Journal of clinical and diagnostic research

The Central Corneal Thickness in Normal Tension Glaucoma, Primary Open Angle Glaucoma and Ocular Hypertension

Anupama C. Shetgar, Mariyappa B. Mulimani

Aims and Objectives: To compare the Central Corneal Thickness (CCT) of Normal Tension Glaucoma (NTG) with those of Primary Open Angle Glaucoma (POAG) and Ocular Hypertension (OHT) and to study the effect of CCT on the diagnosis and management of glaucoma patients. Method: A total of 99 patients 35(35.35%) females and 64(64.65%) males were included in the study with four study groups-37 controls (males-24 and females-13), 22 NTG (males- 11 and females-11), 28 POAG (males-21 and females-7), and12 OHT (males-8 and females-4). The CCTs of all the participants were measured by using ultrasonic pachymetry. The IOPs were measured by using applanation tonometry. The measured IOPs were corrected by using a linear correction formula. The measurement significant changes (>=1.5) and outcomes significant changes (>=3.0) for the study groups were calculated. Results: The mean CCT of the normals was 527.65± 21.90 µ, the mean NTG was 503.91 ± 11.31 µ, the mean POAG was 525.25± 23.59 µ and the mean OHT was 572.25± 22.71 µ. The difference which was observed in the mean CCT among the groups was statistically significant (p<0.05). The measurement significant change (>=1.5) after correcting the IOP for CCT was observed in 32.258% of the total glaucoma patients, with 27.3% patients ( 6 out of 22) in the NTG, 66.7% patients (8 out of 12) in the OHT and 21.4% patients ( 6 out of 28) in the POAG groups showing it. The difference which was observed was statistically significant (p<0.05). The outcomes significant change (>=3.0) after correcting the IOP for CCT was seen in 6.45% of the total glaucoma patients, with none of the NTG group patients showing outcomes significant changes, whereas 3.57% patients (1out of 28) in the POAG and 25% patients ( 3out of 12) in the OHT groups showed these changes. The difference which was observed was statistically significant (p<0.05). Conclusion: This study confirmed that the central corneal thickness was significantly lower in the normal tension glaucoma patients as compared to those in the controls and in the primary open angle glaucoma patients, whereas the ocular hypertension patients had significantly higher central corneal thicknesses than the controls and the primary open angle glaucoma patients. No significant difference was found between the primary open angle patients and the controls. Due to the effect of CCT on the measurement of the IOP by using an applanation tonometer, which is the main parameter in the diagnosis and the follow up of the glaucoma patients, many POAG patients are misdiagnosed as NTG patients and the normals are misdiagnosed as OHT patients and they are improperly managed. Measurement of the central corneal thickness aid the ophthalmologist in making a correct diagnosis and in a better management of glaucoma and the glaucoma suspects, especially when their corneal thickness differs markedly from the normal thickness.

Polypoidal Lesions in the Nasal Cavity

Kalpana Kumari M.K., Mahadeva. K.C.

Introduction: Nasal polyps are polypoidal masses arising from mucous membranes of nose and paranasal sinuses. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and nontender. Aims and Objectives: The purpose of this study was to study the histopathologic spectrum of polypoidal lesions of the nasal cavity. Materials and Methods: The study comprised of 100 consecutive cases of polypoidal lesions in the nasal cavity, received in the department of pathology. The age and sex of the patients were recorded. The tissues were routinely processed for histopathologic sections and stained with haematoxylin and eosin stains. Special stains like Periodic acid Schiff (PAS) was done wherever applicable. The cases were classified into neoplastic and nonneoplastic lesions. The neoplastic lesions were further classified according to WHO classification on histopathologic examination. Results: Analysis of 100 polypoidal lesions in the nose and paranasal sinuses with clinical diagnosis of nasal polyps, revealed 66 cases were nonneoplastic and 34 were neoplastic;17 (50%)were benign and 17(50%) were malignant. True nasal polyps both inflammatory and allergic together comprised 44 cases of the 100 polypoidal lesions in the nasal cavity. Angiofibroma and inverted papilloma were the most frequent benign tumour accounting for 12/17(0.7%). The most common malignant tumour was anaplastic carcinoma 7/17(0.4%). Nonneoplastic and benign tumours were common in younger age groups whereas malignant tumours were most common in older males. Conclusion: The majority of polypoidal lesions in the nasal cavity are nonneoplastic.

A Comparative Analysis on the Efficacy and Safety of Intaxel® and Taxol® in Advanced Metastatic Breast Cancer

Background: Among the presently available cytotoxic drugs, paclitaxel, in combination with doxorubicin and carboplatin, come under the highly active therapy for metastatic breast cancer. Between the two brands of paclitaxel (Intaxel, which is marketed by Fresenius Kabi and Taxol, the original paclitaxel which is manufactured by BMS) the similarity has not been evaluated in clinical trial settings till date. This prospective, controlled, randomized, multicentre, open-label phase IV study was planned to compare the safety and efficacy of Intaxel with Taxol, when they were used in combination with carboplatin or doxorubicin, as a second line treatment for metastatic breast cancer. Methods: Fourty nine eligible patients were randomized to receive Intaxel or Taxol with either doxorubicin or carboplatin. The patients who had received a prior anthracycline based chemotherapy were randomized to the paclitaxel/carboplatin arm. The patients were evaluated in three phases i.e. at baseline, during the treatment and at follow up for the tumour response, the time period till the disease progression and the toxicity. The time till the disease progression was assessed by the Kaplan–Meier method. The continuous and categorical variables were assessed by using the ANOVA test and Fisher’s exact test, respectively. Results: After 3 cycles, an objective response rate of 55.56% (CR = 3, PR = 7) was noted in the Intaxel group and that of 59.09% (CR = 1, PR = 12) was noted in the Taxol group. After 6 cycles, an objective response rate of 50% was noted in both the groups. No significant difference was observed in the response rate of the two groups after 3 cycles (p > 0.05) and at the end of the treatment (p > 0.05). The patients who received Intaxel had a lower incidence of thrombocytopaenia (p = 0.0146) and neurosensory loss (p = 0.008) as compared to those who received Taxol. Conclusion: The results of this study demonstrated that the safety and efficacy of Intaxel and Taxol are equivalent when they are used in combination with other cytotoxic agents as the second line of treatment for metastatic stage IV breast cancer.

Deficiencies of the Microelements, Folate and Vitamin B12 in Women of the Child Bearing Ages in Gorgan, Northern Iran

Maliheh Sedehi, Naser Behnampour, Mohammad Jafar Golalipour

Background: The deficiencies of folic acid, vitamin B12, and microelements during pregnancy may affect the health of newborns. Objectives: To assess the serum levels of folate, vitamin B12, iron, zinc and copper in healthy women of the childbearing ages in Gorgan, northern Iran. Methodology: This descriptive, cross-sectional study was carried out on 100 women of childbearing ages in northern Iran during November 2007-March 2008. The serum levels of folate, vitamin B12, iron, copper and zinc were evaluated by laboratory tests. Results: Iron, copper , folate, vitamin B12 deficiencies and folate with vitamin B12 deficiency were detected in 13%, 32% , 13% , 32% and 11% women of the childbearing ages, respectively. According to the ethnicity, vitamin B12, folate and iron deficiencies in the Sistani group were observed in 38.3%, 12.9% and 12.9% of the women, respectively. In the native Fars group, the above mentioned deficiencies were found in 31.1%, 13.4% and 7.5% of the subjects. Folate and vitamin B12 deficiencies were observed in the urban habitant in 32.7% and 11.5 % of the subjects as compared to those in the rural habitant (in 30.4% and 15.2%of the subjects respectively). The folate deficiencies in the under and above 18 years old subjects were 22.2% and 9.9%, respectively. Conclusions: This study showed that the deficiency of the micronutrients was considerable in women of the childbearing ages in Gorgan, northern Iran.

The Carotid Intima Media Thickness: A Predictor of the Clincal Coronary Events

Background: The Carotid Intima-Media Thickness (CIMT) is a simple and an inexpensive tool which can be used to assess the cumulative effect of atherosclerotic risk factors and it is also an independent predictor of the future cardiovascular risk. Nevertheless, criticism has been raised throughout the scientific community, based on the observations which indicated a weak correlation between CIMT and coronary atherosclerosis. It has been suggested by the International Atherosclerosis Project, that the atherosclerotic process occurs at the same time in the carotid, cerebral and the coronary arteries. Measurement of the Carotid Intima-Media Thickness (CIMT) of the Common Carotid Artery (CCA) by B-mode ultrasound was found to be a suitable non-invasive method, to visualize the arterial walls and to monitor the early stages of the atherosclerotic process. Aim: This study sought to determine the usefulness of B-mode ultrasound as a non-invasive marker to examine the association between CIMT and the extent and the severity of coronary artery disease and its association with the cardiovascular risk factors, if any. Methods: A cross-sectional study was done among hundred cases and hundred age and sex matched controls who were in the age group of 30-65 years. The cases included those who had undergone coronary angiography. The controls included non-diabetic non-hypertensives with no cardiovascular risk factors. The CIMT was assessed by using a 7MHz linear array transducer. Fasting blood samples were collected for measuring the blood sugar and the lipid profiles. Results: The statistical analysis was done by using the Student’s t test and ANOVA and a p value of <0.001 was considered to be significant. The Average Carotid Intima Media Thickness (AVCIMT) was higher in the cases (0.90 vs 0.47 in controls, p<0.001, very highly significant). The AVCIMT was found to be higher in those with triple vessel disease (1.00mm) >double vessel disease (0.91mm) >single vessel disease (0.82mm) >normal coronaries (0.65mm). Conclusion: The easy applicability and the non invasive nature of B-mode ultrasonography make it suitable for use as a surrogate endpoint for measuring the atherosclerotic burden in people with cardiovascular risk factors. Even in this present study, we found a significant association between the extent of carotid atherosclerosis which was measured by B-mode ultrasound, and the presence, its extent, or the lack of coronary atherosclerosis which was documented by coronary angiograph

The Knowledge, Attitude and Practice Towards Blood Donation Among Voluntary Blood Donors in Chennai, India

Uma S., Arun R., Arumugam P.

Introduction: An integrated strategy for blood safety is required for the provision of safe and adequate blood. Recruiting a sufficient number of safe blood donors is an emerging challenge. The shortage of blood in India is due to an increase in the demand, with fewer voluntary blood donors. A study on the knowledge, attitude and the practice of donors may prove to be useful in the successful implementation of the blood donation programme. Our aim was to find the level of the knowledge, attitude and practice of blood donation among voluntary blood donors. Material and Methods: A structured questionnaire was given to 530 voluntary blood donors to assess their knowledge, attitude and practice with respect to blood donations. The statistical analyses were done by using the SPSS software. The associations between the demographic factors were analysed by using the Chi square test. Results: Among the 530 donors, 436 (93%) were males and 36 (7%) were female donors. 273 (51.2%) donors knew about the interval of the donation and 421 (79.4%) donors knew about the age limit for the donation. 305 (57%) donors felt that creating an opportunity for the donation was an important factor for motivating the blood donation and 292 (55%) donors felt that the fear of pain was the main reason for the hesitation of the donors in coming forward to donate blood. Conclusion: A majority of the donors were willing to be regular donors. The donors showed positive effects like a sense of satisfaction after the donation. Creating an opportunity for blood donation by conducting many blood donation camps may increase the voluntary blood donations.

The Diagnostic Utility of Intraoperative Cytology in the Management of Ovarian Tumours

Ananthalakshmi Vijayakumar

Background: The present study was done to evaluate the status of intraoperative cytology as a diagnostic and supportive investigation for ovarian tumours. Materials and Methods: The present study was conducted in the Department of Pathology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India during a time span of 13 months (June 2011 to June 2012). A prospective investigation was performed on 50 cases of suspected ovarian neoplasms. Imprint smears were made intraoperatively from fresh samples from various representative areas, and they were immediately fixed in 95% ethyl alcohol and stained with the haematoxylin and eosin stain. The results were compared with the final histopathological diagnoses in each case. Results: There were 20 benign lesions, 4 borderline epithelial neoplasms and 26 malignant tumours according to the final histopathological diagnosis. The overall diagnostic accuracy of imprint cytology has been satisfactory, with those of 90% of the cases correlating with the final diagnoses. Characteristic cytological patterns were noted in various surface epithelial, sex cord stromal and germ cell tumours. Conclusion: Imprint cytology can be used as an adjunct to histopathology for a rapid and an early diagnosis in the operation theatre, particularly in developing countries like ours, where the facility of frozen sections is often not available, since a rapid preliminary diagnosis may help in the surgical management planning.

