Journal of clinical and diagnostic research

Evaluation of Outcome of Corrective Ulnar Osteotomy with Bone Grafting and Annular Ligament Reconstruction in Neglected Monteggia Fracture Dislocation in Children

Tanmay Datta, ND Chatterjee, Ananda Kisor Pal, Sunil Kumar Das

Introduction: Neglected Monteggia fracture dislocation in the paediatric age group constitutes significant disability in respect to pain, stiffness, deformity, neurological compromise and restriction of activities of daily living. Materials and Methods: A longitudinal prospective study was done on 21 children with old Monteggia fracture-dislocation which included 18 cases of Bado type I and 3 cases of Bado type III at the department of orthopaedics, IPGME&R,SSKM hospital, Kolkata, India between 2007 and 2012. All were treated by modified Hirayama corrective osteotomy of ulna with wedge bone grafting along with restoration of its length and reconstruction of annular ligament using Bell Tawse method and fixation of radial head with transcapitellar Kirschner wire. Average follow up period was 5.5 years. Results and Analysis: Results were evaluated on the basis of 100 point Mayo Elbow Performance Index, radiology and questionnaire. The mean postoperative increase in Mayo Elbow Performance Index score was 30 with average increase in the range of movement by 30o. In three cases, there was subluxation of radial head and in addition one had transient palsy of posterior interosseous nerve. Three cases showed distortion of the radial head which were insignificant functionally. Results of improvement in mean MEPI were analysed by chi-square test and was significant at 0 .01 level of significance. Conclusion: Study showed good results with modified Hirayama osteotomy with annular ligament reconstruction using Bell Tawse procedure which is a more biological option for restoration of elbow biomechanics.

A Population based Study on Alcoholism among Adult Males in a Rural Area, Tamil Nadu, India

Background: India’s reputation as a country with a culture of abstinence especially in matters regarding alcohol is underserved. There has been a rapid proliferation of city bars and nightclubs in recent years and people are fast shedding its inhibitions about alcohol as a lifestyle choice. This scenario has led to fears of an undocumented rise in alcohol abuse among all sections of society. Policies by the government has been laid down to regulate sales and pricing of alcohol, but not well improvised. Our aim was to find out the prevalence of alcoholism among adult males in a rural population and also to analyze its association between various factors. Materials and Methods: A cross sectional study in a rural population at Kuthampakkam village, in Poonamallee block of Tiruvallur district in Tamil Nadu, India. The study population included adult male population. Simple random sampling method was adopted. A structured questionnaire was used to collect information regarding the background characteristics, history of alcoholism and certain social factors. Statistical Analysis: Data entry and analysis was done using Statistical Package for Social Sciences (SPSS) version 15 software. Descriptive statistics were calculated for background variables and the prevalence of the alcoholism. Chi-square test and p-value were calculated to see the association between alcoholism and social factors. Results: A total of 157 adult male were enrolled in the study. The mean age of the study participants was 37.20 years. The prevalence of alcoholism among the study participants was 35.7%. Among them only 4.5% who presented with symptoms of chronic alcoholism had taken treatment. Reasons for not taking treatment for alcoholism among study population were mainly due to their family problems (55.2%). Conclusion: Although alcohol consumption has existed for many centuries, the quantity, usage pattern, and resultant problems have undergone substantial changes over the past 20 years. These developments have raised concerns about the public health and social consequences. Awareness among the population and necessary rehabilitation and self-help programs will help in bringing down the prevalence of alcoholism.

Emergence of Escherichia coli, Co-Producing NDM-1 and OXA-48 Carbapenemases, in Urinary Isolates, at a Tertiary Care Centre at Central India

Atul Khajuria, Ashok Kumar Praharaj, Mahadevan Kumar, Naveen Grover

Objective: To detect genes encoding carbapenem resistance in urinary isolates of Escherichia coli recovered from hospitalized patients in tertiary care centre in Pune, India. Materials and Methods: From Jan 2012 to Dec 2012, a total of 300 consecutive non-duplicate (one isolate per patient) clinical isolates of Escherichia coli were recovered from urine cultures of hospitalized patients including hospital acquired infection cases admitted to the medical and surgical intensive care units. Polymerase chain reaction (PCR) assays and sequencing was used to determine the presence of beta-lactamase encoding genes. Conjugation experiments were performed to determine the transferability of beta-lactamase. Results: All the isolates were completely resistant to the second and third generation cephalosporins tested as well as carbapenems. All the isolates showed 100% susceptibility to tigecycline and colistin in vitro. Conjugation experiments demonstrated that blaNDM-1 was transferable via plasmid. All the isolates showed presence of blaNDM-1 and co-association of blaOXA-48 was 25/45(55%) of the isolates. Repetitive element based PCR (REP PCR), Enterobacterial Repetitive Intergenic Consensus (ERIC PCR) and Randomly Amplified Polymorphic DNA (RAPD) revealed a diversity of six clonal types among E.coli isolates. Conclusion: Co-production of NDM-1with OXA-48 in urinary isolates of E. coli was detected for the first time in India. Transmission of plasmid carrying these resistant genes to other members of Enterobacteriaceae will increase incidence of multidrug resistance. Early detection of these genes will help in prevention and adequate infection control by limiting the spread of these organisms.

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Kulvinder Singh, Navdeep Singh, CL Thukral, Kunwar pal Singh, Varun Bhalla

Aims: The purpose of the study was to evaluate the role of Magnetic Resonance Imaging in detection and characterization of perianal fistulae and correlating it with surgical findings. Methods: Fifty consecutive patients with suspected perianal fistulae having one or more external openings were prospectively selected for MRI evaluation. Previously operated or patients with recurrent perianal disease were excluded from the study. MRI findings were recorded according to “St. James’s University Hospital MR Imaging Classification of Perianal Fistulae” and correlated with surgical observations. Finally, comparison between T2-weighted fat saturated and postcontrast T1-weighted fat saturated sequences was done. Results: Amongst the total of 50 patients, per-operative findings confirmed perianal fistulae in 45 patients. The sensitivity and specificity of MRI in correctly detecting and grading the primary tract was found to be 95.56% and 80% respectively; for abscess, it was 87.50% and 95.24% respectively. High sensitivity was also discerned in identification of secondary tract (93.75%), correct localization of internal opening (95.83%) and for correctly detecting the horse-shoeing (87.50%). Our assumption of null hypothesis was accepted on comparing results of T2-weighted fat saturated sequences and postcontrast T1-weighted fat saturated sequences. Conclusion: Magnetic Resonance Imaging (MRI) was highly accurate in assessment of surgically important parameters (primary tract and its grading, internal opening, secondary tract, abscess, horseshoeing) of perianal fistulae. Comparison of results of imaging findings on T2-weighted and postcontrast T1-weighted fat saturated sequences were statistically similar, so contrast study can be omitted, particularly while evaluating primary / previously unoperated perianal fistulae.

Beneficial Effects of Nebivolol in Comparison with Atenolol on Safety and Tolerability in Essential Hypertension

Topical Vs Combination Ciprofloxacin in the Management of Discharging Chronic Suppurative Otitis Media

G S Renukananda, Santosh U.P., Nitha Mary George

Objectives: To study the microbial flora and determine the efficacy of topical ciprofloxacin ear drops in comparison with combination of topical and oral ciprofloxacin as first line management in patients diagnosed with chronic suppurative otitis media. Materials and Methods: Prospective randomized interventional clinical trial on 100 patients who presented with an acute episode of CSOM to our outpatient department. Results: In our study, topical ciprofloxacin therapy was found to be an effective treatment for an acute on chronic otitis media as was the combination therapy though the overall recurrence rate was found to be more in the former group. Conclusion: In the absence of systemic infection or serious underlying disease, topical antibiotics alone constitute first line treatment for most patients with chronic suppurative otitis media, finding no evidence that systemic antibiotics alone or in combination with topical preparations improve treatment outcomes compared with topical antibiotics alone.

Knowledge, Awareness and Prevention of Cervical Cancer Among Women Attending A Tertiary Care Hospital in Puducherry, India

JansiRani Siddharthar, Bhuvaneshwari Rajkumar, Kuberan Deivasigamani

Background: Cervical cancer is one of the most common cancers among women worldwide, with highest mortality in India. The incidence and mortality of cervical cancer can be reduced by screening women for precancerous lesion and by administration of human papilloma virus vaccine to adolescent girls. Knowledge of the women about cervical cancer and awareness about its prevention are the key factors that determine their utilization of screening services. Methods: A cross sectional survey of women attending Gynaecology Out-Patient Department (OPD) in a tertiary care hospital in Puducherry was conducted. Information about their knowledge of cervical cancer, awareness of its prevention and their socio demographic characters were collected. Results: Mean age of the study population was 40.45 ± 12 years. Less than half of the study population (178, 44.5%) knew about cervical cancer. Less than one-fourth of the population knew about screening services for prevention of cervical cancer, and majority (389, 97.2%) were not aware of vaccination as prevention for cervical cancer. Conclusion: Our study population shows poor knowledge about cervical cancer and is unaware of the concept of prevention. Hence extensive health education to the public is needed regarding cervical cancer and its prevention.

Allergic Bronchopulmonary Aspergillosis (ABPA)-The High Resolution Computed Tomography (HRCT) Chest Imaging Scenario

Manjot Kaur, Dharampal Singh Sudan

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a progressive disease which can lead to recurrent exacerbations, bronchiectatic changes and end-stage fibrosis. Early diagnosis and treatment prevents its progression and alleviate its clinical manifestations. High resolution CT of the chest has emerged as a promising investigation for its diagnosis. Aims and Objectives: To review the high resolution computed tomography (HRCT) chest manifestations in ABPA patients. Materials and Methods: This study included 110 patients with ABPA who had undergone HRCT of the chest in the routine diagnostic workup for ABPA. The scans were assessed for changes in bronchi, parenchyma and pleura and findings consistent with ABPA were evaluated. Results: HRCT chest was normal in 24 patients. 86 patients demonstrated central bronchiectasis with predilection for upper and middle lobes. Centrilobular nodules with or without linear opacities (tree in bud pattern), mucoceles and high-attenuation mucus were seen in 86%, 59% and 36% patients respectively. Conclusion: Central bonchiectasis combined with centrilobular nodules and mucus impaction (especially high attenuation mucus) strongly favour the diagnosis of ABPA.

A Study of Etiological Pattern in an Epidemic of Acute Febrile Illness during Monsoon in a Tertiary Health Care Institute of Uttarakhand, India

Ragini Singh, S P Singh, Niaz Ahmad

Background: Many parts of India are endemic for the dengue, malaria, typhoid and scrub typhus infections. The relative contribution of these illnesses in an outbreak of acute febrile illness is not known in this region. Objective: The present study was conducted to find out the etiological pattern in an epidemic of acute febrile illness in Uttarakhand during the monsoon period. The study also focuses on concurrent infections and tries to find out the mortality outcomes. Materials and Methods: A retrospective study of four months was conducted on 1141 patients who presented with fever, and were suspected to have dengue, malaria, typhoid or scrub typhus. Patients of 12-years of age or above were included in the study. Serological tests for dengue, malaria, typhoid and scrub typhus were performed. Slides for malaria parasite were examined. In case of enteric fever only culture positive cases were included in the study. Result: Among the 1141 febrile patients dengue was detected in 812(71.2 %), malaria in 146(12.8%), typhoid in 92(8.1%) and scrub typhus in 69(6.0%) cases. Mixed infection was noted in 22(1.9%). Conclusion: Maximum (71.2 %) cases of fever were caused by dengue but significant number (32.3%) of patients suffered from malaria typhoid and scrub typhus. Many (1.9%) suffered from concurrent and multiple infections.

Morphological Study of Dendritic Cells in Human Cervix by Zinc Iodide Osmium Method

Suganthy Rabi, J Lionel, Inbam Indrasingh

Background: Dendritic cells (DCs) are a heterogeneous population of antigen presenting cells that have been identified in several tissues including the female reproductive organs. The aim of the present study is to demonstrate the morphological differences of dendritic cells in normal human exocervix using the Zinc Iodide Osmium (ZIO) procedure. Materials and Method: Normal cervical tissues obtained from nine patients who underwent abdominal hysterectomies for various ailments were processed for histochemical study. Six microns thick serial sections were taken and viewed under a light microscope. The diameters of the cells were measured under a magnification of 40x using the Cellsens image analysing software and analysed using SPSS version 16. Results and Conclusion: In the normal human exocervix, a greater density of ZIO-positive DCs was noted in the epithelium and subepithelium and their distribution was not uniform. In some areas of epithelium, the ZIO-positive cells in the basal layer showed a typical dendritic morphology, while the cells in the intermediate and superficial layers were nondendritic polygonal cells. Intraepithelial capillaries were noted, which were surrounded by ZIO-positive nondendritic polygonal cells. There was significant difference in the mean diameters of typical DCs (8.61±1.86 µm) and nondendritic polygonal cells (10.97±1.93 µm). In the subepithelium the DCs had typical morphology and their distribution varied. ZIO positive DCs were noted in the epithelium and cervical glands of endocervix also. In conclusion, the human cervix has different subsets of ZIO positive DCs with varied distribution. Their functional role has yet to be defined.

Evaluation of Fetal Central Nervous System Anomalies by Ultrasound and Its Anatomical Correlation

Deepali Onkar, Prashant Onkar, Kajal Mitra

Introduction: Central nervous system anomalies are often severe and are the most common indications for therapeutic abortions. Ultrasound examination helps to identify and evaluate them well before birth. Objectives: Present study was undertaken to evaluate the incidence of central nervous system anomalies in utero by ultrasound and to confirm them by autopsy or postnatal examination. Method: Ultrasound screening of 7485 pregnant women was performed. Pregnancy with ultrasound findings of central nervous system anomalies were followed up. Prenatal ultrasound findings were confirmed by autopsy in cases of therapeutic abortions and fetal losses. In case of live birth postnatal findings were noted. Results: Ultrasound detected central nervous system malformations in 24 fetuses. Ultrasound findings were matching in 83% on autopsy. Autopsy and postnatal findings together were matching with ultrasound in 85.7%. Two cases had additional minor findings on autopsy. Conclusion: The incidence of central nervous system malformations on ultrasound was 0.31%. Autopsy and postnatal examination showed high degree of correlation with ultrasound findings.

Effect of age and Blood Pressure on Surrogate Markers of Atherosclerosis in Patients with Type 2 Diabetes Mellitus

Background: Increased arterial stiffness may be an important path- way linking diabetes mellitus to increased cardiovascular risk. Aim: The study was conducted to assess the surrogate markers of arterial stiffness in patients with Type 2 diabetes mellitus (T2DM), and compare with age-matched hypertensive and healthy controls. Also the effect of age and blood pressure on these markers was evaluated. Settings and Design: This cross-sectional study was carried out at a tertiary care hospital in West India. Methods: After a detailed medical history and anthropometric evaluation, all the participants were subjected to measurements of Arterial Stiffness Index (ASI), Pulse Wave Velocity (PWV), and Augmentation Index (AIx) using a non-invasive oscillometric method. The four study groups consisted of patients with T2DM (>5 years) along with hypertension, newly diagnosed patients with T2DM (<2years) without hypertension, hypertensive controls, and healthy controls. Results: PWV, ASI, AIx were elevated in patients with T2DM compared to healthy controls (p<0.05). Patients with T2DM above 60 years had higher carotid-femoral PWV, ASI and AIx than those below 60 years (p<0.05). ASI and AIx were significantly increased in patients with T2DM with hypertension having systolic BP > 140 mmHg compared to those with systolic BP < 140 mmHg. A very strong correlation between PWV and AIx in patients with T2DM and hypertensive controls was observed. Conclusion: This study reveals that markers of arterial stiffness (PWV, ASI, AIx) were increased significantly in patients with T2DM compared to healthy controls. Age and systolic blood pressure had significant influence on these markers. Thus, oscillometric markers have potential utility in identifying subclinical atherosclerosis in patients with T2DM.

Study of Cardiovascular Reactivity to Mental Stress in Different Phases of Menstrual Cycle

Jnaneshwara P Shenoy, Sahana PA, Shivakumar J

Background: It is a well known fact that normally female sex hormone levels fluctuate during the menstrual cycle. The presence of receptors for these hormones on both heart and blood vessels may also hint at variations in physiological functions during menstrual cycle. So this study was an attempt to determine whether the follicular and luteal phases of menstrual cycle are characterized by variations in cardiovascular parameters in the resting state and also examine changes in cardiovascular reactivity to mental stress challenge during both the phases of menstrual cycle. Methodology: Thirty healthy females in the age group of 18- 25 years with regular menstrual cycles fulfilling the inclusion criteria were examined for cardiovascular parameters (heart rate and blood pressures) at rest and their reactivity to mental stress during the follicular and luteal phase and were compared by using paired t-test. A p-value of <0.05 was considered as statistically significant. Results: The women included in the study produced the well known reactivity to mental stress, in terms of blood pressure and heart rate increases, but the two phases of menstrual cycle were indistinguishable in so far as reactivity patterns were considered. The resting values of these cardiovascular parameters were also alike during the two phases. Conclusion: We were unable to unearth any differences in resting and reactivity values of cardiovascular parameters during the course of a normal menstrual cycle. This shows that stress reactivity variations during different phases of menstrual cycle may not be due to variations in hormonal levels per se, but due to collusion of hormonal variations and unknown genetic influences.

