva voce on the other hand has all these qualities. If introduced from the beginning of the course, it will impart an educational impact to the students. Aim: To develop structured oral viva voce for BDS first year students. Compare the marks obtained by traditional viva voce examination with the marks obtained by structured viva voce examination. To analyse the perception of students and faculty towards structured viva voce examination. Materials and Methods: Topic wise structured viva cards were prepared and validated by four subject experts. A total of 29 students were divided into four groups and each group faced the structured as well as traditional viva voce examination. Marks obtained in both the exams were compared. Feedback was taken from students as well from faculty by 5-point Likert scale questionnaires. Results: The marks scored by students in structured and conventional viva were Group A (n=8) 7.11±0.78, 5.67±0.86 (p=0.0001); Group B (n=7) 7.29±0.75, 5.29±1.12 (p=0.001); Group C (n=7) 8.43±0.53, 7.43±0.53 (p= N.S); Group D (n=7) 8.00±0.89, 6.16 ±1.47 (p=0.002) respectively. The variation in marks ranged from 4 to 8 in conventional and 6 to 9 in structured viva voce. Students and faculty also accepted structured viva voce well. Conclusion: The structured viva voce is a better assessment tool. Marks scored and student’s feedback was favorable towards Structured Viva Voce and they found it more objective, student friendly and felt more confident. Faculty also appreciated it as a better scoring method.

Assessment of Correlation between Carotid Artery Calcification and Alveolar Bone Loss: A Retrospective Study of CBCT Findings

Nilsun Bagis, Umut Seki, Kaan Orhan

Introduction: One of the main causes of the cardiovascular diseases is atherosclerosis which is characterised by thickening and the loss of elasticity of the arterial walls. Chronic periodontitis is one of the risk factor of coronary artery disease. Immune response to chronic periodontitis may exert an endothelial cytotoxic effect known to be a risk for atherosclerosis and periodontal pathogens have been demonstrated in atherosclerotic plaques removed during carotid endarterectomy in previous studies. Aim: The aim of this study was two folded: (1) to figure out the prevalence of Carotid Artery Calcification (CAC) using Cone Beam Computed Tomography (CBCT) images with a Field of View (FOV) including entire craniofacial area; and (2) to examine the correlation between CAC and radiographic evidence of alveolar bone loss. Materials and Methods: For this retrospective study, CBCT images of 256 patients were chosen. The images were retrospectively evaluated for having CAC and divided groups as with CAC and without CAC (control subject). The patients who had CAC were further evaluated regarding alveolar bone loss with CBCT images according to age and gender, without systemic disease. All images were independently observed by two observers. Alveolar bone loss investigations were performed on maxillary and mandibular teeth on panoramic radiographs according to Progressive Rate Index (PRI). Pearson chi-square statistical analyses were made among groups as alveolar bone loss according to CAC (Unilateral/Bilateral) (p<0.05) and Student t-test were among groups (CAC and control) according to age and gender (p<0.05). Results: Of all, 60 patients (23.4%) had CAC (age range 35-70 year; 25 female-35 male; mean age 44.5 years). The rest 196 patients served as control subjects. While alveolar bone loss did increase considerably according to age groups, statistical difference was found between group younger than 50 and 60-70 age group (p<0.05). The patients with CAC had higher alveolar bone loss than the control subjects according to all age groups and gender (p<0.05). Conclusion: Radiographic parameters according to PRI revealed that alveolar bone loss was more prevalent among subjects with carotid artery calcifications. Periodontal status and its role as a risk factor in triggering cardiovascular events should be taken into account by not only dental professionals but also the medical professionals in order to plan prevention programs.

Nephroprotective Effect of Ethanolic Extract of Flax Seed

Shruti Bhide, Sunil Bhojne, Hemant Kanase, Sanket Raut, Pradnya Dethe

Introduction: The treatment of Acute Kidney Injury (AKI) remains empirical and hence the quest for an effective agent for this condition still remains a challenge. The nephroprotective effect of flax seeds has been proven in pre-clinical models of kidney injury like lupus nephritis and in model of Type 2 diabetes mellitus where flax seeds meal ameliorated proteinuria. Aim: To evaluate the nephroprotective effect of Ethanolic Extract of flax seed/Linum Usitatissimum (EELU) in Gentamycin induced nephrotoxicity in Wistar rats. Materials and Methods: The study was initiated after Institutional Animal Ethics Committee approval. A total of 46 adult male Wistar rats were randomly divided into six groups with eight rats in each group except normal control (n=6) (Group I). The positive control (Group III) received alpha lipoic acid (25 mg/kg/day p.o). The three study groups received EELU in dose 0.7 (Group IV), 1.4 (Group V) and 2.8 (Group VI) mg/kg/day per oral (p.o.) respectively. All groups, except normal control group (Group I), received gentamycin 150 mg/kg/day intraperitoneal (i.p.) for 10 days. The nephroprotective effect of EELU was assessed using following variables body weight, Blood Urea Nitrogen (BUN), Serum creatinine, kidney Malondialdehyde (MDA), and Glutathione (GSH) levels and kidney injury on histopathology. One-way ANOVA was used to analyse parametric data while the non-parametric data was analysed using Kruskal Walis test. Results: EELU in the dose of 2.8 mg/kg/day showed significant improvement in BUN (27.89±6.44 mg/dL), serum creatinine (1.3±0.29 mg/dL), MDA (196.88±17.88 mmol/gm), GSH (1.63±0.12 µgm/gm) and histopathology as compared to Disease control (p>0.05). These findings were statistically similar to positive control group (p<0.05). EELU in the dose of 1.4 mg/kg/day showed significant improvement in BUN (29.34±7.30 mg/dL), serum creatinine (1.89±0.26 mg/dL), MDA (235.71±22.42 nmmol/gm), GSH (1.37±0.22 µgm/gm) and histopathology as compared to Disease control (p>0.05). Improvement in BUN and histopathology was statistically similar to positive control group (p<0.05). EELU in the dose of 0.7 mg/kg/day showed significant improvement in BUN (34.24±3.10 mg/dL), serum creatinine (1.91±0.67 mg/dL), MDA (261.86±23.22 nmmol/gm) as compared to Disease control (p>0.05). Conclusion: The present study demonstrated the nephroprotective effect of EELU in high dose (2.8 mg/kg/day) in the model of gentamycin-induced nephrotoxicity in Wistar rats and prevented the acute kidney injury most probably due to its antioxidative potential. Findings of the study suggest that EELU can be used as therapeutic agent in patients who are at risk of kidney injury and further clinical studies should be planned.

Antibiogram and Virulence Characteristics of Multi-drug Resistant Staphylococcus aureus from Nasal Cavity of Healthy Students of Niger Delta University, Amassoma, Bayelsa State, Nigeria

Adebola Onanuga, Darlington Deboh Eboh, Gloria Timipre Okou

Introduction: Nasal carriage of Staphylococcus aureus (S.aureus) in healthy population has been reported to be a significant risk factor for the development of severe infections with limited clinical treatment options. This is due to the increasing emergence of Multidrug resistance (MDR) which is posing a serious health problem in the society. Aim: To determine the antibiogram and virulent characteristics of nasal S. aureus by accessing its antibiotic resistance profile and pathogenic potentials among healthy students of Niger Delta University, Bayelsa State, Nigeria. Materials and Methods: Four-hundred healthy University students were screened for nasal carriage of S. aureus from April to October 2016 using conventional standard techniques. The suspected S. aureus isolates were screened for the presence of nuc and mecA genes for confirmation of S. aureus and Methicillin-resistant S. aureus (MRSA) respectively using Polymerase Chain Reaction (PCR). Antimicrobial susceptibility patterns of confirmed isolates were determined using Kirby-Bauer diffusion technique. Phenotypic expressions of haemolysin and biofilm production among the isolates were determined using Blood-Agar and Congo Red Agar tests. Results: The prevalence of nasal carriage of S. aureus was 47 (11.8%). Thirty-seven (37/47; 78.7%) and 30 (30/47; 63.8%) of the isolates were haemolysin and biofilm producers respectively. The biofilm producing S. aureus isolates were found to be significantly higher in the males than the females (Odds ratio=2.394; ?2=5.474; p=0.019). No isolate possessed mecA gene but 31 (66%) S. aureus were phenotypic MRSA. The S. aureus isolates exhibited high rates of resistance to erythromycin (87.2%), co-trimoxazole (85.1%), tetracycline (83%), ciprofloxacin (74.5%), amoxicillin/clavulanic acid (51.1%) and low rates to gentamycin (36.2%), and levofloxacin (6.4%). The prevalence of MDR among the isolates was 41 (87.2%) and the most prominent phenotypic antibiogram combinations among the isolates were “E, SXT, TE” and “CIP, SXT, TE”. Conclusion: The high prevalence of virulent and MDR S. aureus among these healthy individuals may lead to their potential spread in the community thereby constituting a serious health concern.