The Antibiotic Susceptibility Patterns of Uropathogenic Escherichia Coli, With Special Reference to the Fluoroquinolones

Abdul Rahaman Shariff V A, Suchitra Shenoy M, Taruna Yadav, Radhakrishna M

Context: The emergence of drug resistance to trimethoprim-sulfamethoxazole, the penicillins, cephalosporins, and fluoroquinolones by Uropathogenic Escherichia coli (UPEC) has limited the options for selecting the appropriate antibiotic for the treatment of urinary tract infections. Aims: The The E. coli isolates, which were obtained from the culture of urine samples,were studied for their antibiotic resistance patterns, with special reference to the antimicrobial activity of the fluoroquinolones and the production of the extended spectrum ß-lactamases. (ESBL), Settings and Design: This was a hospital based, prospective study which was done for a period of eighteen months. Material and Methods: This study was done by using the standard culture techniques for urine samples, the modified Kirby-Bauer disk diffusion method for the antibiotic susceptibility testing and the disk diffusion method to confirm the ESBL production by the clinical isolates of E. coli in urine. The sensitivity pattern was correlated with the clinical condition and the presence of the risk factors. The statistical analysis which was used: The statistical analysis was done by using the proportions of sensitive, resistant and intermediates. Descriptive statistics like the total, mean and percentage were done by using the Statistical Package for the Social Sciences (SPSS), version 15.0. Results: The hospital isolates showed high degrees of resistance to the penicillins, cephalosporins, nalidixic acid and the fluoroquinolones, with 59% of the isolates being ESBL producers. Conclusions: The incidence of the multidrug resistant strains of Escherichia coli has been steadily increasing over the past few years. The knowledge on the resistance pattern of the bacterial strains in a geographical area will help in guiding the appropriate and the judicious use of antibiotics. Also, the formulation of an appropriate hospital antibiotic policy will go a long way in controlling these infections.

The Total Antioxidant Power of Semen and Its Correlation with the Fertility Potential of Human Male Subjects

Pranjali Prabhakarrao Pahune, Ajay Rajeshwar Choudhari, Parikshit Ashok Muley

Background: There are growing evidences that the damage which is caused to the spermatozoa by the Reactive Oxygen Species (ROS) plays a key role in the male infertility. The seminal plasma is endowed with many enzymatic and nonenzymatic antioxidants which protect the spermatozoa against oxidative stress.The present study was undertaken by using a simple, colourimetric, ferric reducing, antioxidant power for assessing the total antioxidant power rather than the individual antioxidants. The measurement of the individual antioxidants in the seminal plasma, such as Superoxide Dismutase, Vitamin E, etc. is time consuming, which often requires sophisticated and expensive techniques and these measurements may not correlate with the quality of semen. Aim: To evaluate the total antioxidant capacity of seminal plasma by estimating the Ferric Reducing Antioxidant Power (FRAP) of semen in different groups of subjects and to correlate it with the different seminogram parameters. Material and Methods: The semen samples were obtained from 150 male partners of infertile couples who attended the Reproductive Biology Unit (Infertility Clinic) of the Department of Physiology, MGIMS, Sevagram, who were aged 20-58 years and they were analyzed for the routine seminogram parameters. All the subjects were categorized into two main groups, A. The subjects with abnormal ejaculates, who were further sub classified into the following groups i) Asthenoteratozoospermics (n=25) ii) Oligoasthenoteratozoospermics (n=26) and iii) Azoospermics (n=19) and B. The subjects with normal ejaculates (n=80). The total antioxidant power was measured spectrophotometrically by using the Ferric Reducing Antioxidant Power (FRAP) assay. Results: The Total Antioxidant Capacity (TAC) was found to be significantly lower in the abnormal ejaculates than in the normal ejaculates. A statistically significant positive correlation was observed between the TAC and all the seminogram parameters such as the sperm concentration, sperm motility and sperm morphology (p<0.05). Conclusion: A decreased seminal plasma antioxidant capacity (TAC) could have significant role in the aetiology of impaired sperm functions. So, the TAC may be used as specific biomarker for assessing the oxidative stress in sperms.

Adverse Drug Reaction Monitoring of Antidepressants in the Psychiatry Outpatients Department of a Tertiary Care Teaching Hospital

Swati Mishra, Trupti Rekha Swain, Manjushree Mohanty

Background and Introduction: Depression is a prevalent mental disorder and the 4th leading cause of disability in the world as per the World Health Organization (WHO). The adverse Drug Reactions (ADRs) to antidepressants are common and they can lead to a non compliance or even a discontinuation of the therapy. This study entitled us to monitor the ADR profile of the antidepressants in a tertiary care teaching hospital. Patients and Methods: A longitudinal, observational study was conducted in the Outpatients Department of Psychiatry in S.C.B. Medical College and Hospital l in collaboration with the I.M.S and SUM Hospital. A total of 160 cases were studied for ADRs by using a predesigned CDSCO form. The patients who were on TCAs, SSRIs and newer antidepressants (SNRIs/NDRIs) were assessed by doing physical examinations, neurological examinations and relevant lab tests. The causalities were assessed by the criteria of the WHO-UMC. The analysis of ADRs was done by using the Chi square test. Results: Among the 160 patients who took antidepressants, 26.87% reported ADRs, with at least one possible causality.None were labeled as certain, as a rechallenge was not performed.ADRs were mostly observed in polytherapy (14.37%) and with antidepressants like TCAs (58.84%). Conclusions: Agitation, anxiety and insomnia were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the Psychiatry Outpatients Department and due care must be taken to avoid these ADRs.

The Isometric Handgrip Exercise As a Test for Unmasking Hypertension in the Offsprings of Hypertensive Parents

Rinku Garg, Varun Malhotra, Usha Dhar, Yogesh Tripathi

Background: A familial history of hypertension increases the risk of hypertension in the offsprings. Aims and Objectives: The present study was undertaken to assess the underlying hypertension by using the Isometric Handgrip (IHG) exercise test in the offsprings of hypertensive parents and to compare it with age-matched controls of normotensive parents. Material and Methods: The isometric handgrip test was performed in the study and control groups. The resting blood pressure was recorded before exercise and afterwards the subjects were asked to perform the isometric handgrip exercise with the dominant hand for 2 minutes. Then the blood pressure was recorded in the sitting position during and 5 minutes after the completion of the exercise. Statistical Analysis: The analysis of the results was done by ANOVA with SPSS, version 17.0, by using the unpaired ‘t’ test. Results: The results showed that the Resting Systolic (SBP), Diastolic (DBP) and the Mean (MBP) Blood Pressures were higher (p <0.001) in the offsprings of the hypertensive parents as compared to those in the control subjects of normotensive parents. During the isometric handgrip exercise test, the rise in the systolic, diastolic and the mean blood pressures was significantly higher (p<0.001) in the offsprings of the hypertensive parents. After 5 minutes of exercise, the SBP, DBP and the MBP were found to be significantly higher (p<0.001) in the study group as compared to those in the control group. Conclusions: An early and a regular screening of the children of hypertensive parents is necessary to prevent any future cardiovascular complications.

Liver Function Profile Anomalies in HIV Seropositive Tuberculosis

Background: The Human Immunodeficiency Virus (HIV) and the Tuberculosis (TB) co infection are contributory to each other in causing a progressive decline in the cell mediated immunity and a damage to the hepatobiliary system. The aim of our study was to estimate the extent of liver damage which was caused by these infections before the start of the therapy with hepatotoxic drugs like Antiretroviral Therapy (ART) and Antitubercular Drugs (ATD). Methods: One hundred and ninty three confirmed HIV positive cases were enrolled in this study. The cases were divided into 2 groups; Group 1-100 subjects with TB and Group 2-93 subjects without TB.80 age and sex matched controls were also included (Group 0). Some parameters of the serum Liver Function Test (LFT) were estimated biochemically by using an auto analyzer (ERBA XL600,Transasia). Results: The serum total bilirubin, Alanine Transaminase (ALT), Aspartate Transaminase (AST) and the Alkaline Phosphatase (ALK-P) levels were significantly higher in the cases as compared to those in the controls, more so in the cases with the associated TB co infection, except the AST levels. The Group 1subjects had lower serum total protein and albumin levels and altered albumin/globulin ratios as compared to the controls. A statistically significant difference was absent in the serum total protein levels between the Group 2 cases and the Group 0 controls. No significant differences were observed when the values for serum total protein, albumin and globulin and the albumin: globulin ratios among the two case groups (1 and 2) were compared. Conclusion:,/b> The results have shown the importance of estimating some LFT parameters, prior to the start of ATD and ART in these cases. Hence, a mandatory performance of LFT is recommended, as it is simple and cost effective.

Variations in the Peak Expiratory Flow Rate with Various Factors in a Population of Healthy Women of the Malwa Region of Punjab, India

Harpreet Kaur, Jagseer Singh, Manisha Makkar, Khushdeep Singh, Ruchika Garg
Objective: The present study was undertaken to study the variations in the Peak Expiratory Flow Rate (PEFR) with various factors like age, height, weight, body surface area (BSA) and the Body Mass Index (BMI) in healthy women of the Malwa region of Punjab, India. Material and Methods: Three hundred healthy women who were aged 20-50 years were selected from the Malwa region of Punjab and their PEFRs were determined. The influences of age, height, weight, BSA and BMI on the PEFR were studied. The PEFR test was performed by using a mini Wright Peak Expiratory flow meter. Results: The mean PEFR of the women of the Malwa region of Punjab was found to be 395.87 ± 56.81 litres/minute. The PEFR increased with an increase in the age, height, weight and the BSA, but it decreased with an increase in the BMI. Conclusion: This study generated the preliminary values of PEFR for the women of the Malwa region of Punjab, India.

The Effect of Counselling on the Academic Performance of College Students

Renuka Devi M.R., P.R. Devaki, Madhanika Madhavan, P. Saikumar
Introduction: The adjustment difficulties of college students have been an emerging issue. Many studies have proved that the adjustment difficulties like appetite disturbance, concentration problems and depression are most evident in freshmen. To help college students in resolving their adjustment issues, we made efforts in the form of establishing a counselling system to provide intervention to the students, so that their social and emotional problems did not interfere with their academic performances, for the current study. We chose to examine the relationship between the college counselling experience and the academic performance in a sample of freshmen. Aim: To explore the relationship and the effect of counselling on the academic performance of college students. Objective: 1. To find the relationship between the academic performance and counselling. 2. To find the relationship between the number of sessions and the academic performance. Material and Methods: Fifty Four First MBBS college students of the SBMCH 2007-2008 batch, who underwent face to face individual intake interviews with college faculty members, were given questionnaires and the analysis was based on their response to the questions and their academic performance. Result: This study showed that there was an increase in the average marks by about 15%-25% among 43% of the students and by about 10% -15% of marks among 13% of the students. There was no marked improvement among 31% of them and there was no change in 4% of the students .The second part of the study showed that the number of sessions correlated positively with the academic performance. Conclusion: This study showed that the counselling services in colleges had been effective in easing out the students’ personal difficulties. The constructive support which was received from individual counselling seemed to have a positive influence on the academic performance and the number of sessions correlated positively with the academic performance.

