Journal of clinical and diagnostic research

Comparative Evaluation of the Etching Pattern of Er,Cr:YSGG & Acid Etching on Extracted Human Teeth-An ESEM Analysis

Introduction: Etching of enamel and dentin surfaces increases the surface area of the substrate for better bonding of the tooth colored restorative materials. Acid etching is the most commonly used method. Recently, hard tissue lasers have been used for this purpose. Aim: The aim of the present study was to evaluate and compare the etching pattern of Er,Cr:YSGG and conventional etching on extracted human enamel and dentin specimens. Materials and Methods: Total 40 extracted non-diseased teeth were selected, 20 anterior and 20 posterior teeth each for enamel and dentin specimens respectively. The sectioned samples were polished by 400 grit Silicon Carbide (SiC) paper to a thickness of 1.0 ± 0.5 mm. The enamel and dentin specimens were grouped as: GrE1 & GrD1 as control specimens, GrE2 & GrD2 were acid etched and GrE3 & GrD3 were lased. Acid etching was done using Conditioner 36 (37 % phosphoric acid) according to manufacturer instructions. Laser etching was done using Er,Cr:YSGG (Erbium, Chromium : Ytrium Scandium Gallium Garnet) at power settings of 3W, air 70% and water 20%. After surface treatment with assigned agents the specimens were analyzed under ESEM (Environmental Scanning Electron Microscope) at X1000 and X5000 magnification. Results: Chi Square and Student “t” statistical analysis was used to compare smear layer removal and etching patterns between GrE2-GrE3. GrD2 and GrD3 were compared for smear layer removal and diameter of dentinal tubule opening using the same statistical analysis. Chi-square test for removal of smear layer in any of the treated surfaces i.e., GrE2-E3 and GrD2-D3 did not differ significantly (p>0.05). While GrE2 showed predominantly type I etching pattern (Chi-square=2.78, 0.05

0.10) and GrE3 showed type III etching (Chi-square=4.50, p<0.05). The tubule diameters were measured using GSA (Gesellschaft fur Softwareentwicklung und Analytik, Germany) image analyzer and the‘t’ value of student ‘t’ test was 18.10 which was a highly significant result (p<.001). GrD2 had a mean dentinal tubule diameter of 2.78µm and GrD3 of 1.09µm. Conclusion: The present study revealed type I etching pattern after acid etching, while type III etching pattern in enamel after laser etching. The lased dentin showed preferential removal of intertubular dentin while acid etching had more effect on the peritubular dentin. No significant differences was observed in removal of smear layer between the acid etched and lased groups. Although diameter of the exposed dentinal tubules was lesser after lased treatment in comparison to acid etching, further long term in vivo studies are needed with different parameters to establish the usage of Er,Cr:YSGG as a sole etching agent.

Early Onset of Atherosclerosis of The Carotid Bifurcation in Newborn Cadavers

Introduction: The anatomy of arterial bifurcations affects blood flow and has a significant role in the development of vascular disease. Therefore, it is important to know the structural characteristics of the Common Carotid Artery (CCA) and its branches for early onset of atherosclerosis in newborns. Aim: The present study was conducted to evaluate the characteristics of CCA in newborn cadavers. Materials and Methods: Eight carotid arteries obtained from newborn cadavers were used. The outflow to inflow area ratios was calculated to evaluate vessel diameters. Additionally, scanning electron and light microscopic investigations were conducted with tissue samples. The brachial artery of each cadaver was used as controls. Correlation between area ratios and atherosclerotic endothelial damage was determined. Results: Light microscopic investigations demonstrated that control group sections showed no positivity for Oil red O staining, while carotid bifurcation regions depicted widespread occurrence of intimal lipid accumulations. Scanning electron microscopic examination of control group sections presented regular endothelial topography, while carotid bifurcation region topography exhibited numerous blood cells and separated endothelial cells. Fibrin accumulation on endothelial surface in low area ratios was another important finding in the examination of its endothelial surface degeneration. The above-mentioned morphological findings seemed to be quite parallel to outflow to inflow area ratio data favouring low area and degeneration. Conclusion: The correlation between area ratios and the histological characteristic of cerebral vessels of newborn cadavers indicate that early stages of atherosclerosis began in early embryologic life.

Incidence of Mast Cells in Gingival and Periapical Inflammation- A Kaleidoscopic Study

Ankita Singh, Gadiputi Sreedhar, Jiji George

Introduction: Mast cells are large granular cells that have classically been related to neutrophil stimulation during early step of inflammation. Aim: The objective of this work was to identify the incidence of mast cells in inflammatory lesions like periapical granuloma, pyogenic granuloma, gingival hyperplasia. 1. To assess the staining intensity of mast cells by using different metachromatic stains. 2. To correlate the above findings histopathologically. Materials and Methods: In this study, we used 5 micron thick sections from paraffin-embedded tissue blocks of previously diagnosed periapical and gingival inflammatory lesions. The sections were stained with routine H & E and metachromatic stains like Toluidine blue, Alcian blue, Aldehyde fuchsin and Giemsa. The number of mast cells was quantified. Statistical analysis was done and mast cell numbers were compared. Results: In both gingival and periapical inflammatory lesions, toludine blue showed more number of mast cells followed by giemsa. Giemsa stain showed statistical significance in differentiating both periapical and gingival lesions (p<0.05) in terms of mast cell count. Moderate inflammation (46.4%) was seen in a higher propotion of gingival inflammations whereas periapical inflammatory lesions revealed severe inflammation (53.3%). In both types of inflammatory lesions, higher staining intensity was shown by toludine blue followed by giemsa which was statistically significant. Conclusion: Mast cell number is inversely proportional to inflammatory response in gingival inflammatory lesions and directly proportional to inflammatory response in periapical inflammatory lesions. Although, toludine blue is found to be a better stain, giemsa has equivalent properties as that of toludine blue.