Effectiveness of Structured Teaching Programme on the Knowledge about Rehabilitation of Stroke Patients among Caregivers in a Selected Hospital, Kolkata, India

Moitreyee Roy, Ranu Bag

Introduction: Stroke is a major global health problem and second leading cause of death worldwide. In India, the incidence of stroke rate has increased from 56/100,000 person to 117/100,000 person. Stroke rehabilitation is an active process and begins during acute hospitalisation. Stroke survivors may return to an active and productive lifestyle through rehabilitation. Aim: To determine the effectiveness of Structured Teaching Programme (STP) on the knowledge about rehabilitation of stroke patients among caregivers. Materials and Methods: A pre-experimental pre-test, posttest research design was used to conduct this study. Purposive sampling was the sampling method used to collect data from family caregivers of stroke survivors on the basis of semistructured interview schedule. After collecting pre-test data, STP was organised for intervention of stroke rehabilitation to samples. Seven days were provided to the samples for utilising STP which was organised for 45-50 minutes through lecture, discussion and planned Audio-Visual (AV) aids. Posttest information was gathered after seven days from the day of teaching intervention. Seven days was assigned after getting expert opinions as well as to give time for implication of knowledge through practice of stroke rehabilitation. The sample characteristics were described by frequency, percentage and t-test was used to describe the difference between pre-test and post-test knowledge score. Chi-square test was also used to find out the association between knowledge of caregivers regarding stroke rehabilitations and selected demographic variables. Results: The mean pre-test knowledge score was 9.76 and mean post-test knowledge score was 14.7. There was a statistically significant improvement in the level of knowledge regarding stroke rehabilitations among caregivers (t0.001,29=3.659) and no association was found between pre-test knowledge level and selected demographic variables. Conclusion: The demand of stroke rehabilitation by involving family caregivers is increasing as it will help stroke patient to improve activity of daily livings as well as decrease disability and prevent complications.

The Semi-automated Software (MyAnkle^TM) for Preoperative Templating in Total Ankle Replacement Surgery

Norliyana Mazli, Mohd Yazid Bajuri, Azrulhizam Shapii, Mohd Rohaizat Hassan

Introduction: MyAnkleTM software is semi-automated digital templating software for total ankle replacement surgery. This software enables a surgeon to review multiple sizes of implant over the radiograph for implant size determination. It has autoscaling properties which matches the magnification of the radiograph and template. This software is evaluated by testing the accuracy and inter-observer reliability of pre-operative digital templating for total ankle replacement. Aim: To evaluate the accuracy and inter-observer reliability of pre-operative digital templating of tibia and talar component size for total ankle replacement using MyAnkleTM digital templating software. Materials and Methods: This was retrospective study in which digital radiographs of patients who had undergone primary total ankle arthroplasty were evaluated. The operations were done in between year 2014 until 2017 in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). All cases were using nonconstrained anatomic shaped 3-component system prosthesis (Hintegra). The digital templating software (MyAnkleTM) was used for templating, by two foot and ankle surgeons from different centres. The predicted implant size was compared with the actual components selected at the time of surgery and its accuracy was measured. The inter-observer reliability was analysed using the linear weighted kappa (?) analysis. Results: The size of tibial and talar component was accurate in 83.3% and 91.7% respectively. The accuracy of correct predicted size for second surgeon was 66.7% for talar component size and 58.3% for tibia component size. The inter-observer reliability for tibial and talar component size was substantial, weighted kappa (?)=0.802 (95% CI, 0.623 to 0.982), p<0.001. Conclusion: MyAnkleTM software is an effective tool for preoperative planning in total ankle replacement surgery. It provides rapid, reproducible accurate results and cost-effectiveness.

Comparison of the Incidence of MACCE in Primary Percutaneous Coronary Intervention vs. Delayed Primary Percutaneous Coronary Intervention 24 hours After Taking Fibrinolytic Therapy in Patients with STEMI

Introduction: Annually, over one million Percutaneous Coronary Interventions (PCIs) are performed worldwide. PCI is considered the most common procedure for revascularisation in patients with Coronary Artery Disease (CAD). Primary PCI (PPCI) is recognised as the best available option for the management of patients with ST-Segment Elevation Myocardial Infarction (STEMI). The most important issue about PCI is timing between symptoms’ onset and performing intervention. In non-capable PPCI situations, fibrinolytic therapy alone or followed by angiography and intervention 2-24 hours after it, seems the best alternative choices, but delayed PCI’s results >24 hours were also promising. The Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) include cardiac death, nonfatal myocardial infarction, cerebrovascular events and target vessel revascularisation. Aim: To compare the occurrence of MACCE after PPCI and PCI >24 hour of successful fibrinolytic drugs. Materials and Methods: The study was conducted among 457 patients with STEMI, admitted to Farshchian Heart Centre, Hamadan, Iran during 2013-2016. Ninety seven patients were managed with PPCI alone within 90 minutes of symptoms’ onset and 360 patients took Reteplase within 30 minutes followed by PCI >24 hours of successful fibrinolytic therapy and were classified as control and case groups, respectively. Both groups evaluated for MACCE at 3, 6, 12, 24 and 36-month follow-up after PCI. Data analysis was performed with SPSS 18.0. Chi-square test and independent t-test used for analysis. All statistical analyses were carried out at 95% confidence level. Results: Among 457 patients, 310 (67.8%) were male and 147 (32.2%) were female. There was no statistical significant difference in the occurrence of MACCE, including cardiac death (1% vs. 1.1%; p=0.946), non-fatal myocardial infarction (2.1% vs. 2.5%; p=0.803), target vessel revascularisation (5.6% vs. 8.2%; p=0.327), cerebrovascular complications (2.1% vs. 1.1; p=0.465), and total MACCE (13.4 vs. 10.3; p=0.382) between control group versus case group. Conclusion: The incidence of MACCE between STEMI patients undergoing PPCI and those managed with fibrinolytic therapy followed by PCI >24 hours later was similar.

Evaluation of Serum Zinc, Copper Level and their Correlation with Cu/Zn Ratio and FT3/FT4 Ratio in Hypothyroidism

Shahnaz Khatun, GS Santhini, E Malligai, HR Vinoda Kumar

Introduction: Hypothyroidism is a condition characterised by deficiency of thyroid hormones due to defect in hormone synthesis pathway or development of resistance at the tissue level. It has been observed that trace elements may influence hormonal function at several levels. Various studies suggest that reduction in zinc and copper levels adversely affect the endocrine system. Aim: To determine the serum zinc and copper levels in hypothyroidism and its effect on the progression of hypothyroidism. Materials and Methods: The present case-control study was conducted among 80 hypothyroid patients and 80 apparently healthy individuals aged 18-55 years. Serum zinc (Zn) and copper (Cu) were measured by the colorimetric assay using semi-automated analyser. Free triiodothyronine (T3), free thyroxine (T4) and Thyroid stimulating hormone (TSH) were measured using the chemiluminiscence immunoassay method. Individual parameters by independent sample t-test and correlation was analysed by Pearson’s correlation test. The p-value <0.05 was considered significant. Results: No statistical difference was observed in the BMI among the two groups. Zinc levels in hypothyroid group (85.21 µg/dL) were significantly (p-value=0.002) lower as compared to the control group (100.83 µg/dL). However, copper levels in hypothyroid group (151.1 µg/dL) were increased as compared to the control group (140.5 µg/dL) but the difference was not statistically significant (p=0.09). In the hypothyroid patients, the Copper to Zinc (Cu/Zn) ratio was 1.7/1, which was higher than that of control group 1.3/1 (p-value=0.001). Zinc was found to be negatively correlated with TSH (r-value=-0.248; p-value=0.033) and positively correlated with FT4 (r-value=0.374; p-value=0.001). Cu/Zn ratio was found to have a weak positive correlation with FT3/FT4 ratio (r=0.0875; p-value=0.45). Conclusion: This study proved the presence of imbalance of trace elements like zinc and copper among hypothyroid patients and thereby emphasises on their importance in maintenance of thyroid homeostasis.

Diagnostic Utility of Real Time Multiplex PCR for Identification of Atypical Bacterial Respiratory Pathogens

Nitya Batra, Pratibha Kale, Vikas Khillan

Introduction: Infections are common in cirrhosis and is the leading cause of progression of liver failure and increased mortality. Non-specific findings on radiology prompt a need for a diagnostic armamentarium targeting both typical as well as atypical pathogens. With the advent of molecular diagnostic techniques, an early diagnosis and timely initiation of therapy prevents the injudicious use of antibiotics. Aim: To determine the utility of real time multiplex Polymerase Chain Reaction (PCR) as a diagnostic aid in identification of atypical bacterial respiratory pathogens in cirrhotic patients. Materials and Methods: The observational study was conducted at Tertiary Hepatobiliary Centre, Institute of Liver and Biliary Sciences Hospital, New Delhi, India, from April to September 2018. Bronchoalveolar Lavage (BAL)/mini-BAL samples were collected from 88 suspected cases of pneumonia for routine laboratory work-up as per clinician request. The lower respiratory tract samples were subjected to semi-quantitative culture and PCR. Results were analysed on the basis of aetiological categorisation of liver diseases, radiological and microbiological findings. Results: Among 88 samples, nine were positive either by culture or PCR. PCR analysis revealed three positive samples. A sample positive for Legionella species on PCR showed growth of A. flavus in culture. Another sample was positive for both Legionella species and S. aureus on PCR. The third sample was positive for S. aureus on PCR and on culture grew Methicillin Sensitive S. aureus (MSSA). Conclusion: Liver disease is a risk factor for development of Legionella and other atypical pathogens. Therefore, it becomes important to actively look for such pathogens during the workup of a patient with clinical suspicion of pneumonia. Thus, early diagnosis help in limiting the use of indiscriminate antimicrobials, and timely initiation of targeted antimicrobials. Use of molecular techniques like PCR help in identifying the atypical pathogens which are neglected and thus determines the course of treatment.