Role of TSH on Urinary Calcium Excretion in Post Menopausal Women of South Indian Population

Niranjan G, Amrutha P V, Srinivasan A R, Ramesh R, Sathishbabu M, Sathiya R
Background: Unforeseen aberrations in the hormonal status during the early postmenopausal period are responsible for several complications including osteoporosis. Thyroid Stimulating Hormone (TSH) receptors are isolated from various tissues including the bone. A low serum TSH level is known to stimulate osteoclastic activity in bone and accelerate bone resorption. Urinary calcium/creatinine (UCa/Cr) excretion ratio could be an indirect and an early indicator of loss of Bone Mineral Density (BMD). With this background, this study was planned to explore the association of serum TSH levels with the UCa/Cr excretion ratio. Methods: Forty eight women in the postmenopausal age group, with their menopausal age not more than seven years of duration were included in this study. Based on their TSH values, these subjects were divided into two groups A (TSH<0.5 mIU/L) and B (TSH>0.5mIU/L). Urinary calcium, UCa/Cr excretion ratio, serum phosphorous, calcium and calcium phosphorous multiplication products were estimated and compared between the two groups. Results: Twenty two (46%) women were biochemically asymptomatic hyperthyroid cases and Twenty six (54%) were euthyroid. This study documents high UCa/Cr in Group A compared to that of Group B (p<0.05). We also observed significant negative correlation of TSH with UCa/Cr excretion ratio (p=0.041, r = -0.43). Conclusion: Low serum TSH levels were associated with increased UCa/Cr excretion ratio in postmenopausal women of South Indian population.

Profile of The Chikungunya Infection: A Neglected Vector Borne Disease which is Prevalent In The Rajkot District

Chundawat Bhagwati, Madhulika. M, Krunal D Mehta, Goswami Y.S
Background: Chikungunya Virus has been responsible for significant human morbidity probably for several hundred years; yet in spite of its prevalence, the Chikungunya Virus epidemiology and the mechanisms of virulence and pathogenesis are still poorly understood and undetermined. Aims: This study was done to show that the Chikungunya infection has shown a change in its pattern of occurrence with respect to the clinical features, the gender and the age group which are predominant and the season of the outbreak. The present study was conducted to evaluate the features of the Chikugunya infection in patients with acute febrile illness from various geographical regions of Rajkot district, Gujarat, India. Type of Study: A cross-sectional study, multi centric study. Statistical Method: The Chi-square test for the goodness of the fit and independence. Methods: One hundred ninty three serum samples of suspected cases of patients who attended the outdoor and indoor patients departments at a tertiary care hospital, Rajkot and the primary health centres, the community health centre and the urban health centres that were covered in the Rajkot district, which were collected during the period of one year from 1st January 2011 to 25th December 2011, were studied. The sera were processed and tested for the detection of the Chikungunya IgM antibody by using a solid phase, capture micro well ELISA technology. Results: Out of the total 193 cases, 84 were positive for the Chikungunya IgM antibody. Out of the total 84 positive cases, 32 were males (38.09%) and 52 were females (61.9%). Female patients showed more prevalence of this disease. A majority of the patients presented with fever, headache and joint pain: 44(52.38%). The highest prevalence of Chikungunya was found in the 40-50 years age group, which occurred in 34 (40.47%) cases. In the months of November and December, the occurrence of Chikungunya was more. Conclusion: This study emphasizes the need for a continuous surveillance on the disease burden by using multiple diagnostic tests and it also warrants the need for appropriate molecular diagnostic techniques for an early detection of the Chikungunya virus.

Evaluation of Anti-Secretory and Anti- Ulcerogenic Activities of Avipattikar Churna on The Peptic Ulcers in Experimental Rats
Background: Avipattikar churna, a poly-herbal formulation, is one of the popular ayurvedic formulations which is used for peptic ulcer diseases but the scientific documentation with regards to its effect for the indication is lacking. Aims: This study was carried out to evaluate the anti-secretory and the anti-ulcerogenic activities of the churna and to compare its activity with that of ranitidine in a pyloric ligated model of rats. Material and Methods: Four groups of rats with 6 animals in each served as the ulcer controls, churna low dose (500 mg/kg), churna high dose (750mg/kg) and ranitidine (25mg/kg). The control group rats received only vehicle (2% (v/v) gum acacia), while the rats of the other groups received the respective dose of the churna or ranitidine which was suspended in the vehicle. The treatments were given twice a day, orally, for two days. After 1 hour of the last dose, pyloric ligations were performed and the rats were sacrificed for evaluation after four hours of the ligations. The gastric contents were collected and its volume, pH and acidity were measured. The numbers of ulcers and their lengths were measured which were used to calculate the gastric irritancy index and the curative ratio. The histological examinations of the gastric tissues were also performed. Results: The churna, in both doses, significantly decreased the volumes of the gastric contents, the ulcer score, the length of the ulcer, the gastric irritancy index and pH increased as compared to those in the control group. The effects of the churna were comparable to that of ranitidine. The histopathological evaluation of the gastric tissue also supported the results. Conclusion: Avipattikar churna has anti-secretory and anti-ulcerogenic effects which are comparable to those of ranitidine in peptic ulcer diseases.

The Effect of Vitamin C on the Erythrocyte Antioxidant Enzymes in Intoxicated-Lead Rat Offsprings

Samira Eshginia, Abdoljalal Marjani
Objective: Lead exposure or lead poisoning is known to cause a large spectrum of physiological, biochemical, and behavioural disorders in animals. This study was aimed at assessing the effect of vitamin C on the erythrocyte superoxide dismutase, glutathione peroxidase and the glutathione reductase activities in intoxicated- lead rat offsprings. Methods: This study was performed on the pups from female Wistar albino rats. The rats were divided into 4 groups and the treatments were administered through drinking water. Group1 (control group) consumed distilled water. Group 2 (lead group) consumed a solution of lead acetate (300mg/L). Group3 (lead + vitamin C) consumed a solution of lead (300mg/L) which was supplemented with vitamin C (2g/L). Group4 (vitamin group) consumed a solution of vitamin C (2g/L). The enzyme activities were determined in all the 4 groups. Results: The administration of lead showed a decrease in the enzyme activities. The superoxide dismutase activity was increased after the administration of lead in combination with vitamin C. The lead treated rats showed significantly lower body weights at birth and at weaning. The vitamin C treatment showed a significant increase in the body weight. The haemoglobin levels were significantly decreased in the lead-treated rats. The addition of vitamin C to the lead treatment and vitamin C alone could elevate the haemoglobin levels significantly. Conclusion: The results of this study showed that lead alterates the erythrocyte antioxidant enzyme activities. There was an increase in the superoxide dismutase activity following the treatment with vitamin C. This study suggests that the treatment with vitamin C during lactation has a therapeutic effect in the treatment of lead intoxication. The administration of vitamin C prevents haemoglobin reduction in the erythrocytes.

A Study of the Outbreak of Chikungunya Fever

Supriya Satish Patil, Satish R. Patil, P.M. Durgawale, A.G. Patil
Background and Objectives: Chikungunya fever occurred in an epidemic form in the state of Maharashtra after a gap of about 32 years. Many cases with symptoms which were suggestive of Chikungunya fever were reported from the village Kasegaon, Dist Sangli, Maharashtra, India. Hence, this study was done to assess the magnitude of the outbreak and to identify the possible socio-environmental factors which are responsible for Chikungunya fever. Materials and Methods: This cross sectional study was carried out at Kasegaon by a team from the Krishna Institute of Medical Sciences, Karad, Maharashtra, in collaboration with the Primary Health Centre, Kasegaon. Dist Sangli. Results and Conclusion: The Chikungunya prevalence was 9.6%. There were 154 clinically suspected Chikungunya fever cases. Of these, 54.5% were males and 45.5% were females. About 72.7% of the cases were in the age range of 11-50 years, which is the active age group. The main symptoms were an acute onset of fever with joint pain (100%). Multiple joints were involved in (89.6%) cases. The mean duration of the fever was 3 days (range 1-10 days). About 40.3% people preferred to consult a government health facility. In the affected area, 83.1% people were aware of Chikungunya fever. Only few (1.1%) knew the vectors which were responsible for the Chikungunya transmission. Among the people in the affected area, 33.1% had knowledge on insecticide spraying, 23.2% had knowledge on the use of mosquito nets and repellents, 12.5% had knowledge on source reduction and 0.8% had knowledge on larvicides.

Intestinal Cryptosporidiosis and the Profile of the CD4 Counts in a Cohort of HIV Infected Patients

Rashmi K.S., Ravi kumar K.L.
Background: Cryptosporidium is an infectious enteric pathogen which is capable of causing life-threatening illnesses in immunocompromised patients. Aims: This prospective study was planned to know the frequency of intestinal cryptosporidiosis in HIV infected patients and its correlation with their immune status. Also, the conventional diagnostic methods were compared with the copro-antigen detection test by using Enzyme Linked Immuno Sorbent Assay (ELISA). Settings and Design: This was a prospective cohort study. Methods and Material: Three consecutive stool samples which were collected from 90 HIV seropositive patients and 50 seronegative controls were screened for cryptosporidiosis by wet mount, direct modified ZN (Ziehl Neelsen) staining, modified ZN staining with formol ether concentration and copro-antigen detection by ELISA. Their immune statuses were measured by CD4 + cell counting. Statistical Analytical Tests which were Used: Odds ratio, Chi square test, Fisher extract test. Results: Cryptosporidiosis was detected in 15 HIV seropositive cases. 13 cases had CD4 cell counts of < 100 cells/ µL. The formol ether concentration technique resulted in an increased number of oocysts/oil immersion field in 8 cases. ELISA was positive in 2 cases which were shown to be negative by modified ZN staining. All the controls were negative for cryptosporidium. Conclusions: Cryptosporidiosis is an opportunistic infection in HIV infected people who present with diarrhoea. The wet mount technique, though it is simple and inexpensive, is insensitive for the detection of cryptosporidium. The conventional modified ZN staining and the modified ZN staining with concentration have a sensitivity and a specificity of 85.71% and 98.84% respectively. The copro antigen detection by ELISA which has a greater sensitivity and specificity, is a useful tool in epidemiological studies.

A Critical Evaluation and Comparison of Antimicrobial Prophylaxis in Elective Surgeries Across three Hospitals
Objectives: 1. To evaluate and compare the pattern and rationality of prophylactic antimicrobial therapy in elective surgeries. 2. To evaluate and compare the adherence of hospitals to the standard guidelines on prophylactic antimicrobial therapy. Methodology: A total of 150 patients each from a government hospital (group I), medical college teaching hospital (group II), and corporate hospital attached to the institution (group III) who had undergone elective, non-complicated surgery were included. The number & types of antimicrobials used along with duration were noted. Rationality was assessed on the basis of Kunin’s criteria, ASHP guidelines & SIGN guidelines. Statistical analysis was done using appropriate tests. Results: Cephalosporins were the most commonly used antimicrobials in all three groups (52.6%,85.7% & 84.8% respectively) followed by nitroimidazoles. Antimicrobial prophylaxis was appropriate in only 14.1%, 23.3% & 32.9% cases in the three groups respectively (p<0.01).The most common problem was prolonged duration of administration in 50.3%,58% & 45% respectively. The implementation of prophylaxis with respect to regimen & duration was erroneous in 20.1%, 12.7% & 4.7% respectively (p<0.01). Conclusion: The rationality & regimen of antimicrobial prophylaxis was comparatively better in the corporate hospital followed by medical college hospital and the government hospital. The present study calls for an urgent review on rational use of antimicrobials for prophylaxis in all the 3 hospitals.

