Journal of clinical and diagnostic research

To Evaluate the Effect of Perceived Stress on Menstrual Function

Introduction: Menstrual irregularities affect 2-5% of childbearing women, a number that is considerably higher among females under constant stress during a cycle. Aim: To study the effect of perceived stress on cycle length, regularity and dysmenorrhoea. Materials and Methods: A cross-sectional study was conducted on 100 female undergraduate students of a medical college. A questionnaire along with the Perceived Stress Scale (PSS) and Pictorial Blood Assessment Chart (PBAC) was provided to the students. The menstrual pattern was then correlated with the PSS using the chi- square test and the Fisher’s Exact test for statistical analysis. Observations and Results: Out of the 100 undergraduate medical students, 30 students had a PSS score >20 while 70 had a score =20. An association was established between high stress levels (PSS >20) and menstrual irregularity. No association was found in students with PSS >20 with hypomenorrhoea, menorrhagia, dysmenorrhoea, long cycle length and short cycle length. Conclusion: High stress levels (PSS >20) was associated with only menstrual irregularities and not with duration, amount of flow or dysmenorrhoea. Hence, other causes should be looked for in young women complaining of menstrual problems before stress is assumed to be the cause.

Association of Parental Origin with Clinical Profile in Klinefelter Syndrome

Ranganath Vallabhajosyula, Sayayee Rajangm, Lalitha C.

Introduction: Several genomic imprinting mechanisms have been postulated to report the parent-of-origin in Klinefelter syndrome. It was stated in the literature, parental origin has an effect on behavioral phenotype of Klinefelter individuals, but the association of the same on clinical profile was less reported. The detailed clinical phenotype when studied with the known origin of extra X may possibly explain the imprinting effect that may be helpful to derive diagnostic criteria in the syndrome. In the present study, we investigated the parental-of-origin of extra X chromosome in Klinefelter syndrome probands with an aim to report the association between the phenotype with that of its karyotype and the parental origin of supernumerary X. Materials and Methods: Seventy two probands that were referred to division of Human Genetics, St.John’s Medical College, Bangalore with variable complaints and phenotypic features were diagnosed with informed consent as Klinefelter syndrome with a confirmed karyotype. The Karyotype was prepared by peripheral lymphocyte culture and GTG banding method. The parental origin was studied in 9 families of Klinefelter probands with standard protocol for GENE SCAN using X-chromosome specific Short Tandem Repeat markers. The outcome was analyzed to determine the parental origin by GENE MAPPER. Statistical analysis: Statistical analysis was conducted to ascertain the significance of parental origin of supernumerary X with the phenotypic profile with confirmed karyotype. Results: Seven of nine probands had 47, XXY karyotype and 2 were mosaic with 47,XXY/46,XY karyotype. Five probands had their supernumerary X from maternal side and four were paternally derived. Sixteen features as framed proforma were tabulated against the originated X in Klinefelter probands. 55.56% of Klinefelter stigmata were seen in prob and who had maternally derived X and the rest were with paternal X. Conclusion: The findings of the present study points on parent-of-origin effect on clinical profile and indicate that the imprinted X chromosome genes show differential effect general and systemic traits.

Feasibility and Response of Concurrent Weekly Docetaxel with Radical Radiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma

Jomon Raphael C, Rajesh I, Rajesh B, Selvamani B, Subhashini John

Objective: (1) To study the feasibility, adverse effects and response of concurrent weekly Docetaxel with radical radiotherapy in inoperable locally advanced head and neck squamous cell carcinoma. (2) To assess the compliance and tolerance of weekly Docetaxel with radiotherapy. Material and Methods: Twenty one patients with stage III and IV head and neck squamous cell carcinoma satisfying inclusion criteria were selected and treated with conventional external radiotherapy of 70Gy in 35 fractions with weekly concurrent Docetaxel (15mg/sqm), administered one hour before radiotherapy. Assessment of toxicities and evaluationof response was carried out. Results: Majority of patients had stage IV diseaseand 17/21 (81%) received the planned radiotherapydose of 70Gy and =4 cycles of weekly chemotherapy. Duration of treatment ranged from 7.1to 11.2 weeks. The toxicities noted were Grade III mucositis in 57% and grade III skin reaction in 23%, grade III dysphagia in 38% and grade II weight loss in 23% of patients. Systemic toxicities associated with chemotherapy were minimal and there was no dose limiting toxicities. The overall locoregional response at first follow up was 85%, with complete response of 70% and partial response of 15%. Conclusion: Concurrent Docetaxel is a feasible and suitable alternate to Cisplatin and 5-Fluorouracil chemotherapy with good patient compliance. The late toxicities and survival need to be followed up.

A Comparative Study of Bacterial and Parasitic Intestinal Infections in India

Beena Uppal, Naz Perween, Prabhav Aggarwal, Shyam Kishor Kumar

Background: Infectious diarrhea causes a major health problem in developing countries with significant morbidity and mortality. Very often, rehydration therapy alone does not suffice, mandating the use of antimicrobial agents. However, rapidly decreasing antimicrobial susceptibility is complicating the matters. Materials and Methods: The study aimed to determine the prevalent bacterial and parasitic agents of diarrhea in India. A cross-sectional study was done at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, during 2012-14. Stool samples were received from patients of all age groups and processed for bacteriological and parasitological identification by microscopy, bacterial culture, biochemical identification, serotyping and antimicrobial susceptibility tests. The study also aimed to identify the recent papers (after year 2000) reporting aetiology of infectious diarrhea in India involving the general population as a whole and compare them with present findings. Results: Out of 6527 samples, 581 (8.90%) were positive for bacterial pathogens. A total of 280 samples (of 3823 under-five year children) were positive for diarrheagenic Escherichia coli. Other organisms like Vibrio cholera were found in 159 (2.44%) cases, Shigella spp. in 126 (1.93%), Salmonella Typhi in 7 (0.11%), Salmonella Typhimurium in 6 (0.10%), Aeromonas hydrophila in 3 (0.05%) cases. Levels of resistance to nalidixic acid, amoxicillin and ciprofloxacin were alarmingly high. Third generation cephalosporins were seen to be moderately active except against E. coli. Parasites were identified in 312 (4.78%) cases. Giardia intestinalis, Ascaris lumbricoides and Entamoeba histolytica were identified in 2.27%, 1.15% and 0.64% cases respectively. Conclusion: Analysis of recent nationwide studies revealed V. cholerae was the most common bacterial/parasitic agent of diarrhea across all populations, being followed by diarrheagenic E. coli and Giardia intestinalis. Periodic laboratory monitoring of antimicrobial susceptibility pattern is essential, as is formulation of effective antibiotic use policy.

Efficacy of Prophylactic use of Antibiotics to Avoid Flare up During Root Canal Treatment of Nonvital Teeth: A Randomized Clinical Trial

Iftikhar Akbar

Objectives: Flare-up during root canal treatment of non vital teeth is a common clinical incident. The aim of the present study was to assess the effect of prophylactic use of antibiotics to avoid flare up during root canal treatment of the teeth having asymptomatic necrotic pulp. Materials and Methods: A randomized double blind clinical trial with parallel design was conducted on 100 subjects with asymptomatic non vital teeth. They were randomly divided into two groups. The first group (50 participants) was given two gram amoxicillin one hour before the first visit of root canal treatment; the second group (50 participants) did not receive any treatment (control group). In both groups, root canal treatment was performed in two visits. The flare up was assessed by the pain visual analogue scale and based on the swelling criteria. The data were processed and analyzed using SPSS statistical software 17. A p-value of 0.05 or less was considered statistically significant. Results: A total of 80% of participants in the experimental group had flare up while 12% of participants had flare up in the control group. Prophylactic Amoxicillin had no effect on inter-appointment flare up (p > 0.05). There was no relationship between flare up and patient’s age, gender and tooth type (p > 0.05). Conclusion: Prophylactic use of Amoxicillin in asymptomatic non vital teeth before root canal treatment had no effect on the incidence of flare-up.

The Influence of Implant Abutment Surface Roughness and the Type of Cement on Retention of Implant Supported Crowns

Objectives: To provide relative data on the retentive characters of the commonly used cements on different implant abutment surfaces. Materials and Methods: A total of 20 implant abutments were divided into 2 groups. Ten implants were unaltered and ten were air borne particle abraded with 50µ aluminium oxide. Three luting agents (Tempbond, IRM and ImProv) were used to secure the crowns to abutments. All the crowns were removed from the abutment with an Instron machine at 0.5mm per minute and tensile bond strengths were recorded. Statistical analysis was performed using Anova, Paired t-test and Post-Hoc tests. Results: IRM showed the highest mean tensile strength among the three cements when used with treated and untreated implant abutment surfaces. Change in the abutment surface roughness had no effect on the mean tensile bond strength of TempBond and IRM cements, whereas ImProv cement showed reduced tensile strength with sandblasted surface. Conclusion: When increased retention is required IRM cement with either sandblasted or milled surface could be used and when retrievability is required cements of choice could be either TempBond or ImProv.

Awareness and Attitude Regarding Breastfeeding and Immunization Practices Among Primigravida Attending a Tertiary Care Hospital in Southern India

Introduction: Infant mortality rate (IMR) is considered as one of the most sensitive indicators of health status of a community. Infant mortality figures in India are very high and the two important causes which contributes maximum to the IMR is inadequate breastfeeding and immunization. The major cause of death among under five children in India is neonatal sepsis, diarrhea and pneumonia and breast milk is protective against all the three diseases. Immunization along with breastfeeding reduces a significant number of infant and maternal mortality. Disease like neonatal tetanus is rampant in our country and it can be prevented by vaccination of the women during pregnancy. This study tries to find out the awareness and attitude among the primigravida females regarding breastfeeding and immunization. Materials and Methods: This facility based cross-sectional study was conducted among 186 primigravida who came to the hospital for delivery and antenatal check-up during March 2014 in three associated teaching hospitals of Kasturba Medical College, Mangalore, which is situated in coastal South India. Approval was obtained from the Institutional Ethics Committee (IEC) of KMC (Manipal University), Mangalore, India. A pre tested, semi structured questionnaire was used as the data collecting tool. Results: Majority (n=163, 87.6%) were Hindus followed by Muslims (n=16, 3.2%). Nearly half of the participants (n=92, 49.5%) were in the 21-25 y age group, 54.8% participants were not aware of correct position of baby during feeding and 10.8% (n=20) believed that immunization should be stopped if it showed side effects. Breastfeeding and Immunization is an effective way of reducing child and maternal mortality. The results from our study showed that many participants had lacunae in knowledge and attitude and adequate health education should be given to the pregnant women.

“Ozone” – The New Nemesis of Canker Sore

Ayesha thabusum. D, R. Sudhakara Reddy, Rajesh. N

Background: Recurrent aphthous ulceration or recurrent aphthous stomatitis is one of the most debilitating and painful oral mucosal disease. This disease entity has no specific cause to occur and no proper laboratory procedures are present to elicit the diagnosis. The treatment options are largely palliative and aimed at reducing symptoms thereby improving patient’s oral condition. In the present study the subjects witnessed alleviation of clinical symptoms related to the aphthous ulceration. Aims and objectives: The aim of the study was to explore the effectiveness of ozonated oil in the treatment of recurrent aphthous ulcer and to compare with sessame oil in order to analyse the effectiveness between the two topical oil medications. Materials and Methods: A single-blinded placebo-controlled trial comprising of 30 subjects with recurrent aphthous ulcers were divided into Group 1, Group 2 and Group 3 with 10 subjects in each group was performed. Patients in Group 1 received ozonated oil, Group 2 received sesame oil and Group 3 received placebo. Treatment response was assessed by measures of pain reduction, ulcer duration on 2nd, 4th and 6th day. Data were analyzed using Wilcokson signed rank test and Friedman test. Results: Participants treated with ozonated oil showed significant reduction in ulcer size, erythema and also alleviated the ulcer pain on 4th day of evaluation when compared to sesame oil and placebo group. On 6th day subjects treated with ozonated oil and sesame oil showed significant reduction in ulcer size and erythema. No significant difference was observed in placebo group when compared with other two groups on subsequent 2nd, 4th and 6th day of evaluation. Conclusion: Ozonated oil and sessame oil, both showed similar effectiveness in relieving the ulcer pain. Ozone with its wide variety of inherent properties has proven to be choice of treatment in completely relieving the ulcer pain and ulcer size when compared with that of its counter medication (i.e. sesame oil).Therefore the results obtained in the present study forecast ozone to be used as a novel treatment approach in recurrent aphthous ulcers.

Utility of Microbiological Profile of Symptomatic Vaginal Discharge in Rural Women of Reproductive Age Group

Deepa Lokwani Masand, Jaya Patel, Sweta Gupta

Introduction: Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Owing to social stigma majority of affected women hesitate to seek medical consultation. Therefore the actual incidence of vaginal discharge is much more than what is reported. The aim of the study is to determine the microbiological profile of symptomatic vaginal discharge in rural area and its utility in the management of genital tract infection. Materials and Methods: This was a descriptive type of observational study, conducted in sexually active women of reproductive age group (18-45 years) attending the OPD/IPD of Obstetrics and Gynaecology Department of National Institute of Medical Sciences, Shobhanagar, Jaipur (Rajasthan), over a period of 18 months from June 2012 to December 2013. Hundred sexually active non pregnant women of reproductive age group (18-45 years) were included in the study. After taking consent general physical examination along with pelvic examination was performed. Two high vaginal swabs and blood sample were collected for various tests. Hanging drop preparation was immediately made. This was followed by gram staining and culture. Chlamydia trachomatis IgM antibody was detected by ELISA method. Results: Out of 100 women with symptomatic vaginal discharge, specific diagnosis was obtained in 89% of cases whereas no specific aetiology was found in 11% cases. Mean age was 32.60 years. Fifty-three percent patient had Bacterial vaginosis, candidiasis was found in 14% cases, 16% had Chlamydia trachomatis infection while Trichomonas vaginalis infection was detected in 6% cases. Homogenous discharge was most prevalent (52%), followed by mucopurulant discharge in 23% of women. Conclusion: Patient with symptomatic vaginal discharge need to be actively managed with appropriate antimicrobial agents. Judicious management may be helpful in prevention of HIV, HPV, CIN and post infection sequelae.

Evaluation of Quantum of Disability as Sequelae of Electric Burn Injuries

Background: All will agree that invention of electricity has changed the world. Today nobody can think of living without an uninterrupted supply. Electricity is definitely a boon to the mankind but this turns into a curse when it becomes a cause of disaster. Electrical burn injuries are the most destructive injuries with a potential of causing significant functional disability and extensive disfigurement in the survivors. Materials and Methods: We carried out a retrospective observational study on the 110 patients of electric burns admitted to our hospital between January 2007 and October 2014. The aim of the study was to determine the demographic and clinical profile of patients who had sustained electrical burn injury, with a special emphasis on limb loss. Section-2 of Workman's Compensation Act 1923 was used for the calculation of an individual's disability due to amputation. All the data was analysed using method of simple percentages and presented in a tabular form. Result: Forty eight patients (43.63%) of electric burn belonged to the age group of 21-30 y, with male preponderance (M:F:: 93.6 : 6.4). This shows that the individual affected more often are invariably the breadwinners of the family.Twenty four, out of these 110 patients have undergone one or more than one amputation. Significantly the numbers of upper limb amputations have exceeded any other amputation in this study. Mortality in patients of electrical burns is 6.36% in comparison to mortality of 45.67% in all burn patients. Conclusion: Loss of upper limb completely reduces the earning capacity of an individual. Future and fortune of the individual's family is jeopardized. Such accidents can be prevented by following safety norms and simple precautions while using the electrical equipment.

The Effect on the Flexural Strength, Flexural Modulus and Compressive Strength of Fibre Reinforced Acrylic with That of Plain Unfilled Acrylic Resin – An in Vitro Study

Aim: The aim of this in vitro study was to compare the flexural strength, the flexural modulus and compressive strength of the acrylic polymer reinforced with glass, carbon, polyethylene and Kevlar fibres with that of plain unfilled resin. Materials and Methods: A total of 50 specimens were prepared and divided into 10 specimens each under 5 groups namely group 1- control group without any fibres, group 2 – carbon fibres, group 3- glass fibres, group 4 – polyethylene, group 5- Kevlar. Universal testing machine (Tinius olsen, USA) was used for the testing of these specimens. Out of each group, 5 specimens were randomly selected and testing was done for flexural strength using a three point deflection test and three point bending test for compressive strength and the modulus was plotted using a graphical method. Statistical analysis was done using statistical software. Results: The respective mean values for samples in regard to their flexural strength for PMMA plain, PMMA+ glass fibre, PMMA+ carbon, PMMA+ polyethylene and PMMA+ Kevlar were 90.64, 100.79, 102.58, 94.13 and 96.43 respectively. Scheffes post hoc test clearly indicated that only mean flexural strength values of PMMA + Carbon, has the highest mean value. One-way ANOVA revealed a non-significant difference among the groups in regard to their compressive strength. Conclusion: The study concludes that carbon fibre reinforced samples has the greatest flexural strength and greatest flexural modulus, however the compressive strength remains unchanged.