Effect of Pilates on Lower Limb Strength, Dynamic Balance, Agility and Coordination Skills in Aspiring State Level Badminton Players

Preeti, Sheetal Kalra, Joginder Yadav, Sonia Pawaria

Introduction: Badminton, considered as one of the fastest racquet sports in the world requires excellent strength, dynamic balance, quick reflexes and coordination. Pilates is a form of training that focuses on strengthening core muscles of body and achieving mind body connection. Traditionally Pilates has been used for posture training and enhancing core strength. Now-a-days it is increasingly being incorporated into athletic training programmes for injury prevention and enhancing performance. Aim: To evaluate the efficacy of Pilates on lower limb strength, dynamic balance, agility and coordination skills in aspiring state level badminton players. Materials and Methods: Forty male aspiring badminton players in the age group of 17-28 years were included in this experimental study and randomly divided into two groups- Experimental and control group with 20 players in each group. Experimental group (Group A) received Pilates training along with conventional training whereas control group (Group B) was given conventional training only that included warm up, cool down and sports specific exercises. All players were evaluated for lower limb strength, agility, dynamic balance and upper limb coordination with Vertical Jump Test, 10 m Shuttle Run Test, Star Excursion Balance Test and Hand-Eye Coordination Test respectively. Both groups received training for 5 weeks twice a week, for 60 minutes. ANOVA and Student t-test was used to compare the intergroup difference in the analysis of the data collected for all variables at 1^st week, 3^rd week and last day of the 5^th week of intervention. Results: Both groups improved significantly at the end of 5^th week but experimental group showed highly significant difference for lower limb strength, dynamic balance, agility and coordination as compared to Control group (p<0.05). Conclusion: Pilates is an effective method for improvement in lower limb strength, agility, dynamic balance and coordination skills in badminton players.

Outbreak of Dengue Fever in Bundelkhand Region: A Tertiary Care Hospital Study Report

Parveen Kumar, Namita Srivastava, Anil Kumar, Kumari Poonam, Manju Choudhri

Introduction: Dengue is most widely spread mosquito-borne viral disease which is a major public health threat globally. The incidence of dengue fever is increasing year after year with morbidity and mortality in urban and suburban areas of tropical and subtropical regions of the world. However, data related to its exact incidence in many parts of India is still lacking. The present study reports the dengue fever outbreak in 2018 in Bundelkhand region. Aim: To know the incidence of laboratory-confirmed dengue cases among clinically suspected patients in Bundelkhand region and to examine the diagnostic efficacy of two commercially available dengue NS1 and IgM ELISA tests. Materials and Methods: A total of 1794 blood samples of suspected dengue patients over the year 2018 (January to December) from Medical College and nearby hospitals of Bundelkhand region sent to Microbiology department for routine dengue diagnosis were included in this study. For the laboratory diagnosis of dengue cases, NS1 and IgM ELISA tests were performed by using the commercially available “RecombiLISA Dengue Ag ELISA kit (CTK Biotech, Inc., San Diego, CA)” and “National Institute of Virology (NIV) dengue IgM capture ELISA kit (NIV, Pune, India)” as per the manufacturer’s protocol respectively. Results: Out of 1794 suspected dengue cases, 1014 (56.52%) were males and 780 (43.47%) were females. Majority {1344 (74.9%)} of patients were adults with mean age of 29.2±12.8 years, while 25.1% were paediatric cases with mean age of 9.1±3.72 years. Out of 1794 cases, 625 (34.8%) patients were found to be dengue positive by NS1 and/or IgM dengue ELISA. In the present study, the first dengue ELISA positive case of 2018 was detected in the last week of June. The highest positivity rate was observed in October (42.3%), followed by November (38.9%). Maximum number of dengue cases were detected from Jhansi (38.8%), followed by Lalitpur (37.6%), Banda (26.3%) and Jalaun (20.2%), etc. Conclusion: The author’s experience of dengue fever outbreak in the year 2018 in Bundelkhand region has been demonstrated in this study. Both NS1 and IgM ELISA tests were useful for the laboratory confirmation of dengue cases. NS1 in combination with IgM ELISA offers most sensitive diagnosis for dengue as few cases which were missed by IgM were picked by NS1 ELISA test (and vice versa). Hence, continuous monitoring for dengue infection is important during the post-monsoon season when the peak of dengue virus infection was observed.

The Reliability of Panoramic Radiographs in the Evaluation of Location for Impacted Maxillary Canine Teeth: Comparison of Prediction Methods

Neslihan Ebru Senisik, Gizem Karacin, Derya Yildirim, Mine Cesur

Introduction: The sagittal locations of Impacted Maxillary Canine (IMC) can be predicted on panoramic radiographs (OPGs). In general, the prediction methods that include the superimposition of the IMC crown on the root or neck of the adjacent incisor, determination of the sector of IMC crown, magnification of IMC, vertical level of IMC crown and angulation of IMC can be used for localising the maxillary IMC, as labially or palatally. The reliability of these prediction methods should be discussed. Aim: To compare the reliability of prediction methods used for detecting the sagittal location of IMC with only a single OPG, according to method’s success, need for Cone-Beam Computerised Tomography (CBCT) and contentment with method. The effects of the vertical level, included sector and angulation of IMCs were examined regarding the method’s success. Materials and Methods: OPG-CBCT records of 69 individuals with IMCs (53-unilateral, 16-bilateral; 85-in total) were included in the study. An experimental research design was performed to measure the validity and reliability of prediction methods. Sagittal locations were predicted using superimposition, sectors, magnification, angulation and combined methods by 25 volunteer dentists. The prediction results of volunteers were compared with true locations determined by CBCT. Need for CBCT, volunteer contentment with method was evaluated statistically. The similarities between each frequency distribution of IMC for methods and the true position were examined by Kappa test. The Mann-Whitney U test for two independent groups, Kruskal-Wallis test for more than two independent groups and Friedman test for more than two dependent groups were used. The Bonferroni–Dunn and the CF multiple comparison tests were used for the multiple comparison methods. Results: Prediction methods showed statistically similar mean ranks. The highest need for CBCT was for the magnification and combined methods. The highest contentment with method was obtained with the superimposition and the lowest with the magnification method. The highest prediction success for location was obtained for IMCs that were localised in Sector 1 (canine cusp tip corresponds to the deciduous canine) and Sector 5 (canine cusp tip corresponds to the midline of the central incisor) in all methods. Conclusion: For the accurate prediction of the true IMC location, the success of the prediction methods for OPG was similar. Sectors 1 and 5 were the locations where sagittal position of IMC was predicted with high accuracy.

Effects of Lactobacillus acidophilus on Biochemical Indices and Liver Histology in Streptozotocin-induced Diabetic Rats

Yemisi Adesiji, Samsudeen Owolabi, Olubunmi Gloria Ayelagbe, Adekunle Olowe

Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic disease reportedly caused by insulin resistance and characterised by hyperglycaemia and altered lipid profile. Administration of probiotics may improve the prognosis of diabetes as well as alleviate associated complications and metabolic disorders. Lactobacillus acidophilus supplementation has been reported to have hypoglycaemic effect, maintain blood insulin level and inhibit lipid peroxidation. Aim: To study the effects of L. acidophilus ATTCC4356 on plasma glucose, lipid profile, markers of liver function and hepatic histology in streptozotocin-induced diabetic rats. Materials and Methods: Thirty-six adult albino rats were divided into six groups. Group 1 served as controls (given placebo as graded doses of distilled water), Group 2 as diabetic untreated, Groups 3, 4 and 5 received 0.05 mL, 0.1 mL and 0.2 mL (1.5×10⁸ CFU) L. acidophilus respectively while Group 6 was treated with glibenclamide at 10 mg/kg body weight orally for four weeks. Blood glucose, lipid profile, liver enzymes, albumin and total protein were measured, microbiological profiling of faecal sample was done and hepatic tissue examined histologically. Data were analysed statistically using SPSS Version 18.0. Differences in value of biochemical parameters among the treated groups and controls were analysed using ANOVA and p-values <0.05 were considered significant. Results: Significant decrease in glucose levels (p<0.05) were observed in control and treated groups compared with diabetic untreated rats with the lowest value (75.83 mg/dL) recorded in the group administered 0.2 mL L. acidophilus after 2 weeks. Alkaline Phosphatase (ALP) and Aspartate Aminotransferase (AST) activities were moderately decreased by probiotics treatment. There were non-significant reductions in triglyceride, total cholesterol and low density lipoprotein cholesterol (p>0.05) in treatment groups. Histological changes include mild haemorrhage and fibrosis across the hepatic cyto-architecture of treated and untreated rats but not controls. Conclusion: Administration of 0.05 mL, 0.1 mL and 0.2 mL graded doses of L. acidophilus probiotics had weight-reducing, hypoglycaemic effects, improves dyslipidemia and hepatic enzymes activity in diabetic rats compared to controls. This showed the desirable characteristics of probiotics in ameliorating biochemical abnormalities associated with T2DM even at lower dosage. However, L. acidophilus did not bring about observable preservation of hepatic cytoarchitecture nor reversal of histopathological alterations associated with T2DM in diabetic-induced rats.