The Effect of a Primary Postpartum Haemorrhage (PPH) on the “Near-Miss” Morbidity and Mortality at a Tertiary Care Hospital in Rural Bangalore, India: A Four Year Analysis

Umashankar K.M., Dharma Vijaya M.N., Sudha R., Kavitha G., Laxmi
Aim: To assess the risk factors, the mortality and the “near-miss” morbidity in primary PPH. Setting and Design: A retrospective analysis of 124 women with PPH (within 24 hrs of delivery) over 4 consecutive years in a tertiary care hospital in rural bangalore. Materials and Methods: The case sheets of the patients, which were identified by the labour record registers as having PPH were reviewed by the same person, to identify the actual impact of the condition. The data was analyzed by Chi-square analysis. Result: PPH (the loss of blood that caused significant alterations in the maternal condition or a blood loss of 500 cc in vaginal deliveries or of >1000 cc in caesarean sections) was recorded in 124 women; 60 had delivered in hospitals (Group-A) and 64 had been referred after their deliveries (Group-B) from various peripheral centres, i.e., maternity hospitals, nursing homes and district and community health centres. The maternal mortality ratio during this period was 71/100,000 (4 deaths/5600 live births). Of these 4 deaths, 0 were in group A and 4 were in group B. The “near-miss” morbidity was higher than the mortality (total 20/124; 6/60 in Group-A and 14/64 in Group-B). The delayed referrals and the lack of an active 3rd stage management in Group-B were responsible for most of the adverse events. Conclusion: Both the “near-miss” morbidity and the mortality in PPH reflect the level of obstetric care in the developing world. These need to be reduced by strengthening the peripheral delivery facilities, the active 3rd stage management and the timely referrals.

Role of Fine Needle Aspiration Cytology in Head and Neck Lesions of Paediatric Age Group

Purnima Mittra,Rajni Bharti,Manmohan Krishna Pandey
Context: Fine Needle Aspiration Cytology [FNAC] of the head and neck region is well accepted as a diagnostic procedure. Various studies in the context of FNAC in the head and neck region are available for the adult population, but only few studies are available for the paediatric age group. Aims: To study the role of fine needle aspiration cytology and its utility in paediatric head and neck lesions. Settings and Design: This was a hospital based, prospective study. Methods and Materials: Hundred cases of head and neck lesions of the paediatric age group [0-15 years] were studied for cytomorphology through fine needle aspiration cytology and the results were correlated with the histomorphology. Results: There was a male predominance in the case distribution among both the sexes in children [55%]. The head and neck lesions were most frequent in the age group of 10-15 years, followed by the age group of 5-10 years than the age group of 0-5 years. Lesions in the cervical lymph nodes constituted 81% of the head and neck lesions and 87% of the adequate smears, followed by those in the skin and subcutaneous tissues [3 cases (3.2%)], the thyroid [4 cases (4.3%)] and the salivary gland [1 case (1%)]. 88.17% cases of head and neck lesions in children were diagnosed as benign on their smears and 11.83% cases were diagnosed as malignant, of which 8 cases of malignant lesions were located in the cervical lymph nodes, 1 case was located in the thyroid and 2 cases of malignant lesions were located in the orbits. Conclusions: FNAC is an important and a non-invasive, investigational tool in children for identifying and planning the medical management of inflammatory and infectious conditions. It helped us in indicating the diagnosis of the lesions in congenital or aquired malformations, cystic lesions and benign neoplastic lesions, in which surgical management were needed and we got confirmations on histological examinations. For the malignant lesions, FNAC was a more important investigation tool than an accurate investigation tool, which suggested about the lesions and guided us to do more advanced specific investigations for obtaining the diagnosis.

Simultaneous Determination of Levodopa and Carbidopa from Fava Bean, Green Peas and Green Beans by High Performance Liquid Gas Chromatography

Mohseni Mehran S.M., Golshani B.
Introduction: According to many studies, sprouted fava beans are a rich source of levo-dihydroxy phenylalanine (L-dopa) the precursor of dopamine, and they are now being investigated for use in the management of Parkinson’s disease. The addition of Carbidopa (C-dopa) can reduce the daily use of the L-dopa dosage requirements and it can also reduce the side effects which are associated with the L-dopa administration. Method: The present research was conducted to find the levo-dihydroxy phenylalanine (L-dopa) and Carbidopa (C-dopa) in fava beans, green peas and green beans by High Performance Gas Chromatography (HPLC). Carbidopa (C-dopa) is a peripheral decarboxylase inhibitor. As a substitution therapy, it used in combination to treat Parkinson’s disease. Result: We obtained L-dopa and C-dopa from fava beans which were in the fresh and dry sprouted form, whose concentrations were 1.4,1.5 and 2.6,2.4 mg/ml respectively. The maximal stimulation of the L-DOPA content was seen on day 8 for the fava beans, which was 100% higher than that of the control level. Conclusion: The results of this study indicate that faba beans are a good source of natural L-dopa and C-dopa. The quantification of this capacity according to the stage and the plant part could be suitable for applications in the food industry and in plant medicine. The consumption of fava beans can increase the levels of L-dopa and C-dopa in the blood, with a marked improvement in the motor performance of the patients with Parkinson disease, without any side effects.

Evaluation of the Virulence Markers in the Clinical Isolates of Citrobacter Species: The First Report from India

Ritu Nayar, Indu Shukla, S Manazir Ali
Background: Citrobacter, a gram negative bacillus, is emerging as one of the major pathogens in hospital settings, with a potential to cause serious infections. Virulence markers are the factors which enhance the survival ability of the micro-organisms. Among the gram negative bacilli, these have been extensively studied in Escherichia coli. To the best of our knowledge as per internet search, we report that this study has been done for the first time in India on Citrobacter. Aims: An investigation was done to determine the ability of Citrobacter in producing virulence markers like the ability to survive the serum bactericidal activity, the resistance to the intracellular killing in the Polymorphonuclear Leucocytes (PMNLs) and the Cell Surface Hydrophobicity (CSH). Settings and Design: This prospective study was conducted in the Department of Microbiology of a tertiary care hospital in Aligarh, India, for a period of one year and six months. Material and Methods: A total of 105 clinical isolates and 20 control isolates from healthy subjects were identified as having Citrobacter spp. by using standard biochemical tests and they were studied for the presence of virulence markers like the ability to survive the serum bactericidal activity, the resistance to the intracellular killing in the Polymorphonuclear Leucocytes (PMNLs) and the cell surface hydrophobicity. The statistical analysis which was used: The standard deviations and the p-values were calculated for comparison. Results: Out of the 105 clinical isolates of Citrobacter which were studied, 86.6% isolates were resistant to 100% serum after 180 minutes of incubation and intracellular killing in PMNL was demonstrated in 17% strains. The Salt Aggregation Test (SAT) for the cell surface hydrophobicity was positive in 17.1% strains at different concentrations of ammonium sulphate. The presence of more than one virulence marker was present in 71.4% of the clinical isolates while in the control isolates. Conclusions: The presence of the virulence markers in Citrobacter demonstrated its pathogenic potential. Its invasiveness and ability to disseminate can be studied by identifying these markers.

PCR as a Diagnostic Tool for Extra-Pulmonary Tuberculosis

Ganavalli S. Ajantha, Praveen C. Shetty, Raghavendra D. Kulkarni, Umesh Biradar
Introduction: Extra-Pulmonary Tuberculosis (EPTB) accounts for approximately 40% of the tuberculosis cases. Though it is not communicable, it is a significant cause of morbidity. This study was conducted to know the efficacy of the Polymerase Chain Reaction (PCR) as an additional tool, along with the conventional methods, in the diagnosis of EPTB. Materials and Methods: Clinical samples were collected from suspected cases of EPTB. The Ziehl-Neelsen staining (ZNS), culture on the Lowenstein-Jensen medium (LJM) and PCR testing with the use of a commercial kit were performed on the homogenized samples. Results: A total of 182 samples which were received for the molecular diagnosis of EPTB were also tested by ZNS and culture on LJM for the presence of Mycobacterium tuberculosis. Of these, 22 were positive by at least one of the tests which were used. PCR detected the maximum number of cases of EPTB, followed by culture. The results of PCR and the conventional tests were analyzed by using McNemar’s test for the correlated proportions-the exact method of ‘IBM SPSS Statistics 20’. The analysis showed a statistical significance. Conclusions: Whenever they are feasible, using all the available tests in combination increases the laboratory detection rates of M. tuberculosis from clinical samples. PCR must be included in the diagnostic panel of EPTB.

The Efficacy of Nardostachys Jatamansi Against The Radiation Induced Haematological Damage in Rats
Introduction: Radiation is increasingly being used for medical purposes and it is an established weapon in the diagnosis and the therapy of cancer. An exposure to 1-2 Gys causes the NVD (Nausea, vomiting, diarrhoea) syndrome, whereas an exposure to 2-6 Gys causes the haematopoietic syndrome. The aim of the present study was to investigate the protective effect of the Nardostachys jatamansi root extract (NJE) on the radiation induced haematological damage in rats. Materials and Methods: EBR was performed at the Microtron Centre, Mangalore University, India. Rats were treated with NJE once daily for 15 days before and after the irradiation. After the irradiation, blood was collected for determining the peripheral blood counts (RBC and WBC), haemoglobin, the platelet count and the packed cell volume (PCV) at 6 hours, 12 hours, 24 hours, 48 hours and 5, 10 and 15 days post irradiation. The data was analyzed by one way ANOVA, followed by the Tukey’s test for multiple comparisons. Result: NJE provided protection against the radiation induced haematological disorders. The rats treated with NJE exhibited a time dependent significant elevation in all the haematological parameters which were studied and its modulation upto the near normal level was recorded. Conclusion: From this study, we concluded that, NJE provides protection by modulating the radiation induced damage on the haematopoietic system.

Primary Nailing in the Open Fractures of the Tibia-Is it worth?

Atul Agrawal, Vijendra Devisingh Chauhan, Rajesh K. Maheshwari, Anil Kumar Juyal
Context (Background): The tibial shaft is one of the most common sites of open fractures. The specific methods of skeletal stabilization and soft tissue treatment of open fractures continue to be topics of debate in the orthopaedic traumatology. Aims: To evaluate the results of the intramedullary nailing in the open fractures of the tibia, especially in the Indian scenario. Settings and Design: An observational, descriptive study which was done at a tertiary care hospital from 2006 to 2010. Material and Methods: A prospective study was done on thirty cases which had sustained open fractures of the Gustilo and Anderson grades I, II and III, who were operated for primary intramedullary interlocking nail fixation after thorough debridement and closure of their wounds with suturing, lateral skin release, split thickness skin grafting and muscle pedicle flap, where ever necessary. All the patients were followed up for a minimum of two years. Statistical Analysis: Descriptive statistics and Fisher’s Exact test were used. Results: Of the total thirty cases, ten were of grade I, seven were of grade II, three were of grade IIIA, seven were of grade IIIB and three were of grade IIIC. Dynamization was done in nine cases. The average time to union was 16.0 weeks in the grade I cases, it was 18.3 weeks in the grade II cases, it was 23.6 weeks in the grade III A cases, it was 28.4 weeks in the grade III B cases and it was 32 weeks in the grade III C cases. The mean time to union was 20.7 weeks. Infection occurred in 3 cases. Delayed unions were observed in 4 cases. A non union occurred in 1 case of type IIIC. A mal union was observed in 1 case of type IIIB. 1 case of grade IIIC had the compartmental syndrome. No case had any implant failure (nail / screw breakage), or deep vein thrombosis. Conclusion: We conclude that the unreamed intramedullary nailing in cases of open fractures of the tibia, with an early soft tissue coverage, results in a faster soft tissue and bony healing, an easier soft tissue coverage, a better biomechanical stability and early rehabilitation and infection rates as comparable to those which are seen with other methods.

The Learning Styles and the Preferred Teaching–Learning Strategies of First Year Medical Students

Poonam Kharb, Prajna Paramita Samanta, Manisha Jindal, Vishram Singh
Introduction: The purpose of teaching is to facilitate learning and to encourage the learners to learn more effectively. The learning style is an individual’s consistent way of perceiving, processing and retaining new information. Educational researchers have shown an increasing interest in the learning styles, the related instructional methods and the andrgogical teaching techniques. This interest is spurred by a desire to help the students to become capable and successful learners. Aim: The aim of this study was to determine the preferred learning styles of medical students as well as their preferences of specific teaching-learning methods. Method: A cross sectional study was conducted on 100 first semester medical students who were enrolled at SMS & R, Sharda University, India. The VARK questionnaire, version 7.1 was used to categorize the learning preferences/modes as visual (V), auditory (A), read and write (R) and kinaesthetic (K). The students were also asked to rank the various teaching methodologies viz. lectures, tutorials, demonstrations and practicals/dissections from the most preferred choice to the least preferred one. Results: The majority (61%) of the students had multimodal VARK preferences. Among them, 41%, 14% and 6% preferred the bimodal, trimodal and the quadrimodal ways of information presentation. 39% of the respondents had one strong (unimodal) learning preference. The most common unimodal preference was kinaesthetic, followed by visual, auditory and read and write. The most preferred teaching methodology was practical/dissection (39%) and tutorial was the least preferred one (12%). Conclusion: One single approach to teaching does not work for every student or even for most of the students. The educators’ awareness of the various learning styles of the students and their efforts towards matching the teaching and learning styles may help in creating an effective learning environment for all the students.