Alteration of Interferon Gamma (IFN-?) in Human Plasma with Graded Physical Activity

Ambarish Vijayaraghavaavaava, Ra dhika K

Introduction: Practice of regular exercise is beneficial for health. Physical exercises have been demonstrated to alter levels of the cytokine interferon Gamma in plasma. IFN-? is known to be an anti-inflammatory cytokine. Methods: We assessed the effect of single bout of moderate exercise and a single bout of strenuous exercise and one month of regular moderate exercise on plasma IFN-?. The study consisted of 18 healthy volunteers (10 males and 8 females) with the mean age, 20.94 years, range, 18-25 years. The exercise regime adopted is the standardized 10m Shuttle Walk Test regime. IFN-? was estimated using the Sandwich ELISA technique. The reagent kit was obtained from Duoset ELISA Development System of R & D Systems Europe Ltd. The readings were taken at 450nm using Organon Teknika Reader 230S. Statistical methods: Friedman test has been used for analysing IFN-? values. Results: Mean and SD values of IFN-? (in picograms per ml) for baseline (no exercise) was: 54.56 ± 28.54 (log transformation: 1.68±0.23), for acute moderate exercise: 28.94 ± 38.46 (log transformation: 1.34 ± 0.24), for acute strenuous exercise: 20.06 ± 16.96 (log transformation: 1.18 ±0.33) and after one month of regular moderate exercise: 106.33 ± 21.51 (log transformation: 2.02 ± 0.09). The change in IFN-? levels showed significant difference between; a) baseline and moderate exercise, b) baseline and strenuous exercise, c) moderate and strenuous exercise, d) strenuous exercise and end of one month of regular moderate exercise, e) baseline and end of one month of regular moderate exercise, f) moderate exercise and end of one month of regular moderate exercise. IFN-? showed overall significance between different grades of exercise (p < 0.05). Conclusion: Plasma IFN-? decreases with one bout of acute moderate exercise, it decreases further with one bout of acute strenuous exercise and increases at end of one month of regular moderate exercise, which is more than baseline value. This shows that regular moderate exercise has beneficial effects on health by way of increasing plasma IFN-? level.

Study of Cholesteryl Ester Transfer Protein (CETP) I405v Genotype and Its Association with Lipid Fractions in Myocardial Infarction Patients: A Case Control Study

Prakash D. Zende, Mangesh P. Bankar, Abdul rahman A. Momin, Pramod S. Kamble

Objectives: We determine the significant relation of HDL cholesterol and total cholesterol/HDL cholesterol between CETP I405V genotypes and activity of CETP. CETP is an essential for transfer of cholesterol ester to the liver from peripheral tissues which facilitating its transfer to TG rich VLDL. Reduction activity of CETP I405V may associate with genotypes of CETP I405V. This study is undertaken to assess the presence and impact of CETP I405V genotype in our population. Materials and Methods: In this study 100 acute myocardial infarction patients and 100 normal age & sex matched healthy individuals were included. Serum Lipid profile was estimated by using universal standard methods whereas CETP I405V genotype was studied by ARMS PCR. Result: There is presence of CETP 405Val genotype both in patient as well as in control group. Results show that HDL cholesterol (p<0.0001) and ratio of total cholesterol/HDL cholesterol are significantly (p<0.0043) associated with Val/Val genotype. In addition to that the CETP I405V genotype is associated with inhibition of CETP activity with higher HDL-C level and decreased total cholesterol/HDL cholesterol ratio. Conclusion: Our results show that the CETP I405V genotypes are very much significantly determinant of HDL cholesterol in patients with CHD.

Validation of Method Performance of pH, PCO2, PO2, Na+, K+ of Cobas b121 ABG Analyser

Sunil Kumar Nanda, Lopamudra Ray, Asha Dinakaran

Introduction: The introduction of a new method or new analyser is a common occurrence in clinical biochemistry laboratory. Blood gas measurements and electrolytes are often performed in Point-of-Care (POC) settings. When a new POC analyser is obtained, the performance of the analyser should be evaluated by comparison to the measurements with the reference analyser in the laboratory. Objectives: Evaluation of method performance of pH, PCO2, PO2, Na+, K+ of cobas b121 ABG analyser. Materials & Methods: The evaluation of method performance of pH, PO2, PCO2, Na+, K+ of cobas b121 ABG analyser was done by comparing the results of 50 patient samples run on cobas b121 with the results obtained from Rapid lab values (reference analyser). Correlation coefficient was calculated from the results obtained from both the analysers. Precision was calculated by running biorad ABG control samples. Results: The correlation coefficient values obtained for parameters were close to 1.0 indicating good correlation. The CV obtained for all the parameters were less than 5 indicating good precision. Conclusion: The new ABG analyser, Cobas b121 correlated well with the reference ABG analyser (Rapid Lab) and could be used to run on patient samples.

Clinico Immunological Profile of Children Infected with HIV Through Vertical Transmission, in Southern India

Praveen R Shahapur, Indira Bairy

Background: Karnataka, being “High Prevalent State” of southern India, the HIV infection among antenatal women has crossed 1%. There are very few reports available with CD4 count and stage wise clinical spectrum among children. The clinical spectrum among HIV infected infants and children vary in different areas of the world. Hence it is important to know the spectrum of opportunistic infections and their respective CD4 count among HIV infected children of our locality. Materials and Methods: The opportunistic infections among 31 paediatric seropositive patients were evaluated. These all patients were classified as per CDC guide lines into stage I, stage II, and stage III based on CD4 counts of > 1000cells/µl, 500-999 cells/µl,<500cells/µl respectively. The opportunistic infections were diagnosed by standard laboratory investigations. Clinical spectrum presented by each stage children was documented. Results: Children in stage I were 5(16.1%),stage II 14(45.1%) and stage III 12(38.7%). Oral candidiasis (29%) was the commonest, followed by recurrent respiratory tract infection (25.8%), tubercular lymphadenitis (16.1%) and chronic diarrhoea (12.9%). Conclusion: The present study showed the children with higher CD4 count had few infections and children with lower CD4 count presented with multiple opportunistic infections. This study also showed vertical transmission as the sole mode of transmission.

A Retrospective Clinical Study of the Etiology and Post-operative Visual Outcome of Rhegmatogenous Retinal Detachment

Achyut N Pandey, Anil Kakde

Aim: To study the etiology of rhegmatogenous retinal detachment and visual outcome after retinal detachment surgery. Materials and methods: Retrospective study conducted at the tertiary eye care hospital over a period of one year. Thirty eyes of 30 patients were included after fulfilling the inclusion criteria. Complete ocular examination details of each patient such as visual acuity for distant vision (checked with Snellen’s acuity chart),slit lamp examination, fundus examination (done with +90D lens) and binocular indirect ophthalmoscopy. In addition the following were noted: extent of the detachment present, position and number of breaks, status of the macula, presence of PVR, mobility of retina and presence of any peripheral retinal degenerations, and fundus photographs of the patient (before and after surgery). Results: Risk factors for retinal detachment included myopia in 7 eyes (23.3%), prior cataract surgery in 10 eyes (33.3%), peripheral retinal degeneration in 3 eyes (10%) and traction with new vessels in 1 eye (3.3%). Eighteen eyes (60%) presented with macula off while 12 eyes (40%) presented with macula partly or completely attached. Visual acuity at presentation was <3/60 in 16 eyes. Following surgery, retina was attached in 28 eyes (93.3%) and remained detached in 2 eyes (6.7%). Visual acuity after surgery was <3/60 in 12 eyes.Visual acuity improved in 13 eyes (43.3%), remained the same in 16 eyes (53.3%) and worsened in 1 eye (3.3%). Conclusion: Myopia and prior cataract surgery are important risk factors for Rhegmatogenous Retinal Detachment. Majority of patients in this setting presented late with Rhegmatogenous Retinal Detachment and this was responsible for relatively poor visual outcomes despite good anatomical results after surgery. Proper screening of eyes at risk and education of patients is important for preventing visual loss due to retinal detachment.

Antidepressant Effect of Ketamine in Sub Anaesthetic Doses in Male Albino Mice

Lourdu Jafrin Antony, Venkata Naveen Kumar Paruchuri, Ramchandar Ramanan

Background: Depression is the most common mental disorder in community settings, and is a major cause of disability across the world. Antidepressants such as SSRI (Selective Serotonin Reuptake Inhibitor) and TCA (Tricyclic antidepressants) are used. These drugs affect the adrenergic and serotonergic pathways. These drugs have an unfavorable side effect profile, take longer time to act and are not very effective in resistant cases. Alternate pathways involving the glutamate receptors have also been linked with depression, hence Ketamine an NMDA antagonist was evaluated for the antidepressant effect. Aim: To study the antidepressant effect of ketamine in subanaesthetic doses in male albino mice. Study Design, Materials and Methods: The study was a randomized controlled animal study done on 30 male albino BALB/c mice divided into five groups with Imipramine (10mg/kg) as the standard drug and Ketamine in varying doses (5, 7.5, 10 mg/kg) as the test drug. The animal model used was the forced swim test. The reduction in immobility time was taken as the index of the antidepressant effect. Statistical analysis: The data were analysed with the one way ANOVA test using SPSS version 12. Results and Conclusion: The data analysis showed that Ketamine at a dose lower dose of Ketamine (5mg/kg) did not show a significant antidepressant effect in contrast to the higher doses (7.5 and 10mg/kg) which showed significant antidepressant effect (‘p’ < 0.05). The inference of this study is that Ketamine has significant antidepressant property at variable dose ranges and further studies can be done on these lines.

Microbiological Profile and Drug Sensitivity Pattern among Community Acquired Pneumonia Patients in Tertiary Care Centre in Mangalore, Coastal Karnataka, India

Background: Community Acquired Pneumonia (CAP) is the most common respiratory tract infection in day to day practice. The knowledge of organism commonly causative of CAP helps in early empirical treatment initiation. Aim: To study the microbiological profile of patients with community acquired pneumonia and to study drug sensitivity pattern. Methods: Hospital based cross sectional study among 100 patients with CAP was conducted in a tertiary care hospital of Southern India. Sputum culture showed that out of 100 patients 39 had an identifiable etiology with 12 patients having evidence of mixed infection. Result: Micro-organisms isolated in sputum culture were Streptococcus pneumoniae (31%) followed by, Pseudomonas pyogens (15%), Klebsiella pneumoniae (13%). AFB smear was found to be positive in 6 patients. Organisms were found to be sensitive for piperacillin plus tazobactum (41%), aminoglycocides (amikacin- 46%, gentamicin-31%), third generation cephalosporins (Cefotaxim-36%, Ceftriaxone-18%) and macrolides (Erythromicin- 31%, Azithromycin-18%). Sensitivity to chloramphenicol was observed in 31% sputum culture positive patients. Ciprofloxacin sensitivity was seen among 49%. Conclusion: Most of the organisms were found to be sensitive to monotherapy with extended spectrum beta lactamases, third generation cephalosporins, fluroquinolones, macrolides.

Penile Incarceration with Encircling Metallic Objects: A Study of Successful Removal

Pushpendra Shukla, Shyam Lal, G.P. Shrivastava, Lal Mani Singh

Objective: This article aimed at to study the various treatment options according to the grading scale for penile incarceration. Materials and Methods: A retrospective review, of all the case files of patients presented with penile incarceration with encircling metallic object was performed. The patients were analyzed for age, marital status, motive, object used, who applied it, trauma grade, duration of incarceration, removal technique, removal time, anesthesia used and recovery time. Result: A total of seven patients were identified. The average age was 46.71 years. Self-sexual gratification was the most common motive (five patients). Six patients presented within 24 hours. Grade II of injury was commonest type of injury seen in five patients. The technique of removal chosen was according to grade of penile injury, duration of incarceration and type of object used. Spinal anesthesia was used in most of the cases (five patients). Conclusion: Penile incarceration with encircling metallic objects is a rare presentation and requires urgent intervention according to trauma grade to prevent complications.

Role of Information Communication Technology in Higher Education: Learners Perspective in Rural Medical Schools

Background: Higher education has undergone profound transformation due to recent technological advancements. Resultantly health profession students have a strong base to utilize information technology for their professional development. Studies over recent past reflect a striking change in pattern of technology usage amongst medical students expanding prospects exponentially by e-books, science apps, readymade power-point presentations, evidence based medicine, Wikipedia, etc. Aim & Objectives: The study was undertaken with an aim to explore the general perceptions of medical students and faculties about the role of Information Communication Technology in higher education and to gauge student’s dependence on the same for seeking knowledge and information. Study Design: Cross-sectional, mixed research design. Materials and Methods: The study was conducted in Department of Physiology, Datta Meghe Institute of Medical Sciences (Deemed University). Study population included students (n=150) and teaching faculty (n=10) of Ist phase of medical curriculum. The survey questionnaire (10 closed ended and 5 open ended items) and Focus group discussion (FGD) captured the perceptions and attitudes of students and faculties respectively regarding the role and relevance of technology in higher education. Observations and Results: Quantitative analysis of closed ended responses was done by percentage distribution and Qualitative analysis of open ended responses and FGD excerpts was done by coding and observing the trends and patterns respectively. Overall the observations were in favour of increasing usability and dependability on technology as ready reference tool of subject information. Learners valued text books and technology almost equally and regarded computer training as a desirable incorporation in medical curriculum. Conclusion: Role of technology in education should be anticipated and appropriate measures should be undertaken for its adequate and optimum utilization by proper training of students as well as facilitators.

Comparison of Cognitive Functions Between Male and Female Medical Students: A Pilot Study

Namrata Upadhayay, Sanjeev Guragain

Background: There are gender differences in cognitive abilities. The major enigma is whether males or females perform better in various cognitive tasks. The reports were found to be contradictory. Studies have shown that oestrogen and testosterone accentuate cognitive functions. But the effects of progesterone on cognitive functions are still contradictory. Objective: To assess and compare the cognitive functions between male and female students. (Title changed according to the objective). Methods: This study was conducted on healthy male (n=21) and female (n=21) volunteers who were aged between 19-37 years. Cognitive functions which were assessed in males (one time) and females (two times: during preovulatory and postovulatory phases of the menstrual cycle) were attentional: visual reaction time (VRT) and Go/No-Go VRT; perceptual: fast counting (FC), executive: Erisken Flanker Test (EFT) and Stroop Test (ST), and working memory. Data were compared by using Mann-Whitney U-test. Results: Cognitive functions infemale preovulatory phase were comparable to male cognitive functions. In addition, the female postovulatory phase cognitive functions were also similar to those of males in all the tasks, except those seen in VRT and ST. Male performed better than females in VRT (M: 331.66 ms, IQR: 286.99-375.33 vs. M: 367.8 ms, IQR: 340.66-435.66; p=0.05). However, in ST, females showed higher accuracies in reading colour interferences than males (M: 100%, IQR: 95.12-100 vs. M: 95.24%, IQR: 86.36-100; p=0.04). In addition, males showed trend of a poorer performance than females in Go/No-Go VRT, ST colour reading normal time and interference time and in working-memory time. Conclusion: Male cognitive functions were comparable to female preovulatory phase cognitive functions. However, females, during postovulatory phase of their cycle, may have advantages in executive tasks (Stroop test) and disadvantages in attentional tasks (VRT), as compared to males.

Prevalence of Rubber Dam Usage During Endodontic Procedure: A Questionnaire Survey

Shashirekha G, Amit Jena, Asim Bikash Maity, Pankaj Kumar Panda

Aim: To determine the prevalence and frequency of rubber dam usage for endodontic procedures among general practitioners, specialized practitioners, undergraduate final year students and Endodontists in the state of Odisha, India. Methodology: A pre-piloted questionnaire was distributed among 737 subjects. Dentists and final year students were surveyed in relation to their prevalence of rubber dam usage. Statistical Analysis Used: Chi-square/ Fisher Exact tests have been used to find the significance of study parameters on categorical scale between two or more groups. Results: Overall response rate was 71%. While about 94% of the subjects knew the use of rubber dam, 30% have used it for root canal cases and 23% use them for all cases of root canal treatment. Use of rubber dam was 15.4% in paediatric patients and 34.4% in adult patients. 68% of subjects received knowledge about rubber dam usage in undergraduate school. 75% felt that rubber dam should be compulsory before endodontic treatment & 90% were willing to gain knowledge through training and continuing dental education programs. Conclusion: Whilst rubber dam is used frequently for root canal treatment than operative treatment, in the present survey there is a low prevalence of its usage during endodontic therapy. This presents quality issues, as well as medico-legal and safety concerns for the professional and patients alike. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry at dental school and through continuing dental education for practitioners to update their knowledge.