Evaluation of Effect of Carisolv, EDTA-S and EDTA on Periodontally Diseased Root Surfaces: An In-vitro Scanning Electron Microscopic Study

Introduction: Periodontal disease results in recession and bone loss which causes morphological changes in the root surface. Traditional treatment like scaling and root planing successfully remove plaque and calculus and necrosed cementum but leaves smear layer which may interfere with normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. However, there were certain drawbacks with respect to the conventional root conditioning agents such as the acidic pH which can damage the root surface. Hence, there has been a search for more efficient biocompatible root conditioning agents. The newer insight in the area of root conditioning agents was introduction of Carisolv. However, the evidence with respect to Carisolv as an effective root conditioning agent is scarce. Aim: To evaluate the effectiveness of Carisolv, EDTA-S and EDTA on periodontally diseased root surface and ability to remove smear layer. Materials and Methods: The study constituted of sixty single rooted teeth which were extracted due to periodontal disease. These teeth were randomly allocated into 4 groups (n=15)- Group I: Scaling and Root Planing (SRP) alone, Group II: Carisolv+SRP, Group III: SRP+15% EDTA gel, Group IV: SRP+EDTA-S (EDTA+Texapon/Soft soap mixed in 1:1 ratio) gel. These teeth were treated with the root conditioning agents and evaluated with scanning electronic microscope. The teeth were evaluated for surface morphology, presence of smear layer, Patency of dentinal tubules, Roughness loss of tooth substance index and Sampaio’s Index for root surface modification. These values were statistically analysed using Mann-Whitney U Test. Results: The results demonstrated a highly statistical significance (p<0.01) for removal of smear layer and patency of dentinal tubules in favour of Group II (Carisolv) at both 1000X and 1500X as compared to Group I, III and IV. Conclusion: Carisolv showed better root biomodification properties as compared to Ethylene Diamine Tetra-acetic Acid (EDTA) and Ethylene Diamine Tetra-acetic acid-S (EDTA-S). It was also concluded that EDTA and EDTA-S did not show any significant differences when compared to scaling and root planing alone as a root biomodification agents. The use of Carisolv as a root biomodification agent showed promising results and hence it can be recommended for in-vivo use.

The Effect of Morphine, Codeine and Methadone on Orthodontic Tooth Movement and Histological Features of Bone Tissue in Rats: An Experimental Study

Introduction: Orthodontic treatments are associated with pain. Opioids are commonly used to alleviate such pain which in turn can interfere with orthodontic treatment. Information about the effect of different types of opioids in Orthodontic Tooth Movement (OTM) is not substantial. Aim: To evaluate and compare the effect of three exogenous opioids (Morphine, Codeine and Methadone) on orthodontic tooth movement. Materials and Methods: Forty-eight male Wistar rats were randomly divided into four equal groups. Control group received a normal saline injection, and the three other groups received a daily injection of morphine, methadone, and codeine at the dose of 6,3,30 mg/kg/day respectively. A NiTi closed coil spring was used to tip the left upper first molar mesially. After twenty-one days of forced delivery, the rats were sacrificed, and the rate of tooth movements was measured by a feeler gauge. Then, maxilla was dissected, fixed, and examined histologically. Kruskal-Wallis’s test was used for the comparison of OTM between four groups and for multiple comparisons, analysis Mann-Whitney test was implemented. Results: The highest amount of tooth movement occurred in the control group (0.279 mm) which was significantly higher than the other three opioid groups (p<0.05). The differences in tooth movement between morphine, methadone, and codeine groups were not statistically significant (p>0.05). There was no statistically significant histological difference between the four groups (p>0.05). Conclusion: All three opioids used in this study reduced OTM regardless of differences in terms of duration of the effect.

Is Rapid Dengue Test Necessary at Primary Health Centre? A Study in Bandung City, Indonesia

Lia Faridah, Nisa Fauziah, Savira Ekawardhani, Riyadi Riyadi, Kozo Watanabe

Introduction: Dengue is one of the most common arthropod-borne viral disease in the tropical and subtropical regions of the world. The disease is a burden in terms of morbidity, mortality and economic aspect. There is no specific drug for dengue infection yet and the availability of a vaccine is limited in most of the Indonesia’s endemic areas. In endemic areas, most of dengue fever cases clinically resemble other diseases such as malaria, typhus, or just flu-like syndrome. Early verification of suspected dengue outbreaks is very important, allowing better public health response that leads to a proper clinical care. Unfortunately, the use of dengue Rapid Diagnostic Tests (RDTs) is still rare at first level of the health care provider in Indonesia, where the country has the policy of a gradual health service supported by the National Health Insurance (NHI). Aim: The study measured the usefulness of dengue RDT at the Primary Health Center (PHC) in endemic areas. Materials and Methods: DENV NS1 antigen test kit (NS1 RDT) was used to detect dengue fever for all acute fever patients at three sites of PHC which had high dengue case history. Dengue fever 2017 report was used as comparative data for the analysis. The collected data were analysed using an independent t-test. Results: A total of 237 blood samples from patients with acute fever were collected from Sukajadi, Neglasari and Padasuka PHC. Fifty-one samples out of 237 (21.5%) were positive with the DENV NS1 antigen test. The number of reported dengue case before and after the implementation of DENV NS1 antigen test increased significantly (p<0.05) for each PHC; Sukajadi (p=0.01), Neglasari (p=0.01) and Padasuka (p=0.03). Conclusion: NS1 RDT effectively increased the diagnosed and reported cases when used in the PHCs. Hence, we strongly suggest that government should make a policy that supports the use of NS1 RDT at the PHCs for the early detection of dengue infection, since those PHCs are the spearheads in the implementation of health care programs in Indonesia.

Diagnostic Yield of Post-mortem Needle Biopsies and their Spectrum: Experience from a Tertiary Care Hospital

Neha Nigam, Niraj Kumari, Narendra Krishnani, Ranjana Ranade

Introduction: Conventional autopsy provides important information regarding cause of death, clinico-pathological correlation and is a paramount source of learning. Developing countries have low acceptance rates, denial and limited accessibility for conventional autopsy. Needle autopsy has come up as an alternative to conventional autopsy. Aim: Aim of the study was to analyse postmortem needle biopsies to gauge their utility in lending postmortem diagnosis as well as study its spectrum. Materials and Methods: This was a retrospective study and includes 334 patients. Different organs sampled were liver, lung, kidney, spleen, brain, heart, testis, lip and nose. Clinical data and histopathology slides were retrieved and reviewed by three pathologists. Results: A total of 428 biopsies were received from 334 patients. Forty five (10.5%) biopsies from different organs were non representative. A definite diagnosis was offered in 304 biopsies with an overall diagnostic yield of 79.4%. Liver and kidney biopsies had the maximum diagnostic yield of 89.2% and 69.2%, respectively and most diagnostic category encountered were multiacinar necrosis and fungal infection respectively. Major disagreement (Class 1 and Class 2) between clinical diagnosis and needle autopsy diagnosis was found to be in 21/334 cases (6.3%), where patient would potentially have survived if the clinical diagnosis had been correct. Conclusion: Diagnostic dilemma is a wistful part of medical science. Postmortem needle biopsy has an important role in diagnosis making, improvising the quality of academics and patient care. Level of information and diagnostic yields are high with liver and kidney.

Confirmatory Factor Analysis of Hindi Version SPADI Scale in Overhead Athletes with Shoulder Impingement Syndrome

Saurabh Sharma, M Ejaz Hussain

Introduction: The Shoulder pain and disability index (SPADI) is a commonly used patient rated outcome measure to assess the impact of shoulder disorders on pain and disability. The Shoulder impingement syndrome (SIS) is patho-mechanical disorder frequently affecting overhead athletes. Aim: The aim of this study was to determine the psychometric properties of the Hindi version SPADI using Confirmatory factor analysis (CFA) in overhead athletes with SIS. Materials and Methods: In this cross-sectional study, the athletes were first familiarised with the Hindi SPADI scale and then asked to complete the Hindi version SPADI scale. Construct validity using CFA method and Composite reliability (CR) with help of derived factor loadings and average error variance was calculated. Results: A total of 80 overhead male athletes with SIS were recruited after standardised clinical diagnosis. The athletes had an age range of 17-25 years The results showed that five factor thirteen item Hindi version SPADI demonstrated acceptable levels of fit indices (Comparative fit index=0.93, Goodness of fit index=0.87 and Absolute goodness of fit index=0.80, Root mean square of approximation=0.065 and chi-squared degree of freedom=1.34). The CR value of each factor ranged from 0.60 to 0.74 indicating satisfactory reliability. Conclusion: The five factor thirteen items Hindi SPADI has acceptable psychometric properties and composite reliability and is suitable for use in overhead athletes with SIS. This will help in addressing disability causing health issue.