The Role of the Endogenous Antioxidant Enzymes and Malondialdehyde in Essential Hypertension

Aquil Ahmad, Usha Singhal, Mohd Mobark Hossain, Najmul islam, Imran Rizvi
Context: Oxidative Stress is caused by an imbalance between the production of reactive oxygen species and a biological system’s ability to readily detoxify the reactive intermediates. Aims: 1. To compare the levels of Malondialdehyde (MDA), in hypertensive and normotensive subjects. 2. To compare the levels of the antioxidant enzymes, namely, Catalase, Glutathione peroxidase (GPX) and Superoxide Dismutase (SOD) in hypertensive and normotensive subjects. 3. To determine the correlation between the MDA levels and the mean arterial pressure (MAP) among hypertensive subjects. 4. To determine the correlation between the antioxidant enzyme levels and MAP among the hypertensive subjects and to evaluate the effect of 6 months of antihypertensive therapy with a tight blood pressure control on the MDA levels. Materials and Methods: In this cross sectional study, 25 normotensive and 40 hypertensive subjects were recruited. The hypertensive subjects were further subdivided into three sub-groups: Prehypertensives, Stage I hypertensives and Stage II hypertensives. All the subjects underwent a blood pressure measurement and the markers of oxidative stress in their sera were estimated. The subjects of Stage I hypertension and Stage II hypertension were given antihypertensive treatment for 6 months and their blood pressures were tightly regulated and brought to the normotensive state. After 6 months, the estimations of the markers of oxidative stress were done again. Results: The MDA levels were significantly increased in the stage I and stage II hypertension groups as compared to those of the control group (p<0.05). The antioxidant enzymes (SOD, Catalase and GPX) were significantly decreased (p<0.05) in the prehypertension and in the stage I and stage II hypertension groups as compared to those in the control group. There was a significant increase in the levels of the antioxidant enzymes after 6 months of a tight regulation and bringing of the blood pressure to the normotensive state by giving antihypertensive therapy. Conclusion: On comparison of the present study with other studies in which the use of antioxidants were found to be ineffective in the blood pressure reduction, it can be concluded that oxidative stress is an effect rather than a cause of essential hypertension.

Computer and Internet Utilization among the Medical Students in Qassim University, Saudi Arabia

Yousef HOmood Aldebasi, Mohamed Issa Ahmed
Background: Computer-based training (CBT) and internet-based training (IBT) have become a vital part of the Medical Education. A cross-sectional study was carried out in Qassim University-Kingdom of Saudi Arabia (KSA), with the objective of assessing the pattern of the computer and Internet utilization among both male and female medical students. Methods: A total of 500 medical students from 4 different medical colleges of Qassim University participated in this study. A semi-structured, pre-tested questionnaire was used to collect the data and the data analysis was done by using SPSS, Version 17. Results: Forty two percent female and twenty four percent male students used computers to get general information, 80% of the students reported using computers for academic activities and 52% females and 22% males used computers for entertainment. Most of the females preferred using computers at home (84%), while 54% males used computers at cyber cafés. For the information retrieval, 84% males used the internet, followed by journals/library (36%) and textbooks (35%), while the females preferred textbooks (75%) and the internet (14%). Google was found to be most commonly used search engine. Conclusion: The internet creates an educational delivery system; it is highly needed to increase the credit hours for the university requirement courses in computer application and the internet use for both among the male and female students.

The Cytological Grading of Malignant Neoplasms of The Breast and Its Correlation With The Histological Grading

Vidya Vasudev, Rangaswamy R., Geethamani V.
Background and Objectives: Breast carcinoma is one of the leading causes of malignancy in females. The diagnosis of breast carcinoma is often made by fine needle aspiration cytology. Nuclear grading is an important prognostic factor. It is important to grade breast carcinomas, which will provide valuable information to the treating oncologists to plan their management. The purpose of this study was to compare the cytological grading and typing with the histological grading and typing and the regional lymph node metastasis. Methodology: This retrospective and prospective study was done on 60 cases with malignant and suspicious diagnoses on FNAC, which had histopathological correlations, from January 2004 to December 2007. The cytological grading was done by Robinson’s Method and the histopathological grading was done by the modified Scarff Bloom Richardson method. Cytological and histological typings were also done. The statistical analysis was done by using the SPSS software: The Chi square test was used and a contingency tale analysis (cross tabs procedure) was also done. Results: The cytohistological grading correlation was accurate in 7 cases (100%) of grade 1, 22 cases (71%) of grade 3 and 9 cases (42.9%) of grade 2 cancers. The accuracy was 62.7% (p< 0.001). A higher cytological grade was associated with a nodal metastasis. (cc : 0.399, p < .006) The cytological typing was accurate in 44 cases out of the 60 cases. Interpretation and Conclusion: The cytological grade correlated well with the histological grading accuracy (62.7%) and a higher grade was associated with a nodal metastasis (p < 0.006), Hence the cytological grading and typing should be routinely incorporated in the cytology reports and they can be of great value in guiding the choice of the treatment protocols.

Peripheral Blood T-Cell Populations in COPD, Asymptomatic Smokers and Healthy Non-Smokers in Indian subpopulation- A Pilot Study

Rashmi Teresa Mathai K., Smitha Bhat
Background: COPD is a major global health problem affecting 4-10% of Indian adult male population. Immunological processes have been implicated in the pathogenesis of COPD. As compared to healthy smokers, COPD patients have airway inflammation indicated by the presence of CD8+ T cells in the lung. This predominant increase in CD8+ T cells in the lung may be reflected in the peripheral blood. In an attempt to understand why only some smokers develop COPD, we compared the peripheral T-cell markers in COPD patients with that of asymptomatic smokers, and healthy nonsmokers. Methods: Twenty healthy non-smokers (HNS), 19 asymptomatic smokers (AS) and 21 COPD male patients (age and pack year-matched) were identified after clinical evaluation and spirometry. Blood CD3+, CD4+, CD8+ T-cell populations were measured. Results: Smokers with COPD had severe airflow limitation (FVC, 69.8+16.7%; FEV1, 47.47+16.9%; FEV1/FVC, 53.1+13.3%). The BMI was found to be significantly lower among patients with COPD (19.1+4.8kg/m2) as compared to AS (23+4.3kg/m2) and HNS (23.7+4.0kg/m2) (p value = 0.003 HS). The mean CD3+T-cell absolute count in COPD patients (1154.3+582.2), showed a marked decline as compared to that of AS (1251.9+491.6) and HNS (1424.9+352.2). The mean CD4+T-cell counts in COPD patients (652.7+340.5) were also lower when compared to AS (745.7+313.8) and HNS (832.5+220.7). The mean CD8+T-cell counts among COPD patients (424.7+264.3) were, similar to the counts observed among AS (426.9+193.2) and HNS (500.4+191). Though not statistically significant, the absolute counts of CD3+, CD4+ and CD8+ lymphocytes among COPD patients tended to be lower. No significant difference in the CD4+/CD8+ lymphocyte ratio between the patient groups was observed. Conclusion: Our study indicates that BMI is related to the severity of COPD, hence proving a systemic component to its pathogenesis. However, we found similar percentages of CD8+Tcells in all the study groups suggesting that predominant CD8+ T cells in the airways may be due to its de novo origin rather than recruitment from blood. However, larger studies are needed to clarify the effect of disease severity, beedi smoking and ethnicity.

A Study on the Nutrient Foramina of Adult Humerii

Shanta Chandrasekaran, K.C. Shanthi
Background: It is not uncommon to see the non union of the fractures in the long bones. Among the various reasons for the nonunion of the fractured bones, the nutrient artery plays an important role. Objectives: This study was aimed at analyzing the nutrient foramina in dry adult humerii ,with regards to the number, size and the location of the nutrient foramen with respect to the surfaces and the zones and its distance from the mid point of the humerus. Materials: This was an analytical study. All the humerii from various medical colleges of the Vinayaka Missions University in Salem were included in the study. Those which were damaged and those which had pathological abnormalities were excluded. The following parameters were noted; namely, the length of the humerus, the number and the size of the nutrient foramen and the location of the nutrient foramen with respect to the surfaces and the zones of the humerus and its distance from the mid-point of the humerus were analyzed. The length of the humerus and the mid point of the humerus were measured by using the osteometric board, whereas the size of the nutrient foramen was measured by using various size of hypodermic needles. When more than one foramen was found, the larger one was taken as the dominant foramen and its size was measured. All the data were noted and the statistical analysis was done by calculating the mean, the range and the standard deviation. Results: Totally, 258 adult dry humerii were studied. The mean length of the humerii was 27.96 cm, with a SD of 2.18. The mean size of the nutrient foramen was 0.828 mm, with a SD of 0.26. The mean distance of th dominant nutrient foramen from the mid point of the humerus was 2.31 cm, with a SD of 1.25 cm. In majority of the humerii (86.43%), the nutrient foramen was located in the middle 1/3rd of the bone and in 13.57% of the bones, it was located in the lower 1/3rd of the bone. The location of the nutrient foramen in the anteromedial surface was 89.92%, that in the posterior surface was 8.53% and that in the anterolateral surface was 1.55%.

The Microbial Colonization Profile of Respiratory Devices and the Significance of the Role of Disinfection: A Blinded Study

Savita Jadhav, Tushar Sahasrabudhe, Vipul Kalley, Nageswari Gandham
Introduction: Approximately 10-40% of all the nosocomial infections are pulmonary, which lead to grave complications. Elderly, debilitated, or critically ill patients are at a high risk. The respiratory care equipments which include ventilators, humidifiers, nebulizers may have been identified as the potential vehicles which cause major nosocomial infections if they are colonized by fungi or bacteria. Aim: To determine the rate of colonization by bacteria and fungi of the oxygen humidifier chambers of the portable cylinders and central lines at our hospital. The Hudson’s chambers of nebulizers were also studied for the same. Methods: Swab samples were obtained from the equipments by using sterile cotton swabs on a tuesday, as these chambers were usually cleaned on every Saturday. Spot samples were taken from the ICUs, wards, the casualty and OPDs on a single day. Air samples were also obtained on the same day to determine whether the fungal spore load in the inhaled room air was normal or high. We performed a disinfection with 70% ethanol after cleaning these devices. Results: 53/70 (75.71%) samples showed fungal growth; out of which, 23/33 (69.70%) were from the ICU, 24/30(80%) were from the wards and 6/7 (85.71%) were from the OPDs. 23/30 (76.66%) swabs from the central line humidifiers, 18/23(78.26%) swabs from the O2 cylinder humidifiers and 8/17 (47.5%) swabs from the nebulizers grew bacteria. Of the total 61(87.14%) bacterial isolates, 42(68.85%) were gram negative bacteria and 19(31.14%) were gram positive cocci. Out of the 42 gram negative bacteria, 17 were multi-drug resistant like ESBL producers ie. Pseudomonas spp. (6) Acinetobacter spp.(4), Klebseilla pneumoniae (4), E.coli (2) and Stenotrophomonas maltophila (1). Our findings (before disinfection) showed that the colonization rate for fungi was 75% and that for bacteria, it was 87%. After the 70% ethanol disinfection and strict compliance with the hand hygiene, the colonization rates reduced significantly. The fungal colonization rate was reduced and only 15% fungi grew after the disinfection, while only 12% bacterial colonization rate was found. Conclusion: This study indicates a potential in-hospital source of allergens and infections. The oxygen and nebulizer chambers need to be cleaned more frequently with disinfectants, to control the possible nosocomial infections.