Comparision of Coronally Advanced and Semilunar Coronally Repositioned Flap for the Treatment of Gingival Recession

Background: Gingival Recession (GR) occurs in population with low oral hygiene levels. Root coverage may be achieved by a number of surgical techniques, including pedicle gingival grafts, free grafts, connective tissue grafts, gtr may also be used. The objective of the present study is to compare the clinical outcomes of the Semilunar Coronally Repositioned Flap (SCRF) and Coronally Advanced Flap (CAF) procedure in the treatment of miller’s class I gingival recession defects in maxillary teeth. Materials and Methods: Twenty systemically healthy patients, with isolated miller’s class 1 gingival recessions, were selected and allocated randomly into two groups, Group I and Group II with 10 patients in each. In Group I, the patients were treated with coronally advanced flap procedure with sling sutures, whereas in Group II, patients were treated with semilunar coronally repositioned flap without sutures. Results: Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean ± SD. Significance is assessed at 5 % level of significance. Student t-test (two tailed, dependent) has been used to find the significance of study parameters between baseline - 3 months and baseline - 6 months, 90% Confidence interval for mean has been computed. Conclusion: CAF provides consistently better results than SCRF With all other parameters, such as clinical attachment levels, percentage of root coverage and complete root coverage and esthetics were taken into account, caf was found to be superior. In contrary to this, there is significant increase in width of keratinized tissue in scrf group.

Red Cell Distribution Width and Serum BNP Level Correlation in Diabetic Patients with Cardiac Failure: A Cross – Sectional Study

Subhashree, A.R.

Introduction: Red cell distribution width (RDW) is a red cell measurement given by fully automated hematology analyzers. It is a measure of heterogeneity in the size of circulating erythrocytes. Studies have shown that it is a prognostic marker in non - anemic diabetic patients with symptomatic cardiovascular disease but its correlation with cardiac failure in diabetics has not been studied so far. Moreover, studies have also shown that a higher RDW may reflect an underlying inflammatory state. Since Diabetes is a pro inflammatory state there is a possibility that it might have an influence on the RDW values even when there is no cardiac failure, but research data on this aspect is lacking. B-type natriuretic peptide (BNP) is a proven marker for cardiac failure whose values are comparable with echo cardio graphic findings in assessing the left ventricular dysfunction. Aim and Objectives: This study aimed to find out the correlation between RDW% and serum BNP levels in Diabetics with heart failure (cases) when compared to those without failure (controls). Further, we compared the RDW % values of the cases with controls. Settings and Design : The study was approved by institutional ethical and research committee. A cross-sectional study was conducted with patients attending the Diabetes clinic of a tertiary care hospital in Chennai, India, during the period of October to December 2013. Hundred known cases of type II Diabetes mellitus attending Diabetes centre of the Hospital, with clinical and Echo cardio graphic features of cardiac failure were included as cases. Hundred age and gender matched diabetics with negative history of cardiovascular disease and with normal Echo cardio graphic features were included as controls. Informed consent was obtained from all the cases and controls. Demographic data and clinical history were gathered from all the cases and controls by using a standardized self – administered questionnaire. Biochemical and hematological parameters which included Fasting and Postprandial blood sugar, Glycosylated hemoglobin, Complete Blood count including RDW and serum BNP were performed for all the cases and controls. Statistical Analysis: Results were tabulated and analysed using SPSS 20.0 version Results: A statistically significant correlation (p<.001) was found between Red cell Distribution Width % and Serum B type Natriuretic Peptide values in the cases. Further, RDW% showed a statistically significant difference between cases and controls. Conclusion: RDW% can be used as a screening parameter to identify cardiac failure in Diabetic patients similar to non-diabetic cardiac failure. RDW% values are significantly higher in cases of Diabetes with failure in comparison to uncomplicated Diabetes.

Comparision of three Laboratory Tests for Detection of Ampc ß Lactamases in Klebsiella Species and E. Coli

D.L. Maraskolhe, V.S. Deotale, D.K. Mendiratta, Mrs P. Narang

Background and objective: AmpC ß lactamases are one of the important causes of drug resistance in gram negative bacteria. Failure to detect these enzymes in the laboratory has contributed to therapeutic failures but there are till date no standard guideline available. This study was therefore undertaken to evaluate three phenotypic laboratory tests and the inhibitors used in two of the tests to detect AmpC ß lactamases produced by E. coli and Klebsiella species as they are most commonly isolated organisms. Methods: E. coli and Klebsiella isolates from different clinical samples were tested for ESBLs production as per CLSI guidelines and excluded from the study. The non-ESBLs isolates were then screened for AmpC ß lactamases production, by cefoxitin and then confirmed by three different methods i.e.; Disc Potentiation Test (DPT) , Double Disc Synergy Test (DDST) and Modified Three Dimensional Test (M3DT) which in the absence of molecular methods, was taken as the gold standard. Boronic acid and cloxacillin were used as inhibitory agents in the Disc Potentiation and Double Disc synergy Tests. Results: A total of 2933 isolates were tested out of which 165 isolates were detected as non ESBLs producers,135 (81.82%) when screened for AmpC ß lactamases based on resistance to cefoxitin were labelled as positive. 30 (18.18%) cefoxitin sensitive isolates were labelled as probably non AmpC producers . M3DT, in addition to detecting all the 135 (100%) cefoxitin resistant isolates, also detected 5 (16.67%) cefoxitin sensitive isolates as AmpC producers. Other phenotypic tests, DPT and DDST with different inhibitors like boronic acid and cloxacillin in different potencies were all found to be less sensitive. The best results among these two methods were obtained with DDST using cloxacillin 500µg. Conclusion: In the absence of recommended guidelines for AmpC detection, the study reports, among the tests performed, M3DT as the best phenotypic method for AmpC confirmation, as it is not only the most sensitive but also specific test for AmpC as it rules out the resistance due to other mechanisms like the porin channel.

Correlation of Plasma Lipid Profile with Salivary Oxidative Stress Markers in Type II Diabetes Mellitus Patients

Rajeshwari S G, Afreen Arshad Choudhry, Arpitha Gururaja, Krishnananda Prabhu

Introduction: Diabetes is known to be associated with greater production of reactive oxygen species (ROS) like malondialdehyde (MDA) and decreased antioxidants like total thiols and its estimation in plasma is used in monitoring the redox status. The aim of this study was to analyse the association between plasma lipid profile parameters like HDL and LDL with salivary MDA and thiols in diabetic patients. Materials and Methods: Sixty subjects between the age group 35- 70 years who were diagnosed with type II diabetes mellitus based on fasting blood glucose and glycated haemoglobin levels who attended the dental OPD at Kasturba Medical College and Hospital, Manipal consented to participate in this study. Plasma glucose, HDL and LDL were estimated in Cobas autoanalyser by hexokinase method, homogenous enzymatic colorimetric assay and Friedwald’s formula respectively. Assessment of glycated hemoglobin was by ion exchange chromatography, MDA by thiobarbituric acid as a substrate and thiols by Ellmann’s manual method in plasma and saliva. Results: The association of plasma LDL with salivary MDA was found to be positive and significant and that with salivary thiols was negative and significant. Also, the association of plasma HDL with salivary MDA was found to be negative and significant and that with salivary thiols was positive and significant. Conclusion: Results indicate the potential of saliva as a tool to monitor prognosis of diabetes.

Tryptophan Hydroxylase 2 Gene Polymorphism in Anxiety and Depressive Disorder in Kashmiri Population

Raheel Mushtaq, Sheikh Shoib, Tabindah Shah, Sahil Mushtaq

Background: The gene of tryptophan hydroxylase is widely recognized as a major candidate gene in many psychiatric disorders. However, no study has been done which investigates tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorders in Kashmiri population (India). Objectives: To study tryptophan hydroxylase 2 (TPH2) C 11993 A gene polymorphism in anxiety and depressive disorders. Method: Sixty patients of depression disorder, 60 patients of anxiety disorder and 40 unrelated healthy volunteers (control) were studied in a case control design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fischer’s exact test, odds ratio, 95% confidence interval (C.I) and p-value of <0.05 was considered to be statistical significant. Results: The mean age ± SD of anxiety, depression and control group was 32.73±10.99, 32.20±10 and 29.75±10.12 respectively and the difference was found to be statistically non significant (p=0.349).The mean HAM-A (Hamilton rating scale for anxiety) score and HAM-D (Hamilton rating scale for depression) score was high in both groups (anxiety and depression) and found to be statistically significant (p=0.001).Depression group had AA genotype (55.2%) than control (37.5%) and was found to be statistically non significant (p=0.890).Comparison of allelic frequency revealed no association of A allele in anxiety group (76.67%) compared with control (75.5%) and was found to be statistically non significant (p= 0.866), OR 1.09 (0.56-2.11). Conclusion: TPH2C 11993 A gene was not found to be associated with major depressive disorder (MDD) and anxiety disorder in Kashmiri population.

Clinico- Pathological Profile of Adnexal Torsion Cases: A Retrospective Analysis From A Tertiary Care Teaching Hospital

Introduction: Torsion of the adnexa is a rare condition which can be potentially lethal for the women. The clinical presentation can be varied and can be seen in any age group. Understanding the clinical and pathological profile of patients suffering from adenexal torsion can guide the clinicians in diagnosing and managing the condition. Objective: To analyze the clinical and pathological profile of adnexal torsion cases in a tertiary care teaching hospital Materials and Methods: The study was a retrospective analysis of hospital records. It included all cases of adnexal torsion that underwent laprotomy between January 2007 to December 2012 in a tertiary care teaching hospital. The study was approved by the Institute’s human Ethics Committee. Results: A total of 18 patients were included in the study. Majority (66.7%) of participants were in the reproductive age group. Abdominal pain was the most common symptom seen in 77.8% of patients. The other symptoms were abdominal distension, back ache and dysuria. Majority of the women belonged to Para 2 (44.4%) and Para 3 (27.8%). The proportion of women with one and two LSCS was 11.1% and 16.7% respectively. Tenderness (38.9%), mass (22.2%) were the common per abdomen findings. Perspeculum findings were normal in majority (88.9%) of the participants. About 39.2% of the patients presented with a mass in either fornices or pouch of Douglas on pervaginal examination. The side of lesion was only on right in 9 (50%) , only left in 7(38.9%) and both sides in 2 (11.1%) of cases. On histopathological examination, of the lesions there were mucinous cystadenoma (33.3%) serous cystadenoma (16.7%) and benign cystic teratoma (16.7%) as most common lesions. Conclusion: Adnexal torsion, though a rare clinical condition can present as an emergency most of the times. High index of suspicion is required for diagnosis, as the clinical presentation can be varied. But the diagnosis can be made certain only on the operating table, either by laparoscopy. Avoiding a delay in operating upon the patient will help prevent complications, and aid in conserving the ovary.

The Role and Efficacy of Herbal Antimicrobial Agents in Orthodontic Treatment

Aims: To assess the effect of herbal antimicrobial agents on Streptococcus mutans count in biofilm formations during orthodontic treatment. Materials and Methods: We calculated the growth inhibition of oral bacteria in the orthodontic appliances after herbal antibacterial agents were placed in culture media. The Minimum Inhibitory Concentrations (MICs) of these agents on Streptococcus mutans growth were determined. After cultivating colonies of Streptococci in biofilm medium with these herbal antimicrobial agents and orthodontic attachments, viable cell counting was performed from the bacteria which were attached on them. Scanning electron microscopy (SEM) analysis of morphology was observed on bacterial cells which were attached to orthodontic attachments. The effects of these agents were then evaluated and recommendations were forwarded. Results: There was an increase in count of Streptococcus mutans with respect to the herbal antibacterial agents. Conclusion: Despite the antibacterial functions of these herbal agents, there was increase in the biofilm formation caused by Streptococcus mutans to orthodontic bands, which had occurred most likely through upregulation of glucosyl transferase expression. These extracts may thus play an important role in increased bacterial attachment to orthodontic wires. Thus, this study was corroborative of an amalgamation of Ayurvedic therapy and Orthodontic treatment.

Gradingof Extraction and Its Relationship with Post-operative Pain and Trismus, along with Proposed Grading for Trismus

Background: Extraction of mandibular third molars are somewhat a matter of interest because of its malpositioning , curved roots, proximity to vital structures due to this the procedure is often associated with post operative complications like pain and trismus. The extraction of third molar was classified in four grads according to the difficulty of the procedure. Aims: The purpose of this paper is to find any significant relationship between grading of extraction and post operative complications like pain and trismus. Materials and Methods: A total number of 180 patients need to go for extraction of third molar was included in the study. The variables taken into account were grading of extraction, pain six hour post operatively trismus one day after extraction, and trismus five day after extraction. The four grades of extractions as described by Parent in 1974 were statistically analyzed by computing pearson product moment correlation coefficient with post operative pain and trismus first and fifth day to find any co relation between them. Results: The grading of extraction was found significantly correlated with post operative pain, trismus one day after and fifth day of surgery.

Comparison of Salivary Beta Glucuronidase Activity in Chronic Periodontitis Patients with and without Diabetes Mellitus

Jaiganesh Ramamurthy, Jayakumar ND, Sheeja Varghese

Aim of the study: The aim of the study was to estimate the salivary beta glucuronidase (ß) activity in patients with chronic periodontitis with and without diabetes mellitus and to evaluate the relationship between Beta Glucuronidase activity and Periodontal clinical parameters. Materials and Methods: The study consisted of 80 patients of both sexes with age ranging from 20-60 years and they were divided into four groups. Clinical parameters such as Gingival index, Probing depth and Clinical attachment loss were measured. Salivary Beta Glucuronidase activity was measured using spectrophotometer with reagents like phenolphthalein glucuronic acid, phosphate and glycine buffer. Results: The mean BG activity of Group IV (1.17 ± 0.27) was significantly higher than mean BGA levels of Group I, II, III. The p-value was < 0.05. The mean BGA levels of Group III (0.78 ± 0.17) was significantly higher than mean BGA levels of Group I, Group II at 5 % level. There was a significant positive linear relationship between salivary ß Glucuronidase level and Probing Depth, clinical attachment level in the experimental Groups. Conclusion: The salivary ß Glucuronidase level was higher in Diabetic patients with periodontitis than nondiabetic periodontitis patients.

Chlorhexidine Chip in the Treatment of Chronic Periodontitis – A Clinical Study

Aim: The aim of this study was to clinically evaluate the use of biodegradable chlorhexidine chip when used as an adjunct to scaling and root planing(SRP) in the treatment of moderate to severe periodontitis patients. The study also intended to compare the combined therapy(SRP and Chlorhexidine chip) with chlorhexidine chip alone in individuals with periodontitis. Materials and Methods: Fifteen patients with three sites having a probing depth of 5-8mm were considered for the study. Sites were numbered 1, 2, 3 randomly. The clinical parameters assessed were the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Following baseline evaluation, on two sites scaling and root planing (SRP) was performed, no treatment was carried out in the third site. Chlorhexidine chips were placed on one site with SRP and another without SRP. A periodontal pack was placed on the site to prevent dislodgement of the CHX chip. Clinical parameters were recorded at baseline, one month and three months. Duration of the study was for three months. Statistical Analysis: T-test and Analysis of variance (ANOVA) has been carried out in the present study. Results: All three groups presented with an improvement in the clinical parameters compared to baseline. There was no statistically significant difference between the SRP and SRP + CHIP group in all parameters. There was a significant difference when these two groups were compared to the chip alone group. The mean reductions in PPD were 2.8mm (SRP group), 2.6 (SRP+CHIP group), 0.8 (chip alone group) The mean gain in CAL were 2.8mm (SRP group), 2.5 (SRP+CHIP group), 0.7 (chip alone group). Reduction in bleeding on probing were significant for the SRP and SRP +CHIP group but not for the chip alone group. Conclusion: The CHX chip did not provide any clinical benefit beyond that achieved with conventional scaling and rootplaning after a three month period.

Effect of Platelet-Rich-Plasma (PRP) and Implant Surface Topography on Implant Stability and Bone

Renu Kundu, Manu Rathee

Purpose: To evaluate the effect of Platelet-Rich-Plasma (PRP) and different implant surface topography on implant stability and bone levels around immediately loaded dental implants. Materials and Methods: Dental implants were placed in subjects divided into two groups and four subgroups on basis of implant treatment with PRP and implant surface topography used. A total of 30 implants were placed, 15 in each group. For PRP group, implants were placed after surface treatment with PRP. Temporization was done within two weeks and final prosthesis was given after three months. Implant stability was measured with Periotest at baseline, one month and three months. Bone height was measured on mesial & distal side on standardized IOPA x-rays. Results: A statistically significant difference was noticed in implant stability with PRP at baseline. The effect of PRP on bone height changes was not statistically significant. A synergistic effect of PRP and square thread-form was observed on improved implant stability and bone levels; however, no such effect is seen with PRP and reverse buttress thread-form. Conclusion: Within the limitation of this study, enhancement on implant stability and bone healing was observed with PRP treated implant surfaces, and with use of implant with square thread-form.