A Comparison of Manual and Automated Methods of Quantitation of Oestrogen/Progesterone Receptor Expression in Breast Carcinoma

R. Vijayashree, P. Aruthra, K. Ramesh Rao

Background: Oestrogen/progesterone receptor expression in breast carcinoma is associated with good response to hormonal therapy and overall better prognosis. The predictive and prognostic capabilities of these receptors are enhanced by quantitation of immunoreaction. There are several manual and automated methods for this purpose. Whether they yield comparable results that can be used interchangeably is not yet clear. Aim: To compare the manual methods (H-score and Allred score) with automated methods (Immunoratio) for quantifying immunohistochemical (IHC) reaction for ER/PR in breast carcinoma. Materials and Methods: Samples from established cases of breast carcinoma were processed and stained by immunohistochemical methods to demonstrate oestrogen receptor (ER) and progesterone receptor (PR). Receptor expression was quantified by manual methods (H-score, modified H-score and Allred score) and automated methods (basic and advanced Immunoratio). In modified H score, the intensity of reaction was assessed by measurement of mean grey value {H (MGV)} or optical density {H (DC-OD)} of deconvoluted image. The manual counting was done with cell counter plugin of Image-J (NIH). The scores were compared and Pearson’s correlation coefficient was determined. Results: Both manual and automated methods produced results that were comparable. There was a statistically significant positive correlation among all methods (p<0.02). The strongest correlation was observed between advanced immunoratio and H (DC-OD) (p=<0.001). Basic immunoratio appeared to be less reliable than the other methods. Staining intensity measurements by various methods did not significantly affect correlation. However, intensity measurements by optical density resulted in lower H-scores but led to more reliable detection of negative immunoreaction. Conclusion: Both manual and automated methods of quantitation are comparable. Advanced immunoratio is a reliable alternative to manual methods. Cell Counter plugin is a useful tool for manual counting and quantitation.

HER 2 Expression in Gastric and Gastro-esophageal Junction (GEJ) Adenocarcinomas

Introduction: Gastric cancer is one of the leading causes of cancer mortality in the world/India with majority being diagnosed at an advanced stage. Various chemotherapeutic regimens have modestly improved overall survival leading to quest for novel therapeutic agents. Overexpression of HER2 in many gastric cancers has lead to the advent of targeted therapy with anti HER2 antibody like Trastusumab which has improved the overall survival. Materials and Methods: Sixty cases of gastric adenocarcinomas (44 biopsies and 16 gastrectomies) over the past five years ( June 2009 to June 2014),were included in the study. Diagnosis was confirmed by review of slides and IHC with anti HER2 antibodies was performed using Dako Real Envision Detection system and scoring was done by Hoffmann et al., scoring system. Results: Of the 60 cases, majority were males (60%),with a mean age of 65.65 yrs. Tumours in antrum (76.7%) formed the major bulk. HER2 expression was observed in 26.7% of Tumours, predominantly in males (p=0.006) and intestinal type (p= 0.054). HER2 expression correlated with Tumour grade (moderately differentiated and well differentiated, p= 0.042). Tumours of gastro-esophageal junction (GEJ) showed HER2 expression in 45.5% as opposed to 22.4% in gastric location. Poorly differentiated and diffuse type of adenocarcinomas did not express HER2. Two of three Tumours from patients in the age group 31-40 y expressed HER2. Conclusion: Male gender, intestinal-type and moderately differentiated gastric cancers may be the ones that can be targeted for therapy using Herceptin. Though trastusumab is approved for advanced gastric and GEJ cancers, it’s role in adjuvant / neo-adjuvant setting in early stages needs to be evaluated with newer agents like Pertuzumab, Bevacizumab, especially in young patients.

Keystone Flap: Versatile Flap for Reconstruction of Limb Defects

Aravind L. Rao, Rakesh K. Janna

Background: There is always a constant search for a new solution to tackle defects in the limbs. The technique has to be simple, easily reproducible and performed within a short duration. The answer is keystone island flap keystone flap is a simple, less time consuming, durable and easily reproducible option to reconstruct most of the limb defects. Aim:The aim of this article is to study the usefulness of keystone flap in reconstruction of various upper and lower limb defects. Materials and Methods: This retrospective review involves study of 20 patients undergoing keystone flap reconstruction for various defects from 2012 to 2014. Patient demographic data, medical histories, comorbidities, surgical indications, defect characteristics and locations, hospitalization, complications and follow-up were evaluated and are presented as uncontrolled case series. Results: Ages of the patients were ranging from 18 to 65 y with an average of 38.75y. Among the defects, 10 were following trauma (50%), 5 were due to tumour resection (25%), 3 followed debridement of abscess (15%) and another 2 defects were due to surgical wound dehiscence (10%). The largest defect covered by this flap in our study measured 45 x 18 cm and the smallest defect was 8 x4 cm. The average intra-operative time was 45.5 min (range 20-90 min). Fourteen flaps were done to cover lower limb defects (70%), 4 for upper limb defects and 2 were for defects in the axilla. Partial flap necrosis was observed in one case. The average duration of hospital stay of patients was 3.45 d. All patients were followed until they achieved stable, healed wound.The overall success rate was 95%. Conclusion: Keystone flap can be safely used to cover various limb defects with minimal pain, a sensate cover and excellent cosmetic outcome, minimizing the need for microsurgical techniques or prolonged operative time.

Analysis of Out Door Patients’ Prescriptions According to World Health Organization (WHO) Prescribing Indicators Among Private Hospitals in Western India

Prakash R Shelat, Shivaprasad Kalakappa Kumbar

Background: Prescription is document through which doctor, patient and pharmacist are communicated. Many a times if these documents are not properly written or misinterpreted it can affect management of patients. WHO established prescribing indicators to analyse prescription and promoted rational use of drugs and better management of patients. Aim: To study the prescription pattern according to WHO prescribing indicators among private hospitals. Settings and Design: The observational, prospective study carried out at different private hospitals at metro city in Western India to study the prescription pattern among private hospital. Materials and Methods: Study was conducted at different private hospitals of metro city. A total of 250 prescriptions of outdoor patients from various departments of private hospitals were collected for a period of three months (August to October) 2012 and evaluated. Statistical analysis: The study was analysed using Z-test. Results: Patient details like age and gender was not written in all (100%) prescriptions. It was noticed that dose, direction of drug and duration of treatment was not completely written in 90%, 74% and 80% of prescriptions respectively. Abbreviations were used in all (100%) prescriptions. Doctor’s medical registration number was mentioned in 0% prescriptions. Total 869 drugs were prescribed in 250 prescriptions. Average number of drug prescribed was 3.38±1.79 (Mean±SD). It was reported that Group II (3 to 4 encoutner) was significantly higher as compared to Group I (less than or equal to 2 encoutner) and Group III( more than four encounter). It was significantly (p<0.05) prescribed brand name prescriptions (93.33%) as compared to generic name prescriptions (6.7%). Percentage of encounter with antibiotics and injections was 54% and 18% respectively. Approximately 70% drugs were prescribed according to Essential Medicine List (EML) of State. Antibiotics accounted 30% of prescribed drugs which was significantly higher as compared to other group of prescribed drugs. Conclusion: Our study revealed that prescription errors were most commonly observed at private hospitals and antibiotics was commonly prescribed in private sector. Therefore, strict policy to good prescribing practice and strict antibiotic policy in outdoor patients are required to promote rational use of drugs.

Obstetric Acute Kidney Injury; A Three Year Experience at a Medical College Hospital in North Karnataka,India

Introduction: Acute kidney injury is a rare and sometimes fatal complication of pregnancy, the incidence of which has been declining worldwide, though still high in developing countries. There are recent observations of increasing incidence in some developed countries attributed to hypertensive disorders of pregnancy. Materials and Methods: In this study, we have analysed the records of all patients referred to the dialysis unit of a medical college hospital in Karnataka for acute kidney injury related to pregnancy. AKIN (Acute Kidney Injury Network) criteria for the diagnosis of acute kidney injury were adapted. Age, parity, gestational age, causative factors for acute kidney injury, mode of delivery, access to antenatal care, operative procedures, blood component transfusions, number of haemodialysis, time for initiation of haemodialysis, duration of hospital stay and mortality were analysed by finding mean, standard deviation and standard error. Results: Fifteen patients out of 21563 who delivered in our hospital developed acute kidney injury. These (n=15) were out of 149 patients of acute kidney injury of various aetiologies who underwent haemodialysis between 2012 and 2014. Of these two were unregistered for antenatal care. Ten were multiparous, Eleven were from rural background, one had home delivery, six had vaginal delivery, seven had caesarean section and two had second trimester abortion. Placental abruption with intrauterine death was the commonest Cause in 9 out of 15 cases. All had severe anaemia. Patients received a mean of 3.9 (SD+/- 2.4) sessions of haemodialysis. Eleven patients recovered completely, two died and two left against medical advice. Conclusion: Obstetric acute kidney injury is associated with poor access to antenatal care, multiparity and rural background. Placental abruption is the commonest cause of obstetric acute kidney injury. Blood component transfusions, avoidance of nephrotoxic drugs and early initiation of haemodialysis are associated with better outcome.

Honey Versus Diphenhydramine for Post-Tonsillectomy Pain Relief in Pediatric Cases: A Randomized Clinical Trial

Soroush Amani, Soleyman Kheiri, Aliahmadi

Introduction: Tonsillectomy is one of the most common surgeries done worldwide and often the first one a child sustains. Pain relief after tonsillectomy is helpful for oral feeding after surgery. Acetaminophen and diphenhydramine have been conventionally used for reducing pain. This study was conducted to compare the effect of honey and diphehydramine on pain relief after tonsillectomy. Materials and Methods: For this randomized clinical trial study, 120 patients of 5 to 12 years undergoing tonsillectomy were recruited. The patients were divided into four groups randomly. After tonsillectomy and beginning of eating, Group A took 5cc honey alone every hour, Group B was given 5 cc 50% honey (mixed with water) every hour, group C was treated with 1mg/kg diphenhydramine every 6 hours and group D was observed without any intervention. In all patients, severity of the pain was evaluated by ocher questionnaire at recovery, and 3, 6, 12 and 24 hours after surgery. The data were analyzed using ANOVA and the repeated measures ANOVA (SPSS version 17). Results: The repeated ANOVA showed a significant decreasing trend of pain scores during the study for both pain scales (p < 0.05), but the rate of trend was similar between the four groups (p > 0.05). No statistically significant difference in pain was detected among the groups. Conclusion: Although honey can help the pain decrease, more research is supported for confirmation of this effect.

Surgical Site Infections Due to Rapidly Growing Mycobacteria in Puducherry, India

Background: Rapidly growing Mycobacteria are increasingly recognized, nowadays as an important pathogen that can cause wide range of clinical syndromes in humans. We herein describe unrelated cases of surgical site infection caused by Rapidly growing Mycobacteria (RGM), seen during a period of 12 months. Materials and Methods: Nineteen patients underwent operations by different surgical teams located in diverse sections of Tamil Nadu, Pondicherry, Karnataka, India. All patients presented with painful, draining subcutaneous nodules at the infection sites. Purulent material specimens were sent to the microbiology laboratory. Gram stain and Ziehl-Neelsen staining methods were used for direct examination. Culture media included blood agar, chocolate agar, MacConkey agar, Sabourauds agar and Lowenstein-Jensen medium for Mycobacteria. Isolated microorganisms were identified and further tested for antimicrobial susceptibility by standard microbiologic procedures. Results: Mycobacterium fortuitum and M.chelonae were isolated from the purulent drainage obtained from wounds by routine microbiological techniques from all the specimens. All isolates analyzed for antimicrobial susceptibility pattern were sensitive to clarithromycin, linezolid and amikacin but were variable to ciprofloxacin, rifampicin and tobramycin. Conclusion: Our case series highlights that a high level of clinical suspicion should be maintained for patients presenting with protracted soft tissue lesions with a history of trauma or surgery as these infections not only cause physical but also emotional distress that affects both the patients and the surgeon.

Prognosis of Left Ventricular Systolic Dysfunction in Septic Shock Patients

Introduction: The prognosis of myocardial dysfunction in critically ill patients with sepsis and its association with mortality is controversial. We aim to determine the significance of left ventricular systolic dysfunction in septic shock patients and their associated outcome. Materials and Methods: A prospective, single center, observational study was carried out at an intensive care unit of a tertiary care hospital. A total of 66 patients diagnosed with septic shock were enrolled in the study from September 2010 to June 2012. The 2D echocardiography was performed for all the patients. Ejection fraction < 50% was the diagnosing parameter for the patients with systolic dysfunction in septic shock. Acute Physiology and Chronic Health Evaluation III (APACHE III) score was calculated. Results: The mean age of patients were found to be 53.71 ± 16.76 years. The mortality rate was found to be 48.48% and among them 43.75% patients had ejection fraction < 50%. Non-survivors exhibited significantly lower mean blood pressure (74.19 ± 10.28 versus 80.59 ± 11.31; p = 0.008), lower ejection fraction (52.59 ± 16.37 versus 62.56 ± 8.31; p = 0.029) and higher APACHE III score (89.34 ± 15.41 versus 70.65 ± 13.27; p < 0.001). The receiver operating characteristic curves APACHE III score (area under curve = 0.830) and ejection fraction (area under curve = 0.656) were used to predict the mortality in septic patients. Conclusion: Low ejection fraction, a marker to measure left ventricular systolic dysfunction is a predictor of mortality in septic shock patients. However, more research is needed to confirm the findings.

Comparative Evaluation of Fracture Resistance of Root Obturated with Resilon and Gutta-Percha Using Two Different Techniques: An in Vitro Study

Vijayakumar L. Shiraguppi, Hema B.S., Chandu G.S., Niranjan Desai, Antriksh Azad

Introduction: Present study evaluated the fracture resistance of endodontically treated teeth filled with Gutta percha and a new resin based obturating material (Resilon). Materials and Methods: A total of 150 freshly extracted Mandibular premolar with fully formed apices were selected and decoronated at cemento-enamel junction (CEJ). Teeth were divided into Group A and Group B of 75 teeth each. In Group A canals were prepared up to # no 40 K file and Group B up to #no 80 K file. Both the groups were sub divided into five group of 15 teeth each as control group (unfilled canals), lateral condensation with Gutta-percha using AH 26 sealer, vertical condensation with Gutta-percha using AH 26 sealer, lateral condensation with Resilon using resilon sealer, vertical condensation with Resilon using resilon sealer. Each specimen was subjected to compressive load using Universal testing machine. The force required to fracture was recorded and data were analysed by ANOVA, Duncan’s test and student T test. Result: The result showed that there is statistically significant difference among experimental groups (p < 0.05). The groups with the Resilon material displayed higher mean fracture loads than the Gutta percha groups. No statistically significant differences were observed between different preparation techniques. Conclusion: Obturating the canals with the new resin-based obturation material increases the in vitro fracture resistance of endodontically treated teeth when compared with standard Gutta percha techniques.

Course of Near-hanging Victims Succumbed to Death: A Seven Year Study

Introduction: Near hanging refers to victims who survive a hanging injury following attempted hanging, long enough to reach hospital. Delayed deaths in near hanging patients are mostly due to complication of hanging. The purpose of this study was to evaluate the demographics, mortality patterns and cause of delayed deaths in near hanging victims. Materials and Methods: In this study autopsy files over a seven year period from 2007 to 2013 were reviewed, and data of near hanging deaths (attempted hanging cases who succumbed to death and subjected for medicolegal autopsy) was extracted. Records of 14,000 autopsies was reviewed, and 10 deceased having died delayed deaths after near hanging episode were identified. In each case, the patients’ details, including gender, age, type of suspension, type of ligature material used for hanging and subsequent hanging mark produced were reviewed using autopsy reports and photographs taken during autopsy. Results: Demographic and pathological aspects of the each case discussed to throw light on autopsy findings in victims who died following near hanging. Complete suspension was present in 3 cases, while partial suspension was present in 7 cases. Survivals in delayed death after near hanging episode have ranged from 9 h to 72 d. Hypoxic encephalopathy was the most common cause of death, followed by pneumonia. Conclusion: Most of the near hanging patients did succumb to hypoxic encephalopathy; however, consolidation of lungs (pneumonia) was the next common cause of death reflecting need for aggressive oxygen therapy and selective resuscitation should be performed in all such cases.

Adolescent Health: Present Status and Its Related Programmes in India. Are We in the Right Direction?

C. Sivagurunathan, R. Umadevi, R. Rama, S. Gopalakrishnan

Adolescence is a phase of rapid growth and development during which physical, physiological and behavioural changes occur. They constitute more than 1.2 billion worldwide, and about 21% of Indian population. Morbidity and mortality occurring in this age group is mostly due to preventable causes. Young and growing children have poor knowledge and lack of awareness about physical and psychological changes that occurs during adolescence and the ill health affecting them. Existing Adolescent health programmes focus on rendering services like immunization, health education for sexual and reproductive health, nutritional education and supplementation, anemia control measures and counseling. Adolescent health programmes are fragmentary at present and there is no comprehensive programme addressing all the needs of adolescents. Access and availability of health care services are severely limited. Lack of accurate information, absence of proper guidance, parent’s ignorance, lack of skills and insufficient services from health care delivery system are the major barriers. Interventions should focus on providing psychological and mental health services and behaviour change communication towards leading a healthy lifestyle, restricting advertisement related to junk food products, awareness creation about reproductive and sexual health, educating parents to prevent early marriage, teenage pregnancy and to counsel their children on nutrition and reproductive health. Universal coverage of Adolescent friendly clinics is highly recommended. To be cost effective, all health services addressing adolescent should come under single programme. This review is intended to create awareness among the stakeholders about the importance of strengthening adolescent health services in order to meet their felt needs.