Reproducibility of ‘The Bethesda System for reporting Thyroid Cytopathology’:A MultiCenter Study with Review of the Literature
Background: To achieve the standardization of the thyroid FNA reporting, the National Cancer Institute (NCI) hosted the “NCI Thyroid Fine Needle Aspiration State of the Science Conference”, which led to the formation of ‘The Bethesda System for Reporting Thyroid Cytopathology’ (TBSRTC). Materials and Methods: The present study was undertaken by 2 experts in thyroid FNA, who in a double blinded fashion, examined and re-classified 80 random FNA cases according to the 6 levels of TBSRTC for an inter-observer review, to study and assess the new terminology for ease of reproducibility and to note the rate of disagreement overall or in any particular category. The FNAs were reclassified in a double blinded fashion according to the 6 levels of TBSRTC which are: non diagnostic (ND); benign; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS); follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), Hurthle cell type/suspicious for a follicular neoplasm, Hurthle cell type (FNHCT/SFNHCT); suspicious (SUS), and malignant. Results: In the present study, the maximum number of cases was reclassified under the benign category (61.25% cases), followed by the FN/ SFN category and the AUS/FLUS category (11.25% and 10.00% respectively). An agreement was reached in 66 cases (82.5%); the experts disagreed in 14 cases-17.5% (where 1 expert did not agree with the other). Individually; a 93.87% agreement was noted for the lesions in the benign category, for 50% lesions in the AUS/FLUS category, for 66.66% lesions in the FN/SFN and the SUS categories, for 71.42% lesions in the FNHCT/ SFNHCT categories and for 100% lesions in the ND and the malignant categories. Thus, the maximum disagreement was noted in the AUS/FLUS category. Conclusion: The implementation of TBSTRC which stands for a unique, international and a universal terminology for reporting the thyroid cytology; should be encouraged in our country, because of its relative ease of reproducibility. Although there was a great deal of agreement in implementing TBSTRC in the present study; disagreements were seen in the categories of AUS/FLUS and FN/SFN in the study which was conducted at our centre. This corroborated with the findings of the studies which were done elsewhere.

Lecture Classes in Human Anatomy: The Students’ Perceptions
Introduction: The human anatomy, or in brief, the body structure has fascinated man for ages. Due to the information explosion and the increase in specializations, this knowledge is available in a very sketchy manner in high school biology courses. The first comprehensive course on the human anatomy is taught to the first year medical students in medical colleges. This is in keeping with the regulations of the Medical Council of India. The anatomy lecture classes occupy a considerable time of the course, to provide the students with an effective knowledge of the gross anatomy, histology, embryology and the clinical anatomy. On the other hand, the students’ feedback regarding the lecture methods and the teaching environment is crucial in judging the efficacy of the present curriculum. Objective: To obtain the students’ feedback about the environment of the lecture classes, as regards the venue, the teaching and learning aids which are used, the lecture class schedule of the university (the number of classes per week, the durations of the lecture classes, etc.) and the existing departmental practices (display of the class routine in advance, synchronization between the lecture and the practical classes), so that their suggestions could help the faculty in planning the most effective teaching procedures. Methods: A semi structured questionnaire was supplied to the students to get their feedback. Result: Most of the students found the air conditioned seminar room’s environment to be more comfortable and they supported the existing durations of the lecture hours with the combined use of chalk and a board and overhead projectors (OHPs). Conclusion: The perceptions of the learners helped in modifying the departmental practice in the desired way.

Lipid Peroxidation and the Total Antioxidant Status in the Pathogenesis of Age Related and Diabetic Cataracts: A Study on the Lens and Blood

Ashok V. Katta, R.V. Katkam, H. Geetha
Background: Cataract is one of the major causes of a visual impairment, which eventually leads to blindness. An oxidative damage to the lens proteins is a major factor which leads to cataract formation. Therefore, we intended to study the relationship between the biochemical markers of oxidative stress and various forms of cataracts. Methods: We examined the lenses and the sera of 120 subjects who were aged 50 to 80 years, who were distributed in two groups, viz. the study group (90 patients) and the control group (30 subjects). The oxidative stress was assessed by estimating the lipid peroxidation product in the form of thiobarbituric acid reactive substances (TBARS), the antioxidant status by measuring the levels of vitamin E and the total antioxidant capacity (TAC). The study group patients were further divided into those with nuclear cataracts (30 patients), cortical cataracts (30 patients), and diabetic cataracts (30 patients). Results: In this study, it was found that the levels of TBARS in the study group were significantly high (p<0.001), whereas the TAC (p<0.001) and the vitamin E (p<0.001) levels were significantly low, both in the lenses and the blood of the study group as compared to those of the control group. Conclusion: Thus, the present study suggests that an imbalance between the oxygen free radicals and the antioxidants may lead to lipid peroxidation in the lens. Also, the elevated levels of glucose in the diabetic cataracts lead to the auto-oxidation of glucose and a non-enzymatic glycation of the lens protein. Thereby, the high molecular weight proteins aggregate in the cataract.

The Effect of a Primary Postpartum Haemorrhage (PPH) on the “Near-Miss” Morbidity and Mortality at a Tertiary Care Hospital in Rural Bangalore, India: A Four Year Analysis
Meningioma is a common benign intracranial neoplasm. The incidence of an extracranial extension to other sites is rare. Due to the neglected intracranial component, the chances of an under diagnosis or a misdiagnosis of the extracranial component is there, which may adversely affect the management and therefore, the prognosis. Here, we are reporting a case of a 39 years old male patient with a preoperative probable diagnosis of a malignant bone tumour which involved the skull bone, which was made, based on the imaging studies , which was histopathologically found to be an invasive meningioma with an extensive extracranial skull vault involvement and was confirmed by immunohistochemistry. We have proposed a term, “carpet meningioma” for this extracranial invasive meningioma, because it had covered the skull vault like a carpet. The follow up studies after 1 year have revealed no evidence of a recurrence.

An Interesting Case of Hypertriglyceridaemic Pancreatitis

Anupama Pujar K., Anil kumar V. R., Sridhar M., Kulkarni S. V.
Hypertriglyceridaemia is a well-known but uncommon cause of acute pancreatitis. A serum triglyceride level of more than 1000mg/ dl is needed to precipitate the pancreatitis. A 35 year male patient, who was a known diabetic who was on oral hypoglycaemics, presented to us with pain in the abdomen and vomiting of one day’s duration. His serum amylase was normal. The serum was highly lactescent. The triglycerides were 1901mg/dl. CECT of the abdomen showed features which were suggestive of pancreatitis. The patient was managed just as the pancreatitis of any other eitiology. He was started on fibrates, atorvastatin, and antioxidants to prevent a relapse. His diabetes was controlled by insulin. He recovered well.

Internal Jugular Phlebectasia: Diagnosis by Ultrasonography, Doppler and Contrast CT

Manash Kumar Bora
Jugular phlebectasia is an isolated saccular or fusiform dilation of a vein without tortuosity. Its aetiology remains controversial. It is infradiagnosed, as it is generally asymptomatic. However, it has been increasingly recognized in recent years due to the better imaging techniques which are available. Phlebectasia of the Internal Jugular Vein (IJV) is a rare disease. It is mostly unilateral and it involves only the right side. It is usually a childhood disease which is diagnosed during the study of an intermittent neck mass. Its treatment is controversial. Presently, a conservative approach to unilateral or bilateral asymptomatic phlebectasia is recommended. Symptomatic phlebectasia requires surgery. The diagnosis is suggested by clinical features which can be confirmed by noninvasive radiology. This paper is reporting a case of unilateral right internal jugular phlebectasia in a 12 year old female patient who complained of an intermittent, right sided neck swelling, where we used UltraSonoGraphy(USG) with Doppler and Contrast enhanced CT(CECT) to evaluate the lesion.

Myoepithelioma of the Parotid Gland Presenting as a Retroauricular Cutaneous Nodule: A Case Report

Yumi Mochizuki, Ken Omura, Kae Tanaka, Kei Sakamoto, Akira Yamaguchi
We are reporting a case of recurrent myoepithelioma of the parotid gland, that emerged as a cutaneous mass. She had a retroauricular subcutaneous mass with an underlying diagnosis of a cutaneous myoepithelioma, which was excised at a hospital’s Dermatology Department 2 years earlier. The tumour was observed above the platysma and it was considered as a cutaneous myoepithelioma without the parotid gland structures. She had undergone a partial parotidectomy approximately 20 years earlier. At her first visit to our department, there was no evidence of facial nerve palsy or cervical lymphadenopathy. The radiological findings showed a multinodular growing mass of the parotid gland, just beneath the retroauricular skin and a total parotidectomy was performed. It was considered that even if the cutaneous mass emerged, the relationship between the cutaneous mass and the parotid gland should be pre-surgically examined by computed tomography (CT) or Magnetic resonance image (MRI). A long-term continuous follow-up was also needed.

Myoepithelial Carcinoma of the Breast
Breast carcinoma is the commonest cancer among females in a majority of the Indian cities. The advances in the research and management have improved the breast cancer survival significantly in the past three decades globally. Adenocarcinoma is the commonest histological variant which arises from the ductal epithelia. The myoepithelial cells (ME) are the normal components of the breast parenchyma, which separate the ductal epithelia from the basement membrane and the stroma. The pure ME cell carcinoma is extremely rare and only 38 cases have been reported so far in the indexed literature. This may owe to the difficulties in the identification, and the non availability of established diagnostic criteria. We herein describe the clinical, radiological and the pathological characteristics of a case of myoepithelial carcinoma, to supplement the available literature. The possible impact of these cells in clinical practice was also reviewed. Identification and the further research on the genesis of these tumours, and the pathways by which the ME cells regulate the milieu interior of the breast epithelia, may unravel new molecular targets to prevent or treat both epithelial and myoepithelial cancers at early stages.

Giant Sporadic Low Grade Malignant Peripheral Nerve Sheath (MPNST) of Left Thigh

Dhiraj B. Nikumbh, K.H. Suryawanshi, N.V. Dravid, T.B. Patil, C.M. Rokade
Malignant Peripheral Nerve Sheath Tumours (MPNST) are rare spindle- cell sarcomas which are derived from the schwann cells or the pleuripotent cells of the neural crest. MPNSTs are usually located in the peripheral nerve trunk roots, extremities and in the head and neck region. These tumours may arise as sporadic variants or in patients with neurofibromatosis1 (NF1). The estimated incidence of MPNSTs in the patients with NF1is 2-5% as compared to a 0.001% incidence in the general population. Herein, we are reporting a case of a giant sporadic (NF1 independent) low grade MPNST of the left thigh in 65 year female patient, which had a good prognosis.

Rhino-Orbital Mucormycosis in Diabetes Mellitus

Ravindra V. Shinde, Geeta S.Karande, S.T. Mohite, S.R. Patil
Rhino-orbital mucormycosis is a rare but life threatening infection that generally occurs in patients with diabetes mellitus and other immune deficiency conditions. Rhino-orbital and Rhino-cerebral are two form of the disease. As such the condition is a medical emergency. Early recognition and treatment are essential because it may lead to death in few days. Fungal infection of nasal cavity is uncommon but is being seen with increasing frequency in patients with immune deficiency.

Bowel Block in Pancreatitis
Acute pancreatitis is a multisystem disorder which can result in a variety of complications. Vascular complications can occur commonly in acute pancreatitis. Splenic artery rupture, aneurysms; gastro duodenal artery aneurysms; splenic venous thrombosis; portal venous thrombosis and rarely, superior mesenteric venous thrombosis, are the vascular complications of pancreatitis. Ischaemic stricture of the small bowel can occur secondary to pancreatitis, but it is extremely rare. Hence, we are reporting this case of a proximal jejunal stricture which occurred secondary to the pancreatitis which was caused by a superior mesenteric thrombosis.