The Effect of Different Chemical Surface Treatments of Denture Teeth on Shear Bond Strength: A Comparative Study

Background: The development of better cross linked acrylic resin teeth has solved the problems related to wearing and discoloration of acrylic teeth. The same cross linking at ridge lap region acts as a double edge sword as it weakens the bond between denture base and tooth. Aim of Study: The purpose of study was to evaluate the effect of surface treatment on the bond strength of resin teeth to denture base resin using monomethyl methacrylate monomer and dichloromethane with no surface treatment acting as control. Settings and Design: Denture base cylinder samples in wax (n=180) were made with maxillary central incisor attached at 450 (JIST 6506). These samples were randomly and equally divided into three groups of 60 each. These specimens were then flasked, dewaxed as per the standard protocol. Methods and Material: Before acrylization, ridge lap area was treated as follows: Group A- no surface treatment act as control, Group B treated with monomethyl methacrylate monomer, Group C treated with dichloromethane. Digitally controlled acryliser was used for acrylization as per manufacturer’s instructions and shear bond strength was tested on Universal Testing Machine (Servo Hydraulic, 50kN High Strain, BISS Research). Statistical Analysis used: Result was statistically analyzed with One-way analysis of variance (ANOVA) and Post-hoc ANOVA Tukey’s HSD test at 5% level of significance. Results: The application of dichloromethane showed increased bond strength between cross linked acrylic resin teeth and heat cure denture base resin followed by monomethyl methacrylate monomer and control group. Conclusion: The application of dichloromethane on the ridge lap surface of the resin teeth before packing of the dough into the mold significantly increased the bond strength between cross linked acrylic resin teeth and heat cure denture base resin.

Non-Invasive Diagnosis of Helicobacter pylori: Evaluation of Two Enzyme Immunoassays, Testing Serum IgG and IgA Response in the Anand District of Central Gujarat, India

Context: Validation of an accurate and less cumbersome noninvasive method to detect current Helicobacter pylori infection is a requisite for any laboratory. Objectives: The purpose of this study is to corroborate the usefulness of two commercially available kits NovaTec ELISA-A and ELISA-G, in the detection of ongoing H.pylori infection. Materials and Methods: Two hundred and twenty eight consecutive serum samples of symptomatic patients who attended the endoscopy unit of “Deep” surgical hospital, Anand, which were collected during the period from 27th February 2008 to 31st august 2011, were studied. The sera were processed and tested for the detection of the H.pylori IgG and IgA antibody by using a solid phase; capture micro well ELISA, procured from Nova Tec immunodiagnostica GmbH Germany. Results: IgG ELISA showed 100% sensitivity and Negative predictive value (NPV), while IgA ELISA was better in terms of specificity (61.4%) and accuracy (63%) as compared to IgG ELISA. We found 7% (16/228) of IgA positive cases with IgG negative response. IgG response was more common in reflux esophagitis patients (OR 1.451, 95%CI-0.850-2.477) and then in gastritis (OR 0.962, 95%CI-0.570-1.621) and duodenitis(OR-0.806, 95%CI-0.112-5.827), while IgA positive response was more common in duodenitis patients (OR-1.383, 95%CI-0.191-9.995) and reflux esophagitis patients (OR 1.289, 95% CI-0.756-2.197) and least in duodenal ulcer patients (OR 0.670, 95%CI-0.222-2.029). Conclusion: IgG update is reliable and accurate test and can be expedient as a screening test and thus serve as an alternative to endoscopy. For the purpose of excluding infection with H.pylori, the performance of IgG is moderate (low specificity) but can be improved by conjunctional IgA testing which will offer some additional diagnostic value.

Ankyloglossia among Children of Regular and Special Schools in Karnataka, India: A Prevalence Study

Pavithra. M. Bai, Anna. C. Vaz

Background: Tongue-tie (more formally known as ankyloglossia) is a congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict the mobility of the tongue tip impairing its ability to fulfil its functions. Ankyloglossia is uncommon, but not rare. Incidence figures reported in the literature vary widely, ranging from 0.02% to 4.8%. Incidences of upto 10.7% have been reported. Since the literature provides no uniformity of information with regard to the incidence of tongue tie. The aim of this study was to evaluate the occurrence of tonguetie in general population and mentally challenged population, measure the grades of tongue-tie and also to determine the relations of gender with tongue-tie. Materials and Methods: Seven hundred school children in the age group of 9-17 years were examined for the presence of tongue-tie, 350 from regular schools and 350 from special schools. The presence of tongue-tie was evaluated, measured and graded into grades 1 to 5 according to KOTLOW’s method and data subjected to statistical analysis. Results: Significantly higher incidence of 16.4% population having tongue-tie was identified, of which 18.57% were from general schools and 13.71% from special schools but the differences were not statistically significant. Males showed greater incidence than females and grades I, II, III were more predominantly seen than grade IV, but the differences were not significant statistically. Conclusion: Diagnostic criteria and definitive classifying systems are needed to allow for further comparative studies.

Polarizing and Light Microscopic Analysis of Mineralized Components and Stromal Elements in Fibrous Ossifying Lesions

Introduction: Fibro-osseous lesions, along with few reactive lesions of the jaws exhibit an overlapping histo-morphologic spectrum with respect to the nature of calcifications and stromal components. This causes difficulty in assessing the origin, pathogenesis and diagnosis of these lesions. Aim: The present study analyses the mineralized components, cellularity, stromal density and stromal composition (nature of collagen, presence of elastic and oxytalan fibres) in cases of ossifying fibroma (OF), fibrous dysplasia (FD) and peripheral ossifying fibroma (POF). Materials and Methods: The study included a histochemical evaluation of six cases each of FD, OF and POF. Five consecutive sections of each case were stained with hematoxylin and eosin, picrosirius red (to assess maturation of fibres in polarizing light), van Gieson (for area fraction and collagen density) and aldehyde fuchsin (for elastic and oxytalan fibres) respectively. Results: Significantly higher amounts of mature bone were seen in FD while cementicles having microlamellar pattern were predominant in OF and POF (p < 0.001). Area fraction, collagen density and immature stromal fibre content was higher in POF followed by FD and OF (p= 0.039). Oxytalan and elastic fibres were absent in FD. Conclusion: Higher cellularity of the stroma in OF was indicative of its neoplastic behaviour. Higher composition of oxytalan and elastic fibres in OF and POF supports their periodontal ligament origin. FD was distinct with more mature fibres in a lamellated bone and absence of oxytalan fibres.

Plasmid Profile Analysis and bla VIM gene Detection of Metalo ß-lactamase (MBL) Producing Pseudomonas aeruginosa Isolates from Clinical Samples

Jayanthi S., Jeya M.

Introduction: Pseudomonas aeruginosa is a frequent colonizer of hospitalized patients. They are responsible for serious infections such as meningitis, urological infections, septicemia and pneumonia. Carbapenem resistance of Pseudomonas aeruginosa is currently increasingly reported which is often mediated by production of metallo-ß-lactamase (MBL). Multidrug resistant Pseudomonas aeruginosa isolates may involve reduced cell wall permeability, production of chromosomal and plasmid mediated ß lactamases, aminoglycosides modifying enzymes and an active multidrug efflux mechanism. Objective: This study is aimed to detect the presence and the nature of plasmids among metallo-ß-lactamase producing Pseudomonas aeruginosa isolates. Also to detect the presence of bla VIM gene from these isolates. Materials and Methods: Clinical isolates of Pseudomonas aeruginosa showing the metalo-ß-lactamase enzyme (MBL) production were isolated. The MBL production was confirmed by three different methods. From the MBL producing isolates plasmid extraction was done by alkaline lysis method. Plasmid positive isolates were subjected for blaVIM gene detection by PCR method. Results: 2076 clinical samples yielded 316 (15.22%) Pseudomonas aeruginosa isolates, out of which 141(44.62%) were multidrug resistant. Among them 25 (17.73%) were metallo-ß-lactamase enzyme producers. Plasmids were extracted from 18 out of 25 isolates tested. Five out of 18 isolates were positive for the blaVIM gene detection by the PCR amplification. Conclusion: The MBL producers were susceptible to polymyxin /colistin with MIC ranging from 0.5 – 2µg/ml. Molecular detection of specific genes bla VIM were positive among the carbapenem resistant isolates.

To Study the Levels of C - Reactive Protein and Total Leucocyte Count in Patients Operated of Open and Laparoscopic Cholecystectomy

Background: The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC). Materials and Methods: This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups. Results: There were no differences in the preoperative serum CRP and TLC concentrations – in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters. Conclusion: The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

Decontamination Methods Used for Dental Burs – A Comparative Study

Aims & Objectives: Infection control and modes of sterilizations are the key factors to avoid cross transmission of infection in the field of dentistry. Transmission of disease or infection is noted with improper sterilization of reused instruments. Dental burs are the most important tool in any endodontic or conservative procedures of teeth involving tooth contouring, restorative filling procedures and endodontic procedures. Hence, the present study is undertaken to assess the efficacy of different methods of sterilization or decontamination which are routinely used in dental clinics. Materials and Methods: For the present study 96 round diamond burs were selected and divided into 6 groups. These burs were used for the access cavity preparation to get contamination and subjected for bacteriological culture. After getting base line date burs were subjected to manual scrubbing, hot air oven, glass bead sterilizer, ultrasonic cleaner and autoclave to get post decontamination data. Results: The study revealed that mean colony forming units/ml of Streptococcus mutans decreased maximum for autoclave with 80% reduction, for Lactobacilli 76% reduction and for Candida albicans maximum reduction seen for glass bead sterilizer with 74%. Conclusion: Findings of our study revealed that none of the methods used were found to be absolutely efficacious in the decontamination of dental burs. However, among the experimental groups used in the present study, autoclave was found to be the relatively best method.

Combating Nasal Septum Deviation in Le Fort 1 Orthognathic Surgery Complications, with Submental Intubation

Introduction: Orthognathic Le Fort 1 osteotomy, a surgical procedure performed to correct the aesthetics of mid face. Some of the complications of this surgery are hemorrhage, loss of sensation due to facial nerve damage, nasal septum deviation leading to crooked nose and snoring. Nasal septum deviation is the most common complication and one of the most noticeable complications that is developed during the Le Fort 1 osteotomy. Aim: To ascertain that Submental Intubation in Orthognathic Le Fort 1 Osteotomy combats Nasal septum Deviation. Materials and Methods: Medical records and clinical data of 32 patients who underwent orthognathic Le Fort 1 Osteotomy under submental orotracheal intubation were analyzed to understand if nasal septum deviation and other complications of Le Fort 1 Osteotomy occurred in such cases based on 6 parameters. Results: No complications of nasal septum deviation or other complications that’s associated with orthognathic Le Fort 1 Osteotomy were found in the 32 cases that were analyzed. Discussion: The surgeon needs to have a non-obtrusive nasal canal so as to determine the extent to which the nasal septum needs to be reduced so that it does not cause nasal septum deviation post the procedure. Submental oratracheal intubation provides the surgeon with an excellent view of the operating field, enough space for intra oral manipulation of the bone and septum for intra oral operation and control of dental occlusion. Conclusion: Submental intubation is a better method of intubation during Le Fort 1 osteotomy as it does not cause nasal septum deviation or other associated complications.

Comparative Study of High Dose Mono-Therapy of Amlodipine or Telmisartan, and Their Low Dose Combination in Mild to Moderate Hypertension

Jaswant Goyal, Zafer Yab Khan, Prerna Upadhyaya, Barkha Goyal, Shipra Jain

Introduction: Hypertension is one of the major public health challenges worldwide. Angiotensin receptor blockers (ARBs) and Calcium channel blockers (CCBs) are among the first line antihypertensive drugs. However, optimal treatment strategies in mild to moderate hypertensives who failed to achieve blood pressure (BP) control with low-dose mono-therapy are not well established. This study was done to compare efficacy and safety of high dose mono-therapy of Amlodipine, Telmisartan and their low dose combination in mild to moderate hypertensives who failed to achieve BP control with low dose mono-therapy of either drug. Materials and Methods: A total of 96 patients, fulfilling inclusion and exclusion criteria were enrolled in the study after obtaining informed consent. Patients were randomized into three treatment groups i.e. Telmisartan 80 mg, Amlodipine 10 mg and low dose combination of Telmisartan 40 mg +Amlodipine 5 mg once daily for two months. The systolic BP, Diastolic BP, and ADRs were recorded at 0, 2, 4, 8 weeks. Results: In the present study, significant reduction of mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) was seen in all the three treatment groups. Low dose combination of Amlodipine 5 mg and Telmisartan 40 mg showed statistically significant reduction in SBP as compared to Telmisartan 80 mg mono-therapy and in DBP as compared to Amlodipine 10 mg mono-therapy. Maximum adverse drug reactions (ADRs) were reported in Amlodipine mono-therapy group, like ankle oedema, constipation, headache and fatigue. Discussion and Conclusion: In term of BP control, low-dose combination therapy appears a better therapeutic approach than high-dose mono-therapy.

Evaluation of the Hepato and Nephron-Protective Effect of a Polyherbal Mixture Using Wistar Albino Rats

Onyekachi Ogbonnaya Iroanya, Olumide Adedapo Adebesin, Joy Okpuzor

Aim:A polyherbal formulation prepared from a mixture of leaves of Gongronema latifolia, Ocimum gratissimum and Vernonia amygdalina (GOV) was evaluated for hepato-nephro protective properties against acetaminophen-induced toxicity in Wistar albino rats. Materials and Methods: Normal Wistar albino rats were orally treated with different doses of GOV extract (2, 4 and 8 g/kg b. wt), distilled water and some standard hepatoprotective drugs such as Liv 52 and silymarin for 14 days. However, a day prior to the 14th day, 3 g/kg body weight dose of Acetaminophen (APAP) was administered p.o. 1h before GOV and the standard drugs to induce hepatic and renal damage. The normal control was setup which received only distilled water. The serum levels of liver marker enzymes, biochemical analytes, antioxidant enzymes and hematological parameters were monitored. Results: The results showed that pretreatment of experimental animals with a different doses of the polyherbal formulation dose dependently caused a significant (p=0.05) increase in the levels of most of the measured hematological parameters but significantly (p=0.05) reduced the levels of MCV and monocytes when compared to the APAP induced toxin control group. Rats pretreated with GOV exhibited significant (p< 0.05) increase in serum levels of ALP, ALT, AST, GGT, LDH, Cholesterol, Triglycerides, Urea and a subsequent decrease in Albumin, Creatine and Total protein when compared to the normal rats. This trend in enzyme and biochemical analytes levels were significantly (p< 0.05) reversed when compared to toxin control group. GOV significantly (p< 0.05) and dose dependently increased the serum, kidney and hepatic CAT, GPx, GSH, GST, SOD and total protein activity in APAP induced damage in rats compared to the toxin control groups. Conclusion: The data from this study suggest that the polyherbal formulation possess hepato and nephron-protective potential against acetaminophen induced hepatotoxicity in rats, thus providing scientific rationale for its use in traditional medicine for the treatment of liver diseases.