Comparative Evaluation of Cleaning Efficacy of Prime Pedo^TM and DXL-Pro^TM Pedo Rotary Files with Conventional H Files in Root Canals of Primary Teeth: An In Vitro Study

Farhin Katge, Sanjana Ghadge, Manohar Poojari, Khushboo Jain, Devendra Patil

Introduction: Pulpectomy is the treatment of choice for primary teeth with irreversible pulpitis or necrosis. Chemo-mechanical preparation is an important aspect of pulpectomy. Mechanical instrumentation can be accomplished by instrumentation with hand, rotary or reciprocating systems. Nickel-Titanium (NiTi) rotary files have inherent flexibility which preserves the original anatomy of root canals in primary teeth during instrumentation. Aim: To evaluate and compare the cleaning efficacy of two paediatric rotary files (Prime PedoTM, DXL-ProTM with H files in root canals of primary molars. Materials and Methods: A total of 54 extracted primary maxillary and mandibular molars were selected for the study. The selected teeth had at least two-third of root length. Teeth with internal or external pathological root resorption or perforation in the furcation area were excluded from the study. Sixty intact root canals were selected for the study. India ink was injected in all the root canals using 30-gauge insulin syringe. The remaining traces of ink after instrumentation were evaluated for assessing the cleaning efficacy. The first set of root canals (n=20) were instrumented with Group I rotary files (Prime PedoTM). The second set of root canals (n=20) were instrumented with Group II (DXL-ProTM) rotary files and third set of root canals (n=20) were instrumented with H files. Teeth were decalcified and dehydrated. They were then cleared in methyl salicylate. The samples were observed under stereomicroscope at 10X magnification for residual ink at coronal, middle and apical third of root canal. The scores obtained were analysed using One-Way ANOVA test. Results: Prime Pedo (p<0.025) and DXL-Pro (p<0.012) files had better cleaning efficacy compared to H files at the coronal and apical third of root canals. Intergroup comparison between Prime Pedo and DXL-Pro showed no statistically significant difference. No significant difference could be found between three file systems at middle third of root canals. Conclusion: Paediatric rotary files had a better cleaning efficacy as compared to H files at coronal and apical third of root canals. However, at middle third, no difference in cleaning efficacy was found between two paediatric rotary files (Prime PedoTM, DXL-ProTM) and H files. Paediatric rotary files can be used as an alternative to conventional H files in routine paediatric endodontics for better instrumentation of root canals.

Serum Ferritin, Iron Deficiency Anaemia and Haemoglobin A1c in Non-diabetic Pregnant Women

Omar E Fadlelseed, Ishag Adam, Duria A Rayis, Gasim I Gasim

Introduction: The association between Iron Deficiency Anaemia (IDA) and Haemoglobin A1c (HbA1c) levels is not yet fully investigated. It is suggested that iron-deficiency anaemia may increase concentrations of HbA1c during pregnancy. Aim: To assess the association between serum ferritin (S-ferritin), IDA and HbA1c among non-diabetic pregnant women. Materials and Methods: A cross-sectional study was carried out at Saad Abuelela hospital (Khartoum) during the period from February 2017 to August 2017. Data were gathered using a questionnaire. A 75-gram oral glucose tolerance test was performed. HbA1c and S-ferritin were measured. t-test, Mann-Whitney U test and linear regression were performed. Results: One hundred and fifty-four non-diabetic pregnant women were enrolled. The mean (SD) of age, parity and gestational age were 27.8 (4.7) years, 0.9 (1.0) and 26.8 (1.0) weeks, respectively. The median (interquartile) of HbA1c and S-ferritin were 4.4 (3.8-5.0)% and 20.7 (10.1-35.7) µg/L respectively. Of the 154 women, 103 (66.9%) had anaemia, 56 (36.4%) had iron deficiency (ID) and 38 (24.7%) had IDA. There was no significant difference in the level of HbA1c {4.4 (3.6- 5.2)% vs. 4.4 (3.9-4.9)%, p=0.726} between women with IDA and women with no IDA. Likewise, there was no significant difference in the median (interquartile) of HbA1c level in anaemic women {4.5 (4.0-5.0)% vs. 4.4 (3.8-5.1)%, p=0.496}, ID {4.4(3.9-5.0)% 4.4 (3.8-4.9)%, p=0.562} compared with non-anaemic women. There was no association between haemoglobin, S-ferritin, IDA and log of HbA1c in linear regression. Conclusion: This study found no association between IDA and HbA1c in non-diabetic Sudanese pregnant women.

A Cross–sectional Study on Grip Ability Test and its Relation with “ Hy” Band: Surrogate Marker for Amyloidosis in Patients with Rheumatoid Arthritis

KR Senthil Kumari, GJ Swetha Varsha

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory disease of autoimmune origin. The disease has specific predilection for small joints of the body especially joints of the hand. Thus, by evaluating the hand grip ability, we can measure the severity of RA. The “Hy” band occurs due to an increase in prealbumin as shown by Serum protein electrophoresis. Few studies on Prealbumin show that increased prealbumin is directly associated with Amyloidosis. Amyloidosis being a known complication of RA drew attention towards “Hy” band. Aim: To establish Grip Ability Test (GAT) as a predictor of RA severity and find its correlation with presence of “Hy” band. Materials and Methods: This cross-sectional study was conducted at Government Villupuram Medical College, Tamilnadu, India. The study included 20 RA patients diagnosed by ARA/EULAR 2010 criteria, recruited from the Department of Orthopaedics. After due ethical clearance, all demographic data, DAS28 score, ESR, Duruoz Hand Index were obtained. GAT was performed using Handgrip Dynamometer. “Hy” band was detected by Serum electrophoresis using automated capillary zone electrophoresis. The values were pooled and statistical analysis was performed using epi info version 7.2.2 p-value <0.05 was considered significant. Results: There was a statistically significant correlation between GAT and disease activity (p=0.001). Statistical significance for correlation between “Hy” band and GAT values was dull (p=0.7279 in dominant hand and 0.3337 in non-dominant hand). Conclusion: GAT shows significant correlation with disease activity. Hence, GAT will serve as a reliable and objective method of measuring disease severity in RA. GAT may be used as a clinically simple performance based prognostic tool. The presence of “Hy” band shows no correlation with GAT scores.

Therapeutic Effects of Green Tea on Nonalcoholic Fatty Liver Disease in 10-16-Year-Old Children

Introduction: Nonalcoholic Fatty Liver Disease (NAFLD) is characterised by fat accumulation in the liver. Treatment of NAFLD in children is an important issue but the options are limited. Green tea has antioxidant and anti-hyperlipidemic effects but studies; on the effect of green tea in children are limited. Aim: To investigate effect of green tea on NAFLD in children. Materials and Methods: In this study, 52 children aged 10-16 years with NAFLD were divided into two groups of 26 each: Intervention and control. For both groups, modification of diet and intensification of physical activity were prescribed for three months. Intervention group was also treated with green tea tablets. Sonography and measurements of liver enzymes {Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST)}, lipid profile and Body Mass Index (BMI) were conducted before and after the intervention. The data were analysed by the Statistical Package for the Social Sciences (SPSS) version 19.0 using ANCOVA. Results: After treatment with green tea, fatty liver grade decreased significantly in the intervention group compared to control group (p<0.0001). In addition, this treatment caused significant decrease in ALT, AST, and triglyceride levels and significant increase in High-Density Lipoprotein (HDL) level (p<0.05), but Low-Density Lipoprotein (LDL) level did not decrease significantly in the intervention group compared to control. Conclusion: Oral prescription of green tea was effective in improving fatty liver grade, decreasing hepatic fat accumulation and improving liver function, weight loss and reducing ALT and AST without any side effects. These effects can be due to green tea compounds such as polyphenols especially catechin and antioxidant and anti-hyperlipidemic effects.

Comparing the Effect of Dextrose and Oxytocin to Reduce Postpartum Haemorrhage: Randomised Controlled Trial

Zainab Suhrabi, Malihe Akbari, Hamid Taghinejad, Golnaz Azami

Introduction: Post-partum haemorrhage is a leading cause of maternal mortality and morbidity worldwide. There are different management procedures adopted for the treatment of post-partum haemorrhage. Aim: To evaluate the efficacy of dextrose in Post-partum Haemorrhage (PPH) and compare it with Oxytocin (a conventional method). Materials and Methods: A two-arm randomised controlled trial was conducted among 120 pregnant women admitted to the delivery room of the Obstetric and Gynaecological Unit of a Teaching Hospital. Participants were randomised to receive either 20 unit of oxytocin in 1000 mL ringer lactate solution (routine administration, control group) or 200 mL of 10% dextrose solution (intervention group). The primary outcome measured in this study was amount of blood loss. The outcome was assessed at 1 hour and 2 hours. Data were analysed using SPSS version 22.0, chi-square and student’s t-tests. Authors used expected maximisation to handle missing data to enable an intention-to-treat analysis. Results: At baseline, the groups were homogeneous in regards to socio-demographic variables. The average blood loss was significantly lower in the intervention group (dextrose 10%) compared to the control group (oxytocin) (p<0.05). Conclusion: Administering of dextrose 10% to pregnant women at the third stage of labour was associated with lower post-partum haemorrhage than oxytocin.