A Rare Case of Cervical Tuberculosis which Simulated Carcinoma of the Cervix
Cervical tuberculosis is a rare form of genital tuberculosis. The manifestations of genitourinary tuberculosis are protean in nature. A high index of suspicion is required for making prompt diagnosis. The definitive diagnosis is based on the demonstration of the characteristic lesion on histopathology or on bacterial isolation. We are reporting a rare case of isolated cervical tuberculosis which mimicked carcinoma of the cervix. A 24 years old para 1, live 1, woman presented with secondary amenorrhoea and post coital bleeding which were there for one year. The speculum examination revealed a friable cervix which bled on touch. Though the clinical history and the examination findings were suggestive of a cervical malignancy, the histopathological examination revealed a granulomatous inflammation which was suggestive of tuberculosis. The patient responded well to the antituberculous therapy.

Dilated Cardiomyopathy: An Anaesthetic Challenge

Haramritpal Kaur, Ranjana Khetarpal, Shobha Aggarwal
Idiopathic dilated cardiomyopathy is a primary myocardial disease of unknown etiology characterized by left ventricular or biventricular dilation and impaired contractility. Depending upon diagnostic criteria used, the reported annual incidence varies between 5 and 8 cases per 100,000 populations. Dilated cardiomyopathy is defined by presence of: a) fractional myocardial shortening less than 25% (>2SD) and/or ejection fraction less than 45% (>2SD) and b) Left Ventricular End Diastolic Diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Such cases are always a challenge to the anesthesiologist as they are most commonly complicated by progressive cardiac failure. We report the anesthetic management of a patient with dilated cardiomyopathy undergoing surgery for carcinoma breast.

A Huge Primary Ovarian Leiomyoma With Degenerative Changes-An Unusual Presentation

Ranjan Agrawal, Mukta Kumar, Lata Agrawal, Keshav Kumar Agrawal
Primary ovarian leiomyoma is a rare benign tumour of the ovary, which is seen in women who are aged between 20 years to 65 years. Ovarian leiomyomas can be confused with other spindle cell tumours which display gross anatomical and histological similarities. A case of a primary leiomyoma of the ovary in a pre-menopausal female is being presented here, due to its huge size and unusual presentation.

A Case of Ankylosing Spondylitis and Discussion of the Literature

M.P. Ranjith, R. Divya
Ankylosing spondylitis (AS) is a systemic rheumatic disease.Its pathogenesis has not been completely understood, but the HLA-B 27 molecule, immune cells and cytokines are thought to be involved. Nonsteroidal anti-inflammatory agents are the first line of drugs and they effectively relieve the symptoms. Biological therapies which use Infliximab, which help in targeting the underlying inflammatory process in AS, have been used recently. Here, we are reporting a case of AS, with the established classical skeletal deformities.

Stroke in the Postpartum Period: A Case Study

Allison SJ, Basit A, Omer Mohd Hussein, Ahmed RA
A twenty six years old woman presented with visual disturbance, headache and gait disturbance ten weeks postpartum. Imaging studies identified an acute infarction in the left thalamus. This case report discusses her presentation, investigations and management and the aetiology of stroke in pregnancy and the postpartum period.

Invasive (solid) Papillary Carcinoma of the Breast: A Report of Two Cases

Leena J.B., Reshma G. Kini, Safeena Amber
Papillary carcinoma is a rare malignant tumour of the breast with an incidence of 1-2% in the general population. The clinical behaviour of solid papillary carcinomas is generally indolent unless it is associated with invasion. Here, we are reporting two cases of solid invasive papillary carcinomas of the breast, who were 2 female patients aged 44 years and 55 years., with breast masses which were diagnosed by FNAC and confirmed by histopathology. The exact incidence and the clinical behaviours of such cases need to be ascertained by further research.

An Extra-adrenal Pheochromocytoma Presenting as Malignant Hypertension-A Report of two Cases

Mahesh Kumar U, Pankaj Pande, Savita SS, Ashwin PK, Balasaheb Ramling Yelikar
Malignant hypertension is a complication of hypertension characterized by elevated blood pressure (200mm/140mm Hg), is considered a medical emergency and is rarely secondary to paraganglioma. Malignant hypertension is unique in its relationship to a catecholamine secreting paraganglioma. We present two rare cases of malignant hypertension associated with paraganglioma of tonsil and urinary bladder.

MRI Sequence and Characteristic Features in ‘Giant Cell Tumor’ of Clivus

Dhananjaya K.V.N., Muralidhar Pai, Ajit Mahale, Kausalya Kumari Sahu
Giant cell tumours of the clivus are rare. These tumours present in the second and third decades of life and they are slightly more frequent in women than in men. We are presenting a case of a 20 years young patient who came with the complaints of headache, retro-orbital pain and recurrent transient bleeding from the nose since two and half months. MRI of the brain with contrast was done and its features were suggestive of a Giant cell tumour of the clivus. A transnasal endoscopic biopsy was done under general anaesthesia and the histopathology report suggested that the features were of a giant cell tumour. Excision of the mass was done by Transnasal endoscopy. Post operatively, the patient did not recover from the lateral rectus palsy which was there on the right side. The patient was discharged with an advice of a follow up and radiotherapy. Radiation therapy and chemotherapy may be effective as adjuvant treatments. Even though a recurrence usually occurs within 4 years of the initial treatment, these patients will need to be carefully followed for the remainder of their lives.

Primary Melanoma of the Spinal Cord: A Case Report
Primary melanoma is an extremely rare tumour of the spinal cord. We are reporting a case of primary melanoma of the spinal cord in a 55-years-old male patient. Magnetic resonance imaging showed an extradural intraspinal lesion opposite the L4 vertebral body. The lesion was completely resected and a microscopic diagnosis of melanoma was made. Thirty eight months later, the patient is alive, with no evidence of any tumour recurrence.

Septic Arthritis caused by Group A Streptococcus in Newborn: An Unusual Presentation
Streptococcal sepsis in neonates is a potentially lethal condition. A wide spectrum of clinical presentations has been often reported in Group B Streptococcal infections in neonates. Bone and joint infections which are caused by Group B Streptococcus are also encountered frequently, but they have not yet been reported in case of Group A Streptococcal infection in neonates. Here, we are reporting a case of septic arthritis and late onset neonatal sepsis which were caused by Group A Streptococcus in a full term, healthy baby.

A Case Report on the Bardet Biedl Syndrome with Hypokalaemic Paralysis

Prasanth Y.M., Mohammed Ashraf, Venkatesh B.M., Sharol Menezes, Abraham Mohan
The Bardet-Biedl syndrome (BBS), a rare autosomal recessive disorder, was first described by Bardet and Biedl in 1920. Here, we are reporting a case of the Bardet-Biedl syndrome with hypokalaemic paralysis. A 22 years old male patient presented with an acute onset, rapidly progressive, flaccid weakness in all four limbs. An examination revealed a moon shaped face, acanthosis nigricans, lower limb polydactyly, central obesity, small testicular size, absence of the axillary and pubic hairs, severely impaired social adaptive functioning and retinitis pigmentosa. The central nervous system examination showed hypotonia, a grade zero power and absent reflexes. The laboratory reports showed that the patient had hypokalaemia and diabetes mellitus. The literature showed hypokalaemic paralysis as a rare complication of the Bardet-Biedl syndrome.

Tuberculous Salpingitis: A Case Report

Annie Rajaratnam, Prema D’Cunha, Zevita Furtado, Hilda Fernandes
Tuberculosis (TB) of the genital tract commonly occurs secondary to a primary lesion. The mode of spread is via the lymphatics, the haematogenous route or less commonly by a peritoneal spread. The fallopian tubes are the first targets, followed by the pelvic organs. Isolated cases of TB which occur in a unilateral fallopian tube are rare, particularly with it as a primary site. The aim of this study was to report a rare case of TB of the left fallopian tube in a post menopausal lady with no positive history, clinical or laboratory finding to suggest it to be a secondary focus. As the pre-operative diagnosis was that of a right ovarian neoplasm, the patient underwent staging laparotomy. TB of the left fallopian tube was diagnosed, as there were numerous typical granulomata throughout the fallopian tube.

Desmoplastic Melanoma: A Diagnostic Dilemma

Ashwin Alva K, Rajeshwara K V, Udaykumar
Desmoplastic melanoma (DM) is an uncommonly encountered type of melanoma. A pigmentation is frequently absent, although a lentigo or lentigomaligna-like discolouration, adjacent to the nodule, is not uncommon. Hence, the clinical impression at presentation may vary from those of basal cell or squamous cell carcinomas, dermatofibromas or sarcomas to cysts and indurated plaque-like lesions which resemble scars. Making a cinical diagnosis of this tumour is difficult and it may very often mislead the physician. The clinical appearance of DM may be highly variable and the diagnosis of the tumour is difficult. We are reporting a case of DM which was diagnosed histopathologically and confirmed by immunohistochemistry (IHC), for its rarity and unique presentation.

The Beta Lactam Antibiotics as an Empirical Therapy in a Developing Country: An Update on Their Current Status and Recommendations to Counter the Resistance against Them

Bhaskar Thakuria, Kingshuk Lahon
In a developing country like India, where the patients have to bear the cost of their healthcare, the microbiological culture and the sensitivity testing of each and every infection is not feasible. Moreover, there are lacunae in the data storage, management and the sharing of knowledge with respect to the microorganisms which are prevalent in the local geographical area and with respect to the antibiotics which are effective against them. Thus, an empirical therapy for treating infections is imperative in such a setting. The beta lactam antibiotics have been widely used for the empirical treatment of infections since the the discovery of penicillin. Many generations of beta lactams have been launched with, the claims of a higher sensitivity and less resistance, but their sensitivities have drastically decreased over time. Thus, the preference for beta lactams, especially the cephalosporins, as an empirical therapy, among the prescribers was justified initially, but the current sensitivity patterns do not support their empirical use in hospital and community acquired infections. There is a need for increasing the awareness and the attitudinal change among the prescribers, screening of the antibiotic prescriptions, the strict implementation of antibiotic policies in hospital settings, restricting the hospital supplies and avoiding the prescriptions of beta lactams, a regular census of the local sensitivity patterns to formulate and update the antibiotic policies, upgradation of the laboratory facilities for a better and faster detection of the isolates, proper collection, analyses and sharing of the data and the encouragement of the research and development of newer antibiotics with novel mechanisms of action.

Spontaneous Biliary Perforations: An Uncommon yet Important Entity in Children
Spontaneous or idiopathic biliary perforations are an infrequently encountered but an important cause of surgical jaundice in paediatric patients and one of the most common causes of surgical jaundice in infancy. A pre-operative diagnosis with a clinical history and physical findings may not be possible in most of the cases. The exact cause of the perforation remains unclear and the diagnosis is made at the time of laparotomy for an acute abdomen. An early, efficient and an effective surgical management is associated with a good prognosis; however, a delay in the correct diagnosis or an inappropriate management may result in bacterial contamination of the biliary ascites, with an unfavourable outcome. The relative rarity of this condition is reflected by the very few case reports, limited case studies and scarcity of published literature.

An Ocular Prosthesis For A Geriatric Patient: A Case Report

Vikas B. Kamble, Mukesh Kumar, Debashis Panigrahi
When geriatric patients with maxillofacial defects are handled, the clinician must be confident of addressing and managing the psychology of these patients. It is also required that the clinician must understand and be sensitive to the medical and financial states of geriatric patients. The loss of an eye has a far-reaching impact on an individual’s psychology and an immediate replacement is necessary to promote the physical and psychological healing of the patient and to improve his/her social acceptance. Special approaches and treatment goals are considered while treating geriatric patients with ocular defects and special consideration is given to the appointment length, the number of appointments and their medical and financial statuses. This article presents the prosthetic rehabilitation of a geriatric patient with an ocular defect, with a customized stock ocular prosthesis, by using a minimal intervention geriatric approach.