A Cadaveric Study of Bilateral Configuration of Posterior Bifurcation of Posterior Communicating Artery in Indian Population

Anubha Saha, Aniruddha Sarkar, Shyamash Mandal

Introduction: Various studies have been done regarding variations of circle of Willis, but few literatures are available about the detail configurations on Indian population. Posterior communicating artery is the main collateral channel between the vertebrobasilar and carotid system. It may act as a main source of blood flow via posterior cerebral artery if fetal configuration is present. Aim of the study is to see the bilateral configurations to compare the blood supply of both cerebral hemispheres via posterior cerebral artery in human cadavers. Materials and Methods: Fifty six formalin fixed brains were used for study. The specimens were classified into 3 types and 21 subtypes according to the configuration of the vessel of both hemispheres. As hemodynamic balance is dependent on the calibre of the vessel, the diameter of the arteries were also taken into consideration. Pearson’s correlation had been done. Result: In present study type I is 57.2%, type II is 37.5% and type III is 5.4%. Incidence of unilateral fetal type posterior cerebral artery is in high percentage (33.9%). Greatest diameter of posterior communicating artery is 3.8mm on right and 3.6mm on left side. Significant correlations also have been found between arterial segments of different types. Conclusion: It is expected that the study will help to enrich the knowledge about the arterial predominance of origin of posterior cerebral artery of both cerebral hemispheres in normal or variant cases and its effect on perfusion images.

Comparison of Two Brushing Methods- Fone’s vs Modified Bass Method in Visually Impaired Children Using the Audio Tactile Performance (ATP) Technique

Chrishantha joybell, Ramesh Krishnan, Suresh Kumar V

Background: To evaluate the effectiveness of two brushing techniques - Fone’s method Vs Modified Bass method in visually impaired children using the Audio Tactile Performance (ATP) technique. Settings and Design: Eighty institutionalised visually impaired children, aged between 4-15 y were randomly selected. Materials and Methods: Baseline plaque scores were recorded using Silness and Loe plaque index. The subjects were then randomly divided into two groups of which, 40 were trained with Fone’s method and and other 40 with Modified Bass method using the ATP technique. Plaque scores were evaluated again after two months. The effectiveness of oral hygiene maintenance in these children were analysed and evaluated statistically. Statistical analysis: Data was analysed using Wilcoxon signed rank test and paired t-test. Results: Both Fone’s and Modified Bass method showed reduction in plaque which was statistically significant. There was an increase in the frequency of tooth brushing following training. Conclusion: The Fone’s method and the Modified Bass method of tooth brushing showed a significant improvement in the oral hygiene of visually impaired children when taught using an effective communication tool, the ATP technique.

Gingival, Plasma and Salivary Levels of Melatonin in Periodontally Healthy Individuals and Chronic Periodontitis Patients: A Pilot Study

Thodur Madapusi Balaji, Hannah Rachel Vasanthi, Suresh Ranga Rao

Introduction: Periodontal disease is an inflammatory condition affecting tooth supporting structures in which dysregulated immune response and oxidative stress mediate tissue destruction. Melatonin, the pineal gland hormone is a regulator of circadian rhythm, an antioxidant and an immunomodulator. Previous studies have shown lowered melatonin levels in saliva, plasma and gingival crevicular fluid (GCF) of patients with periodontal disease. Till date no study has assessed the melatonin levels in gingival tissues. Materials and Methods: Five healthy individuals and 15 chronic periodontitis patients were recruited for this pilot study. 5ml of whole saliva, 2 ml peripheral blood and gingival tissue samples were obtained from each individual at 8.00 am in fasting state. Melatonin assay was performed with a commercially available ELISA kit. Statistical analysis was done to assess the difference in mean melatonin levels among the groups. Results: No statistically significant difference was found in mean melatonin levels between healthy individuals and chronic periodontitis patients in saliva (p=.266) and plasma (p=.933) samples, whereas in gingival tissue samples (p=.015), the melatonin levels were significantly lowered in chronic periodontitis patients compared to healthy individuals. Conclusion: This study demonstrates the presence of melatonin in gingival tissue. Furthermore, melatonin levels are lowered in gingival tissues of chronic periodontitis patients.

A Comparative Study of Clinical Parameters in Submerged and Non submerged Implants

Aim: The aim of this study was to evaluate and compare the radiographic bone loss and soft tissue parameters around one stage and two stage implants. Materials and Methods: Twenty four patients with submerged implants and twenty four patients with non submerged implants at the time of loading were assessed in this prospective cohort study. The soft tissue assessment included probing depth (PD), papilla index (PI), mucosal thickness (MT) and keratinized tissue (KG); another parameter assessed was the radiographic distance between the shoulder of the implant and alveolar crest evaluated at baseline (loading time) and 3,6 and 12 months after loading in both groups.Data were analysed using repeated measures analysis of variance (ANOVA) and multiple comparisons were done using LSD method. Results: The changes in the soft tissues including PD, KG, MT and PI had no significant differences in either group. The amount of bone loss 3 and 6 months after loading was significantly greater in one stage implants (0.93±0.45 mm at 3months and1.45±0.58 mm at 6months, for one stage and 0.32±0.21 mm at 3months and 0.74±0.43 mm at 6 months for two stage group). But the change of this index 12 months later was not significantly different between the two groups (1.87±0.76mm for one stage and 1.65±0.59mm for two stage group). Conclusion: Based on the results of this study there is no difference in hard and soft tissue changes one year after loading of one or two stage implants.

Burden of Care on Caregivers of Schizophrenia Patients: A Correlation to Personality and Coping

Background: Schizophrenia is a mental disorder where the caregivers are likely to face increasing levels of burden and stress. The present study aims to explore the relation between burden of care on the caregivers of schizophrenic patients with various psychological parameters including their coping strategies, personality type, overall quality of life and socio-demographic details. Materials and Methods: The participants included in the study (n=110) were administered a socio-demographic data sheet and questionnaires to assess their personality type, burden, quality of life, and coping mechanisms of having a schizophrenic in the family. These questionnaires were administered in individual setting. Their informed consent was taken prior to the administration of tools and their privacy was taken care of. The data obtained was analysed statistically. Results: Most of the caregivers were females. The caregivers were observed to have moderate and high levels of burden. Burden on the caregivers showed a significant correlation with psychoticism and their overall quality of life. A significant correlation was seen between the levels of coping and extrovert type of personality, and also with the environmental health of the caregivers. Caregivers belonging to nuclear families coped better than those of joint families. Conclusion: The study concludes that certain personality traits like psychoticism and certain social traits such as living in joint families can increase the risk of caregiver burden in looking after family members suffering from schizophrenia. A need for psychological assistance for the vulnerable caregivers to help them reduce the burden levels and employ positive coping strategies has, therefore, been emphasized in our study.

Study on Assessment of Renal Function in Chronic Liver Disease

Nupur Das, Agnihotri Bhattacharyya, Baishakhi Paria, Sujoy Sarkar

Introduction: Renal dysfunction is common in chronic liver disease. The cause of this renal dysfunction is either multi-organ involvement in acute conditions or secondary to advanced liver disease. Objectives: The study was undertaken to assess the renal function in chronic liver diseases and find out the association of alteration of renal function with gradation of liver disease. (assessed by child-pugh criteria) and to find out the association of alteration of renal function among the cases of chronic liver disease of different aetiology. Materials and Methods: This cross-sectional, observational study was undertaken in Department of General Medicine, Calcutta National Medical College & Hospital, Kolkata during March 2012 to July 2013 with 50 admitted patients of chronic liver disease after considering the exclusion criteria. The patients were interviewed with a pre-designed and pre-tested schedule, examined clinically, followed by some laboratory investigations relevant to diagnose the aetiology of chronic liver disease, and to assess the severity of liver and renal dysfunction. Data was analysed by standard statistical method. Results: Eighty six percent of the patients were male and the mean age of study population was 43.58 y, 68% patients suffered from alcoholic liver disease, followed by 14% patients had chronic Hepatitis-B, 10% patients developed acute kidney injury, 20% had hepato renal syndrome and 14% had IgA deposition. The distribution of serum urea and creatinine across the categories of Child Pugh classification tested by Mann-Whitney test and the distribution was statistically significant. Conclusion: The present study has found significant association between severity of liver dysfunction and certain parameters of renal dysfunction.

Thyroid Hormones and Prolactin Levels in Infertile Women in Southern Nigeria

Introduction: Human infertility is a complex global health problem. It has multiple social consequences which are especially profound for thyroid hormones in infertility with the aim of determining the degree of association of thyroid hormones with hyperprolactinemia in our population. Materials and Methods: The serum levels of prolactin, T3, T4 and TSH were determined in 90 hyperprolactinemic infertile women, 90 normoprolactinemic infertile women and 50 fertile women. The hormones were assayed using Enzyme Linked Immunosorbent Assay kits. Statistical Analysis: Analysis of variance and Pearson’s correlation were used to analyze the data, with the significant p-level set at 0.05. Results: A significantly higher mean serum prolactin and TSH were observed among the infertile groups compared to the fertile controls (p<0.05). The mean serum T3 and T4 were significantly lower in the hyperprolactinemic infertile women compared to the fertile controls (p<0.05). The mean TSH and T3 of normoprolactinemic infertile women and controls were comparable (p>0.05). However, the mean T4 was significantly lower in normoprolactinemic infertile women compared to the fertile controls (p<0.05). In all the groups, TSH correlated inversely with T3 and T4, while T3 correlated positively with T4. It was only in the control group that prolactin correlated positively and significantly with TSH. Conclusion: It is therefore concluded that hyperprolactinemia with thyroid dysfunction may be a major contributory hormonal factor in infertility among infertile women and as such, estimation of prolactin, T3, T4 and TSH should be included in the workup for infertile women especially those with hyperprolactinaemia.

Accessory Pancreatic Duct Patterns and Their Clinical Implications

Lokadolalu Chandracharya Prasanna, KV Rajagopal, Huban R Thomas, Kumar MR Bhat

Context and Objective: Accessory pancreatic duct (APD) designed to reduce the pressure of major pancreatic duct by forming a secondary drainage channel. Few studies have mentioned the variant types of accessory ducts and their mode of formation, some of these have a clear clinical significance. Present study is aimed to evaluate the possible variations in the APD and its terminations. Materials and Methods: Forty formalin fixed adult human pancreas with duodenum in situ specimens were studied by injecting 1% aqueous eosin, followed by piece meal dissection of the head of the pancreas from posterior surface. Formation, tributaries, relations, and the termination of the accessory pancreatic duct were noted and photographed. Results: Accessory ducts revealed 50% belonged to long type, 22.5% were of short and ansa pancreatica type each, and embryonic type of duct pattern was seen in 5% specimens. 75% of long type ducts showed positive patency with eosin dye, followed by ansa type (44.4%), and least patency was found in short type (22.2%). With regard to the patency of the accessory pancreatic ducts towards their termination, we found 52.5% of the accessory ducts and 5% of the embryonic type pancreatic ducts were patent and in 42.5% of the specimen the ducts were obliterated. In 85% of specimens the minor duodenal papillae was anterosuperior to the major papilla and superior to the major papillae in 10% of the cases, and in 5% minor papillae was absent. The average distance between the two papillae was 2.35 cm. Conclusion: The knowledge of the complex anatomical relations of the gland with its duct, duodenum and bile ducts are essential for the surgeons and sinologists to plan and perform both the diagnostic as well as therapeutic procedures effectively.

To Study the Prevalence of Impaired Glucose Tolerance in Patients with Hepatitis C Virus Related Chronic Liver Disease

Background: Hepatitis C infection is a major cause of Chronic Liver Disease and the prevalence of Diabetes Mellitus is also high. Diabetes has been hypothesised as one of Extrahepatic manifestations of Hepatitis C. Aims and Objectives: The objective of our study was to study the prevalence of impaired glucose tolerance in patients with HCV related liver disease. Study Design: The study was a prospective study conducted over a period of one and half year in Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Materials and Methods: The study was conducted taking total of 100 Hepatitis C virus positive patients above 40 years of age who had fasting blood glucose levels =110mg/dl on two occasions, 24 hours apart. These patients underwent an oral glucose tolerance test. Blood sugar levels were tested at 0 and 2 hours. Based on the findings, patients were classified to have impaired glucose tolerance if levels were between 140-200mg/dl and frank diabetes if the levels were = 200mg/dl. These findings were further assessed according to age, gender, Body Mass Index (BMI) Child Turcott Pugh score and Ultrasonography findings. Statistical Analysis: In our study all the statistical analysis was done using simple z-test and student t-test. The p-values were calculated and the results assessed accordingly. Results and Conclusion: Out of 100 patients, 78 were males and rest females. The mean age of the study group was 55.89+11.22 years. Mean BMI of males was higher than in females (21.98kg/m² v/s 20.13kg/m²). Maximum patients belonged to Child Turcott Pugh class C. Out of 100 patients,80 had cirrhosis on ultrasound. On doing Glucose Tolerance Test, 40 patients were found to have impaired glucose tolerance and one patient to be diabetic. The prevalence increased significantly as age increased and had significant relation with gender. On assessing according to BMI, there was not much significant relation but prevalence was significantly related to severity of disease.

Brain and Lung Abscesses in a 48-year-old Man with Focal and Segmental Glomerulosclerosis

Ali Momeni, Fereidoon Rahmani, Hamid Nasri

Focal segmental sclerosis (FSGS) is a common cause of idiopathic nephrotic syndrome in the adult population. A patient aged 48- year-old was admitted for evaluation of azotemia. Renal biopsy showed tip lesion FSGS and acute tubular necrosis. After methyl prednisolone pulse therapy, partial remission occurred, and he was stable with oral prednisolone and cyclosporine. Few months later two serious complications including lung and brain abscess occurred. We describe a case of FSGS with lung and brain abscess, who responded to medical management.

Effect of Chicken Egg Shell Powder Solution on Early Enamel Carious Lesions: An Invitro Preliminary Study

Aim: To evaluate the remineralization potential of enamel surface lesion using chicken eggshell powder (CESP) solution. Materials and Methods: Ten freshly extracted un-erupted third molars decoronated at cement-enamel junction (CEJ) used in this study. Each decoronated tooth was sectioned to get 4 samples of enamel blocks such that 40 blocks were obtained which were then subjected to demineralization protocol and grouped as: Group 1-untreated group, Group 2-subsurface demineralization, Group 3-subsurface demineralization + 7 days CESP immersion, Group 4- subsurface demineralization + clinpro application. The samples were evaluated for X-ray fluorescence spectroscopy analysis, microhardness testing and atomic analyses using energy dispersive X-ray spectroscopy. The data were statistically analysed by using one-way ANOVA and Tukey – Kramer multiple comparison test. Results: X-ray Fluorescence spectroscopy shows Calcium concentration of 98% and 0.46% of phosphate. Group 4 (Clinpro) shows the highest efficacy in enhancing the remineralization followed by Group 3 (CESP). The results of atomic analyses showed that quantitative amounts of Ca weight % and P weight % is statistically greater for all the three groups except the demineralized group. Conclusion: CESP with higher calcium content can remineralise enamel surface lesion.

Palmoplantar Psoriasis- Ahead in the Race-A Prospective Study from a Tertiary Health Care Centre in South India

Background: Psoriasis is a common and chronic T cell mediated skin disorder with varied clinico-morphological types. Most of the published studies have reported chronic plaque type psoriasis to be the commonest type. Aim: To find the incidence of palmoplantar psoriasis in a tertiary health care centre in South India. Materials and Methods: A prospective study done over a period of six months recruiting the patients attending the Dermatology out-patient department in a tertiary health care centre. Results: Incidence of palmoplantar psoriasis was found to be highest among all morphological forms of psoriasis. Conclusion: Incidence of palmoplantar psoriasis is under-expressed. It is actually ahead in the race.

Anatomical Variations in the Pattern of the Right Hepatic Veins Draining the Posterior Segment of the Right Lobe of the Liver

Poonam Shilal, Anita Tuli

Background: The pattern of drainage in the right posterior lobe of liver varies considerably. The knowledge of this variation is very important while performing various surgeries on the right posterior lobe. Aim: A study was conducted to see the variations in the pattern of drainage of posterior segment of the right lobe of liver. The aim was to see the variations of right hepatic vein and small accessory hepatic veins draining the posterior segment, the presence of which led to modifications in drainage of posterior segment. Material and Methods: Sixty formalin fixed adult human liver specimens were dissected manually. Results: According to the pattern of drainage of tributaries of right hepatic vein, the right hepatic vein was classified into type I, type II, type III and type IV. According to presence of inferior right hepatic vein, three types of drainage of posterior lobe were seen: Type I, (76.36%) right hepatic vein was large, draining wide area of posterior segment. A small inferior right hepatic vein drained the small area of posterior segment. In Type II, (19.92%) both right hepatic and inferior right hepatic veins were medium sized draining the posteroinferior segment of the right lobe concomitantly. In Type III, (32%) accessory veins, the middle right hepatic vein drained the posterosuperior (VII) as well as the posteroinferior (VI) segment. In one specimen, there were numerous middle right hepatic veins draining the right posterior segment. The knowledge of anatomic relationship of veins draining right lobe, is important in performing right posterior segmentectomy. Conclusion: For safe resection of the liver, the complex anatomy of the distribution of the tributaries of the right hepatic vein and the accessory veins have to be studied prior to any surgery done on liver.