Determination of Correlation of Width of Maxillary Anterior Teeth with Extraoral Factor (Interpupillary Width) in Indian Population

Ashish Rathanchand Jain, Deepak Nallaswamy, Padma Ariga

Introduction: Selection of teeth has been a major concern during replacement of teeth for completely edentulous conditions. But little agreement on an effective method has been reached. There are no studies, which prove single esthetic factor that can be used reliably for selection of artificial teeth. This research was carried out as an attempt to better understand and analyse biometric parameters of Indian population. Aim: The aim of the present study was to determine the correlation of width of maxillary anterior teeth with extraoral factor (Interpupillary width) in different facial and tooth forms among Indian population. Materials and Methods: A total of one thousand and two hundred (n=1200) dentulous individuals who visited to Dental department for general dental check-up were included in this study. Subjects were selected based on Multistage Sampling. In the first stage, each state is considered as a cluster, which are selected randomly and in second stage from the selected states, the respondents are selected randomly using simple random sampling procedure. All intraoral measurements (CMA-Combined Width of Maxillary Anterior Teeth, MCIWR-Maxillary Central Incisor Width Right Side, MCIWL-Maxillary Central Incisor Width Left Side, Tooth form) were carried out on the artificial stone casts of maxillary arches using dental floss, flexible ruler and digital vernier caliper. Extraoral Facial measurements (IPD-Interpupillary distance) were recorded using digital Vernier caliper. Independent t-test was used to compare two variables. Pearsons correlation was used to know interconnection between IPD and CMA, MCIWR, MCIWL by linear Correlation analysis. Simple and Multiple Regression Analysis was applied to predict the width of maxillary anterior teeth. One-way ANOVA was used to compare more than two means between different facial forms. To determine statistical significance, these tests were used in this study. Results: The dominant type of facial form in the studied population was oval with an incidence of 800 subjects. The mean Interpupillary distance was (59.07±3.06 mm). Interpupillary distance was strongly positively correlated with CMA (r=0.983), MCIWR (r=0.959), MCIWL (r=0.953). There was significant difference between males and females, the mean interpupillary width and widths of maxillary central incisor were greater in males. The difference in the mean IPD values was statistically significant between various facial and tooth forms, oval and square, square and tapering, oval and tapering, (p<0.001, p<0.001, p<0.001), respectively. The distance between the center of the right and left pupils is suggested to be 5.9 times the width of the maxillary central incisor in Indian population. Conclusion: Hence findings of the present study showed that when the width of the maxillary central incisor (right and left) and CMA were compared with interpupillary width, strong positive correlation was found in Indian population. Hence, the findings of this study support the premise that single extraoral (IPD) anatomical variable, which was strongly correlated, justifies its use in choosing appropriately sized maxillary anterior teeth. However, final decisions about tooth selection should be made during the trial insertion stage of the denture and should be confirmed through consultation with the patient.

Appearance of the Optic Nerve Sheath Diameter (ONSD) using Higher Frequency Linear Probes in Detection and Monitoring of Raised Intracranial Pressures-A Cadaveric Study

Kishore Kumar Pichamuthu, Ivan James Prithishkumar

Introduction: Trans-bulbar ultrasonography of Optic Nerve Sheath Diameter (ONSD) is increasingly used to detect raised Intracranial Pressures (ICP). Current guidelines for measuring ONSD are based on earlier descriptions of anatomy of optic nerve sheath using a 7.5 MHz linear probe. There is wide variation in the cut-off value of an abnormal ONSD, mostly due to an edge artefact around the dura and uncertainty over placement of measurement cursors. Aim: To describe the detailed anatomy of the appearance of ONSD on cadaveric simulated models using a higher frequency probe. Materials and Methods: A 20G intravenous cannula was inserted into the subarachnoid space around optic nerve of nine embalmed cadavers and the space gradually insufflated with saline to mimic raised ICP. Axial and lateral ultrasonography of ONSD was done using a high frequency 13 MHz transducer, before and after insufflation of the space. The ultrasonic appearance of optic nerve sheath at normal and increased intracranial pressures was studied. Results: At normal pressures, the true subarachnoid CSF space was either not visible or seen as a thin sliver of anechoic space. At elevated pressures, this space appeared as an anechoic triangular or semi lunar space with scattered trabecular echoes on either side of anterior optic nerve in axial and longitudinal scans. Edge artefacts are easily appreciated. Conclusion: High frequency ultrasound probes (13 MHz) easily guide identification of duramater, distinguish edge artefacts and observe changes in appearance of subarachnoid space in elevated ICP. This would help in precise bed side monitoring of raised ICP especially in resource poor settings. Images described here can be a useful tool to educate and train ICU and emergency care providers.

Fast Food Consumption, Overweight and Obesity among Working Age Persons in Cambodia

Samphors Sim, Wongsa Laohasiriwong

Introduction: Overweight and obesity is an emerging public health concern in developing countries. Some studies reported fast food consumption as one of the major risk factors of overweight and obesity. Aim: This study aimed to determine the prevalence of fast food consumption and its association with overweight and obesity among working age persons in Phnom Penh capital city of Cambodia. Materials and Methods: A cross-sectional study was conducted among 749 working age persons aged 18-59 years who were selected from 12 communes from 5 districts in Phnom Penh capital city of Cambodia by applying multistage random sampling method. Then, the respondents were requested to response to a structured questionnaire interview and anthropometric measurement. Overweight, Body Mass Index (BMI =23.00-24.99 kg/m2) and obesity (BMI=25.00 kg/m2), the main outcome variables was determined by using World Health Organisation (WHO, 2000) for Asian cut-off points. Multiple logistic regressions was performed to determine the association between fast food consumption and overweight as well as obesity status while controlling other covariates and presenting adjusted odds ratio (OR adj.) with 95% Confident Interval (CI) and p-value. Results: Of the total 749 respondents, 50.20% were female with a mean age of 32.26±11.12 years. As high as 62.75%; 95% CI: (59.28%-66.22%) consumed fast food during the past one month. The prevalence of overweight and obese population was 38.72% (95% CI: 35.22%-42.21%). Fast food consumption was significantly associated with overweight and obesity (OR adj.=2.00; 95% CI: 1.39-2.88; p<0.001). Other significant covariates were; male gender (OR adj.=1.53; 95%CI: 1.06-2.20; p=0.020, adults aged 31-59 years (OR adj.=3.02; 95%CI: 1.98-4.62; p<0.001, married (OR adj.=1.69; 95%CI: 1.12-2.54; p=0.012, had family history of overweight and obesity (OR adj.=1.50; 95%CI: 1.01-2.22; p=0.043, drank alcohol (OR adj.=1.60; 95%CI: 1.10-2.31; p=0.013) and had hypertension (OR adj.=2.14; 95%CI: 1.45-3.19; p<0.001). Conclusion: Fast food consumption and over-nutrition are significant problem in Cambodia. Majority of adults aged 31-59 years are overweight as well as obese. So, identifying factors influencing fast food consumption and over-nutrition as well as developing evidence-based approaches to address these problems will help in advancing prevention and management of fast food consumption. It will also reduce over-nutrition in an appropriate manner.

A Five-year Retrospective Study on the Clinical Profile of Myasthenia Gravis with Ocular Involvement in a Tertiary Hospital

Parveen Fatima, Sheetal Savur

Introduction: Myasthenia Gravis (MG) with ocular involvement has an elusive diagnosis. Ptosis and Diplopia are the most common and early presenting features of MG. Acetylcholine receptor (AChR) antibody titre, Nerve conduction studies and chest imaging are important diagnostic tests for MG. A simple test like an ice pack test can help in differentiating MG from other causes of neurological ptosis and other symptoms. Aim: To study the systemic presentation, the profile of ocular involvement, clinical and laboratory tests and treatment modalities used in patients diagnosed with MG in a tertiary hospital. Materials and Methods: This was a hospital based five year retrospective study of 14 cases of MG, diagnosed and treated between January 2012 and December 2016. Analysis of presenting signs and symptoms of generalised and ocular MG was done. Profile of diagnostic clinical, laboratory, and radiological tests performed for each patient and their results were noted and analysed. Various treatment modalities used to manage the cases were noted. Permission from the Institutional Ethics committee was taken prior to starting the study. SPSS software version 23 was used for data analysis. Results: Mean age of presentation was found to be 40.2 years with a predilection for male gender; 81.71% of patients, who presented with Generalised MG, 14.2% had ocular involvement. Ptosis was found to be the most common ocular symptom in combination with diplopia (SD-0.554). Lateral rectus was most commonly involved muscle. Ice pack test, nerve conduction studies were specific in diagnosis of MG. Antibody titres were positive in 66.6% patients. About 30% patients underwent HRCT chest out of which 60% showed some Thymus involvement. Various forms of treatment were used including oral Pyridostigmine, oral steroids and oral immunosuppressants. Conclusion: The pattern of involvement in MG in this study was slightly different. The mean age was lower, there was preponderance of male gender and lateral rectus muscle was most commonly involved muscle. A simple ice pack test is cheap and reliable test to diagnose MG with ocular involvement. We suggest HRCT to rule out thymic abnormalities.

Superoxide Dismutase: A Biomarker for Early Diagnosis of Tuberculosis

Dipak Kumar Chattopadhyay

Introduction: Tuberculosis (TB) is a major public health concern in developing countries. Traditional diagnostic methods such as microscopic detection of organism and histopathological examination are limited in their capacity to provide information on prognosis and treatment efficiency. Abundantly secreted extracellular Superoxide Dismutase (SOD) protects the Mycobacterium tuberculosis (MTB), and elevated levels of the biomolecule are found in tissues and fluids of tubercular patients. Aim: To estimate the levels of serum SOD in lung control disease and tubercular patients; assess the diagnostic potential of SOD assay for detection of tuberculosis at an early onset stage and quantify the serum SOD activity to monitor the course of infection and determine the effectiveness of the anti-Tubercular (anti-TB) drug treatment. Materials and Methods: The present observational study was conducted on 180 participants at B.S. Medical College and Hospital, Bankura, West Bengal, India. The participants were divided into three groups: Group 1: Normal Control (n=30), Group 2: Disease Control/Lung-Disease Control (n=27) and Group 3: Tubercular Subjects (3A- Pulmonary TB and 3B- Extra-pulmonary TB) (n=76). Serum SOD levels of the participants were measured spectrophotometrically. The serum SOD levels of the patients were re-measured after one-month of A-TB drug treatment. In addition, to increase the specificity of the test, the serum of tubercular subjects was incubated with different concentrations of Sodium Cyanide (NaCN) and then assayed for SOD activity. The level of significance was assessed using Student’s t-test. Results: The serum SOD level in tubercular subjects (both pulmonary and extra-pulmonary; with treatment started between 0-15 days) were significantly (p-value <0.01) elevated as compared to the control and lung-disease subjects. Significant decrease in serum SOD levels was observed after one-month of A-TB drug treatment signifying a decrease in mycobacterial load in host tissues. The iron co-factored SOD secreted by M.tuberculosisis was found to be resistant to NaCN whereas Copper-Zinc (Cu-Zn) co-factored SOD was inhibited by NaCN. Conclusion: The serum SOD assay, used in the present study, differentiated between human and mycobacterial origin-SOD, on incubation with NaCN, and diagnosed pulmonary as well as extra-pulmonary TB cases with confidence. Thus, it can be used as a simple, rapid, inexpensive, yet highly sensitive and specific- assay for detection of both human and bovine tuberculosis and primary and secondary drug-resistant cases.