Gene Therapy in Oral Cancer: A Review

M. Sathish Kumar, K.M.K. Masthan, N. Aravindha Babu, Kailash Chandra Dash
Gene therapy is the use of DNA as an agent to treat disease. Gene therapy aims at the insertion of a functional gene into the cells of a patient for the correction of an inborn error of metabolism, to alter or repair an acquired genetic abnormality, and to provide new function to the cell. Many experiments have been done with respect to its application in various diseases.Today, most of the gene therapy studies are aimed at cancer and hereditary diseases which are linked to genetic defects. Cancer usually occurs due to the production of multiple mutations in a single cell which cause it to proliferate out of control. Several methods such as surgery, radiation therapy and chemotherapy have been used widely to treat cancers. But, the cancer patients who are not helped by these therapies can be treated by gene therapy. The purpose of this article is to review the use and purpose of gene therapy in oral cancer.

Comparison of the Salivary and the Serum Nitric Oxide Levels in Chronic and Aggressive Periodontitis: A Biochemical Study

N. Mani Sundar, V. Krishnan, Md Nazish Alam, V.T. Hemalatha, S. Krishnaraj
Background and Objectives: Nitric oxide (NO) is a ubiquitous intercellular messenger molecule with important cardiovascular, neurological, and immune functions. In addition, it has been postulated that the pharmacological inhibition of NO or its actions may be therapeutically valuable in the disease management. The levels of nitric oxide may provide clues about the severity and the state of the underlying disease process. It could be an inflammatory biomarker that may enable clinicians to direct the environmentally based prevention or treatment programmes and to establish whether NO plays a role in the pathogenesis of periodontitis or not. Hence, the aim of the present study was to evaluate the salivary and the serum levels of NO in generalized chronic and aggressive periodontitis. The Study Design: Unstimulated whole saliva and serum samples were collected from a total of 60 subjects who were in the age group of 18-45 years, who participated in this study. They were divided into three equal groups with 20 subjects in each group; group A (healthy controls), group B (chronic periodontitis) and group C (aggressive periodontitis). The clinical parameters were assessed, based on the oral hygiene index simplified (OHI-S), the gingival index (GI), the probing pocket depth and the clinical attachment loss (CAL). A biochemical analysis was performed to evaluate and compare the salivary and the serum nitric oxide levels of the above groups. Statistical Analysis and Results: The statistical comparisons were done under the Griess Reaction. There were statistically significant salivary and serum levels of NO in the groups of periodontitis (group B and C) as compared to those in the healthy controls (group A). A significant positive correlation was found between the values of the salivary and the serum NO levels in chronic and aggressive periodontitis. Conclusion: Nitric oxide is a potent modulator of the inflammatory disease processes and under pathological conditions, NO has damaging effects. As there is a paucity in the studies which have compared chronic and aggressive periodontitis, this study paved an interest for combining the serum and the salivary analysis in comparing the levels of nitric oxide in chronic and aggressive periodontitis.

A Non-Invasive Technique which Demonstrates the Iron in the Buccal Mucosa of Sickle Cell Anaemia and Thalassaemia Patients who Undergo Repeated Blood Transfusions
Background: Iron is vital for all the living organisms. However, excess iron is hazardous because it produces free radical formation. Therefore, the iron absorption is carefully regulated to maintain an equilibrium between the absorption and the body loss of iron. Considering the lack of specific excretory pathways for iron in humans, an iron overload in the tissues is frequently encountered. It can be precipitated by a variety of conditions such as increased iron absorption, as is seen in haemochromatosis or a frequent parenteral iron administration, as is seen in thalassaemia and sickle cell anaemia patients (a transfusional overload). Objectives: To demonstrate the iron overload at an early stage by oral exfoliative cytology in the oral mucosal cells of thalassaemia and sickle cell anaemia patients and to compare the presence of iron in the exfoliated oral epithelial cells with that of the serum ferritin levels in those patients. Materials and Methods: The present study comprised of 40 ß – thalassaemia major and 20 sickle cell anaemia patients who were undergoing repeated blood transfusions of a minimum of 15/more, along with 60 clinically healthy individuals. Scrapings were obtained from the buccal mucosa and they were smeared onto glass slides. Then the slides were stained with a Perl’s Prussian staining kit and they were examined under a light microscope. Results: 72.5% of the thalassaemia patients and 35% of the sickle cell anaemia patients revealed a positivity for the Perl’s Prussian blue reaction and none of the controls showed this positivity. It was also observed that as the serum ferritin levels increased, the iron overload in the oral mucosal cells of the thalassaemia patients also increased, which was not statistically significant, whereas it was statistically significant in case of the sickle cell anemia patients. Conclusion: Since the exfoliative cytology is a simple, painless, non-invasive and a quick procedure to perform, a lot of research should be carried out on the correlation of the Perl’s Prussian blue reaction to the serum ferritin levels.

Photodynamic Therapy: The Imminent Milieu For Treating Oral Lesions
Photodynamic therapy (PDT) is used in curative and palliative treatment of head and neck squamous cell carcinoma (HNSCC) and other oral lesions. Oral infections (such as mucosal and endodontic infections, periodontal diseases, caries, and peri-implantitis) are among the specific targets where PDT can be applied Photodynamic therapy (PDT) efficacy depends on the local dose deposited in the lesion as well as oxygen availability in the lesion. Further long-term clinical studies are necessary in establishing a more specific place of the technique in the field of dentistry.

An Adenomatoid Odontogenic Cyst (AOC) with an Assorted Histoarchitecture: A Unique Entity
AOC - a relatively uncommon lesion of odontogenic origin, that is non-invasive, slow growing and composed of odontogenic epithelium, shows varied clinical and histoarchitectural patterns. It has been regarded as a benign odontogenic tumour for more than a century, sharing its clinical and radiographic features with that of dentigerous cysts. Few cases which have shown the association of this lesion with dentigerous cysts have also been reported. Some authors have reported a distinct hybrid variety of this lesion which was derived from dentigerous cysts. An attempt has been made in this article, in describing this lesion as a “hamartomatous odontogenic cyst” rather than a tumour. Although this lesion has been known to the oral pathologists for a long time, its histogenesis still remains obscure. The present case highlights a new school of thought regarding the origin of this lesion.

Dental Caries Vaccine – A Possible Option?

Shanmugam KT, Masthan Kmk, Balachander N, Sudha Jimson, Sarangarajan R
Dental caries is an irreversible microbial disease of the calcified tissues of the teeth and it has a multifactorial origin. In India, the dental caries prevalence in 35-44 year olds was reported to be 80-95% in a DCI survey. Among the elderly in the 65-74 years age group, the DCI survey reported the caries prevalence to be about 70%, while the present survey reported it to be 51- 95% in various states. Surveys which were done on school children in India showed a carie prevalence of approximately 58%.Among the U.S. population, a survey showed an incidence of 93.8% in adults with either past or present coronal caries and an incidence of 45.3% in children 23. In countries like Brazil and China, it is reaching epidemic proportions. Thus, more effective public-health measures are needed to combat dental caries. Mutans streptococci is one of the main microorganisms which are associated with the aetiology of dental caries. Preclinical studies of immunological interventions have shown that the disease can be interrupted. Clinical trials have indicated that a mucosal immune response to Streptococcus mutans crucial antigens can influence the pathogenesis of dental caries. The dental caries vaccine, when it is used in appropriate individuals at the appropriate time, can reduce the reemergence of the disease.

Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

Santosh Patil, Nidhi Sinha
Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis. Methods: A total of 112 End Stage Renal Disease (ESRD) patients on who were haemodialysis participated in this study. The periapical and the panoramic radiographs for all the patients were evaluated for the presence or absence of the narrowing of the dental pulps and for pulp stones in the pulp chambers and the pulp canals. The panoramic radiographs were also evaluated to determine the carotid calcification. Results: Carotid calcifications were detected in none of the patients. 84 (74.99%) patients had dental pulp narrowing, and 38 (33.92%) patients had pulp stones. There was no statistical correlation between pulp narrowing and Carotid Artery Calcification (CAC) in the haemodialysis patient group. There was also no statistical correlation between pulp stones and CAC in the haemodialysis patients. Conclusion: However, the incidental finding of CAC on a panoramic radiograph can provide life-saving information for the vascular disease patients, but in the present study, no significant relationship was found between the presence of the pulpal calcification and CAC in the ESRD patients who were on haemodialysis. Therefore, the presence of pulp calcification does not seem to serve as a diagnostic marker for carotid atherosclerosis.

Management of an Endodontic Infection with an Extra Oral Sinus Tract in a Single Visit: A Case Report
Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.

Estimation of the Serum and the Salivary Trace Elements in OSMF Patients

Manasi Ankolekar Kode,Freny Rashmiraj Karjodkar
Objectives: Gutkha packets contain trace elements like copper, zinc, iron and magnesium. This study compared the levels of the trace elements in patients with gutkha eating habits with or without oral submucous fibrosis and in healthy patients. Study Design: A total of 75 patients were included in this study and they were divided into three groups, the individuals with a history of gutkha intake with OSMF, the individuals with a history of gutkha intake without OSMF and apparently healthy individuals without OSMF and without any habits. Blood and saliva was collected and they were subjected for analysis by sing atomic absorption spectrometry and a differential pulse anodic stripping voltmeter. Results: The results were tabulated and they were subjected to a statistical analysis. Conclusion: There was a significant difference in the serum Mg and Fe levels between the patients with habits and the normal healthy individuals.A significant difference was observed in the serum zinc levels in the patients with habits with and without OSMF. ltered serum trace element levels are documented in malignant cases and they are considered to be good biomarkers for malignancies. The serum copper and Zn levels and the Cu/ Zn ratio in OSMF patients can be considered as the markers which show a susceptibility towards cancer.

Pyogenic Granuloma on the Upper Labial Mucosa: A Case Report

Kamala K A, L. Ashok, Sujatha G P
Pyogenic granuloma is thought to represent an exuberant tissue response to a local irritation or trauma. It is a reactional response to constant minor trauma and it might be related to hormonal changes. Clinically, these lesions usually present as single nodules or sessile papules with smooth or lobulated surfaces. These may be seen in any size, from a few millimetres to several centimetres. Pyogenic granuloma of the oral cavity is known to involve the gingiva more commonly (75% of all the cases). An extragingival occurrence of pyogenic granuloma is rare. This paper has described an extragingival pyogenic granuloma which occurred on the upper labial mucosa in a 30 years old female patient.

The Pain Management in Orthodontics

Nandita Shenoy, Siddarth Shetty, Junaid Ahmed, Ashok Shenoy K.
Pain and discomfort are the frequent side-effects of the orthodontic therapy with fixed appliances. The people who experience orthodontic pain are likely to self-medicate with nonprescription pain relievers before seeing the dentist. It is imperative for an orthodontist to address questions that might arise in a clinical setting from the viewpoint of the clinicians and the patients/parents. This article will provide an overview of the current management strategies which are employed for alleviating orthodontic pain.

The Morphometrical and Histopathological Changes which were Observed after Topical Ozone Therapy on an Exophytic Fibrous Gingival Lesion: A Case Report

Punit Vaibhav Patel, Sheela Kumar Gujjari
We are presenting 2 cases where ozone therapy was used in the form of ozonated oil on an exophytic fibrous gingival lesion. A 42-years female patient was selected, who presented with a mild to moderately painful, exophytic, fibrous lesion on the upper anterior gingiva. This gingival lesion was treated with 2ml of ozonated oil, thrice daily for one week. After the ozone therapy, the postoperative outcomes were measured and analyzed. Finally, the lesion was subjected to an excisional biopsy and a histopathological evaluation. After the ozone therapy, the patient revealed that there was less pain. On examination of the lesion, an improvement was observed in the clinical sign of the inflammation and also a reduction in the surface ulceration. During the final biopsy, less bleeding was observed. The morphometrical analysis showed a reduction in the size of the lesion. The histopathological analysis showed a reduction in the collagen fibres and in the inflammatory cells in the connective tissue stroma. Topical ozone therapy provides potential benefits for the treatment of exophytic gingival lesions. The observed benefits in present case report needs to be verified in future with well-controlled clinical trials.

A Triad of Developmental Anomalies-An Unusual Case

Rohit Sharma, Praful Narang, Y G Reddy, Amit Kumar Sharma