Occupational Radiation Exposure from C Arm Fluoroscopy During Common Orthopaedic Surgical Procedures and its Prevention

Anupam Mahajan, Sumant Samuel, Atul K Saran, M K Mahajan, M K Mam

Background: Image intensifiers have become popular due to the concept of minimally invasive surgeries leading to decreasing invasiveness, decreased operative time, and less morbidity. The drawback, however, is an increased risk of radiation exposure to surgeon, patient and theatre staff. These exposures have been of concern due to their potential ability to produce biological effects. The present study was embarked upon to analyse the amount of radiation received by orthopedic surgeons in India using standard precautionary measures and also to bring awareness about the use of image intensifier safety in everyday practice. Materials and Methods: Twelve right-handed male orthopedic surgeons (4 senior consultants, 5 junior consultants and 3 residents) were included in a three month prospective study for radiation exposure measurement with adequate protection measures in all procedures requiring C Arm fluoroscopy. Each surgeon was provided with 5 Thermo Luminescent Dosimeter (TLD) badges which were tagged at the level of neck, chest, gonads and both wrists. Operative time and exposure time of each procedure was recorded. Exposure dose of each badge at the end of the study was obtained and the results were analysed. Results: Mean radiation exposure to all the parts were well within permissible limits. There was a significantly positive correlation between the exposure time and the exposure dose for the left wrist (r=0.735, p<0.01) and right wrist (r=0.58, p<0.05). The dominant hand had the maximum exposure overall. Conclusion: Orthopaedic surgeons are not classified radiation workers. The mean exposure doses to all parts of the body were well within permissible limits. Nothing conclusive, however, can be said about the stochastic effects (chance effects like cancers). Any amount of radiation taken is bound to pose an additional occupational hazard. It is thus desirable that radiation safety precautions should be taken and exposures regularly monitored with at least one dosimeter for monitoring the whole-body dose.

Cervicitis: How Often Is It Non-specific!

Naveen Kumar.B.J

Background: Uterine cervix is most often reported as ‘non specific cervicitis’. It is an effort to encourage specific reporting and thereby avoiding the term ‘non specific’ to a possible extent. Materials and Methods: The study is carried out on 613 specimens of uterine cervix received at Department of Pathology, Aarupadai Veedu Medical College, Pondicherry, between 1st January 2010 to 31st December 2012. Histopathology slides of all the cases were studied for the presence of specific features of various inflammatory lesions. Results are expressed in percentage. Results: Chronic nonspecific cervicitis was the commonest inflammatory lesion constituting 89.23% of the cases. Other inflammatory lesions were follicular cervicitis in 6.85%, chronic cervicitis with koilocytosis in 3.75% and only one case (0.16%) of tuberculosis was observed. Conclusion: Importance of these benign lesions of the uterine cervix lies in the fact that some of them like Chlamydia, Papilloma infection have specific treatment and some of them form differential diagnosis for malignant lesions and some progress to malignancy.

Comparative Evaluation of Dexmedetomidine and Esmolol on Hemodynamic Responses During Laparoscopic Cholecystectomy

Background: The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. Aim: The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. Measurements: Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. Results: In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). Conclusion: Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents.

A Study on the Prescribing Pattern of Drugs for Acne in a Tertiary Care Teaching Hospital in Odisha

Nibedita Patro, Monalisa Jena, Maitreyee Panda, Mrutyunjay Dash

Background: Acne vulgaris is a common disease of the skin affecting the socially vulnerable young age group. There are multitudes of treatment options available but till now no studies have been reported to demonstrate the current prescribing pattern of drugs in acne vulgaris. Aim: To study the prescribing pattern of drugs in acne in a tertiary care teaching hospital in Odisha, India. Materials and Methods: The study was an observational study conducted for a period of one year on patients more than 10 yeras age and having acne attending the Skin & VD OPD. Drug induced acne and acneiform eruptions were excluded. Results: A total of 1210 prescriptions of acne were analysed. The male to female ratio was 1:1.29. Most patients presented with grade 2 (60%) acne followed by grade 3 (20.99%). Out of prescribed drugs, 47.44% were oral and 52.56% were topical formulations. Oral isotretinoin (68.10%) was the most frequently prescribed drug among oral formulations. Doxycycline (54.18%) was the most preferable oral antibiotic. The average number of drugs per prescription was 3.003. Polypharmacy was preferred over monotherapy. Conclusion: In the management of acne, judicious and early intervention with oral isotretinoin improves the overall treatment outcome, the fact which has increased its use in acne patients.

Foveal and Macular Thickness Evaluation by Spectral OCT SLO and Its Relation with Axial Length in Various Degree of Myopia

Nancy Elizabeth Samuel, Srikanth Krishnagopal

Purpose: To evaluate the foveal and macular thickness in various degrees of myopia and its association with axial length in low, moderate and high degrees of myopia. Design: A cross-sectional study was done in the Department of Ophthalmology, MGMCRI, Pondicherry, India. Materials and Methods: One hundred and twenty five eyes eyes of 64 myopic subjects between the age group of 20-40 who fulfilled the inclusion criteria were selected and complete ophthalmic examination was done. Cycloplegic refraction was done and the subjects were categorized into low (n=43 eyes), moderate (n=43 eyes) and high (n=36) degrees of myopia. The foveal and macular thickness was assessed using spectral OCT- SLO and axial length was measured by A-scan biometry. Results: The foveae minimum of high myopia (178 ± 26.4 microns) was significantly thicker compared to moderate myopia (p= 0.028). There was no significant intergroup difference in the thickness significance of the outer and inner macular between mild, moderate and high degree of myopia. The mean axial length of high myopia (26.7±0.97mm) was significantly higher compared to moderate (24.6±0.81mm) and low myopia (23.5±0.81mm) with a p-value of p = 0.001. There was a positive correlation of axial length with foveae minimum, fovea and superior inner macula in respect to myopia (p<0.05). Conclusion: The foveal and macular thickness in myopia is influenced by the axial length. Early detection of such changes in macular thickness by using OCT is helpful in understanding the mechanism and factors affecting the structural changes of myopic eyes. Also it implicates the importance of refractive error induced retinal macular changes while interpreting OCT.

A Prospective, Comparative Study of the Occurrence and Severity of Constipation with Darifenacin and Trospium in Overactive Bladder

Manjunatha R., Pundarikaksha H.P., Hanumantharaju B.K., Anusha S.J.

Introduction: Darifenacin and trospium are the commonly used antimuscarinics in the management of overactive bladder (OAB). Constipation is the second most common treatment related side-effect. Though its incidence with the above two medications is known, data on their comparative severity and impact on patient’s well-being is lacking. Materials and Methods: Sixty subjects with OAB included in the study were randomized in 1:1 fashion to receive either darifenacin 7.5 mg OD or trospium extended release 60 mg OD. Treatment response was monitored using overactive bladder symptom score (OABSS). The severity of constipation was assessed using McMillan & Williams Constipation assessment scale (CAS), Bristol stool form scale and Knowles-Eccersley-Scott-Symptom (KESS) questionnaire score administered at baseline, 2 and 4 weeks of treatment. Results: OABSS improved significantly, -5.80 ± 3.99 (p = 0.0005) and -5.27 ± 2.98 (p = 0.0005) in darifenacin and trospium groups respectively. However, the difference between the two groups was not significant either at 2 weeks (p = 0.952) or 4 weeks (p = 0.654) of treatment. A significant decrease in stool consistency was noted with darifenacin treatment (p < 0.05), but the same was not seen with trospium (p = 0.076). There was no significant difference in scores of KESS questionnaire between baseline, 2 weeks and 4 weeks, both within the group and between the groups (p > 0.05). McMillan & Williams CAS scores increased at week 2 and week 4, in comparison with baseline scores in both darifenacin and trospium treated patients, however, the difference between the two groups was not statistically significant (p > 0.05). Conclusion: Darifenacin and trospium are equally efficacious and comparable in tolerability in terms of constipation severity and its impact on patient well-being.

A Comparative Study of the Clinical Efficacy and Safety of Lorazepam and Chlordiazepoxide in Alcohol Dependence Syndrome

Ranjani Ramanujam, Padma L., Swaminath G., Rohini S. Thimmaiah

Background: Currently, benzodiazepines are the preferred drugs in the management of alcohol withdrawal symptoms. Chlordiazepoxide and diazepam, the most frequently used drugs have a long duration of action and are converted to active metabolites in the liver, while lorazepam is shorter acting, with no active metabolites. Objective: To compare and evaluate the safety and efficacy of lorazepam and chlordiazepoxide in patients with alcohol dependence syndrome with symptoms of alcohol withdrawal. Materials and Methods: This was a prospective, randomized, double-blind, study carried out at a teaching hospital in Bangalore. Sixty patients aged =18 y with alcohol dependence syndrome with mild-to-moderate withdrawal symptoms were allocated at a ratio of 1:1 to either lorazepam or chlordiazepoxide, by means of a computer-generated randomization chart. Thirty patients each were started with lorazepam tablets 8 mg/day and chlordiazepoxide 80 mg/day. For both treatment groups, the dose was tapered and at the end of 8 days, the patients were drug-free. The severity of alcohol dependence was assessed using the Severity of Alcohol Dependence Questionnaire (SADQ). The CIWA-Ar was used for quantification of withdrawal symptoms. Liver function tests were performed at baseline and at the end of the study. Results: Of the 60 patients included in the study, 15 patients each had mild and moderate withdrawal symptoms in the chlordiazepoxide group and 17 and 13 patients respectively in the lorazepam group, based on the SADQ score. At baseline, the mean CIWA-Ar scores were similar in both the treatment groups: 24.77±5.98 in the chlordiazepoxide group and 24.90±6.12 in the lorazepam group. There was a significant intragroup decrease in the CIWA-Ar scores measured from baseline to the end of 8 days (p<0.0001) and 12 days (p<0.0001) in both treatment groups, however, there was no significant difference between the two groups. There was no significant difference observed in the liver function tests done at baseline and at the end of study period. Conclusion: Lorazepam is noninferior to chlordiazepoxide in reducing alcohol withdrawal symptoms.

Study of Metastasis in Lymphnode Biopsies with Special Reference to Immunohistochemistry (IHC) in Metastatic Breast Carcinoma

Syed Ali Baqher Hussaini, Sainath K Andola, Anita A M

Context: Lymph nodes are the most common site of metastatic malignancy, and sometimes constitute the first clinical manifestation of the disease. Metastases are tumour implants discontinuous with the primary tumour. The characterization of a neoplasm as primary or metastatic has always troubled surgical pathologists. Aim: To study distribution of lymph node metastasis in North Karnataka region based on age, sex, location and morphological features, and to explore the utility of special stains and immunohistochemistry (IHC) in its diagnosis. Materials and Methods: The present study includes 228 cases of lymph node metastasis studied over a 10-year period (July 2004- June 2014). The H&E slides were reviewed, special stains and IHC done wherever necessary. Results: Out of 228 cases, maximum were seen between 2012-2014 (79 cases, 34.65%). Age ranged from 16-85y (Mean- 47.02) with female predominance (Male:Female 1:2.55.). In 186 cases (81.58%) more than one lymph node received, while in majority of cases (35.09%) size of the lymph node was between 1-2cms. Most common site of metastasis was axillary lymph nodes (33.77%) followed by cervical (22.50%) and pelvic (9.64%). Primary was mainly from breast carcinoma (33.77%) followed by squamous cell carcinoma (31.57%) and adenocarcinoma (10.52%). IHC in 60 cases with breast carcinoma metastasis showed ER positivity in 45.00%, PR positivity in 41.67% and HER2/neu positivity in 38.33%. Conclusion: Identification of the size, number, microscopic type and possible primary site of metastasis is important prognostically especially in breast carcinoma. This study elaborates the pattern of distribution of lymph node metastasis in North Karnataka region with IHC as an aid to diagnosis.

Anatomy of Axillary Nerve and Its Clinical Importance: A Cadaveric Study

Prakash K.G., Saniya K.

Introduction: Axillary nerve is one of the terminal branches of posterior cord of brachial plexus, which is most commonly injured during numerous orthopaedic surgeries, during shoulder dislocation & rotator cuff tear. All these possible iatrogenic injuries are because of lack of awareness of anatomical variations of the nerve. Therefore, it is very much necessary to explore its possible variations and guide the surgeons to enhance the better clinical outcome by reducing the risk and complications. Materials and Methods: Twenty five cadavers (20 Males & 05 Females) making 50 specimens including both right and left sides were dissected as per standard dissection methods to find the origin, course, branches, distribution & exact location of the nerve beneath the deltoid muscle from important landmarks like: posterolateral aspect of acromion process, anteromedial aspect of tip of coracoid process, midpoint of deltoid muscle insertion (deltoid tuberosity of humerus) and from the midpoint of vertical length of deltoid muscle. The measurements were recorded and tabulated. Statistical Analysis: The measurements were entered in Microsoft excel and mean, proportion, standard deviation were calculated by using SPSS 16th version. Results: The axillary nerve was found to take origin from the posterior cord of brachial plexus (100%) dividing into anterior & posterior branches in Quadrangular space (88%) and supply deltoid muscle mainly. It also gave branches to teres minor muscle, shoulder joint capsule & superolateral brachial cutaneous nerve (100%). This study concluded that the mean distance of axillary nerve from the – anteromedial aspect of tip of coracoid process, posterolateral aspect of acromion process, midpoint of deltoid insertion & from the midpoint of vertical length of deltoid muscle measured to be (in cm) as 3.56±0.51, 7.4±0.99, 6.7±0.47 & 2.45±0.48 respectively. The mean vertical distance of entering point of axillary nerve from the anterior upper, mid middle upper & posterior upper deltoid border found to be (in cm): 4.94±0.86, 5.14±0.90 & 5.44±0.95 respectively and the horizontal anterior & horizontal posterior mean distance being 4.54±0.65 & 3.22±0.53 respectively. The mean height, mean width & mean depth of Quadrangular space measured to be (in cm): 2.23±0.40, 2.19±0.22 & 1.25±0.14 respectively. Conclusion: The findings were found to be highly significant when males were compared with females but not significant when sides (right & left) were compared.

Is Urolithiasis Associated with Increased Levels of High Sensitivity C-Reactive Protein and Interleukin-6 in Diabetic Patients?

Background: The prevalence and incidence of urolithiasis is increasing worldwide. Type 2 diabetes mellitus is well known to be associated with insulin resistance which increases the risk of urolithiasis by altering the composition of urine. Both urolithiasis and diabetes mellitus are associated with inflammation. The aim of the study was to assess the serum levels of inflammatory markers i.e. high sensitivity C-reactive protein (hsCRP) and Interleukin-6 (IL-6) in diabetes mellitus patients with urolithiasis in comparison to those without urolithiasis. Materials and Methods: The study involved two groups. Group A consisted of diabetic mellitus patients with urolithiasis (n=30) and Group B consisted of diabetic mellitus patients without urolithiasis (n=30). Blood samples were obtained and analysed for HbA1C, lipid profile, calcium, phosphate and uric acid, and inflammatory markers (C-reactive protein and Interleukin-6) were also measured. Results: We found a significant increase in CRP and IL-6 levels in diabetic urolithiasis cases as compared to diabetes mellitus cases without urolithiasis. However, no significant difference was observed in calcium, phosphorus and uric acid in diabetic patients with and without urolithiasis. We also found that total cholesterol, triglycerides, LDL-cholesterol and VLDL-cholesterol levels were significantly increased, and HDL-cholesterol was significantly decreased in diabetic urolithiasis cases. IL-6 was significantly correlated with total cholesterol in diabetic urolithiasis cases. Conclusion: The data from the present study shows that lipid profile is altered, and Interleukin-6 and C-reactive protein levels are significantly increased in patients with diabetes mellitus and urolithiasis when compared to diabetes mellitus alone.

Primordial Prevention: Promoting Preparedness for Ebola Virus Disease

Background: India may face a danger of immediate spread of Ebola Virus Disease (EVD) if it enters the subcontinent. Preparedness for such a condition is a part of its prevention. Dentists form a sizeable chunk of healthcare in India and may help in augmenting the health care team at the time of such outbreaks. This paper details the development and evaluation of a specially tailored program for dental students and faculty for imparting knowledge on EVD and its prevention strategies. Aim: To assess the knowledge score for EVD and its prevention after attending a specially tailored program. Materials and Methods: A multidisciplinary team was selected for content development and providing an insight on the topic. The program was attended by students and faculty members of Manav Rachna Dental College. The knowledge of the attendees about EVD was assessed at the end of the program through a structured questionnaire. The response rate was 96%. Result: According to the knowledge score attained, 52.4% of the participant had good knowledge level and 2.8% had poor knowledge level. There was no significant difference in knowledge scores between the participants having prior knowledge and those having no previous knowledge about the disease (p = 0.135). Conclusion: High response rate and good knowledge level attained by most of the participants established evidence of a successful program.