Comparative Study of Lithotripsy and Pcnl For 11-15 mm Lower Caliceal Calculi in Community Health Hospital

Narendra Haribhau Wankhade, Jayant Gadekar, Babaji B. Shinde, Julie Anand Tatte

Background and Purpose: Percutaneous Nephrolithotomy (PCNL) is not a popular procedure in smaller sized calculi due to its invasive nature, complications and need for anesthesia. Small sized lower caliceal calculi are generally treated by ESWL but have significantly less clearance rate in spite of several sittings. Here we want to study the efficacy and safe of both procedures in 11 to 15 mm lower caliceal calculi. Materials and Methods: We present comparative study of lithotripsy and PCNL in 11-15 mm lower caliceal calculi in our hospital. Total 156 patients were studied 78 underwent lithotripsy and 78 underwent PCNL. We compared results in the form of clearance rate, the number of settings needed, hospital stay, need for anesthesia, blood transfusion rate, chest complication, the incidence of sepsis, the need for another procedure, need for stenting in either group. Results: We found a 67.95% clearance rate in SWL group and 97.43% clearance rate in PCNL group. Hospital stay was minimum in SWL group and was 46 hours in PCNL group. The procedure time was 42 minutes in PCNL and it was 114 mins in SWL (considering all settings). The rest of the complications like chest complication, sepsis and bleeding were negligible due to the small size of calculi. Conclusion: In a small sized LPC calculi, PCNL is gaining increased popularity due to lower complication and high safety and complete clearance rate. It is wide accepted by society as the patient is totally stone free at the end of the procedure. SWL is less invasive but less effective and has given significant discomfort to patients

Waging War Against Extended Spectrum Beta Lactamase and Metallobetalactamase Producing Pathogens- Novel Adjuvant Antimicrobial Agent Cse1034- An Extended Hope

Manisa Sahu, Sanjith S, Pallavi Bhalekar, Dipti Keny

Preamble: In the visage of multidrug resistance among gram negative bacilli, we look forward to carbapenem group of drugs as empiric choice in seriously ill patients. However increasing resistance to carbapenems, the last resort, is of growing concern for all. It’s high time to look beyond Carbapenems and emphasize on Carbapenem sparers. Objective: This study is to find the susceptibility pattern of the novel adjuvant antimicrobial CSE 1034 a combination of Ceftriaxone+sulbactam+disodium edetate for the current ESBL and MBL isolates in a tertiary care centre. Materials and Methods: A total of 823 gram negative bacterial isolates were obtained from different clinical specimens during the period of March, 2013 to October, 2013. The overall prevalence of metallobetalactamase producing gram negative organisms was 11 percent (n=91). We included a total of 141 clinical isolates for this study. Results: Among 141 clinical isolates, 50 isolates (35%) were ESBL producers and 91 (65%) were MBL producers. Maximum numbers of ESBL producers were identified in Escherichia coli followed by Klebsiella pneumoniae, Acinetobacter baumannii and Proteus spp. Maximum numbers of MBL producers were identified in Klebsiella pneumoniae followed by Pseudomonas aeruginosa. CSE 1034 (Ceftriaxone+sulbactam+disodium edetate) showed fairly good in-vitro susceptibility for these ESBL and MBL producing isolates. It exhibited 64 % to 100% susceptibility and 18% to 22% intermediate sensitivity to ESBL producing isolates and 42 % to 89 % susceptible and 10 % to 51 % intermediate response to MBL producing isolates. Conclusion: With increasing resistance to the commonly prescribed drugs used to treat infections caused by variety of gram negative organisms, Ceftriaxone+sulbactam+disodium edetate, a novel Antibiotic Adjuvant Entity (AAE) may be a promising option.

Radiographical Study Showing Asymmetry in the Surface Area of Carpal Bones in Malnourished Children

Shelja sharma, Vivek Mishra, Vasundhra Kulshreshtha

Background: Protein energy malnutrition, a major health and nutritional problem in India, leads to retardation in bone maturity and eventually physical growth. Many studies have been done on ossification centers of hand bones for estimation of skeletal maturation and to diagnose malnutrition but very few studies have been done so far to see effect of protein energy malnutrition on surface area of carpal bones. Aims and Objectives: The surface areas of carpal bones on radiographs on both sides were calculated, analysed and compared in protein energy malnutrition (PEM) cases and healthy controls upto five years of age to see the variability among study groups. Materials and Methods: The study was conducted in Departments of Paediatrics, Radiodiagnosis and Anatomy of S.N. Medical College, Agra, India consisting of 68 PEM cases and 68 controls of either sex upto five years of age. Radiography of wrist done and surface areas of carpal bones were calculated by using millimeter Graph Transparency paper by Hit method and data were evaluated for significance by using t-test. Result: The surface areas of capitate, hamate and triquetral bones of both hands were reduced in PEM children of all grades as compared to healthy controls. The surface areas of these carpal bones were much reduced in grade 2 and grade 3 PEM cases as compared to healthy controls and grade 1 PEM cases. Asymmetry in surface areas of capitate and hamate bones were ascertained in healthy controls and grade 1PEM cases but due to delay in appearance of ossification centers and reduced surface areas of these bones, asymmetry could not be ascertained in grade 2and grade 3 malnutrition children. Conclusion: The surface areas of capitate, hamate and triquetral bones on both sides were reduced in grade 2 and grade 3 PEM cases as compared to controls. Asymmetry in surface area of carpal bones was ascertained in healthy controls and grade 1 PEM cases.

Stressing ‘Mental Stress’ in Hypertension: A Rural Background Study

Background: Modern life is full of hassles, deadlines, frustrations and demands. Mental stress or psychosocial stress is one of the major risk factor for hypertension which itself is the risk factor for various other cardiovascular diseases. Objectives: To find out the prevalence of hypertension among rural study population above 40 years of age and analyze the relationship between mental stress and Hypertension amongst them. Methodology: A cross-sectional descriptive study was undertaken in rural Maharashtra from January 2007 till December 2008. Systematic random sampling was done to cover 3600 sample size above 40 years of age. A protocol was devised containing requisite items of socio-demographic data and data was collected from individual households with the help of ancillary staff. Mental stress score based on Presumptive stressful life event score (PSLES) was used. For statistical analysis, Chisquare test, F-test and Z-test were used. Results: Prevalence of hypertension was found to be 5.92%. Males had maximum cases of hypertension [169 (7.27%)] compared to females [44 (3.44%)] which was statistically significant (?2 = 21.63, p < 0.001). The rise in number of cases with increasing age was observed. Significant number of cases [127 (7.68%, p= 0.00006)] were found in study population belonging to ‘More stress’ group. Mean mental stress score of hypertensive study subjects was significantly higher (219) than normotensive study subjects (157). Males had significant higher stress score in both hypertensive and Normotensive group. Conclusion: Total 213 cases of hypertension were detected (5.92%). As the stress increases, risk of hypertension increases. Statistically significant association was found between mental stress and hypertension for males. But in females, no such association was found. Mental stress definitely acts as risk factor for hypertension. Invention, propagation and practical application of various stress relieving measures & exercises should be done.

Clinical Examination Allied to Ultrasonography in the Assessment of New Onset Gynaecomastia: An Observational Study

Ruvinder Kaur Athwal, Rosamund Donovan, Mehboob Mirza

Aim: New onset gynaecomastia is a relatively common presentation to breast surgical services. The main aim of clinical and radiological evaluation is to exclude the presence of concurrent breast cancer. There exists much variability in the clinical assessment of male patients presenting with new onset gynaecomastia. Materials and Methods: In the presented pilot study, all the male patients presenting with new onset gynaecomastia to our department over a period of two years were studied. Results: Fifty three patients presented with new onset gynaecomastia during the study period. Clinical examination allied with ultrasonography confirmed benign breast disease in 50 patients with only three patient requiring breast biopsy to exclude malignancy. We detail the efficacy of utilising clinical examination in conjunction with ultrasonography to evaluate new onset gynaecomastia. Conclusion: We show that clinical examination used in conjunction with ultrasonography is both highly sensitive and specific for detecting male breast cancer in patients presenting with new onset gynaecomastia.

Dermatology Specific Quality of Life in Vitiligo Patients and Its Relation with Various Variables: A Hospital Based Crosssectional Study

Nitin Mishra, Madhur K. Rastogi, Pratik Gahalaut, Shikha Agrawal

Introduction: Vitiligo is an acquired, idiopathic skin disease characterized by progressive loss of the inherited skin color. Vitiligo has a special significance to patients in our country because depigmentation is obvious on dark skin and due to the enormous stigma that the disease carries. Materials and Methods: One hundred vitiligo patients aged more than 18 years were included in our hospital based study depending on inclusion and exclusion criteria. All the patients were asked to fill a validated Hindi version of DLQI questionnaire. DLQI scores and its interpretation were recorded separately. Correlation of DLQI scores with different variables like age, body surface area, duration of disease and socioeconomic status were studied using Pearson’s correlations. Mean DLQI scores were also compared between different groups. Results: Male and female patient were statistically similar in all variables, like their age, BSA of the involvement and DLQI score. DLQI interpretation showed that out of 100 patients of vitiligo, 16 felt no effect of vitiligo on their quality of life while 84 patients reported small to very large effect on their quality of life. Out of this 84, 37 felt small effects, 21 felt moderate effect and rest 26 felt very large effect on their quality of life. There was no significant difference among the different groups mentioned except very large effect on quality of life seen significantly more in unmarried patients compared to married one. Conclusion: Vitiligo although a cosmetic disease without any symptoms, it carry a significant social stigma especially in Indian society. Data interpretation in this study indicates that vitiligo affects QOL in majority of vitiligo patients and such patients require more aggressive and empathic attitude from a dermatologist to cure/improve this so called chronic cosmetic disease.

Comparative Efficacy of Two Different Dosages of Intrathecal Magnesium Sulphate Supplementation in Subarachnoid Block

Binesh Kathuria, Neeru Luthra, Aanchal Gupta, Anju Grewal, Dinesh Sood

Background: Spinal anaesthesia is the primary anaesthetic technique for many types of surgeries. Adjuncts to the local anaesthetics (LA) used in spinal anaesthesia can exhibit undesirable side-effects like respiratory depression, urinary retention, pruritis, haemodynamic instability and nausea and vomiting, limiting their use. Magnesium when used in therapeutic doses avoids all of these side-effects. Materials and Methods: We conducted a randomized double blind study on 90 patients, 30 in each group, scheduled for orthopaedic lower limb surgery under subarachnoid block. Group I: received bupivacaine (0.5%), 12.5 mg + 0.5 ml of preservative free 0.9% normal saline, Group II received bupivacaine (0.5%), 12.5 mg + 0.2 ml (50 mg) of preservative free 25 % magnesium sulphate + 0.3 ml of preservative free 0.9% normal saline Group III: received bupivacaine (0.5%) 12.5 mg + 0.3 ml (75 mg) of 25 % magnesium sulphate + 0.2 ml of preservative free 0.9% normal saline for subarachnoid block. The onset and duration of sensory block, the highest dermatomal level of sensory block, motor block, time to complete motor block recovery and duration of spinal anaesthesia were recorded. Statistical Analysis: ANOVA was applied to determine the significance of difference between different groups. If p-value was significant then Turkey’s Post Hoc Multicomparison test was applied. Values of p<0.05 were considered to be statistically significant. Results: The time of maximum sensory block, time of onset of motor block, duration of sensory block, duration of motor block and time of analgesia request were prolonged in patients given magnesium 50mg and 75mg along with local anaesthetic intrathecally. Conclusion: N-methyl-D-aspartate (NMDA) receptor antagonist, magnesium when administered intrathecally along with local anaesthetics prolongs the duration of spinal analgesia without adverse effects.

Isolation of MRSA, ESBL and AmpC – ß –lactamases from Neonatal Sepsis at a Tertiary Care Hospital

Background and Objectives:The emergence of methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum ß– lactamases (ESBLs) in neonatal intensive care unit patients is increasing.This study aims to find out the bacteriological profile in neonatal sepsis and study their antimicrobial susceptibility pattern including detection of MRSA and ESBLs. Materials and Methods:This study was conducted for a period of one and a half years from January 2010 to June 2011 in a tertiary care hospital in Chennai. A total of 182 blood samples were collected using sterile precautions. They were processed following standard laboratory protocol. Antibiogram was done using appropriate antibiotics by Kirby-Bauer disc diffusion method. Isolated Staphylococcus aureus were tested for methicillin resistance using Cefoxitin disc (30µg), ESBL was detected using combined disc method, MIC reduction and Polymerase chain reaction, metallobetalactamases using EDTA and Amp-C beta lactamases using Amp-C disc test. C-reactive protein (CRP) was estimated for all the cases. Results:Out of the 182 cases, 110 (60.4%) were culture positive. 55 (63.9 %) of early onset sepsis cases had Gram negative bacteria (GNB) and 19 (79.1%) of late onset sepsis cases had Gram positive bacteria. Out of the total pathogens, 31 (28.1%) were Klebsiella pneumoniae and 30 (27%) were Staphylococcus aureus. 17 (56.6 %) of Staphylococcus aureus were found to be MRSA and they were 100% sensitive to Vancomycin. 33 (67.3%) of Enterobacteriaceae were ESBL producers. ESBL isolates were 100% sensitive to Imipenem. 3 (6.1%) of Enterobacteriaceae were AmpC producers and 3 (27.2%) of Pseudomonas aeruginosa were MBL producers.CRP was positive in 99 (54.3%) cases, out of which 94 (94.9%) were culture positive. Conclusion:Klebsiella spp. and Staphylococcus aureus were the commonest bacteria causing neonatal sepsis in this centre. Multidrug resistance among the isolates was common. Early diagnosis and institution of specific antibiotics after studying the sensitivity pattern will help in reducing neonatal morbidity and mortality and prevent emergence of drug resistant strains.

Genetic Polymorphism of Interleukin-18 Gene Promoter Region in Rheumatoid Arthritis Patients from Southern India

Background:Interleukin-18 (IL-18) is a pro inflammatory cytokine which plays a key role in the acute and chronic inflammatory phases of Rheumatoid Arthritis (RA). The Single Nucleotide Polymorphisms (SNPs) of IL-18 gene promoter region at positions -137 and -607, are postulated to be associated with RA. To test this, this study aimed to identify the association between these SNPs of the IL-18 gene promoter region of RA in south Indian patients. Materials and Methods:This study was carried on 190 subjects among which 90 were RA patients and 100 were age and sex matched controls. Genomic DNA was extracted by Salting out method. IL 18 gene promotor region SNPs, IL 18 - 607 and IL 18 -137 were amplified by using sequence specific primers. The amplified products of different samples were separated by using a 1.5% agarose gel, stained with ethidium bromide and photographed. All statistical analyses were carried out by using SYSTAT 12 software. Results:At position 607, the frequencies of C allele, CC genotype, A allele and AA genotype were found to be significantly higher in patients and controls respectively and there was no significant difference in CA genotype. At position 137, there was no significant difference between the two groups with regard to G and C allelles but there was a significant increase in GG genotype of patients and CC genotype of controls. There was no association between duration of morning stiffness, rheumatoid factor positivity or negativity, age of onset and gender with distribution of genotypes and alleles. Conclusion:C allele, CC genotype at position -607 and GG genotype at position -137 are risk factors and A allele, AA genotype at position -607 and CC genotype at position -137 have protective effect for RA.

High Resolution Computed Tomography Lung Spectrum in Symptomatic Adult HIV-Positive Patients in South-East Asian Nation

Background: Pulmonary infections remain a leading cause of morbidity and mortality and one of the most frequent causes of hospital admission in HIV infected people worldwide. HRCT may be useful in the evaluation of patients with suspected pulmonary disease. The aim of given study was to determine the High Resolution Computed Tomography spectrum of lung parenchymal and interstitial imaging findings in HIV infected patients presented with chest symptoms. Materials and Methods: This study was conducted in a tertiary health care centre, New Delhi, India. The study consisted of 45 patients. A thorough clinical history of all the HIV positive patients presenting with suspicion of pulmonary disease was taken. General physical and respiratory system examination of all patients was done HRCT scans of the chest were done in all the cases taken in the study. Results: Maximum number of patients was in age group 31-40 years (24 cases). Out of 45 patients included in our study, 32 (71%) were male and 13 (29%) were female. In our series of 45 patients, 62.2% of patients were diagnosed as having pulmonary tuberculosis, followed by bacterial infection in 20% cases and Pneumocystis jiroveci pneumonia (PJP) in 8.9% patients, while 8.9% of the study did not reveal any significant abnormality. Maximum number (22/28) of patients with pulmonary tuberculosis were indentified to have nodular opacities. The most common HRCT finding in bacterial infection was lobar consolidation. The most common HRCT finding in patients with PCP was diffuse ground glass opacities in mosaic pattern of distribution. Conclusion: HRCT is a highly sensitive tool for detecting lung parenchymal and interstitial lesions and allows better characterization of the lesions. HRCT findings should always be correlated with clinical findings, CD4 counts and other available investigations before arriving at a diagnosis or differential diagnosis.

Comparison of 128-Slice Dual Source CT Coronary Angiography with Invasive Coronary Angiography

Rajneesh Madhok, Abhinav Aggarwal

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India as well as worldwide and last decade has seen a steep rise in incidence of CAD in India. Direct visualization of the coronary arteries by invasive catheterization still represents the cornerstone of the evaluation of CAD. Cardiac imaging is a challenge of 21st century and is being answered by 128 slice dual source CT as it has good temporal resolution, high scanning speed as well as low radiation dose. Aim: To assess the diagnostic accuracy of 128-slice dual source CT Cardiac Angiography in comparison with Conventional Catheter Cardiac Angiography. Materials and Methods: Forty patients attending the cardiology OPD with complaint of chest pain and suspected of having CAD were evaluated by CT coronary angiography and conventional invasive Catheter coronary angiography and the results were compared. All patients were checked for serum creatinine and ECG before the angiography. Computed Tomography (CT) coronary angiography was done using SIEMENS 128-slice Dual Source Flash Definition CT Scanner under either Retrospective or Prospective mode depending on the heart rate of the patient. Oral/IV beta-blocker were used whenever required. Results: Coronary arteries were assessed as per 17-segment AHA model. A total of 600/ 609 segments were evaluable in 40 suspected patients on CT coronary angiography, of which 21 were false positives and 8 were false negatives with specificity of 95.12% and sensitivity and positive predictive value of 95.26% and 88.46% respectively. Conclusion: Non-invasive assessment of CAD is now possible with high accuracy on 128-slice dual source CT scanner.