Prevalence and Risk Factor Analysis of Faecal Carriage of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital

Ravikant, M Jeya, A John William Felix

Introduction: Reduced susceptibility of carbapenems against enterobacterial strains have emerged as an important public health problem worldwide. Infection caused by Carbapenem Resistant Enterobacteriaceae (CRE) can affect severely ill patients, and their colonisation of human gut, endangers population at large in communities, and in hospitals. Aim: To determine the prevalence and risk factors associated with faecal carriage of CRE. Materials and Methods: A cross-sectional study was conducted on a total of 156 random stool samples collected from hospitalised patients of surgery wards. CRE were determined by antibiotic susceptibility testing against carbapenems as per Clinical Laboratory Standards Institute (CLSI) guidelines (2017) for a period of eight months from February to September, 2018, in a tertiary care hospital, Chidambaram, Tamil Nadu, India. Those strains appeared to be meropenem resistant were further tested with imipenem, a battery of biochemical test, modified Carbapenem Inactivation Method test (mCIM), Modified Hodge Test (MHT) and Epsilometer (E-test) to detect Extended Spectrum of ß-Lactamases (ESBL). Confirmed carbapenem resistant isolates were also put through molecular analysis to detect the gene responsible for carbapenemase production. Risk factors associated with faecal carriage of CRE were comparatively analysed. Results: Out of a total 156 faecal samples, 222 Enterobacteriaceae isolates were obtained, and 21 isolates from 17 samples were CRE positive, with a prevalence of 10.89% phenotypically. Out of total phenotypically confirmed CRE, 23.8% (5/21) exhibited CRE gene. bla_NDM-1 was the most frequent detection followed by bla_VIM, bla_OXA-48 and bla_KPC, while no isolate was positive for bla_IMP. One CRE isolate co-harboured bla_NDM-1, bla_OXA-48 and bla_KPC and three CRE isolates co-harboured bla_VIM and bla_NDM-1. Length of hospital stay and haemorrhoids were discovered, as independent predisposing risk factors for CRE faecal carriage by multivariate regression analysis. Conclusion: We found high prevalence of faecal carriage of CRE during a non-outbreak situation from surgery wards. Hospitalised patients should be considered a population at risk. Enforcing robust surveillance system, antibiotic stewardship and maintaining unprecedented hygiene are the need of the hour to curb CRE.

Predictors of Fear of Childbirth in the Primiparous Women in Ardabil-Iran

Introduction: Fear Of Childbirth (FOC) is the main factor leading to elective and emergency cesarean section. FOC and prenatal depression affect the women and fetus health status and it is associated with negative neonatal outcomes during pregnancy. Aim: To determine the predictors of FOC in pregnant women. This cross-sectional study was carried out on 230 primiparous women between 24th and 30th weeks of pregnancy who referred to 17 urban healthcare centres of Ardabil-Iran. Six centres of 17 urban healthcare centres were randomly selected using a cluster sampling method. A list of the women who met the inclusion criteria and willing to participate in this study was prepared. The socio-demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and Wijma Delivery Expectancy Questionnaire (WDEQ-A) were used to collect data through in-person interviews. The statistical analyses were performed with the Pearson’s correlation test and the general linear model. Results: The mean (SD) scores of the WDEQ-A and the EPDS were 58.4 (26.1) and 8.9 (5.1), respectively. More than one-third of women (38.6%) had high FOC and about one-third (34.1%) had moderate FOC. On the base of the Pearson’s correlation test, there was a significant correlation between FOC and depression (p<0.001, r=0.51). Moreover, based on the general linear model, the variables of depression, sufficiency of family income and non-male fetal gender were predictors of FOC and they explained 28.5% of the variance in childbirth fear. Conclusion: The present results showed that the pregnancy depression correlated with FOC. Therefore, identifying and treating depressed pregnant women can decrease FOC and its complication on the women and neonates. It may be also effective in reducing unnecessary cesarean sections.

Comparative Evaluation of Accuracy of Immersion A-scan Ultrasound Biometry and Optical Biometry in Cases Undergoing Small Incision Cataract Surgery

Introduction: At present, refractive accuracy is the demand of cataract surgery which can be achieved by providing precise post-operative vision without spectacles. One of the important factors required to give spectacle free vision is calculation of accurate biometry. In developing countries like India, Small Incision Cataract Surgery (SICS) is done more commonly than phacoemulsification with foldable Intraocular Lenses (IOLs). Aim: To evaluate the accuracy of Immersion A-scan and Optical biometry in patients undergoing SICS with foldable IOLs by assessing their one month post-operative refraction and converting these values in predicted emmetropic IOL powers. Materials and Methods: Prospective study was conducted on 60 patients to be posted for cataract extraction in Department of Ophthalmology, Bharati Medical College and Hospital (Deemed to be university), Sangli, Maharashtra, India, for two months from the period of January 1, 2019 to March 1, 2019. Preoperatively patients were randomly divided in two groups containing 30 patients each, Group A was subjected to Immersion A-scan and Group B to Optical biometry. Patients included in the study preoperatively also underwent Best Corrected Visual Acuity (BCVA) estimation, applanation tonometry, slit lamp examination of anterior and posterior segment and Keratometry. Patients were examined post-operatively on 1st, 7th, and 30th day, for slit lamp examination of anterior and posterior segments and also their BCVA was noted. Final refraction was given on 30th postoperative day based on their auto-refractometer readings. Postoperative refraction and actual IOL power placed was used to calculate IOL power that would have produced emmetropia in that particular patient by the help of regression formula. Difference in actual IOL power placed and predicted emmetropic IOL power was also noted in each patient of both groups. Unpaired t-test was used for the statistical analysis. Results: The mean Axial Length (AXL) measured by immersion A-scan in group A was lesser (22.91 mm) than that with IOL master (23.15 mm) with a mean difference of 0.24 mm (p=0.133). Mean actual post-operative refraction at one month in group A was higher (0.90) than that of group B (0.70) with a mean difference of 0.20 (p=0.166). Mean difference between actual IOL (aIOL) placed and predicted emmetropic IOL (eIOL) was higher in group A (1.35) than that of group B (0.96) with a mean difference of both group was 0.39 (p=0.021). Conclusion: In the range of AXL 22 mm to 24.50 mm, used in this study, there is no statistically significant difference in axial length measurements between two methods of Ultrasound biometry and Optical biometry. Patients in Group A of present study had significant post-operative residual refraction as compared to Group B patients, which can be attributed to inaccurate Keratometry as two different methods of Keratometry were done in two groups. Keratometry values can influence post-operative refraction and inaccurate Keratometry may land with post-operative refractive errors. Current study showed certain advantages of optical biometry over USG biometry in that Optical biometry is Non-contact, fast and accurate, but optical biometry cannot be done in mature cataracts and dense posterior subcapsular cataract where immersion USG biometry is required.

Non Pharmacological Management for Xerostomia- A Systematic Review

K Rajkumar, R Ramya, R Lakshmi Swarna

Introduction: There is a substantial amount of literature on electrical nerve stimulation for xerostomia, which includes both intra as well as extra oral techniques that has been used so far. A systematic review would provide a wide knowledge about the use of electrical stimulation as a treatment for xerostomia patients. Aim: To provide a detailed report on the original research in field of electrical nerve stimulation used as a therapy for patients with xerostomia. Materials and Methods: The primary database used was Medline (via PubMed) and Cochrane Central Register of Clinical Trials (CENTRAL). The article selection was carried out by two authors in order to avoid bias. Eligibility criteria for the studies were: it should be an original research, patients with xerostomia and the patients should have undergone any type of electrical nerve stimulation intervention. The finalised list of studies meeting the inclusion criteria was assessed for data extraction. A total of 11 studies was included after thorough verification of the guidelines and inclusion criteria. Results: A total of 10 of the studies reported to show increase in the salivary flow on application of electrical stimulation for those patients with dry mouth irrespective of the aetiology. However high quality studies (i.e., detail recording of the history of dryness, onset, severity etc.,) with more precision about the impulse used and patient details is required for evaluating the effectiveness of the device to be used as an adjuvant treatment. Overall the results observed from this systematic review are that, the use of electrical nerve stimulation technique for treatment of xerostomia is a suitable modality as it is widely accepted by the patients, is a non-invasive procedure and has little or no adverse effects. Conclusion: Electrostimulation is an effective way of triggering reflex salivary stimulation even in a partially atrophied gland or hypo secretion irrespective of its aetiology. The benefits being ease of usage and the acceptability of the patients among the current devices as it is noninvasive makes it an ideal therapeutic device for treating xerostomia.