Effect of Vitamin D3 Supplement in Glycemic Control of Pediatrics with Type 1 Diabetes Mellitus and Vitamin D Deficiency

Sakineh Mohammadian, Nasrin Fatahi, Hossein Zaeri, Mohammad Ali Vakili

Background: Glycemic control prevents microvascular complications in patients with type I diabetes mellitus such as retinopathy, nephropathy and neuropathy that influences quality of life. Some studies show the immunomodulatory effect of vitamin D in synthesis and secretion of insulin. Aims: In this study we evaluate glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency. Materials and Methods: In children with type I diabetes mellitus, level of vitamin D and HbA1C was measured. Patients with type I diabetes mellitus who had vitamin D deficiency (25OHD < 50 nmol/lit) treated with 300,000 units of vitamin D3. Calcium supplement (40mg/kg/day) divided in two doses in order to avoid hungry bone was also used. After three months, 25OHD and HbA1C were measured again. Differences, in mean ± SD HbA1C and 25OHD were evaluated before and after the study. Results: Mean ± SD HbA1C was 9.73±1.85 before the study which was diminished to 8.55±1.91 after vitamin D3 supplement treatment. This decline has a significant difference (p-value < 0.0001). Mean ± SD 25OHD was 17.33±8.97 nmol/lit before the study which is increased to 39.31±14.38 nmol/lit after treatment with vitamin D3 supplement. This increase also has a significant difference (p-value < 0.0001). Vitamin D3 supplement causes the improvement of HbA1C in all groups of glycemic control including HbA1C <7.8, 7.8-9.9, and >9.9. This supplement transfer patients toward better glycemic control for the entire group (p-value < 0.0001). Conclusion: Vitamin D3 supplement improves HbA1C in pediatrics with type I diabetes mellitus and vitamin D deficiency.

Pattern of Cancer in a Tertiary Care Hospital in Malwa Region of Punjab, in Comparison to Other Regions in India

Ramnika Aggarwal, Manuja, Kewal Aditya, G.P.I. Singh=

Context: Cancer pattern varies in different regions and depends on race, lifestyle and diet. There is a lack of definitive information regarding hospital-based cancer profile in Southern Punjab, which is a cotton growing area. Excess of toxins in the macro-environment is thought to be the reason for the high incidence of cancer in this area. Aims: To generate data on the magnitude and pattern of cancer cases reporting in the medical college hospital and to plan activities for prevention of cancer in the field practice area. S ettings and Design: A five year record-based retrospective study from 1stJanuary 2007 to 31stDecember 2011. Materials and Methods: All cancer cases who reported either for diagnosis or for treatment (radiotherapy/chemotherapy/surgery) were included in the study. These confirmed cases of cancer were classified according to the International classification of Disease (ICD-10) given by WHO. Statistical Analysis: Descriptive statistics, percentages. Results: Out of a total of 1328 cancer cases, females accounted for 809 (60.9%) and males for 519 (39.1%) cases. Male to female ratio was 1:1.55. The maximum number of patients were seen in 35-64 yr age group (63.5%). Top five leading sites of cancer in males were lung (9.6%), myeloid leukemia (8.3%), prostate (6.8%), mouth (6.1%) and gall bladder (6.0%); and in females were breast (35.7%), cervix (19.1%), esophagus (5.1%), myeloid leukemia (4.7%) and gall bladder (3.9%). Our figures have been compared with the national data from NCRP. Conclusion: Population-based epidemiological studies are required to find out the disease burden & its cause in this region.

Familial Adenomatous Polyposis (FAP)—A Case Study and Review of Literature

Familial adenomatous polyposis (FAP) is a syndrome characteristically having numerous (hundreds to thousands) polyps in the epithelium of the large intestines with an autosomal dominant inheritance caused by germ line mutations in adenomatous polyposis coli (APC) gene in chromosome 5q21. Most FAP patients have a family history of colorectal polyps and cancer but 25-30% of them are "de novo", without any clinical or genetic evidence of FAP in family members. Prophylactic proctocolectomy is required in almost all patients since all affected patients inevitably develop cancer. We report a case of a 32-year-old man who presented with vague abdominal complaints without any family history, which on evaluation as found to have multiple colorectal polyps and underwent a prophylactic proctocolectomy with end continent ileostomy. Two of his children were evaluated and found to have multiple colorectal polyps on colonoscopy and have been advised regular follow up annually. In conclusion, patients with FAP may present with vague abdominal complaints and without any family history, hence need to be carefully evaluated. Good patient compliance is of prime importance in deciding the treatment and surveillance modality subsequently determining the prognosis of patients with FAP.

Hearing Screening in a Tertiary Care Hospital in India

Amit Kumar, Neha Shah, Kalpesh B. Patel, Rajesh Vishwakarma

Introduction: To study the incidence of hearing loss among children and to determine and confirm the distribution of common risk factors in children with hearing loss presenting at a tertiary care hospital in India. Materials and Methods: Babies underwent hearing screening using Transient Evoked Otoacoustic Emission (TEOAE) and Automated Auditory Brainstem Response (AABR) from November 2009 to September 2011. It was a cross-sectional study carried out at our institute involving 500 babies (=2 y). To identify the high risk babies, Joint Committee on Infant Hearing (2007) High risk registry was used. Results: In our study 110 (22%) babies belonged to high risk category and 11(2.2%) of total screened babies had significant hearing loss. Total number of babies who passed the initial screening with TEOAE was 284 (56.8%). On diagnostic AABR screening of TEOAE REFERRED babies, the babies with no risk factor showed normal AABR tracings whereas from among those with one or multiple risk factors (110 babies), 11(10%) showed different levels of hearing impairment. Hearing loss was highly associated with Neonatal Intensive Care Unit (NICU) admission i.e. 8/11(72.7%), followed by Low Birth Weight (LBW) and hypoxia (6/11 i.e. 54.5% each). Conclusion: Hearing loss is more common in those babies with risk factors (majority being NICU admission, LBW and hypoxia). OAE and ABR screening of infants at risk for significant hearing loss is a clinically efficient and cost effective approach for early detection of significant hearing loss.

Embryonal Rhabdomyosarcoma (RMS) of Retroperitoneum in Young Child

Otorhinolaryngological Manifestations among HIV Positive Children in Coastal Karnataka

Yamini, Chetan Mandelia, Suja Sreedharan

Introduction: With changed clinical profile of HIV related diseases, our study attempted to analyse otorhinolaryngological manifestations in HIV positive children coming to ART centre of a tertiary referral in South India. Materials and Methods: Records of 137 children registered at ART Centre, Government Wenlock Hospital, Kasturba Medical College, Mangalore from 2004 till 2010 were studied and data for this retrospective study was collected. Results: Twenty three (16.8%) children developed otorhinolaryngological manifestations, which were upper respiratory tract infection (13.1%), oral candidiasis (1.4%), otitis media (1.4%) and parotitis (1%). With increasing WHO stage, the ENT manifestations increased (p<0.05) while CD4 count decreased (p>0.05), 35% and 44% cases with ENT manifestations had CD4 counts above 500 cells/mm3 and below 200 cells/mm3 respectively (p>0.05). 24% children on HAART and 10.7% not on HAART developed ENT illnesses (p<0.05). Conclusion: With the current ART protocols, ENT manifestations are seen in 17% HIV positive children, most of which are aspecific.

An Alternative Maxillary Sinus Lift Technique – Sinu Lift System

Parthasaradhi.T, Shivakumar.B, T.S.S.kumar, Ashish.R.Jain, Suganya.P

Objectives: Maxillary sinus augmentation surgical techniques have evolved greatly allowing successful placement of dental implants in the atrophic posterior maxillary region. The purpose of the present study is to evaluate the clinical and radiological outcomes and postoperative morbidity of sinus floor elevation procedures performed using the minimally invasive surgical technique the Sinu lift system. Materials and Methods: Sinus lift procedure was done using the sinu lift system by a transcrestal approach and bone augmentation was done on ten systemically healthy patients using ß- tricalcium phosphate and platelet rich plasma mix. The study was evaluated upto six months period with bone related parameters being assessed at base line using CT scan, OPG and after six months the results were analysed using SPSS Version 18.0 software (p < 0.01 (0.005). Wilcoxson signed rank sum test was used to correlate between preoperative and postoperative measurements. Implant placements were done at the desired area of sinus augmentation with a two year follow up. (Nobel Biocare, Nobel Biocare Holding AG, Zürich-Flughafen, Switzerland) Results: The augmented sites had a significant increase in the bone parameters at the desired grafted region. The mean gain in bone height as observed in CT Scan had revealed increased measurements from 5.80mm±0.98 to 10.20mm±1.68 at the sixth month evaluation. This was statistically significant (0.005). Clinically, no complications were observed during or after the surgical procedure. Conclusion: Within the limitations of this study, the Sinu lift system with a controlled working action resulted in high procedural success and this procedure may be an alternative to the currently used surgical methods.

The Effect of Primer on Bond Strength of Silicone Prosthetic Elastomer to Polymethylmethacrylate: An in vitro Study

Introduction: The aim of the study is to evaluate interfacial bond strength between silicone prosthetic elastomers and polymethylmethacrylate (PMMA). Materials and Methods: Silicone elastomers were attached to PMMA and a total 120 specimens were fabricated which were then subdivided into 12 sub-groups. Each sample was then subjected to laboratory test to determine the bond strength. The specimen of silicone elastomer bonded to acrylic of different surfaces was placed into universal testing machine (HOUNSFIELD HT-400) for “PEEL TEST”. All the values obtained were tabulated and subjected to statistical analysis. Result: The bond strength of silicone elastomer to acrylic resin (TRAVELON) noticed highest (Mean 4.826 ± 0.008 n/mm) when only primer was used as a surface treatment. When silicone elastomer bonded to acrylic resin (DPI) showed the bond strength of (4.351 ± 0.0089) when only primer was used as a surface treatment. Whereas the least bond strength values were found when the silicone bonded to acrylic surface treated by 120 grit sand paper that is (0.076 ± 0.00 n/mm) and (0.082 ± 0.01 n/mm) for DPI and TRAVELON respectively. Conclusion: The bond strength of silicone elastomer to acrylic resin was higher when primer was used on the acrylic surface. The bond strength of silicone elastomer to acrylic resin was more with travelon resin when compared to DPI resin. But when silicone was bonded to acrylic surface with sand papering, showed less bond strength.

Dynamics of Electroencephalogram (EEG) in Different Stages of Chronic Kidney Disease

Aim: To study Electroencephalogram (EEG) in different stages of chronic kidney disease (CKD). Materials and Methods: This observational study was carried out in the Department of Medicine, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha conducted over a period of 24 months, spanning from August 2011 to August 2013. Eighty three cases of CKD at different stages were studied. EEG was done in all the subjects and the various EEG dynamics like morphometric waveform patterns, symmetricity, amplitude were recorded and compared with the different stages of CKD. Results: We found that characteristic changes were observed with increasing severity of CKD. Slow delta wave patterns were more prominent in stage 5 (p<0.0001), asymmetric discharges, dysthymia, sharp wave transients and low amplitude wave forms were more prominent beyond Stage 4 (p<0.0001). Conclusion: EEG can be used as an effective tool for detection of subclinical or latent uremic encephalopathy. EEG findings which are characteristics of uremic encephalopathy can be present in CKD patients without overt signs of encephalopathy. So, EEG can be used as a prognostic indicator of response to clinical therapy of CKD.

Comparison of Outcomes and Quality of Life between Hemodialysis and Peritoneal Dialysis Patients in Indian ESRD Population

Vikas Makkar, Manish Kumar, Rajesh Mahajan, N.S. Khaira

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are important renal replacement treatments in end stage renal disease (ESRD). There is paucity of data comparing outcomes and quality of life (QOL) between the two modalities in Indian scenario. Materials and Methods: We followed 60 End stage renal disease patients (30 CAPD and 30 Maintenance hemodialysis) for a period of one year. Patients were analysed and compared for complications, physical quality of life and psychological well being with a two part self reported questionnaire at baseline and subsequently at six and twelve months. For the physical component appropriate sections of the McMaster Health Index Questionnaire (MHIQ) and for psychological component Psychological General Well-Being Index (PGWB) developed by Dupey was applied. Results: The number of males and females in both groups were comparable (p-value > 0.05).The prevalence of diabetes mellitus, coronary artery disease, obesity and ischaemic heart disease was comparable in both groups (p-value>0.05). Significantly higher mortality was observed in patients undergoing HD (20% vs 0 %, p-value <0.05) at the end of study. At the end of study, 16.6% of patients undergoing HD were found to be anti HCV positive as compared to 3.33% in CAPD. Six episodes of CAPD peritonitis were observed (0.2 episodes per catheter year). Significantly higher number of CAPD patients had negative responses between 2-4 at baseline and subsequently on follow ups in Part A of QOL questionnaire(86.7 vs 23.3 % at baseline, 80 vs 26.7% at 6 months, 80 vs16.7 % at 12 months; p <0.05 ). Mean score in Part B of questionnaire was significantly higher in CAPD patients at baseline and at all follow ups (66.7+11 vs 50.1+17 at baseline, 66.7+12.1 vs 53.32+16.3 at 6 months, 65.3+9.5 vs 48.8+16.7 at 12 months , p <0.05) . Conclusion: CAPD patients have significantly better quality of life in physical as well as psychological aspects and have significantly lower mortality when compared with hemodialysis patients.

A Comparative SEM Investigation of Smear Layer Remaining on Dentinal Walls by Three Rotary NiTi Files with Different Cross Sectional Designs in Moderately Curved Canals

Gaurav Sharma, Pooja Kakkar, Asit Vats

Objective: The objective of this study was to compare the smear layer formed on root canal walls during canal preparation of extracted human teeth by Twisted, Mtwo, and ProTaper rotary nickel titanium instruments. Materials and Methods: Sixty single rooted human premolar teeth with root curvature <250 were selected and randomly divided into three Groups (n= 20 teeth per Group). Three types of rotary nickel titanium instruments were used, Twisted (SybronEndo, Orange, CA, USA), Mtwo (VDW, Munich, Germany) and ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) according to manufacturer’s instructions to instrument the root canals. Irrigation for all groups was performed after each instrument change with 3ml of 3% sodium hypochlorite followed by Glyde (File Prep, Dentsply, Maillefer, Ballaigues, Switzerland) as chelator paste and lubricant. Three different areas (coronal, middle and apical thirds) of the root canal were evaluated using scanning electron microscopy (SEM). The canal wall of each sample was assessed and compared using a predefined scale for the presence or absence of smear layer. Data were analysed statistically using ANOVA and Tukey HSD test Results: All three groups showed statistically significant more smear layer in the apical thirds of the canal as compared to the coronal and middle thirds (p<0.001). Mtwo rotary file system produced significantly less smear layer (p<0.001) compared to Twisted and ProTaper rotary instruments in the apical portion. Twisted Files resulted in less smear layer formation in the apical thirds of the canal compared to ProTaper rotary instruments but were statistically insignificant. Conclusion: Completely clean root canals were not found after instrumentation with any of the three instruments. Under the confines of this study Mtwo instruments produced significantly cleaner dentin wall surfaces throughout the canal length in comparison to Twisted and ProTaper rotary files. Twisted Files proved to be comparable to ProTaper rotary instruments with respect to canal cleanliness in the apical thirds of the root canal.

Comparative Evalution of G bone (Hydroxyapatite) and G-Graft (Hydroxyapatite with Collagen) as Bone Graft Material in Mandibular III Molar Extraction Socket

Background: Bone grafting is a dynamic phenomenon. It is a surgical procedure that replaces missing bone with material either from patient’s own body, or, an artificial, synthetic or natural substitute. A successful bone graft when applied, heals, becomes incorporated, re-vascularises and eventually assumes the form desired. Aims and Objective: The main purpose of this present study was to radiologically assess and compare the regenerative potential of hydroxyapatite with Collagen (G-Graft) and hydroxyapatite (G-Bone) and to evaluate the clinical usefulness of these materials to enhance bone healing in third molar extraction sites through bone formation. Materials and Methods: The study was carried out in the Department of Oral & Maxillofacilal Surgery, patients were divided into three groups. The rationale for assigning the patients to the groups was strictly random: Group I – G-Graft (Hydroxyapatite with Collagen) was used as Bone graft material, Group II – Bone graft material used was G-Bone (Hydroxyapatite), Group III—control group (no grafts was used). Orthopentomogram(OPG) images were taken intra-operatively, just after extraction in the Group III (control), after extraction but before graft placement in Group I & II (study groups) and post-operatively at the end of first month and third month. Bone density of the post-extraction sockets was measured at four random areas through ‘densitometric analysis’ software in the OPG program (Kodak 8000C Digital Panoramic System, Eastman Kodak Company) and an average value was recorded at each review. Results: The percentage increase in bone density between 1st month & 3rd month was 7.55± 12.43 in Group I (G Graft), 4.41± 5.4859 in Group II (G Bone), while that Group III (control) was found to be -0.82 ± 3.96. The bone density increase was found to be statistically highly significant (p<0.01)) between all groups. Conclusion: The present study concluded that G-Graft has a definite regenerative potential and is better than G-bone and can be used in bony defects to enhance the bone healing without provoking any significant inflammatory process. The study also indicates that defects treated with G-Graft attain more density initially and that G-Graft enhances bone healing in early stage.