Brainstem Auditory Evoked Potentials (BAEP)- A Pilot Study Conducted on Young Healthy Adults from Central India

Objective: To Evaluate I, II, III, IV, V wave latencies and I-III, III-V, I-V inter-peak latencies and V/I wave amplitude ratio in Normal subjects in Central India. Methods: We recorded BAEP from 50 healthy normal subjects from the community of same sex and geographical setup. The absolute, interpeak and wave V/I amplitude ratio were measurement and recording was done using RMS EMG EP MARK II machine manufactured by RMS recorders and Medicare system, Chandigarh. Result: Absolute, interpeak and wave V/I amplitude ratio were measured in normal subjects and compared with other previous studies. Conclusion: This study was conducted as exploratory pilot study only on male healthy controls. Since, the study conducted in different regions, there are some differences in the latencies and interpeak latencies and amplitude ratio but they are within range, so reference range of this study can be used for future studies in this Wardha region of Central India.

Association of High Sensitivity C-Reactive Protein with the Components of Metabolic Syndrome in Diabetic and Non-Diabetic Individuals

Background and Objectives: High sensitivity C-reactive protein (hsCRP) has been associated with metabolic syndrome (MetS) and its components. Several studies have suggested hsCRP to be used as a marker for the primary prevention of cardiovascular diseases. So, we aimed to evaluate the association between hsCRP levels and the components of MetS in diabetic and non-diabetic population. Materials and Methods: Type II diabetic patients (T2DM) (n= 121) and healthy controls (n= 121) were enrolled for the study. Anthropometric measurements were taken along with blood pressure from the arm. Ten ml of blood was collected after overnight fasting for the measurement of lipid profile, hsCRP, C-peptide and glucose levels. Insulin resistance (HOMA2-IR) was estimated by HOMA2 calculator utilizing glucose and C-peptide values. All participants were classified into two groups on the basis of the presence or absence of MetS. Data were analysed through SPSS 14 software. Results: hsCRP, C-peptide and HOMA2-IR were significantly higher in T2DM subjects when compared with controls. As the number of the components of MetS increased, there was a linear increase in hsCRP levels in whole study population (p trend <.001), diabetic subjects (p trend <.001), as well as in controls (p trend <.001). HOMA2-IR and hsCRP levels were found to be better than LDL cholesterol and waist circumference for predicting the presence of MetS. Conclusion: hsCRP was found to be better than LDL cholesterol and waist circumference for the prediction of MetS. Hence, hsCRP could be used as a defining marker of MetS in the near future.

Pharmacotherapy of Bipolar Affective Disorder: A Hospital based Study from Sub Himalayan Valley of Nepal

Introduction: In Bipolar disorder the mood of the patients fluctuates between depression and mania. The main objective of the study was to find out the commonest mood stabilizers used for the treatment of Bipolar affective disorders in Western Nepal in hospitalized patients in an actual clinical set up. Methods: This was a cross-sectional study which was conducted between October 2009 and September 2010 at Psychiatric ward at Manipal teaching hospital, Pokhara, Nepal, a tertiary care hospital situated in Western Nepal. The diagnosis of the disease was based on ICD-10 (Tenth revision) Classification of mental and Behavioural disorders, Diagnostic Criteria for Research. We calculated odds ratio and their 95% confidence intervals (95% CI). p<0.05 was considered as statistically significant. Results: 62.1% of the patients were less than 40 yrs, 56.3% were male, 72.4% were unemployed and 75.9% of the patients were having monthly income <10,000/month. As far as ethnicity is concerned 37.9% of the cases were Brahmin and by occupation 29.9% of the patients were students followed by housewife 25.3%, labour 17.2%, retired 13.8% respectively. Drugs and Psychotherapy [OR 1.4, 95% (CI 0.575, 3.4017] was prescribed in age <40 years as compared to age>40 yrs. Male patients [OR 7.22, 95% (CI 0.862, 60.499)] and [OR 2.353, 95% (CI 0.857, 6.455)] received drugs by trade names and drugs not from the national drug list of Nepal as compared to females. Monthly income <10,000/month and [OR 2.8, 95% (CI 0.742, 10.56)] tendency of receiving drugs by trade names. Among the mood elevators Sodium valproate was the commonest drug to be prescribed in 51/87(58.6%) patients followed by Lithium in 30/87 (34.5%) cases and Carbamazepine in 6/87 (6.9%) cases. Sodium valproate was prescribed at 1,000 mg/day, Lithium was prescribed at 900 mg/day in and Carbamazepine was prescribed at 800 mg/day. Conclusion: Among all the mood elevators Sodium valproate is the commonest drug prescribed for the treatment of bipolar affective disorder, recommended that there is a trend of using newer drugs like sodium valproate rather than the conventional mood stabilizers like Lithium for bipolar affective disorder in Western Development region of Nepal.

Mural Adenomatoid Odontogenic Tumour as Anterior Mandibular Swelling: A Diagnostic Challenge

Chhavi Jindal, Reena Bhola Sarkar, Jessica Grewal, Ripin Grewal, Arun Bansal

Adenomatoid odontogenic tumour is an uncommon, benign, hamartomatous lesion that commonly affects the anterior maxilla and has two radiographic variants, follicular and extrafollicular where the former is more common than the latter. Here, we report a case of 15-year-old female with midline swelling of the mandible. Radiographically, impacted right permanent mandibular canine was associated with the radiolucent lesion. Dentigerous cyst was given as provisional diagnosis. However, histologically the lesion represented the features of cystic variant of Adenomatoid odontogenic tumour.

A Simplified Technique for Fabrication of Orbital Prosthesis

Neeraj Sharma, G.K.Thakral, Abhilash Mohapatra, Jyotsna Seth, Pallavi Vashisht

Eye is a vital organ not only for vision, but also an important component of facial expression, and over-all personality of a person. Loss of eye, apart from leading to impaired vision has a crippling effect on the psychology of the patient. Prosthodontic rehabilitation of such cases includes fabrication of prosthesis by acrylic resin, silicone and implants. However, not all patients are willing to use implants for maxillofacial rehabilitation. Therefore, a custom made orbital prosthesis serves as an affordable and satisfactory alternative.

Role of CT Imaging with Volume Reconstruction in Hemi Facial Hypertrophy: A Pediatric Case Report

Gurubharath I., Lakshmi Sudha Prasanna Karanam, Ramesh P

Hemifacial hypertrophy is a rare congenital disorder more common in males.It involves the soft tissue, hard bones and teeth of the face.Its etiology is unknown and multiple theories have been postulated. We present a 6-year-old male with hemifacial hypertrophy and describes the importance of CT volume reconstruction in this condition.

Myofibroblastoma of Female Breast Masquerading as Schirrous Malignancy – A Rare Case Report with Review of Literature

K Bharathi, VS Ajay Chandrasekar, G Hemanathaatha n, S Anuradha

Myofibroblastoma is a rare benign mesenchymal tumour of the breast commonly reported in males. It is a spindle cell neoplasm exhibiting myofibroblastic differentiation with characteristic immunohistochemical staining. Herein, we present a case of myofibroblastoma in a premenopausal female which was mimicking like malignancy clinically. Lump was growing rapidly in size measuring 8 cm x 6 cm and stony hard in consistency. Mammogram showed a large homogeneous hyperdense lump suggestive of fibroadenoma, Hamartoma and fibromatosis. FNAC and trucut biopsy of mass could not be done due to stony hard consistency. Hence excision biopsy was done. Histopathological examination revealed the tumour as myofibroblastoma. Immunohistochemical staining for markers of myofibroblasts like CD-34 and Vimentin showed strong positivity. A negative expression for cytokeratin was noted. This case is presented for its rarity, unusual clinical presentation and stony hard consistency.

Management of Dilacerated and S-shaped Root Canals - An Endodontist’s Challenge

Nasil Sakkir, Khaleel Ahamed Thaha, Mali G Nair, Sam Joseph, Christalin R

The unique morphology of dilacerated and S-shaped root canals often pose utmost challenges in their endodontic management. Common causes of failures in such cases are primarily related to procedural errors such as ledges, fractured instruments, canal blockages, zip and elbow creations. Knowledge of dental anatomy and its variations is essential for the success of endodontic treatment. A clinician is required to have an insight of the morphology of tooth related to its shape, form and structure before commencing treatment. Routine periapical radiographs aids in assessing these morphological variations in the root canal system. This article gives a review of the literature and reports an interesting case of dilacerated and S-shaped root canals of adjacent teeth in the same patient.

Non-pigmented Strain of Serratia Marcescens: An Unusual Pathogen Causing Pulmonary Infection in a Patient with Malignancy

Priyamvada Roy, Nishat Hussain Ahmed,R. K. Grover

Serratia marcescens is a member of the family Enterobacteriaceae. It has emerged in recent years as an opportunistic pathogen of nosocomial infections. Some biotypes of Serratia marcescens produce the non-diffusible red pigment prodigiosin. Though both pigmented and non-pigmented biotypes may be pathogenic for humans, the non-pigmented biotypes are more virulent due to cytotoxin production and presence of plasmids mediating antibiotic resistance. However in India only one study done 31 years back has reported on infections caused by non-pigmented strains of Serratia marcescens. We present a case of a patient with squamous cell carcinoma of the left retromolar trigone, soft palate and buccal mucosa, who developed pulmonary infection with non-pigmented strain of Serratia marcescens. According to the available literature, this is the second report on infection with non-pigmented strain of Serratia marcescens from India. It is imperative to accurately detect the non-pigmented biotypes due to their tendency to cause serious and difficult to treat infections.

Multidrug Resistant Shigella Flexneri: A Rare Case of Septicemia in an Infant

Sanjay Jain, Mukesh Sharma, Raju Gupta, Neetu Shree, Manoj Kumar

Shigellosis is still an important public health problem in developing and under-developed countries. It may lead to rare but potentially fatal various extra intestinal complications like septicemia, involvement of CNS, urinary tract and liver especially in young malnourished children. The disease is difficult to prevent as only few bacteria are required for causing infection and there is increasing infection with multi drug resistant strains. A 6-month-old infant developed septicemia caused by multi drug resistant Shigella flexneri during an episode of gastrointestinal infection. The patient was managed in the emergency ward but unfortunately the infant expired. Considering septic shock, blood culture, stool culture and other relevant investigations were done. Stool as well as blood culture yielded Shigella flexneri. The isolates were multidrug resistant. Following is a rare case presentation of Shigella septicemia with severe shock, DIC and convulsions. The case report demonstrates how shigellosis can lead to a rare life threatening complication and hence should be considered as a possibility in septicemia associated with diarrhea and vomiting in infant and young children.

Multiple Abdominal Veins Thrombosis Secondary to Protein S Deficiency - A Case Report

Abdominal venous thrombosis may present either as Budd-Chiari syndrome (BCS) caused by hepatic vein or proximal inferior vena cava (IVC) obstruction or as an extra hepatic portal obstruction (EHPVO) caused by Portal vein thrombosis or mesenteric vein thrombosis, but a mixed involvement is uncommon. Multiple abdominal venous obstructions presenting with thrombosis of hepatic vein, IVC, portal vein and renal vein are very rarely seen . We are reporting a rare case with thrombosis of IVC, hepatic vein, portal vein and renal vein, with protein S and protein C deficiencies, which was managed by giving anticoagulant therapy.

Atrophic Rhinitis Presenting with Ethmoidal Mucocele: A Case Report

Atrophic rhinitis (AR) is a chronic debilitating nasal mucosal disease predominantly prevalent in tropical countries. In the present case a 70-year-old female presented with a swelling in the right medial canthal area for six months and had features of Atrophic rhinitis with large septal perforation leading to saddle nose deformity. Computed tomography pictures were suggestive of ethmoidal mucocele and was later decompressed endoscopically. The sequelae and complications of AR like nasal septal perforation, saddle nose deformity, chronic rhinosinusitis (CRS), local and systemic spread of infection, atrophic pharyngitis, laryngitis, dacryocystitis and nasal myiasis have been reported in literature. To the best of our knowledge, this is the first reported case of AR presenting with ethmoidal mucocele. A case of AR with CRS is to be treated with caution as it can lead to complications as it is often neglected.

Anything Rare is Possible: Letrozole Induced Eczematous Skin Eruption

Letrozole is used as first line drug in postmenopausal women with early-stage or advanced hormone-sensitive breast cancer. Letrozole has favourable tolerability profile when administered once daily and significant adverse reactions occur rarely. The objective of this report is to describe a case of eczematous skin eruption that occurred during letrozole treatment. A 61-year-old female patient was admitted with lump in the left breast. FNAC, HPE were done and the patient was diagnosed to have invasive ductal breast carcinoma. After a month of completing CT and EBRT, the patient was given 2.5 mg OD tab. letrozole at night. She developed itchy skin lesions over the right thigh that later generalised, at 6- weeks of treatment. The lesion has been defined as eczematous moderate to severe drug eruption. These lesions were attributed to letrozole therapy and recurred within 24h after rechallenge. Drug eruption is associated with many drugs but this is the first such report with letrozole. We suggest of being aware of such reactions during letrozole usage.

Cleidocranial Dysplasia: A Case Report Illustrating Diagnostic Clinical and Radiological Findings

Sarbjeet Singh, Sumeet Sharma, Harvinder Singh, Nikhil Dev Wazir

Cleidocranial dysplasia (CCD) is a rare congenital defect, primarily affecting bones, undergoing intramembranous ossification. CCD presents with skeletal defects of several bones, the most striking feature of which are partial or complete absence of clavicles, late fontanels closure, and presence of open skull sutures and multiple wormian bones. These patients may be first noticed by the dentist because of the aesthetic problems or delayed eruption of teeth experienced by the patient. Here, we report a typical case of CCD in a 15-year-old female who had classical diagnostic feature of this syndrome.

Endodontic Treatment of A Maxillary First Molar with Seven Root Canals Confirmed with Cone Beam Computer Tomography – Case Report

Jorge N. R. Martins

The most common configuration of the maxillary first molar is the presence of three roots and four root canals, although the presence of several other configurations have already been reported. The objective of this work is to present a rare anatomic configuration with seven root canals diagnosed during an endodontic therapy. Endodontic treatment was performed using a dental operating microscope. Exploring the grooves surrounding the main canals with ultrasonic troughing was able expose unexpected root canals. Instrumentation with files of smaller sizes and tapers was performed to prevent root physical weakness. The anatomic configuration was confirmed with a Cone Beam Computer Tomography image analysis which was able to clearly show the presence of seven root canals. An electronic database search was conducted to identify all the published similar cases and the best techniques to approach them are discussed.

Churg Strauss Syndrome – A Case Report

Mallik Arjun Shetty, Ramakrishna Janapati, Krishnaprasad A, Nageshwara Rao M

A male aged 45-years presented with complaints of fever for 7days, cough, breathlessness for 4 days, tingling of hands, feet and weakness of both hands and feet for 4 days duration. He was a known asthmatic with history of recurrent sinusitis in the past. On examination he had bilateral polyphonic wheeze and evidence of distal asymmetric sensory neuropathy with motor weakness. And on investigation he had eosinophilia, pulmonary function test showed reversible airway obstruction,nerve conduction studies revealed mononeuritis multiplex, muscle biopsy suggestive of eosinophilia infiltration, nerve biopsy suggestive of vaculitis, 2DECHO showed RWMA in inter ventricular septum, Coronary angiogram showed narrowing in distal LAD territory. In view of sinusitis, asthma, eosinophilia, tissue infiltration by eosinophils we made a diagnosis of Churg Strauss syndrome.

Recurrent Angiofibroma of Ethmoid Region – A Rare Variant

The common variant of angiofibromas of head and neck region is juvenile nasopharyngeal angiofibroma (JNA). However extranasopharyngeal angiofibromas (ENAF) occurs very rarely at any age in either sex, and they differ from classical JNA in incidence, clinical and radiological presentation. They form the differential diagnosis for any mass nose or nasal polyp. We present a case of recurrent angiofibroma of ethmoid region presented with recurrent lesion with bilateral proptosis and bossing of forehead. MRI showed involvement of bilateral nasal cavities, ethmoids and frontal sinuses with erosions of ethmoid roof and posterior table of frontal sinuses. Entire mass was excised by craniofacial resection which was histopathologically confirmed as Angiofibroma.