Serum Urokinase Plasminogen Activator as a Novel Biological Marker for COPD- A Review

D Rekha, Priscilla Johnson, Subhasis Das, B Rajagopalan, GR Sathya

Chronic Obstructive Pulmonary Disease (COPD), a progressive disease of the airways is associated with chronic inflammation of respiratory passages that leads to irreversible lung dysfunction and distinct morphological changes. The progressive increase in airflow limitation that is seen in COPD is associated with systemic inflammation with the development of extra-pulmonary complications like muscle atrophy, cachexia and osteoporosis. Several biomarkers like C-Reactive Protein (CRP), fibrinogen and Interleukin have been used as an adjunct tool to diagnose COPD. Soluble Urokinase Plasminogen Activator Receptor (suPAR) has been used as a diagnostic marker for congestive heart failure, sepsis, adult respiratory distress syndrome and acute exacerbation COPD. The present narrative review gives a brief overview on clinical significance of suPAR in the diagnosis and prognosis of COPD. The articles quoted in this review were taken from search engines like PubMed Central, Crossref, Web of Science and Google Scholar for articles published from 1991 to 2016, by using domain words like “COPD”, “suPAR”, “inflammation” and “prognosis”. The relevant references cited in these articles were also reviewed.

Low Level Laser as a Therapeutic Alternative in Treatment of Oral Lichen Planus- Review of Literature

Shiladitya Sil, Suryoday Ghosh

Oral Lichen Planus (OLP) is a chronic mucocutaneous disease having oral and systemic manifestations. Topical Steroids are the first line of treatment in OLP. Adjuncts like retinoids, placental extracts, immunomodulators like tacrolimus are supplemented with topical steroids for the management of unresponsive lesions of OLP before the administration of systemic corticosteroids, which has its own complications. There are reports of some lesions of OLP that become unresponsive after prolonged steroid therapy. Low Level Laser Therapy (LLLT) has been used in dentistry for a wide range of therapeutic procedures like de-pigmentation, incisions, curing of composite, frenectomy etc. LLLT has been tried and tested for management of skin lesions in psoriasis and vitiligo successfully that prompted many authors to use LLLT in the management of the oral lesions in Lichen Planus. This review aimed to evaluate the role of LLLT as a therapeutic adjunct in the management of un-responsive and/or symptomatic cases of OLP before the administration of systemic corticosteroids. It also attempts to evaluate if the use of LLLT supplemented with topical steroids can reduce the incidence of unresponsive or resistant lesions of OLP.

Screening for Hydroxychloroquine-Associated Retinopathy: A Review

Ahmad Mirshahi, Morteza Naderan, Mojtaba Abrishami

Hydroxychloroquine (HCQ) is a well-known medication, which is approved for a number of medical disorders. However, the HCQ-associated retinal toxicity is also a very well known complication, which may result in irreversible toxic maculopathy and severe visual loss, if not diagnosed in the early phase. Although some authorities argue about the role of screening, the American Academy of Ophthalmology recommends regular patient evaluations and prescription of HCQ in the recommended dose of less than 5 mg/kg real body weight. High dose, long duration of use and high cumulative dose, renal disease, and some drug interactions are major risk factors. Among various subjective and objective methods proposed for screening HCQ toxicity, visual field evaluation and optical coherence tomography have been recommended as the first line. In this article, we outlined the current published literature concerning the various aspects of HCQ retinopathy. It is recommended that patients be screened for this complication at appropriate intervals in order to detect earliest signs of damage and discontinue the drug in order to prohibit further damage.

The Efficacy of 311-NM Narrowband Ultraviolet B (NB-UVB) and Topical Agents or Lasers Combination Therapy versus NB-UVB Monotherapy for Vitiligo: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Introduction: Even though there is the availability of multiple treatment modalities for vitiligo still its treatment remains challenging. Combination therapies of Narrowband Ultraviolet B (NB-UVB) and various topical agents or lasers are widely used in the treatment of vitiligo. Aim: To compare the efficacy of NB-UVB and topical agents including calcineurin inhibitors, antioxidants, corticosteroids, vitamin-D3 analogues and 5-fluorouracil or lasers combination therapy versus NB-UVB monotherapy for vitiligo. Materials and Methods: Data source: This was randomised controlled trials which was conducted to revealed the efficacy of NB-UVB alone or in combination with topical agents or lasers for vitiligo, manual searches of reference lists and, computerised searches of the PubMed (from 2000 to 2018) Science direct (from 1985 to 2018) and Cochrane Central Register of Controlled Trials (from 2005 to 2017) were conducted with keywords “NB-UVB” or “narrowband ultraviolet B”, “Vitiligo”. Study eligibility criteria: In this study, full-text articles of clinical randomised controlled trials RCTs published in English language literature were selected. Participants: Out of 549 studies, 12 studies with a total of 460 patches or patients were included in the review based on the inclusion and exclusion criteria. Apart from included 12 studies, other 537 studies were excluded due to the following reasons: inappropriate after the title and abstract screening, improper intervention and improper outcome measures, published only in abstract form, not a combination therapy, not an RCT. Intervention: For this systemic review and meta-analysis, application of NB-UVB monotherapy for one group and the combination of NB-UVB with any topical agents or lasers for another group also having treatment success (=75% regimentation) as the primary outcome and treatment failure (<25% regimentation) as the secondary outcome were selected. Study appraisal and synthesis methods: Out of 549 studies, 22 studies were assessed for methodological quality and finally, 12 studies with a total of 460 patches or patients were included in the review based on the inclusion and exclusion criteria. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Results: In this study, 12 randomised controlled trials comprising a total of 460 patches/patients were analysed. The obtained results suggested that combination therapy is superior compared to monotherapy in form of regimentation except calcipotriol combined with NB-UVB. Among all combination therapy, the combination of NB-UVB and antioxidants (2 studies: RR 1.77, 95% CI 0.93 to 3.35; number needed to treat 4.68, 95% CI 2.22 to 41.69) moreover topical calcineurin inhibitors (3 studies: RR 1.79, 95% CI 1.06 to 3.01; number needed to treat 10.7, 95% CI 5.85 to 62.49) was superior to NB-UVB monotherapy for vitiligo. Apart from these, success rate in other combination can’t be predicted because the presence of high level heterogeneity (three studies: NB-UVB combined with fractional CO2 laser group) or could not find heterogeneity as single study (four studies: Others group; NB-UVB combined with ER:YAG laser ablation and 5-fluorouracil, NB-UVB combined with topical steroid and dermabrasion, NB-UVB combined with 5-fluorouracil injection, NB-UVB combined with calcipotriol ointment). Limitation: The verdicts of this study are limited by small numbers of randomised controlled trials and heterogeneities among included studies. Conclusion: In conclusion, adding antioxidant and topical calcineurin inhibitors on NB-UVB yields significantly superior outcomes than NB-UVB monotherapy. For soundest clarification, more large-scale, high-quality, double-blind RCTs regarding the efficacy of topical agents or lasers plus NB-UVB combination therapy should be planned.

Body Weight and Its Relationship with Muscle Strength among Adolescents in Malaysia

Introduction: Few studies have investigated the relationship of handgrip strength as an index of nutritional status to morbidity and mortality in adults and elderly. However, it is not clear if differences exist in handgrip strength, begins at adolescent age and what are their determinants. Aim: To describe the muscle strength of the Malaysian adolescents and to determine the predictors of handgrip strength. Materials and Methods: The study followed a stratified sampling design. This study examined data of 933 students comprising of multi ethnic adolescents, aged 13 years, from March to May 2012. Muscle strength was measured using calibrated hand dynamometer. Data were analysed using multiple linear regression. Results: Male adolescents had greater muscle strength compared to female adolescents (17.8 vs. 14.7 kg). The strength of the right handgrip was greater in both males and females compared to the left handgrip with a difference of 1.39 kg in male and 0.9 kg in female adolescents. Weight and Waist circumference (WC) were significant predictors for handgrip strength for both males and females. Conclusion: This study indicates that weight and WC are among of the determinants of muscle strength for the multiethnic Malaysian adolescents. Future study should focus on exploring causes of the muscle strength and lifestyle.

Features of the Spatial Perception in Persons with Mental Disorders

Alena Alekseevna Koygerova

Many of the various mental pathologies afflicting mankind in modern society require more detailed research. One of the directions requiring additional studying is that of spatial perception in mental patients. The main purpose of the study was to investigate the role of spatial perception in mental health disorders using the coefficient of perspective expansion. Methods and subjects: To carry out this study, a series of experiments were conducted using the graphic test for drawing a cube at various distances from an object. After that, the coefficient of perspective expansion was calculated. Patients from the regional psychiatric hospital with the prevailing diagnosis of schizophrenia were the subjects of the research. The data showed the dependence of the coefficient value to the patient’s mental and emotional state, more so than their intelligence.

In Pursuit of the Broken Prong-Instrument Malfunction during Percutaneous Nephrolithotomy

Sridhar Panaiyadiyan, Prabhjot Singh, Brusabhanu Nayak

Endourological techniques are the mainstay treatment in the contemporary management of urological stone diseases. Instruments malfunction during endourological procedures, however, it appears that such incidences are underreported. Wear and tear caused by improper handling or factory defects may lead to instrument malfunction, resulting in serious accidents. Herein, a case of unexpected broken alligator forceps encountered during Percutaneous Nephrolithotomy (PCNL) is presented. Additional toilsome were done while retrieving the broken fragment, apart from complete stone clearance. To the best of author’s knowledge, this is the first report on instrument malfunction during PCNL, successfully managed by various endourological armamentarium. The present case emphasises meticulous screening, proper handling of endourological instruments to avoid unexpected intraoperative malfunction.