Study of Biofilm in Bacteria from Water Pipelines

Context: A biofilm is a layer of microorganisms contained in a matrix (slime layer), which forms on surfaces in contact with water. Their presence in drinking water pipe networks can be responsible for a wide range of water quality and operational problems. Aim: To identify the bacterial isolates, obtained from water pipelines of kitchens, to evaluate the water quality & to study the biofilm producing capacity of the bacterial isolates from various sources. Settings and Design: A prospective study using water samples from aqua guard & pipelines to kitchens of S.C.B Medical College hostels. Materials and Methods: Standard biochemical procedures for bacterial identification, multiple tube culture & MPN count to evaluate water quality & tissue culture plate (TCP) method for biofilm detection was followed. Statistical analysis: STATA software version 9.2 from STATA Corporation, College station road, 90 Houston, Texas was used for statistical analysis. R esults: One hundred eighty seven isolates were obtained from 45 water samples cultured. The isolates were Acinetobacter spp. (44), Pseudomonas spp.(41), Klebsiella spp.(36) & others . Biofilm was detected in (37) 19.78 % of the isolates (95% CI 30.08% -43.92%) including Acinetobacter spp.-10, Klebsiella spp. - 9, Pseudomonas spp. - 9, & others, majority (34) of which were from kitchen pipelines. Conclusion: Water from pipeline sources was unsatisfactory for consumption as the MPN counts were > 10. Most of the biofilm producers were gram negative bacilli & Pseudomonas & Acinetobacter spp. were strong (4+) biofilm producers.

Evaluation of Suspected Cosmetic Induced Facial Dermatoses with the Use of Indian Standard Series and Cosmetic Series Patch Test

Introduction: Awareness about skin beauty or cosmetic elegance has received worldwide attention in the present day youth oriented society. Along with careful detailed history and thorough examination patch test is considered cornerstone in diagnosis of allergic contact dermatitis. Materials and Methods: Fifty patients suspected clinical diagnosis of contact facial dermatitis due to attended the Department of Dermatology, were included in a hospital based study. The patch test was applied on the upper back of using 32 allergens present in Indian cosmetic series and 20 known allergens in Indian standard battery series procured from Systopic Pharmaceutical Ltd, after applying the patch test, the patient was asked to come after 48h and 72h for reading the results of the patch test. Results: Out of 50 patients there were 32 (64%) females (housewives 36%) patients and 18 (36%) male (farmers 12%). Itching was the most common presenting symptom in 39 patients (78%) least was hypopigmentation and pain in 2%. Forehead was the most common site of involvement in 25 patients (50%) least were cheeks in 15 patients (30%). Erythema was the commonest morphological presentation seen in 36 patients (72%). Hair dye was suspected in maximum number of patients that is 13 (26%). Most common antigen showing patch test positivity was paraphenylenediamine in nine patients (18%). There are significantly more chances of developing positive test reaction with Indian standard series compared to cosmetic series. (p=.0053 using Fischer Exact test). Conclusion: In India there is no legislation regarding labeling ingredients on cosmetics as in the western countries, so labelling of the contents of cosmetic products should be the main challenge in cosmetic dermatitis is to identify.

Periodontal Status Among Patients With Cleft Lip (CL), Cleft Palate (CP) and Cleft Lip, Alveolus and Palate (CLAP) In Chennai, India. A Comparative Study

N.Nagappan, Joseph John.

Background: Long term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with oro facial clefts. Aim: The aim of this study was to assess and compare the periodontal status of patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) reporting to a hospital in Chennai, India. Materials and Methods: The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: patients with cleft lip (CL), Group 2: subjects with cleft palate (CP) and Group 3: subjects with cleft lip alveolus and palate (CLAP). Community Periodontal Index for Treatment needs CPITN Index was recorded. Results: Among the 80 study subjects, 51 (63.8%) were males and 29 (36.2%) were females. Among the 26 study subjects with cleft lip, 10 (38.5%) had healthy periodontium, 4 (15.4%) had bleeding on probing and 12 (46.1%) had calculus. Mean number of sextants coded for healthy and bleeding was maximum among the subjects with cleft palate. Mean number of sextants coded for calculus was maximum among the subjects with cleft lip alveolus and palate. Prevalence of periodontal disease is high among patients with cleft lip, alveolus and palate (35%) than in Cleft lip (32.5%) and Cleft Palate (32.5%). Conclusion: Gingivitis and Calculus is predominantly high in patients with Cleft Palate and Cleft Lip respectively.

Evaluation of Variation in the Palatal Gingival Biotypes Using an Ultrasound Device

Nami Rajpoot, Aarati Nayak, Ranganath Nayak, Praveen Kumar Bankur

Background: The dimensions of gingiva and different parts of the masticatory mucosa have become a subject of considerable interest in Periodontics. Studies assessing the thickness of the facial gingiva are often seen in the literature. The thickness of the palatal gingiva is a subject still less researched in periodontal therapy and implantology. Objectives: To measure the thickness of the palatal gingiva using an ultrasound device ‘Biometric A- Scan’ and to evaluate the variation in the thickness of the palatal gingiva at the sites examined. Materials and Methods: In the 50 subjects examined, the thickness of the palatal gingiva was assessed at the maxillary anteriors, premolars and molars by an ultrasound device ‘Biometric A-Scan’. The results were subjected to statistical analysis using one-way ANOVA test and Newman-Keuls multiple post hoc procedure. Results: Statistically significant variations existed in the palatal gingival thickness. The thickness was highest at the lateral incisor region, followed by canine, premolars, molars and central incisor. Interpretation and Conclusion: In the subjects assessed, the thickness of the palatal gingiva at the lateral–canine area was the highest followed by the premolar area. In periodontal root coverage procedures and during implant therapy, we suggest the inclusion of the lateral incisor area, apart from the canine and premolar area, as a potential donor site for harvesting soft tissue grafts from the palatal area. However, the effect of several factors like age and sex of the patient, the anatomy of the palatal area, the influence of rugae patterns and racial and geographical differences should be taken into consideration prior to harvesting a graft from these sites. Apart from this, the study suggests that, the ultrasonographic measurements provide an elegant means of obtaining the measurements of gingival and mucosal tissues rapidly, accurately and non-invasively. Our endeavour in this research project attempts to open more avenues for studies in the field of advanced periodontal diagnosis, with the use of ultrasound, and expand the horizons of periodontal plastic surgery and implant therapy as well.

Comparative Study in Early Neonates with Septicemia by Blood Culture, Staining Techniques and C – Reactive Protein (CRP)

V. Dhanalakshmi, E. Suguna Sivakumar

Aim: The aim of this study was to compare and evaluate the pathogenic bacteria in neo-natal septicemia by using various diagnostic techniques. Setting and Design: Our study was designed to evaluate a feasible method to diagnose neonatal septicemia even at primary health centre level. Materials and Methods: Blood samples were collected aseptically from 70 neonates. The specimens were inoculated into brain heart infusion broth and subcultures were performed with specific media. Antibiotic sensitivity pattern of isolates was studied by Modified Kirby Bauer Disc diffusion technique and differentiate the isolates by staining methods. C-reactive protein (CRP) was evaluated by using standard kit method. Results: Out of 70 cases of childhood septicemia of age group 1-30 days, 37 had positive CRP, 36 were positive for BCS and blood culture was positive only in 41 cases, where predominant organism being Klebsiella species (n=28, 68.29%) followed by Escherichia coli (n=4, 9.76%), Pseudomonas aeruginosa (n=3,7.31%), Proteus mirabilis (n=2,4.88%) and Coagulase negative staphylococcus (n=4,9.76%). Conclusion: Our findings suggest that Klebsiella species as an important cause of neonatal septicemia. The isolated organisms were found to be highly sensitive to cefatoxime and amikacin. Hence, these antibiotics can be considered as the first drug of choice for neonatal septicemia.

A Randomized Double-blind Controlled Trial of Lactobacillus acidophilus Plus Bifidobacterium bifidum versus Placebo in Patients with Hypercholesterolemia

Sanguansak Rerksuppaphol, Lakkana Rerksuppaphol

Background: Hypercholesterolemia is a major risk factor for cardiovascular disease. Not all patients respond well to traditional cholesterol lowering medications. Probiotics have been evaluated for their cholesterol-lowering effects in humans with variable results. This study was performed to evaluate the efficacy of two probiotics in lowering the serum cholesterol of hypercholesterolemic patients. Materials and Methods: A randomized double-blind controlled trial was conducted comparing placebo to Lactobacillus acidophilus plus Bifidobacterium bifidum in patients diagnosed with hypercholesterolemia. Placebo or probiotic capsules were taken three times daily for six weeks. Pre- and post-treatment total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and triglyceride (TG) levels and demographic parameters of the two groups were compared. From a total of 70 participants, 64 completed the assigned treatment (31 in probiotics group and 33 in the control group).The two treatment groups were matched for age, sex, weight, height, BMI, waist and hip circumferences, and blood pressure. Results: Baseline evaluation revealed no difference between the probiotics group and control group levels of TC, HDL-C, LDL-C and TG. TC levels in the probiotics group decreased during treatment (237.2 vs. 212.7 mg/dL, p<0.05). TC and LDL-C levels in the control group increased significantly from their baseline levels during treatment. TC (212.7 vs 252.8 mg/dL, p<0.001), HDL-C (52.0 vs 59.1 mg/dL, p=0.04) and LDL-C (153.9 vs 182.1 mg/dL, p<0.01) levels in the probiotics group were significantly lower at the end of treatment than the corresponding levels in the control group. Conclusion: A combination of Lactobacillus acidophilus and Bifidobacterium bifidum decreased serum total cholesterol, LDL-cholesterol and HDL-cholesterol levels in hypercholesterolemic patients over a six week period. There was no effect on serum triglyceride or fasting blood glucose levels.

Association of Leukocyte Telomere Length with Oxidative Stress in Yoga Practitioners

Objective: Yoga is a mind-body modulation technique that has been shown to have beneficial effects on various diseases related to various systems in the body. However, the molecular basis of mechanism of action is not clear. Hence, this study was designed to study the leukocyte telomere biology and its relation with homocysteine and oxidative stress in yoga practitioners. Materials and Methods: This is a prospective case-control study involving Yoga practitioners aged 30–40 y with minimum of two years yoga practice (Yoga group) and age, gender and body mass index matched sedentary healthy general population with no medical problems (Control group). Leukocyte telomere length (LTL) was measured by using quantitative PCR (qPCR), fasting plasma homocysteine was measured by a rapid high-performance liquid chromatography assay and the oxidative stress was assessed with total antioxidant status (TAOS), malondialdehyde (MDA) measured by calorimetry. Results: The LTL was shorter in control group than in yoga group (p<0.001). The TAOS was more in yoga group when compared to control group (p<0.008), MDA and homocysteine was high in control group when compared to Yoga group (p<0.001). Further, the LTL was positively correlated with TAOS (r=0.841, p<0.001) and negatively correlated with MDA (r=-0.931, p<0.001) and Homocysteine (r=-0.756, p<0.001). Conclusion: The LTL is well-preserved in people who practice Yoga regularly with lower systemic oxidative stress compared to those who have a relatively sedentary lifestyle despite lack of any medical disorders. The habitual yoga practice seems to inhibit replicative cellular senescence.

Safe, Effective and Easily Reproducible Fusion Technique for CV Junction Instability

Madhukar T Nayak, Raghavendra B S

Introduction: The Craniovertebral junction (CVJ) refers to a bony enclosure where the occipital bone surrounds the foramen magnum, the atlas and the axis vertebrae. Because of the complexity of structures, CVJ instability is associated with diagnostic and therapeutic problems. Posterior CV fusion procedures have evolved a lot over the last couple of decades. There has been a lookout for one such surgical procedure which is inherently safe, simple, easily reproducible and biomechanically sound. In our study, we present the initial experience the cases of CV junction instrumentation using O-C1-C2 screw & rod construct operated by the author. Aims and Objectives: The current study is a descriptive analysis of the cases of CVJ instability treated by us with instrumentation using O-C1-C2 screw and rod construct fusion technique. Materials and Methods: It is a retrospective, analytical study in which cases of CV junction instability operated by the author between January 2010 to March 2014 were analysed using various clinical, radiological and outcome parameters. Conclusion: CV junction instrumentation using O-C1-C2 screw and rod construct fusion technique proved to be safe, effective, easily reproducible and biomechanically sound technique which can be adopted by all surgeons who may be at any stage of their learning curve.

Isolated Renal Hydatid Cyst Masquerading as Cystic Renal Cell Carcinoma: A Case Report

Incidentally detected renal cysts are always a diagnostic challenge especially when they present with equivocal features on imaging. Proper diagnosis is of paramount importance as it affects the treatment decisions. Septal and nodular enhancement on computed tomography (CT) is the strongest predictor of malignant process. A multilocular cystic lesion with heterogeneity on CT goes in favour of hydatid disease. Though the treatment in both these cases is surgical excision, a more careful study of image may ease the treatment planning process much more. We report a case in middle aged lady who presented with vague abdominal pain with loss of weight, who was found to have a cystic mass in the upper pole of the left kidney on imaging turned out to be hydatid cyst though the radiological features were in favour of cystic renal cell carcinonoma.

Solitary Extragnathic Langerhans Cell Histiocytosis –A Rare Case

Yashoda V, Sharath Kumar Reddy E, Bhavani S N, Krishna A, M S Muni Sekhar

Langerhans cell histiocytosis (LCH), mainly affects the skull, vertebrae, ribs and mandible in children and the long bones of adults. Symptoms range from none to pain, swelling and tenderness over the site of the lesion. This disease presents oral manifestations which can sometimes be the first expression of the condition. It occurs in three forms namely eosinophilic granuloma in which isolated or multiple bones are involved, But has a good prognosis whereas other variants Hand-Shuller-Christian disease (chronic dessiminated variant) and Letterer-Siwe disease (acute dessiminated form) have poor prognosis. Occasionally only soft tissues are affected without bony involvement. Males are more commonly affected than females. This article describes a rare variant of eosinophilic granuloma of labial mucosa without bony involvement.

Ameloblastomatous Calcifying Cystic Odontogenic Tumour: A Rare Variant

Calcifying Cystic Odontogenic Tumor (CCOT) was previously described by Gorlin et al., in 1962 as Calcifying odontogenic cyst. CCOT is a rare lesion which accounts for 2% of all odontogenic pathological changes in the jaws. One of the variants, Ameloblastomatous proliferating type of CCOT is even more rare and very few cases have been reported in the light of literature review. This case report is an effort to bring forth a case of ameloblastomatous proliferating type of CCOT in a 65 year male, who presented with a painful swelling in the right jaw crossing midline causing facial asymmetry and confirmed by histopathological evaluation.

Cronkhite—Canada Syndrome (CCS)—A Rare Case Report

Subrata Chakrabarti

Cronkhite-Canada syndrome (CCS) is an extremely rare non-inherited condition characterized by gastrointestinal hamartomatous polyposis, alopecia, onychodystrophy, hyperpigmentation, weight loss and diarrhoea. The aetiology is probably autoimmune and diagnosis is based on history, physical examination, endoscopic findings of gastrointestinal polyposis, and histology. The disease is very rare; approximately 450 cases of CCS have been reported worldwide. The author reports a case of CCS in an elderly Indian male.

Congenital Hyponychia of the Hands with Lymphangiectases: A New Entity?

Angel Fernandez-Flores, Jose Antonio Manjon

We present a case of 58-year-old woman with congenital hyponychia of the ten fingers and oedema of the fingertips as the only cutaneous alterations. There was no associated systemic condition or additional ectodermal abnormality. The biopsy showed lymphangiectases mainly confined to the papillary dermis but also in the reticular dermis. We propose the designation “congenital hyponychia of the hands with lymphangiectases” for this apparently not previously described condition.

Inverse Bell’s Phenomenon: Rare Ophthalmic Finding Following Ptosis Surgeryeyes

Shitole Satish C, Jakkal Tapan P., Khaire B.S.

Bell’s phenomenon is protective reflex in which the globe is turned upwards and slightly outwards during the eyelid closure to avoid corneal exposure. In Inverse Bell’s phenomenon, the eye moves downward instead of upward, this may be seen in the normal population, patients with Bell’s palsy or following conjunctival scarring. We hereby present the unusual complication of transient inversion of Bell’s phenomenon following extensive levator resection surgery performed for congenital ptosis. A 24-year-old male was undergone ptosis correction surgery. On postoperative day two, ocular examination revealed down rolling of eye ball during eyelid closure. It underwent spontaneous resolution within four weeks without any corneal complication. The patients were given frequent lubricating eye drops during this period and advised frequent follow-up for early diagnosis of corneal complication. Here we highlight an inverse Bell’s phenomenon following levator resection surgery, its possible mechanism and risk of corneal complication.