Expressly Fabricated Molar Tube Bases: Enhanced Adhesion

Tarun Sharma, Tarun Singh Phull, Tarun Rana, Varun Kumar

Clinicians, Orthodontists and their patients’ parents often expect the best results in the shortest time span possible. Orthodontic bonding of molar tubes has been an acceptable risk in a modern era of refined biomaterials and instrumentation. Although many orthodontists still prefer banding to bonding, it is the failure rate of the tubes on molars which accounts to an impedance in molar bonding. One of the reasons for molar attachment failures is attributed to improper adaptation of the buccal tube base with or without increased thickness of composite. Merits of banding the second molars especially when these are the terminal teeth for anchorage have been overemphasized in the literature. The present article presents a simple and relatively less time consuming technique of preparing molar tubes to be bonded on tooth surfaces which may be quite difficult to isolate especially for bonding, for example, mandibular second molars. The increased surface area of the composite scaffold helps not only in enhanced bond strength but also serves to reduce the incidence of plaque accumulation given the dexterity of invitro preparation. The removal of the occlusal part of the molar tube scaffold helps in prevention of open / raised bite tendencies. The present innovation, therefore, is not merely serendipity but a structured technique to overcome a common dilemma for the clinical orthodontist. The present dictum of banding being superior to molar tube bonding may prove to be futile with trendsetting molar attachments. It is also an established fact that bonding proves to be a lesser expensive modality when compared to banding procedures.

A Rare Presentation of Gallbladder Carcinoma Metastasis

Sheela Chaudhari, Deepa Hatwal, Pawan Bhat

Gallbladder carcinoma is the 5th most common gastrointestinal cancer. Gallbladder cancer preferentially metastasizes to regional lymph nodes and liver parenchyma. Bone metastases from gallbladder carcinoma are rare presentation. We report a case of gallbladder carcinoma with solitary metastasis to femur bone with surrounding soft tissue involvement, mimicking as soft tissue tumour involving bone.

A Case of Periodic Hypokalemic Paralysis in a Patient with Celiac Disease

Amitabh Ranjan, Pradeep K Debata

A 4-year-old male child presented with recurrent episodes of diarrhoea for 6-months, each episode associated with weakness of all four limbs and documented hypokalemia who on examination had some pallor, short stature, flaccid quadriparesis with absent DTR. The patient responded clinically and biochemically to potassium supplement. TTG and Intestinal biopsy confirmed celiac disease. Patient was put on gluten free diet and patient is doing well with no recurrence. We present a case of Recurrent hypokalemic paralysis with previously unsuspected celiac disease who was not in celiac crisis.

Spontaneous Caecal Perforation Associated with Ogilvie´s Syndrome Following Vaginal Delivery – A Case Report

Harish E, Sundeep VK, Sivasai Krishnaprasad Kola, Dharma Kumar KG

Acute pseudo-obstruction of the large bowel, Ogilvie’s syndrome, can occur in the postpartum period following caesarean section which can result in caecal dilatation and may progress to perforation. This is quiet rare following normal vaginal delivery. Only two previous reports have been found in the English literature. We report a case of Ogilvie’s syndrome with caecal perforation following normal vaginal delivery.

Chordoma cutis – A Diagnosis not to be Missed

Nadeem Tanveer, Kiran Mishra

Chordomas are rare midline tumors of the bone usually arising from sacrum, skull bones and spine, close to neuraxis. However an extensive involvement of the soft tissues can simulate a soft tissue subcutaneous tumour of the gluteal region –a presentation called chordoma cutis. Our patient presented with a gluteal mass and a trucut biopsy was done suspecting a soft tissue tumour. The hematoxylin and eosin stained section of the biopsy closely simulated a lipomatous tumour. However, on closer inspection the clear cells were found to have very fine vacuolations.The usual myxoid background and characteristic physaliferous cells seen in chordomas were not seen. Still a differential of chordoma was entertained in view of the site and age of the patient. Immunohistochemistry for cytokeratin and S-100 was performed and both were unambiguously positive. On literature search, we came across a soft tissue tumour called parachordoma which mimics chordoma both morphologically and immunohistochemically and has also been reported in the gluteal region. An MRI was performed which showed the tumour to be arising from the sacrum and secondarily involving the gluteal soft tissues. This case highlights the importance of considering chordoma in the differential diagnosis of gluteal masses with clear cell morphology even in the absence of physaliferous cells and myxoid background before signing them out as lipomatous tumours.

Gastrointestinal Stromal Tumour of Small Intestine Presenting as a Mesenteric Mass

Gastrointestinal stromal tumors (GISTs) are uncommon tumors; accounts for 0.1% to 3% of all gastrointestinal neoplasm. Most common site of involvement is stomach (60-70%), small intestine (20-30%) and rarely at extra-gastrointestinal sites like omentum and mesentery called as extra-gastrointestinal stromal tumor (EGIST). Diagnosis is based on characteristic histological findings and expression of transmembrane receptor tyrosine kinase protein (CD 117) derived from activated c-kit gene. Herein, we report a case of GIST of small intestine presented as mesenteric mass in a 35-year-old female and discuss review of literature.

Isolated Splenic Hydatidosis

Raghavendra Sawarappa, Aditya Kanoi, Madhumita Gupta, Ashwin Pai, S I S Khadri

A 27-year-old female presented with pain in the left hypochondrium for the past six months. An abdominal examination revealed mild splenomegaly. An abdominal ultrasonography showed two cystic lesions at the superior pole of the spleen. Contrast enhanced CT scan abdomen confirmed the USG findings, demonstrating splenomegaly with nonenhancing cystic lesions having internal septations and suspicious daughter cysts within it, strongly suggestive of hydatid cysts. On serological testing, the patient was positive for IgG Antibodies against Eccinococcus. Following Pneumococcal vaccination, splenectomy was performed taking precautions to prevent accidental rupture or spillage of contents into the peritoneum. The postoperative period was uneventful with the patient making a swift recovery. Histopathological examination revealed extensive necrosis within the cysts. In the midst of the necrotic material, hooklets were seen. These features were consistent with a diagnosis of an infected Hydatid cyst. It is of utmost importance that a correct preop diagnosis is made since all precautions must be taken to prevent dissemination or seeding of the surgical field. Death has been reported due to anaphylactic shock resulting from spillage during excision or biopsy. The most important factor in diagnosing splenic hydatid cyst is the awareness of its possibility.

Primary Ovarian Mucinous Carcinoma with Signet Ring Cells – Report of A Rare Case

Jaya Ganesh P, Vimal Chander R, Kanchana M P, Laks hmi Narasimhan

Presence of signet ring cells in ovarian neoplasms are commonly encountered in Krukenberg tumours of ovary. Unusual presence in primary ovarian mucinous tumours may create a diagnostic difficulty. To the best of our knowledge only very few such cases have been reported in the literature indicating their rarity. We report a case of primary ovarian mucinous carcinoma with signet ring cells. The purpose of this presentation is to sensitize the pathologists to consider primary mucinous carcinoma as a differential diagnosis in tumours with signet ring cells.

Removable Partial Denture Supported by Implants with Prefabricated Telescopic Abutments - A Case Report

Lalit Kumar, Komal Sehgal

Implants have been designed to rehabilitate edentulous patients with fixed prosthesis or implant supported overdentures. Implant-supported single crowns and fixed partial dentures have become successful treatment alternatives to removable and fixed partial dentures. However, it is common to have clinical situations which make it impossible to use conventional as well as implant supported fixed partial dentures. The implant supported removable partial dentures can be a treatment modality that offers the multitude of benefits of implant-based therapy—biologic, biomechanical, social, and psychological to such patients. The aim of this article is to present a case report describing the fabrication and advantages of removable partial denture supported by teeth and implants for a patient with long edentulous span. The patient was satisfied with his dentures in terms of function and aesthetics. Regular follow-up visits over a period of three years revealed that the periodontal condition of remaining natural dentition and peri-implant conditions were stable. There was no evidence of excessive residual ridge resorption or mobility of the teeth, nor were any visible changes in the bone levels of the natural teeth or implants noted on radiographs.

Clear Cell Atypical Fibroxantoma: A Rare Variant of Atypical Fibroxanthoma and Review of the Literature

Recep Bedir, Sule Agirbas , Ibrahim Sehitoglu , Cüneyt Yurdakul, Ömer Elmas

Atypical fibroxanthoma (AFX) is a superficial variant of pleomorphic malignant fibrous histiocytoma. Clear cell atypical fibroxanthoma (CCAFXA) is a rare variant of atypical fibroxanthoma. A 74-year-old male patient presented with a rapidly growing nodule on the shoulder, which had appeared over a 5-months period. Lesion was excised by the plastic surgeon. Microscopic examination showed an ulcerated nodule composed of pleomorphic spindled and polygonal cells with clear or vacuolated cytoplasm. The neoplastic cells were stained positively with CD68 and CD10 and were stained negative with S-100, Melan A, muscle-specific actin, or pan-cytokeratin. Final diagnosis was clear cell atypical fibroxanthoma. CCAFXA should be differentiated from other clear-cell neoplasms of the skin. Best of our knowledge only 11 cases CCAFXA of have been reported in published studies till date. Herein, we reported 12th case in literature of CCAFXA and review of the literature.

Same Dog Bite and Different Outcome in Two Cases – Case Report

Gadekar RD , Domple VK, Inamdar IF, Aswar NR , Doibale MK

There is still no cure for rabies and survival from clinical rabies is extremely rare. It is a preventable disease if the post exposure prophylaxis is initiated in time and administered as per WHO guidelines including administration of rabies immunoglobulin. The role of passive rabies immunization products is to provide the immediate availability of neutralizing antibodies at the site of the exposure before it is physiologically possible for the patient to begin producing his or her own antibodies after vaccination. In this case report, the same dog has bitten to a boy and to an adult. Local wound treatment and use of human rabies immunoglobulin as well as gluteal region as a site of bite were the probable reasons for survival of the boy. On the other hand no local wound treatment, no use of rabies immunoglobulin and finger as a site of bite are the probable reasons for death of an adult due to rabies.

Diagnostic CBCT in Dentigerous Cyst with Ectopic Third Molar in the Maxillary Sinus–A Case Report

Mamatha N.S., Bhuvana Krishnamoorthy, Savitha J K, Pankaja Bhai

Dentigerous cyst is the second most common odontogenic cyst after radicular cyst. This report describes a case of a dentigerous cyst associated with an impacted maxillary third molar. Patient presented with foul smelling discharge through nose and oral cavity. Cone beam computed tomography revealed maxillary third molar displaced to lateral wall of the nose and a unilocular radiolucency obliterating the entire maxillary sinus. A provisional diagnosis of infected dentigerous cyst was made. The cyst was enucleated along with removal of third molar. Histopathological examination confirmed the diagnosis of dentigerous cyst. The patient recovery was uneventful.

A Rare Case of Accidental Esophageal Perforation in an Extremely Low Birth Weight Neonate

Pradeep Suryawans hi, Amit Dahat, Rema Nagpal, Nandini Malshe, Vijay Kalrao

Spontaneous perforation of esophagus in neonates is a rare occurrence. However iatrogenic perforation of the esophagus is not that uncommon, and is most frequently seen in preterm and low birth weight infants. In premature infants, an esophageal perforation (EP) mainly occurs while inserting an orogastric tube. The commonly reported symptoms of EP are sudden onset respiratory distress, due to the pleural effusion and pneumothorax. In our case neonate presented with apnea requiring ventilation. We present a rare case of an Extremely Low Birth Weight (ELBW) neonate with an iatrogenic esophageal perforation who presented with recurrent apneas, outlining aspects of diagnosis and management.

Chondrolipoma of the Lower Lip: A Case Report

Kamakshi G., Yaranal PJ

A chondrolipoma is an extremely rare form of a benign mesenchymal tumour which contains mature fatty tissue and cartilage. We are presenting a case of chondrolipoma of the lower lip which was seen in a 6-year-old girl. Chondrolipomas are rare neoplasms; their terminologies and pathogeneses have been controversial in the past. Chondrolipomas are uncommonly seen in the oral cavity, in children and in females. Hence, we are reporting this present case because rarity of this lesion.

A Rare Case of Delayed Pulmonary Oedema due to Methemoglobinemia Following Laparoscopic Chromopertubation with Methyleneblue

Veerendrakumar CM, Joshi Suyajna D, Madhu YR

The patient is a young infertile lady with right tubal block on hysterosalpingogram was subjected for diagnostic hysterolaparoscopy.Hysterolaparoscopy findings were normal. Transcervical chromopertubation was performed using 20 -30 ml of diluted methylene blue through hysterosalpingogram cannula. Hesitant flow of dye was noted on left side after 2-3 flushing attempts. Ampullary block noted on right side with no spillage of the dye. Patient made an uneventful anaesthetic recovery. Five hours later patient developed tachypnea,hypotension and bluish colored urine was drained. She was shifted to ICU and patient eventually recovered after hemodynamic support with oxygen, steroids and inotropes. Spectrophotometric analysis showed methemoglobin levels of 26.3%. This case is reported for its rare but potentially fatal complication of pulmonary oedema following methylene blue. In this case pulmonary oedema manifested late in the postoperative period compared to other reported cases in the literature where pulmonary oedema was seen during intraoperative period.

Papillary Carcinoma in Median Aberrant Thyroid (Ectopic) - Case Report

Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.

Acanthamoeba Detection in the Anterior Chamber after Therapeutic Penetrating Keratoplasty

RK Agarwal, Garima Mittal, Anuradha Raj, Shalini Gupta

Acanthamoeba infection has been recognized in almost all parts of the world. With most of the literature focusing on contact lens related Acanthamoeba keratitis, ophthalmologists may hesitate to diagnose this entity in patients without lenses. We report the case of a patient with Acanthamoeba infection of the anterior chamber, unrelated to contact lens wear, diagnosed by examination of aqueous tap following penetrating therapeutic keratoplasty.

Garenoxacin in Skin and Skin Structure Infections Sustained due to Road Traffic Accident

Skin and soft tissue infections represent a continuum of symptoms that range from uncomplicated cellulitis to the potentially lethal entity necrotizing fasciitis that is often considered to be microbial invasions of the epidermis, dermis and subcutaneous tissues. Garenoxacin, a newer oral des-fluoroquinolone having potent antimicrobial activity against wide variety of common pathogens involved in skin and skin structure infections (SSTIs), including the resistant strains offer the advantage of broad spectrum of coverage including gram positive, gram negative and anaerobic organisms. This case study indicates the utility of garenoxacin in treating skin and soft tissue infections caused by road traffic accidents.

Anomalous Branching Pattern of the Popliteal Artery: A Case Report

The Popliteal Artery, which is the continuation of the Femoral artery, crosses the popliteal fossa at the distal border of popliteus; it divides into the Anterior and Posterior Tibial arteries. The Posterior Tibial artery divides into terminal branches proximal to popliteus, in which case the Anterior Tibial artery sometimes descends anterior to the muscle.. Either the Anterior Tibial or the Posterior tibial artery may be reduced or increased in size.The dorsalis pedis artery is the continuation of the anterior tibial artery, distal to the ankle. It passes to the proximal end of the first intermetatarsal space, to complete the plantar arch, and provides the first plantar metatarsal artery. In the present case the Popliteal Artery bifurcates into 2 terminal branches at a higher level than the normal. The Anterior Tibial artery was hypo plastic and entered the anterior crural region in front of the popliteus muscle and finally terminated above the knee joint. Further the Posterior Tibial artery was also hypo plastic giving off a hyperplastic Peroneal artery which pierced the interosseous membrane and on entering the dorsum of the foot, it prolonged as the dorsalis pedis artery. The rest of the Posterior Tibial artery continued its course distally and divided into its usual branches, the medial and lateral planter arteries. Awareness of these variations in the vascular branching patterns of the lower limb, acts as a guide during femero distal bypass grafting procedures and surgical and percutaneous vascular reconstructions.

Anatomical Variation: Median Nerve Formation – A Case Vignette

Anju Bala, Pranoti Sinha, Binod Kumar Tamang, Rohit Kumar Sarda

Variations in the arrangement and distribution of brachial plexus and its branches in the infraclavicular part are common and have been reported by several investigators since the 19th century. These variations are significant for the neurologists, surgeons, anesthetists and the anatomists. During routine anatomical dissection of the right axilla and infraclavicular region of a 45-year-old male cadaver, the medial root of the median nerve was found to receive a supplementary branch from the medial aspect of the terminal portion of the lateral cord of brachial plexus and the branch was passing infront of the axillary artery from lateral to medial side. The median nerve was formed by joining of the lateral and medial roots from the lateral and medial cords of brachial plexus, infront of brachial artery, lower down, at the junction of upper one-third and lower two-third of the arm, instead in the axilla. This variation could be one of the cause of pressure symptom which occurs on the axillary artery and also the injury which occurs on the lateral cord or upstream to the lateral cord, which may sometimes lead to an unexpected presentation of weakness of forearm flexors and thenar muscles.