Pseudoactinomycotic Radiate Granules (PAMRAGs)- An Unusual Differential Diagnosis for Ovarian Neoplasm; A Diagnostic Dilemma

Cicy P.J., Tessy P.J., Lekshmidevi P., Letha V., Usha Poothiode

Pseudoactinomycotic radiate granules (PAMRAGs) are rarely detected lesions in ovary. Endometrium is the usual site and a detailed search of literature yielded only two cases in the ovary. PAMRAGs must be differentiated from actinomycotic granules which are also strongly associated with the use of intrauterine contraceptive devices (IUCDs). In cases of suppurative oophoritis due to actinomycosis, a proper diagnosis and culture confirmation is mandatory to avoid further complications. This case is reported due to its rarity, unusual clinical presentation and to highlight the importance of special stains in cases of tuboovarian abscess, where PAMRAGs may cause diagnostic dilemma. Our patient was a 50 yr old female admitted with clinical diagnosis of malignant ovarian tumour. After preoperative work up, panhysterectomy, infracolic omentectomy and excision biopsy of the right inguinal lymph node were done. Peroperatively the right ovary was enlarged and adherent to the fallopian tube and pelvic wall. Gross examination revealed a right tuboovarian mass with yellowish areas of necrosis and fibrosis. Histology showed a suppurative granulomatous lesion with spherical granules having club like peripheral projections. A panel of special stains (GMS, GRAMs and AFB) done were negative. Thus, we ruled out actinomycosis and gave a diagnosis of PAMRAG.

Chrysosporium: An Uncommon Fungus in Chronic Rhinosinusitis

Chronic rhinosinusitis is one of the commonest health problem encountered in rhinology. Of these allergic fungal rhinosinusitis forms a significant group of patients. Patients commonly present with typical symptoms of sinusitis and the diagnosis is often made after imaging and/or intraoperatively. We report a rare case of allergic fungal sinusitis (AFS) caused by Chrysosporium species in a 70-year-old male with no co-morbidities. The fungus was isolated from allergic mucin collected from the sinuses. Therapy with intravenous Voriconazole was given leading to good relief for the patient, and no recurrences have occurred till date. Infections caused by Chrysosporium species are very rare, and is very rarely been reported to cause sinusitis in humans.

Solitary Fibrous Tumour of Lacrimal Gland: A Rare Entity

Vikram Narang, Nagi Anitaraj Rajendra Singh, G.S.Bajwa, Neena Sood

Solitary fibrous tumour (SFT) is a rare spindle cell tumour of mesenchymal origin most commonly encountered in pleura. It can affect the orbital region but SFT of lacrimal gland is rare. We hereby report of a SFT of lacrimal gland in a 50-year-old male presenting with slow growing swelling in left superolateral orbital region. The preliminary fine needle aspiration cytology (FNAC) could not reveal any definite diagnosis. Excision biopsy and immunohistochemistry (IHC) confirmed the diagnosis. Therefore, clinician and pathologist should be aware of this entity and biopsy along with IHC is required to rule out other entities which can mimic it clinically and histopathologically.

T-Cell Lymphoma of the Oral Cavity: Case Report

Kanika Rana, Vineet Narula, Eishaan K Bhargava, Ravi Shankar, Nidhi Mahajan

Lymphomas are heterogenous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin’s lymphoma (HL) and non- Hodgkin’s lymphoma (NHL). NHL can originate from B, T, or natural killer (NK) lymphocytes. Extra-nodal presentation of T-cell NHL is extremely rare, and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in an immune-competent patient. The patient was diagnosed to have T-cell NHL on the basis of biopsy and immunohistochemistry, and was referred to oncology department for chemotherapy for definite treatment.

Pulmonary Hemorrhage (PH) in Extremely Low Birth Weight (ELBW) Infants: Successful Treatment with Surfactant

Pradeep Suryawanshi, Rema Nagpal, Vaibhav Meshram, Nandini Malshe, Vijay Kalrao

We report a case of an extremely low birth weight (ELBW) infant presenting with pulmonary hemorrhage (PH) in which we have given surfactant after an acute episode of bleeding with severe intractable hypoxemia. Surfactant replacement therapy showed improvement in Mean Airway Pressure (MAP) and oxygenation indices. Our case suggests that surfactant replacement therapy is useful in PH.

Nephropathic Cystinosis Presenting as Renal Fanconi Syndrome without Glycosuria

Jayashree Kanthila, Smitha Dsa, Kamalakshi G. Bhat

Renal Fanconi syndrome is diagnosed by its cardinal features of glycosuria without diabetes, aminoaciduria, phosphaturia, and renal tubular acidosis. It is often associated with hypokalaemia, hypophosphatemia and rickets. We report a seven-year-old boy with nephropathic cystinosis who presented with all the cardinal features of renal Fanconi syndrome associated with rickets, pathological fractures, stage IV chronic kidney disease (CKD) and hypothyroidism. Slit-lamp examination of the cornea confirmed the diagnosis. However glycosuria was conspicuously absent. Whenever there are features of rickets with failure to thrive and recurrent vomiting renal rickets should be ruled out. Cystinosis is one such disorder and we report this case due its rarity and interesting clinical presentation.

Oncocytic Lipoadenoma of Submandibular Gland: A Case Reportlymphadenopathy

Harshad V. Parmar

Lipomatous tumours of salivary glands are very uncommonly diagnosed and reported tumours. Majority of these tumours present as painless masses which grow slowly over many years. On the histological grounds, they can be subclassified into ‘’monophasic’’ (lipoma component only) and ‘’biphasic’’ (lipoma component+epithelial component) tumours. A handful of biphasic tumours contain oncocytic component and they have been omitted from the WHO classification of salivary gland tumours so far and this has remained a matter of persistent confusion and controversy over many years. Other rare variants of monophasic tumours include fibrolipoma, sialolipoma, angiolipoma, sialadenosis and very rarely a liposarcoma can also occur in salivary glands. Pre-operative imaging can help in picking up the fatty component of the tumours and guide in accurate classification. FNAC may not be accurate in diagnosis of these tumours. We report a case of 45-year-old gentleman presenting with submandibular gland swelling for which submandibular gland excision was done. A final diagnosis of oncocytic lipoadenoma was made. We present this rare entity to add to the few cases reported to date and hence, to increase recognisation and understanding of these rare tumours, which may help in establishing a reproducible subclassification. We have discussed the pathological aspects with review of literature of this very rare entity.

Small Intestinal Obstruction Secondary to Jejunal Trichobezoar Removed Per Anum Without an Enterotomy: A Case Report

Trichobezoars can rarely present with obstruction. This is usually due to collection of a hair ball in the stomach. We encountered an interesting case of small bowel obstruction due to a jejunal trichobezoar. The treatment generally is an enterotomy with removal of the hair ball. We report a case of a 29-year-old post partum female who presented to us with sub acute intestinal obstruction. Exploratory laparotomy revealed an impacted mass in the distal jejunum which was removed per anum without an enterotomy. Postoperative gastroscopy did not show trichobezoar in the stomach. This case highlights the importance of trichobezoar as a differential diagnosis in young women with small bowel obstruction that can be treated without an enterotomy and avoiding the risks and morbidities associated with it.

A Rare Case of Mixed Connective Tissue Disease (MCTD) with Intricate Features of Lupus, Polymyositis and Rheumatoid Arthritis Presenting with Severe Myositis

Lokesh.S, Kadavanu Tony, Raghupathy, Suresh.V, Balakrishna Malepati

Mixed connective tissue disease (MCTD) includes clinical and laboratorial manifestations of systemic lupus erythematosus, scleroderma and polymyositis along with high titres of anti-U1RNP antibodies. In the initial phases of the disease, muscle enzyme levels increase but the disease remains generally subclinical. Presentation with myositis is uncommon. Our objective is to report a rare case of a patient who presented with a severe onset of myositis characterized by dysphagia, an increase in myopathy and joint involvement suggestive of RA. The patient was initiated on pulse corticosteroid therapy along with methotrexate in view of her elevated Creatine Kinase levels and biopsy findings that were suggestive of severe myositis. The patient showed clinical and laboratory improvement with this regimen. Though severe myositis and arthritis can occur in overlap syndrome, MCTD evolved as a separate disease entity due to presence of high titres of Anti U1-RNP antibodies. The authors emphasize that this is an extremely rare presentation of MCTD with only two previous cases seen in literature, one of a 13 year old child and the other being an adult female both of whom had evidence of myositis on presentation.

Gallbladder Cancer Presenting with Brain and Bone Metastasis: Case Report

Raghvendra Gupta, Manish Singh, Shilpi Karmakar, Saurabh Karmakar

Although gallbladder cancer is a rare disease worldwide, north India has one of the highest incidences of this disease. We report a case of asymptomatic gall bladder cancer with brain metastasis. The patient presented with a scalp lump as the sole presenting feature, with no symptoms attributable to abdominal malignancy. Previously, the lump had been incised by a local practitioner who had probably misdiagnosed it as an abscess.

Intraventricular Haemorrhage as a Complication of Sub Mucosal Infiltration of Adrenaline

Adrenaline infiltration is a widely used technique in head-neck and ENT surgeries to provide bloodless surgical field. However, use of adrenaline has been associated with hemodynamic changes which can be life threatening at times. Therefore, use of higher concentrations of adrenaline should be avoided and a close hemodynamic monitoring is required with use of other vasopressors. In the present case report, a young male died because of intraventricular bleeding caused by adrenaline infiltration during rhinoplasty.

Lorazepam: A Weapon of Offence

Satinder Pal Singh, Sumeet Kaur, Dalbir Singh, Akashdeep Aggarwal

The use of knock out drugs for perpetuation of crime has significantly increased in recent years. These drug facilitated crimes mainly involve robbery and sexual offences. Most of the drugs employed for these purposes affect the nervous system and bring a state of incapacitation and amnesia. The miscreants exploit these properties of drugs to commit such crimes. The unsuspecting travellers on public transport vehicles and women in disco parties are most vulnerable to such crimes. The unrestricted and unregulated sale of prescription drugs and general ignorance of such incidents is a challenge that needs to be addressed promptly.

Vanishing Roots: First Case Report of Idiopathic Multiple Cervico–Apical External Root Resorption

Idiopathic root resorption is a very rare phenomenon. Resorption in tooth is brought about by odontoclastic activity. Special mechanisms in the periodontal ligament exist to prevent mineralization of the periodontal ligament and these periodontal ligament cells produce factors that inhibit mineralized tissue resorption and are capable of regulating bone and cementum formation. When this mechanism is disturbed it manifests in resorption of root structure. This case report is of a 28-year-old male with a very rare phenomenon where external resorption of both cervical and apical portion of root of multiple teeth was observed and it is documented for the first time.

Kodameae ohmeri – An Emerging Yeast: Two Cases and Literature Review

Debadulal Biswal, Manisa Sahu, Asmita Mahajan, Suresh H Advani, Suresh Shah

Kodameae ohmeri is an emerging pathogen in various types of infections. Most infections are seen in patients with compromised immunity like cancer patients. Few cases of neonatal infections due to K. ohmeri have been reported earlier in premature neonates with fatal outcomes. We report two cases of fungemia; the first case was a patient with hematological malignancy, who complained of fever spikes and grew K. ohmeri in blood despite prophylactic voriconazole therapy. The second case was in a mature neonate, who developed respiratory distress and features of sepsis two days after birth, multiple blood cultures were positive for K. ohmeri. Both the patients responded well to Amphotericin B. Repeat blood cultures were sterile and patients were discharged. K. ohmeri is an unusual and emerging fungal pathogen of late an increasing number of cases of fungemia, funguria, endocarditis, peritonitis and wound infections due to the same are being reported. Some occur in immunocompromised patients and some inapparently immunocompetent patients, neonates with an inclination for preterm babies. We report two case of fungemia, one with lymphoma and the second in a neonate.

Myxosarcoma of the Maxilla – A Case Report

Nigel R. Figueiredo, Manoj Meena, Ajit D. Dinkar, Manisha M. Khorate

Myxosarcoma is a rare malignant neoplasm of connective tissue which is characterized by tissue that resembles primitive mesenchyme, and contains relatively undifferentiated cells that show rapid growth and invasion. The cells are stellate or spindle-shaped and are present in a loose matrix which contains mucoid material, reticulum, and collagen fibers. This paper reports a rare case of a myxosarcoma of the left maxilla in a 50-year-old male, which clinically presented as a soft-tissue mass on the buccal gingiva and radiographically showed a mixed radiolucent-radiopaque appearance.

Unusual Presentation of a Primary Ewing’s Sarcoma of the Spine with Paraplegia: A Case Reportusing

Ewing’s sarcoma is a primary malignancy of the bone affecting individuals in the second decade of life. Primary sarcomas of the spine are rare and the occurrence of Primary Ewing’s sarcoma in the spine is very rare. Ewing’s sarcoma occurring in the spine is divided into two types, Ewing’s sarcoma of sacral spine which are very aggressive with poor prognosis and Ewing’s sarcoma of the non sacral spine which is an extremely rare occurrence. Patient may present with neurological deficit when the tumour extends into the spinal canal causing spinal cord compression. Magnetic resonance imaging (MRI) is very sensitive in diagnosing the tumour and defining the extent of the tumour. Here we report an 18-year-old boy who presented with back pain and complete paraplegia of two months duration. The MRI gave a differential diagnosis of infective pathology due to the fluid collection in the paraspinal region, followed by primary malignancy as the second diagnosis. Patient underwent posterior spinal decompression and stabilization, and intaoperatively there was significant collection of pus whose culture showed no growth. The histopathology and immunohistochemistry studies confirmed the diagnosis of Ewing’s sarcoma and patient was started on combination chemotherapy and radiotherapy.

Tetra-Phocomelia: A Rarest of Rare Case

Anil Kumar Shukla, S.C. Sanjay, L. Krishna, N. Krishnappa

We present a rarest of rare case of Tetra-Phocomelia evaluated by antenatal Ultrasonography. It is a condition seen in 0.62 per 100,000 live births. An ultrasonogram was done at 18 wk of pregnancy to assess the fetus and after termination gross specimen was evaluated and X-ray infantograms were done to confirm the findings. The case showed classic Tetra-Phocomelia with limbs like flippers of a seal. Our findings make it rarest of rare as only few cases have been so far reported.

Idiopathic Leukoplakia- Report of a Rare Case and Review

Shesha Prasad R, Ramakrishna T, Anuradha Pai, Sujatha D

Idiopathic leukoplakia is a rare potentially malignant lesion, usually found on the tongue with an increased risk of malignant transformation as compared to the tobacco associated form. The risk of malignant transformation increases with age. Diagnosis poses a challenge to the clinician as it is diagnosed by exclusion of other possible causes leading to hyperkeratosis. We present one such rare case in an elderly male patient who was followed up for a year to record the course of the lesion and to report recurrences, if any.

Keratoameloblastoma A Rare Entity: A Case Report

Ameloblastoma is the second most common odontogenic tumour of oral cavity, which has several different histological variants such as follicular, plexiform, acanthomatous, granular cell, desmoplastic, basal cell, clear cell, hemangiomatous, mucous cell differentiation and keratoameloblastoma. It is common in posterior mandible and has high male predilection in the ratio of 3:1. This report presents a case of keratoameloblastoma in 65-year-old female patient in the anterior mandible region with literature review on clinical features, histopathological findings, radiological appearance and treatment options.

Giant Serpentine Vertebrobasilar Aneurysm with Vertebral Artery Hypoplasia and Fenestration- A Case Report

Pradeep Choudhary, Harsh Vardhan Khokhar, Sangeeta Saxena

Intracranial aneurysm in paediatric age group is rare and association of the aneurysm with congenital vertebral artery anomaly is further rarer. We describe such a case in an 11-year-old male patient who consulted a paediatrician about headache and vertigo, and a noncontrast CT (NCCT) head revealed peripherally calcified hyperdense mass in prepontine and basal cisterns. Magnetic resonance imaging (MRI) including contrast enhanced magnetic resonance angiography (MRA) revealed partially thrombosed giant serpentine aneurysm of right vertebrobasilar artery and contralateral hypoplastic vertebral artery with fenestration. The nondominant left vertebral artery gave off the posterior inferior cerebellar artery, then became hypoplastic and joined with its counterpart to form the basilar artery. This pattern is called as type 9. The patient was kept on conservative management. The role of MRI in this congenital anomaly and its association with vertigo and aneurysm of vertebro-basilar artery is discussed.

Perrault Syndrome – A Rare Case Report

Sampathkumar Geethalakshmi, Veerasigamani Narendrakumar

Perrault syndrome is a rare disease comprising pure gonadal dysgenesis (46 XX) and sensorineural hearing loss in females and deafness alone in affected males. It is an autosomal recessive disorder. Over the years many additional features like marfanoid habitus and central nervous system findings have also been reported. Herein we report a case of sporadic Perrault syndrome in 18-year-old female who presented to our hospital with deaf mutism and primary amenorrhoea. On evaluation, the patient had hypergonadotropic hypogonadism, streak gonads and a normal karyotype (46 XX). Audiologic evaluation showed sensorineural deafness. The patient was started on hormone replacement therapy. She is on regular follow up. We present this case for its infrequent incidence and also to add to the ever expanding clinical spectrum of this disease.

Unusual Communications between the Cutaneous Branches of Ulnar Nerve in the Palm

Variations of dorsal and volar digital cutaneous branches of ulnar nerve are of tremendous clinical importance for successful regional nerve blocks, skin flaps, carpal tunnel release and placement of electrodes for electrophysiological studies. With the aforementioned clinical implications it is worth to report the variations of cutaneous branches of ulnar nerve. In the current case, we have encountered a rare variation (Kaplan`s anastomosis) of ulnar nerve, in the right upper limb. We have noticed that the dorsal cutaneous branch of ulnar nerve divided into three branches, the lateral two branches supplied the skin of the medial one and half fingers of the dorsum of hand. The medial branch established communications with the superficial branches of ulnar nerve and distributed to the skin of the one and half fingers of the volar aspect of hand. The possible outcome of this communications is discussed. Course and distribution of ulnar nerve on the contralateral side was found to be normal.

Resection and Regeneration – A Novel Approach in Treating a Perio–endo Lesion

Vineetha Varughese, Jaideep Mahendra, Anchu Rachel Thomas, N. Ambalavanan

The pulp and the periodontium are invariably anatomically and functionally related to each other. Lesions involving both the periodontium and the pulp complicate diagnosis, treatment planning and prognosis. An emerging approach to periodontal therapy is the concept of regeneration. In this case report, a novel combination therapy of a blend of platelet rich fibrin with bone graft and guided tissue regeneration membrane was used in the treatment of a perio-endo lesion of a multirooted tooth. A successful outcome in alleviating patient’s symptoms and regeneration was seen.

A Rare Case of Heterotopic Pregnancy with Ruptured Left Rudimentary Horn Pregnancy

Setu Rathod, Sunil Kumar Samal

Heterotopic pregnancy(HP) occurs when intrauterine and ectopic pregnancies coexist. We report a case of HP at 14 wk of gestation presenting as ruptured left rudimentary horn ectopic pregnancy with live intrauterine gestation and was managed with emergency laparotomy followed by resection of left rudimentary non communicating horn of uterus. The intrauterine pregnancy continued uneventfully. A female baby was delivered vaginally at 41 wk following induction of labour.

Gossypiboma Mimicking as Dermoid Cyst of Ovary: A Case Report

Dalia Rafat, Seema Hakim, Noor Afshan Sabzposh, Nasreen Noor

Gossypiboma is a rare condition caused by retained postoperative foreign bodies. The condition is under reported because of diagnostic difficulties and medicolegal implications associated with it. It may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 22-year-old woman presented with non specific symptoms and was referred to us with radiological diagnosis of dermoid cyst. On laparotomy the mass was proved to be a gossypiboma resulted from gauze which was retained in caesarean section done two years back. Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of postoperative patients presenting with non specific complains and lump abdomen. Despite thorough history, physical examination, laboratory, and radiographical findings, usually gossypibomas are not suspected and remain an accidental finding. Employment of all preventive measures during surgical procedures and high index of suspicion in post operative patients are the key stones in its management.

Intraosseous Schwannoma of the Maxilla Mimicking a Periapical Lesion: A Diagnostic Challenge

Schwannomas are a type of nerve sheath tumours predominant in the soft tissues of the head and neck. They commonly present as slow growing, painful swellings and may rarely be accompanied by paresthesia. Less than 1% of schwannomas are intraosseous with affliction to the mandible over maxilla. Only 13 cases of maxillary schwannomas have been reported till date. This article documents a rare case of intramaxillary schwannoma that was disclosed during an incidental radiographic examination. It also provides a review of the literature on central schwannomas affecting the maxilla which suggests its affliction to females in the second decade with equal preference to both anterior and posterior segments of the jaw. It also highlights that intraosseous schwannomas may be considered in the differential diagnosis of periapical lesions with nonspecific clinical and radiographic features.

Thrombocytopenia with Unilateral Dysplastic Radius- Is it Thrombocytopenia - Absent Radius (TAR) Syndrome?

Mani Kant Kumar, Indradeo Prasad Chaudhary, Ram Bilas Ranjan, Prashant Kumar

Thrombocytopenia - absent radii (TAR) syndrome is an autosomal recessive genetic rare disorder with hypomegakaryocytic thrombocytopenia and bilateral absent radius that may have additional anomalies. This disorder is characterized by thrombocytopenia resulting in potentially severe bleeding episodes primarily during infancy. We report the case of a 7-day-old term appropriate for gestational age (AGA) male baby, product of non consanguineous marriage presented with bloody loose stool, right sided upper limb deformity and paleness of the body, was diagnosed as TAR syndrome with some atypical presentation. Such type of atypical presentation has not been previously reported in a case with TAR Syndrome.Patient was managed in our hospital with packed cell transfusion and two units platelets concentrates transfusion, Intra-venous antimicrobials, and other supportive treatment. He gradually improved and was discharged after seven days of hospital stay with advice to consult orthopedic surgeon for opinion regarding limb reconstruction.

A Comprehensive Review on Clinical Applications of Comet Assay

Vidya G, Gladwin V, Parkash Chand

Increased levels of DNA damage and ineffective repair mechanisms are the underlying bio-molecular events in the pathogenesis of most of the life-threatening diseases like cancer and degenerative diseases. The sources of DNA damage can be either exogenous or endogenous in origin. Imbalance between the oxidants and antioxidants resulting in increased reactive oxygen species mostly accounts for the endogenously derived attacks on DNA. Among the various methods employed in the estimation of DNA damage, alkaline comet assay is proven to be a relatively simple and versatile tool in the assessment of DNA damage and also in determining the efficacy of DNA repair mechanism. The aim of this article is to review the application of comet assay in the field of medicine towards human biomonitoring, understanding the pathogenesis of cancer and progression of chronic and degenerative diseases, prediction of tumour radio & chemosensitivity and in male infertility. A standardized protocol and analysis system of various variants of comet assay in different types of cells, across the labs will be of useful and reliable clinical tool in the field of Medicine for the estimation of levels of DNA damage and repair mechanisms.

Pressure Alteration Techniques in Endodontics- A Review of Literature

Shinam Kapila Pasricha, Sameer Makkar, Pranav Gupta

The triad of biomechanical preparation, pulp space sterilization and three-dimensional obturation is the hallmark of endodontic success. Complete disinfection of the pulp space cannot be achieved with most sophisticated instrumentation techniques. The role of irrigants in obtaining this goal cannot be underestimated. Optimal irrigation is based on the combined use of two or several irrigating solutions, in a specific sequence. Today’s irrigation armamentarium presents a diverse variety of tools and techniques that can assist the practitioner in reducing bacteria and debris within the canal system. However, currently there is no universally accepted standard irrigation technique. The aim of this article is to review armamentarium and various irrigants in endodontic practice.

SHED - Basic Structure for Stem Cell Research

Rucha Kashyap

The discovery that stem cells from dental pulp are capable of differentiating into endothelial cells raised the exciting possibility that these cells can be a single source of odontoblasts and vascular networks in dental tissue engineering. These so-called mesenchymal stem cell populations have been identified from human exfoliated deciduous teeth because of their ability to generate clonogenic adherent colonies when grown and expanded. In addition to these stem cells, other population of stem cells can be from adult human dental pulp and periodontal ligament. The identification and isolation of these stem cells in adult dental pulp was first reported by Gronthos and co-workers in 2000.These dental pulp stem cells have clonogenic abilities, rapid proliferative rates and the capacity to form mineralized tissues both in vitro and in vivo. The stem cells from human exfoliated deciduous teeth are distinct from dental pulp stem cells by virtue of their proliferation rate, increased cell population doublings and osteoinductive capacity in vivo. It is further demonstrated that human exfoliated deciduous teeth stem cells may not be a single-cell type, may well be a heterogenous population of cells from the pulp.

Angulated Implants: An Alternative to Bone Augmentation and Sinus Lift Procedure: Systematic Review

Nikhil Asawa, Nilesh Bulbule, DilipKa kade, Riddhi Shah

Rehabilitation of completely edentulous patients with implant becomes challenging due to reduced amount of bone available and pneumatisation of maxillary sinus or both. To successfully treat such patients, prior to implant placement, patient has to undergo invasive procedures like sinus lift and/or bone augmentation which is not possible many time due to many reasons. This article focuses on an alternative treatment procedure in which two posterior implants are placed at an angle and two anterior implants are placed axially thereby eliminating the need for sinus lift or bone augmentation procedures. This article broadly discusses this “All on Four” concept in all aspects, its effects on bone, prosthesis survival, forces acting etc along with various related studies.

How can Doctors Improve their Communication Skills?

Piyush Ranjan, Archana Kumari, Avinash Chakrawarty

The process of curing a patient requires a holistic approach which involves considerations beyond treating a disease. It warrants several skills in a doctor along with technical expertise. Studies have shown that good communication skill in a doctor improve patient’s compliance and overall satisfaction. There are certain basic principles of practicing good communication. Patient listening, empathy, and paying attention to the paraverbal and non verbal components of the communication are the important ones that are frequently neglected. Proper information about the nature, course and prognosis of the disease is important. Besides, patients and attendants should always be explained about the necessity and yield of expensive investigations and risks/benefits involved in invasive procedures. One should be extremely cautious while managing difficult encounters and breaking bad news. Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcome. The authors recommend inclusion of formal training in communication skills in medical curriculum and training of practising doctors in the form of CMEs and CPEs.

Integrative Oncology in Indian Subcontinent: An Overview

Integrative oncology is a combination of one where complementary and alternative medicine (CAM) with conventional cancer treatment modalities is used to manage symptoms, control side-effects and improve the state of mental wellbeing. The ancient Indian medicinal approach in cancer treatment and management has a wide array of herbs and practices. There is an increasing demand for traditional and natural medicine by the cancer patients. The conventional oncologic surgeons and physicians should be aware of the role of cCAM that are available in Indian subcontinent and provide a treatment that focuses on the physical and mental state of wellness in combating cancer.

Myoepithelial Cells (MEC) of the Salivary Glands in Health and Tumours

Ravi Teja Chitturi, V. Veeravarmal, R. Madhavan Nirmal, B. Venkat Ramana Reddy

Myoepithelial cells (MEC) are found in the secretory units of many mammalian exocrine glands such as mammary, sweat, lacrimal and salivary glands. They are interposed between the secretory cells and the basal lamina. Immunohistochemically they are found to contain keratin intermediate filaments and are, therefore, considered to have an epithelial origin but at the same time they contain a large number of myofilaments which represent a massive expression of contractile proteins such as actin, myosin, calponin and caldesmon. Thus have smooth muscle like property also and hence the name. Numerous functions of MEC have been described, the most important of them being important for contraction of the glands and recently it has been found to prevent tumour progression. It should be noted that the diversity in the occurrence and dilemma regarding the pathogenesis of salivary gland tumours is due to lack in uniformity regarding the cells participating in its oncogenesis, especially the MEC. Also proper and extensive studies regarding MEC are very limited and thus have posed difficulty for a pathologist to understand this cell. In this review we try to bring about a thorough description of this cell in both physiological and pathological aspects.

An Interesting Review on Soft Skills and Dental Practice

Maya Dalaya, Syed Ishaquddin, Mahesh Ghadage, Geeta Hatte

In today’s world of education, we concentrate on teaching activities and academic knowledge. We are taught to improve our clinical skills. Soft skills refer to the cluster of personality traits, social graces, and personal habits, facility with language, friendliness and personal habits that mark people to varying degrees. Soft Skills are interpersonal, psychological, self-promoted and non-technical qualities for every practitioner and academician, whereas hard skills are new tools or equipment and professional knowledge. Hence, more and more clinicians now days consider soft skills as important job criteria. An increase in service industry and competitive practices emphasizes the need for soft skills. Soft Skills are very important and useful in personal and professional life.

Prompt Diagnosis and Management of Cervical Necrotizing Fascitis

Shivakshi Chansoria, Harsh Chansoria, P.V. Wanjari, Sumeet Jain, Pushkar Gupta

Carotid Artery Calcification and Sailolith in Partially Edentulous Patient: An Accidental Finding on Panoramic Radiograph

Bader K AlZarea

Paget’s Disease in Mandible: A Rare Occurrence in an Indian Sub-Continent

P. Srinivas Chakravarthi, Ranjit kumar Peravali, Vivekanand Kattimani

Bilobed Lipoma of Submandibular Region: An Unusual Presentation

Multimodality Imaging of Hemangiomas-Pictorial Essay

T. Arul Dasan, Basawaraj N.G., Sunita Madhukar Anvekar

Both hemangiomas and vascular malformations are endothelial malformations that closely resemble normal vessels and can be found in all organs of the human body. This pictorial essay encompasses a spectrum of imaging appearances of hemangiomas and vascular malformations. Familiarity of the MR and CT findings can help differentiate these lesions, to confirm the suspected diagnosis, classify the anomaly and document the associated abnormalities.

Super Odontoma – A Destructive Swarm Entity

A Rare Case of Isolated Partial Anomalous Pulmonary Venous Connection to the Inferior Vena Cava

Arunthathy Thangarajah

Tuberculosis Biliary Stricture Simulating as Cholangiocarcinoma

Ranjit Kumar Padhiari, M.K Ramesh, Praveen G.P, Niyaz Ahmed

Teixobactin: A Novel Antibiotic in Treatment of Gram Positive Bacterial Infections

Arunava Kali

Is Scrub Typhus a Cause of Febrile Illness Among Paediatric Population of Delhi?

Sonali Bhattar, Bhanu Mehra, Ishwar singh, Preena Bhalla

Simple Way of Recording Dental Arch Forms

Shreya Gupta, Ram Kishore Ratre, Sandhya Jain, Rita Chandki

Like finger prints each individual has a unique dental arch form design. Recording patient’s dental arch form may be required in various fields in dentistry be it longitudinal studies for evaluating growth, forensic dentistry and most importantly in orthodontic practice for fabricating arch wires for individual patients. An easy and practical method to obtain individual arch form for each patient is explained.

Prevalence of Beta-Cell, Thyroid and Celiac Autoimmunity in North Indian Children with Recent Onset Type 1 Diabetes (T1D)

There is wide variation in the prevalence of pancreatic and other major autoantibodies in different patient populations of Type 1 diabetes (T1D) across continents and even within countries. The data on frequency of associated autoimmunity Indian children with T1D is limited. A retrospective record review of 310 children aged 7.28±3.3 y (range 0.7-15 y) with recently diagnosed T1D attending our Pediatric Diabetes Clinic between April 2004 to September 2014, showed positivity for anti-GAD65, anti-IA2b, anti-TPO and anti-tTGA of 50% (64/128), 16% (12/72), 18.7% (23/123) and 22% (47/212) respectively. The male:female ratio in patients with anti-GAD, anti-TPO and anti-tTG positivity was 1.3, 0.7 and 0.6 respectively. In conclusion, our patient cohort exhibited a moderate prevalence of anti-GAD 65, low prevalence of anti-TPO and high prevalence of anti-tTGA autoantibodies as compared to previous reports. Male preponderance was noted in children with GAD65 positivity.

Transit Fixatives: An Innovative Study

Rajanikanth M, Ravi Prakash A, Sreenath G, Sonia bai JK, shyam N. V.D

Background: Universally accepted fixative is 10% formalin which has been used for preserving the tissues and their architecture. In certain conditions, formalin might not be readily available for immediate fixation. We here by explore more economical, eco-friendly and easily available solutions that can be used as transit media/ transporting media for tissue specimens. Materials and Methods: The study included commonly available solutions like Spirit, Saline, Betadine solution, Hydrogen peroxide (H2O2), Local anesthesia (L.A), Rose water, Coconut oil, Coconut water, Ice cold water, Honey and Milk while keeping formalin as control. The fresh tissue sample was cut into multiple bits and placed in different containers for a period of 8 hours before transferring to formalin solution. Conclusion: Transit fixatives are very important in certain situations where formalin is not readily available. These fixatives can be used to fix the tissues for a period of at least 8 hours without causing any damage or distortion before they are fixed in formalin solution.

Longitudinal Telomere Erosion in Lymphocyte Subsets of Patients with Atherosclerotic Peripheral Arterial Disease (PAD)

Dirk De Beer, Jan Völzmann, Chris toph Kalka, Gabriela M. Baerlocher

Telomere attrition has been linked to accelerate vascular ageing and seems to predispose for vascular disease. Our aim was to study the telomere length dynamics over time and in subsets of leukocytes from 15 patients with peripheral arterial disease (PAD). The mean telomere length in subsets of leukocytes of patients with PAD was in the normal range of age-related telomere length values from healthy individuals. However, we found significant higher telomere attrition for T-cells from patients with PAD over a time period of six months when compared to the controls. The higher telomere loss in T-cells of patients with PAD most likely reflects a higher cell turnover of this leukocyte subset, which is involved in the process of chronic inflammatory disease underlying vascular disease. Further studies are needed to confirm these data and to assess how far this T-cell telomere attrition will correlate to the extent of the disease.