Extraocular Sebaceous Carcinoma on the Chest Wall – A Case Report

Raghuveer MN, Diwakar SR, Thulasi Vasudevaiah, K Manjunath Shenoy

Sebaceous carcinoma is a rare aggressive skin cancer derived from the epithelium of sebaceous glands. Sebaceous carcinomas are generally divided as ocular or extraocular locations. Very few cases of extra ocular sebaceous carcinomas have been reported till date. Among them only six cases were reported which were on the chest wall. We are hereby reporting the seventh case of sebaceous carcinoma on the chest wall. The disease exhibits diverse clinical presentations and histologic patterns, often resulting in a delay in an accurate diagnosis as it may mimic many other cutaneous malignancies like Dermatofibrosarcoma protuberance Basal Cell Carcinoma or Squamous Cell Carcinoma. High degree of suspicion is required and sebaceous carcinoma should be considered as one of the differential diagnosis for an ulceroproliferative growth on the skin.

Hypokalemic Paraplegia in Pregnancy

Maitri Kulkarni, Srividya TV, N Gopal

Hypokalemic myopathy may range from numbness/weakness to complete paralysis. The aetiology may be congenital or acquired. It is characterized by acute muscular weakness with low levels of potassium (<3.5 meq/L). We present a case of 26-year-old multigravida at 36 weeks of gestation with gestational hypertension on treatment, who came with acute onset of pain, numbness and weakness of both legs which worsened following betamethasone injection. She was diagnosed to have Hypokalemic paralysis with potassium levels of 2.1 meq/L. The medical profile remitted promptly on intravenous potassium replacement. Pregnancy was continued till 37 weeks with oral potassium supplements, antihypertensives and regular monitoring of serum potassium levels. The pregnancy was terminated after 37 weeks in view of gestational hypertension. Postpartum period was uneventful, patient was discharged after two weeks when potassium levels and BP returned to normal.

Isolated Duodenal Adenoma Presenting as Gastrointestinal Bleed - A Case Report

Duodenal polyps are rare lesions in patients undergoing Esophago gastro duodenoscopy (EGD), and the prevalence varies widely with range of 0.3-4.6% of cases. Duodenal adenomas most commonly occur in association with familial adenomatous polyposis. Isolated occurrence of such adenomas is very rare and presentation as upper gastrointestinal (GI) haemorrhage is even rarer. We herein report a case of elderly male patient presenting to emergency department with features of upper GI bleeding. Patient was resuscitated followed by EGD was done. On EGD bleeding duodenal polyp was found and endoscopic polypectomy was done to control the bleeding. Subsequent colonoscopy was done and was normal. The histopathological examination of the polypectomy specimen revealed tubular adenomatous polyp which is a premalignant condition. We also highlight the clinical presentation, histological types and treatment modalities available in the literature. However, there is lack of consensus regarding the outcome of various procedure described in the literature.

Pregnancy with Gilbert Syndrome – A Case Report

Mini Mohan, Lakshmi Sailaja P, Peddireddy Vijaya Narasimha Reddy

A primigravida presented to us at 32 weeks of gestation with vomiting, myalgia and jaundice. On examination she had icterus, she was dehydrated, uterus was corresponding to dates and the fetal heart rate was good. On evaluation, all the investigations were normal except mild unconjugated hyperbilirubinaemia and hypoglycaemia. Based on the above findings we derived at a diagnosis of Gilbert syndrome. Dehydration due to vomiting aggravated her jaundice. On correcting her dehydration jaundice resolved, patient improved symptomatically and was discharged two days later. She was later admitted at term and underwent emergency caesarian section in view of fetal distress. Mother and baby were fine postoperatively and was discharged on the fifth postoperative day Gilbert syndrome is rare in obstetric practice. Virtually all patients have decreased activity of Uridine diphosphate glucuronosyl transferase (UDPGT). The case is reported due to its rarity.

Bio-opercular Syndrome: A Case Report and Minireview

S. Praveen-kumar, K Pramod

Opercular syndrome is a well known but neglected entity and is quite common, but it is difficult for non-neurologists to diagnose this entity because of lack of awareness. Inability to speak and swallow with dissociation of automatic voluntary movements in the affected muscles are the essential features of this syndrome. The aetiology in most of the reported cases is vascular (thrombosis or embolism) involving branches of middle cerebral artery supplying the opercular area. We are reporting a case of “bilateral opercular syndrome” caused by stroke in a young patient. He had sudden onset of bilateral facial and tongue palsy, inability to speak and swallow, but with preserved automatic functions. He was mute but verbal comprehension was normal. CT head revealed bilateral perisylvian infarcts.

Myxoid Leiomyosarcoma of Ovary-A Rare Case Report

Divya Ns, Srinivasamurthy V

Primary pure myxoid leiomyosarcoma of the ovary is extremely rare, comprising of only 1% of the ovarian tumours. Patient presented with a mass in the right iliac fossa since three months. Radiological diagnosis of broad ligament fibroid was given. Right salphingo-oophorectomy with enucleation of ischial fossa and wedge biopsy of left ovary was carried out. Based on gross, microscopy and immunohistochemistry a diagnosis of primary myxoid leiomyosarcoma of ovary was made. We report a rare case of primary pure myxoid leiomyosarcoma of the ovary with metastasis to ischial fossa emphasising on reliable prognostic markers. Ovarian leiomyosarcomas are highly aggressive tumours with poor prognosis.

Unilateral Right Pulmonary Agenesis in Adulthood

Hediye Pinar Gunbey, Emre Gunbey, Asli Tanrivermis Sayit, Taner Bulut

Congenital malformations of the lung, which may vary in degrees of severity, are very rare diseases. Pulmonary artery agenesis is a rare anomaly that may occur during the early involution of the proximal portions of the sixth aortic arch, during embryological development of the heart. This agenesis may be accompained by a complete or partial absence of the lung and its bronchus on the same side, which is diagnosed as pulmonary agenesis. In the great majority of the cases, the diagnosis is usually made at or soon after birth and it can be associated with multiple anomalies. However, extremely rare asymptomatic cases may go unnoticed until adulthood. We are presenting a patient with unilateral right pulmonary agenesis, who survived through adulthood without any symptoms and other congenital anomalies. The multislice computed tomography findings and differential diagnoses have been discussed.

Incidental Detection Microfilaria in Subcutaneous Breast Nodule of Lactating Female Fnac: A Rare Case Report

Ajay KR. Singh, Prashant Gupta, Soma Yadav, H.S. Pahawa

Filariasis is a major public health problem which is faced in tropical countries like India. Its diagnosis is made by using peripheral blood smears. However, microfilaria has been detected incidentally during FNACs of various lesions, which were done in clinically unsuspected cases. We are reporting here, an uncommon case of filariasis, which caused a nodular, subcutaneous swelling in left breast of a 30 year old lactating female. A nodular subcutaneous swelling can be caused in breast of a lactating female by lactational associated mastitis, but filaria causing a nodular swelling in a lactating breast is a rare presentation. Aspiration of the swelling demonstrated enormous pathogen presence caused by Woucheria bancrofti and the patient responded well to six weeks of daily anti-filarial treatment with diethylcarbamazine citrate.

Pretibial Myxedema Associated with Euthyroid Hashimoto’s Thyroiditis: A Case Report

Pragya A Nair, Ajay Mishra, Arvind Chaudhary

Pretibial myxedema (PM) is an infiltrative dermopathy which is seen in grave’s disease. It is also associated with hypothyroidism, but is infrequently seen in Hashimoto’s thyroiditis. Lesions are seen commonly over pretibial region as non-pitting oedema or with a plaque morphology. Heat shock protein (HSP) has been reported to be expressed by fibroblasts present at affected site, which cause lesions of PM. Histopathology differentiates it from other dermatoses. Lesions usually resolve spontaneously, but therapies like potent topical steroids, intralesional steroids, gamma globulin, pentoxifylline, surgery and radiotherapy are indicated. Here, a case of PM with euthyroid Hashimoto’s thyroiditis has been reported, which was proven by histopathology.

A Rare Case of Chest Wall Schwannoma with Destruction of Rib, Masquerading as A Breast Mass

Saikat Datta, Ananya Pal, Moumita Maiti, Anup Kumar Boler

Schwannomas are slow growing, benign, nerve sheath tumours of Schwann cell origin. They predominantly involve head, neck and flexor surfaces of upper and lower extremities, while the chest wall is an uncommon location for schwannomas. Schwannomas may rarely cause erosion of adjacent bone. We are reporting a very rare case of a chest wall schwannoma with destruction of rib which occurred in a 35-year-old female patient, which initially presented as a breast mass and was radiologically misinterpreted as a malignant soft tissue tumour.

Osteosarcoma of the Jaws: Case Report on Synchronous Multicentric Osteosarcomas

Shengnan Jia, Binbin Li

Research has shown that osteosarcomas display high potential for metastasis to the lungs, pleurae and bones. Mandible, on the other hand, is an uncommon site for metastatic tumour cell colonization. Nevertheless, a metastatic tumour to mandible might be the first indication of an undiscovered malignancy at a distant site. This case report presents a case of a 61-year-old female patient. An osteosarcoma metastasized to her mandible shortly after the curettage of her jaw cyst. Both the metastatic osteosarcoma and the jaw cyst were confirmed by pathology. Initially, bilateral well-defined radiolucent lesions were shown in her panoramic X-ray image. Also, the diagnosis of a dentigerous cyst was made, based on histology. Two months later, a mixed radiolucent-radio opaque mass, which was confirmed as an osteosarcoma by pathology later, occupied the site of the previously enucleated dentigerous cyst, in her right mandible. Then, an identical osteosarcoma was found in the left pelvis on further doing overall radiological and pathological examinations. The pathologic hypotheses, treatment modality and follow-up of this case have also been presented.

Ischaemic Stroke Following Percutaneous Transluminal Coronary Angioplasty (PTCA): A Rare Complication

Sanket K. Mahajan, Anand B. Sanghi

Stroke following coronary interventions is a devastating and most dreaded complication with significant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors. We hereby describe such a patient who presented to us with the diagnosis of acute coronary syndrome and underwent percutaneous coronary intervention (PCI) but unfortunately developed left sided hemiparesis due to ischaemic stroke (right middle cerebral artery). She was managed as per the standard treatment protocols for acute coronary syndrome and later on for ischaemic stroke which she nicely responded to and was discharged in a haemodynamically stable condition. On follow-up after 15 days, she was totally symptom-free. We will discuss all the possible preventive and treatment measures for this rare complication of PCI.

Palliative Dental Care- A Boon for Debilitating

World Health Organization defines “palliative care” as the active total care of patients whose disease is not responding to curative treatment. Palliative care actually deals with patients at the terminal end stage of the disease. We always face a question why a dentist should be in a palliative team? What is the exact role of dentist? Dental treatment may not always be strenuous and curative, but also can focus on improving quality of life of the patient. Hence forth the present paper enlightens the importance of dentist role in palliative team.

Vibration Therapy in Management of Delayed Onset Muscle Soreness

Zubia Veqar, Shagufta Imtiyaz

Both athletic and nonathletic population when subjected to any unaccustomed or unfamiliar exercise will experience pain 24-72 hours postexercise. This exercise especially eccentric in nature caused primarily by muscle damage is known as delayed-onset muscle soreness (DOMS). This damage is characterized by muscular pain, decreased muscle force production, reduce range of motion and discomfort experienced. DOMS is due to microscopic muscle fiber tears. The presence of DOMS increases risk of injury. A reduced range of motion may lead to the incapability to efficiently absorb the shock that affect physical activity. Alterations to mechanical motion may increase strain placed on soft tissue structures. Reduced force output may signal compensatory recruitment of muscles, thus leading to unaccustomed stress on musculature. Differences in strength ratios may also cause excessive strain on unaccustomed musculature. A range of interventions aimed at decreasing symptoms of DOMS have been proposed. Although voluminous research has been done in this regard, there is little consensus among the practitioners regarding the most effective way of treating DOMS. Mechanical oscillatory motion provided by vibration therapy. Vibration could represent an effective exercise intervention for enhancing neuromuscular performance in athletes. Vibration has shown effectiveness in flexibility and explosive power. Vibration can apply either local area or whole body vibration. Vibration therapy improves muscular strength, power development, kinesthetic awareness, decreased muscle sore, increased range of motion, and increased blood flow under the skin. VT was effective for reduction of DOMS and regaining full ROM. Application of Whole body vibration therapy in postexercise demonstrates less pressure pain threshold, muscle soreness along with less reduction maximal isometric and isokinetic voluntary strength and lower creatine kinase levels in the blood.

High Blood Pressure in Dialysis Patients: Cause, Pathophysiology, Influence on Morbidity, Mortality and Management

Aaron Stern, Soumya Sachdeva, Rohit Kapoor, Jasj it Singh, Sarthak Sachdeva

Dialysis is initiated in a patient with End stage renal disease. The recent guidelines suggest the initiation of dialysis when symptoms and signs of kidney failure are present and not merely a decrease in GFR. The most common complication postdialysis is the occurrence of hypotension. However many dialysis patients are found to be hypertensive. In this article, we mention the cause and pathophysiology of hypertension in dialysis patients and its management.

Omental Torsion

Ghosh Y., Arora R.

Torsion of greater omentum is one of the rare causes of acute abdominal pain. It can be primary or secondary. Primary Omental Torsion (POT) occurs because a mobile, thicken segment of omentum rotates around a proximal fixed point in the absence of any associated or secondary intra-abdominal pathology. Secondary omental torsion is associated with a number of pre-existing conditions most common among them is inguinal hernia, other causes include tumours, cysts, internal or external herniation, foci of intra-abdominal inflammation and postsurgical wound or scarring. Torsion of omentum causes twisting of omentum along its long axis resulting in impaired blood supply. This rare condition is more predominant in middle-aged males. It clinically mimics acute appendicitis. It should be kept in mind as a differential diagnosis for acute abdomen. Laparoscopy can aid in diagnosis and management but explorative laparotomy is the definitive and therapeutic procedure of choice. However the condition is not life threatening as omentectomy reduces the inflammation and focus of adhesions within the abdomen.

Burden of Antibiotic Resistance in Common Infectious Diseases: Role of Antibiotic Combination Therapy

Kishor C Mehta, Ramesh R Dargad, Dhamm raj M Borade, Onkar C Swami

Globally, antimicrobial resistance is alarming concern especially in commonly reported disease entities like respiratory tract infection, enteric fever and infections associated with gram-negative bacilli (GNB). Rational use of antimicrobial drugs reported significant decrease in bacterial burden and may also reduce the risk of disease progression. However, at times in particular indication, certain patient and pathogen factor limits the selection and use of specific antibiotic therapy while in some case, due to presence of additional risk factor, aggressive therapy is required to achieve clinical reemission and prevent complications. Delay in start of suitable antibiotic therapy is another imperative factor for treatment failure and rise of drug resistance. With rapidly increasing antibiotic resistance and decline in new antibiotic drug development, the toughest challenge remains to maintain and preserve the efficacy of currently available antibiotics. Therefore, the best rational approach to fight these infections is to ‘hit early and hit hard’ and kills drug-susceptible bacteria before they become resistant. The preferred approach is to deploy two antibiotics that produce a stronger effect in combination than if either drug were used alone. Various society guidelines in particular indications also justify and recommend the use of combination of antimicrobial therapy. Combination therapies have distinct advantage over monotherapy in terms of broad coverage, synergistic effect and prevention of emergence of drug resistance.

Plasma Torch Toothbrush a New Insight in Fear Free Dentisry

Santosh Kumar CH, P Sarada, Sampath Reddy CH, Surendra Reddy M, Nagasailaja DSV

Dental treatment is considered painful either because of fear or anxiety. Even though fear and anxiety could be managed; the needle pricks and the heat generated with drills are both painful and destructive to the tissues of the tooth. A new technology which can reduce the pain and destruction of the dental tissues will be of huge value. Plasma torch toothbrush fits into such criteria and when developed fully, will be able to apply for many of the dental procedures for increasing the efficiency.

Modified Pelvic Floor Repair in Prolapsed Uterus, with Total Prevention of Vault Prolapse

Suthanthira devi S., Rajeswara Rao N., K.S. Kavitha Goutham, Swayam Jo thi S.

In and around Ammapettai, a rural area with an economically backward community, 515 cases were operated for prolapsed uteri, by doing modified pelvic floor repairs (Dr. Sunthanthradevi’s method), without any incidence of vault prolapse, with patients being followed up for 2 years after their surgeries.

Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency viruses amongst Injecting Drug Users in Mumbai, India

Avantika Shukla, Anuradha Sharma

Foot Index in Right Footed Adults

Shaifaly Madan Rustagi, Sanjeev Thakyal, Patnaik VV Gopichand

HBV & HCV – Awareness in Acute Abdomen Emergency Cases

Hardeep Singh Gill, Gurmanpreet Gill, Amarjit Kaur Gill

A study was conducted on 100 cases of Acute abdomen admitted in surgery department of Govt Medical college and Rajendra Hospital, Patiala, India. Study group included patients with different abdominal emergencies e.g. gastrointestinal perforation, intestinal obstruction, acute appendicitis, acute cholecystitis, pancreatitis etc. Out of these, three cases were positive for HBsAg alone, one for anti Hepatitis C-Virus (HCV) alone and one was positive for both HBsAg and anti HCV.