A Prospective Study of the Functional Outcome of Anterior Cervical Discectomy With Fusion in Single Level Degenerative Cervical Disc Prolapse

Mayur M Kamani, Arjun Ballal, Vikram Shetty, H. Ravindranath Rai, Deepak Hegde

Introduction: Cervical spondylotic myelo-radiculopathy is a form of spinal cord dysfunction syndrome and usually accompanies age related degeneration of the spine. Aim: To determine the functional outcome of anterior cervical discectomy with fusion and plating in single level degenerative cervical disc prolapse. Materials and Methods: A total of 20 patients diagnosed with degenerative single level cervical disc prolapse who presented to the Department of Orthopaedic Surgery, Justice KS Hegde Charitable Hospital, Mangalore from the period of November 2012 to May 2014 were enrolled in the study. Complete clinical and radiological evaluation of the patients was done. A trial of conservative management was tried in all these patients for a period of two months. They were taken up for surgery only when conservative management had failed. Scoring of neck function before the surgery was done as per the Modified Japanese Orthopaedic Association (MJOA) score. All patients underwent anterior cervical discectomy and fusion (ACDF) with tricortical iliac crest bone grafting. Fixation was performed with titanium locking cervical plates. All patients were reviewed at 6 weeks and 6 months postoperatively. Assessment of neck function was done as per the MJOA scoring during all the reviews. Radiographic assessment was also done during all the reviews. The complications noted were documented. The statistical analysis was done using percentages; the arithmetic mean was calculated using SPSS software (version 16.0). Results: Amongst the 20 patients included in the study, 1 patient died postoperatively due to oesophageal rupture. of the remaining 19 patients reviewed and followed up, all of them had improvement of symptoms and were reported to be in the ‘mild category’ as per the MJOA score. One patient developed dysphonia, in the immediate postoperative period due to recurrent laryngeal nerve palsy which recovered in a period of three months postoperative. Conclusion: Single level anterior cervical discectomy with fusion and anterior cervical plating for degenerative cervical disc prolapse with or without myelo-radiculopathy is an effective and safe surgical procedure with minimal complication rate.

Comparison of Hypnotherapy and Standard Medical Treatment Alone on Quality of Life in Patients with Irritable Bowel Syndrome: A Randomized Controlled Trial

Korosh Shahbazi, Kamal Solati, Ali Hasanpour-Dehkordi

Introduction: Irritable bowel syndrome (IBS) is one of the most prevalent gastroenterological disorders. IBS is characterized by abdominal pain, cramping, diarrhea, constipation, bloating and flatulence. Complementary therapy is a group of diverse therapeutic and health care systems products that are used in treatment of IBS. Hypnotherapy helps to alleviate the symptoms of a broad range of diseases and conditions. It can be used independently or along with other treatments. Aim: This study was conducted to compare therapeutic effect of hypnotherapy plus standard medical treatment and standard medical treatment alone on quality of life in patients with IBS. Materials and Methods: This study is a clinical trial investigating 60 patients who were enrolled according to Rome-III criteria. The sample size was determined per statistical advice, previous studies, and the formula of sample size calculation. The participants were randomly assigned to two groups of hypnotherapy plus standard medical treatment group (n: 30), and standard medical treatment group (30). The study consisted of three steps; prior to treatment, after treatment and six months after the last intervention (follow-up). The instruments of data gathering were a questionnaire of demographic characteristics and standard questionnaire of quality of life for IBS patients (Quality of Life IBS-34). The data were analysed by analysis of co-variance, Levene’s test and descriptive statistics in SPSS-18. Results: There were significant differences between the two groups of study in post-treatment and follow-up stage with regards to quality of life (p<0.05). Conclusion: Psychological intervention, particularly hypno-therapy, alongside standard medical therapy could contribute to improving quality of life, pain and fatigue, and psychological disorder in IBS patients resistant to treatment. Also, therapeutic costs, hospital stay and days lost from work could be decreased and patients’ efficiency could be increased.

Reference Equation for Six Minute Walk Test in Healthy Western India Population

Lalita Fernandes, Anthony Menezes Mesquita, Rohit Vadala, Amit Dias

Introduction: The Six Minute Walk Test (6MWT) is used to assess disease progression and survival in chronic cardiopulmonary disorders. However, variability is noted in the six minute walk test distance (6MWD) in different populations. Aim: We aimed to develop a reference equation for 6MWD in healthy Western India population and compare the results with previously published Indian and Caucasian reference equations. Materials and Methods: Total 174 healthy subjects between 25 to 75 years performed the 6MWT. Variables assessed were age, height, weight, body mass index and sex. Predicted equations were derived using multiple linear regression and compared with the equations for North Indian male, South Indian and Caucasian population using Bland – Altman method. Results: The 6MWD mean (SD) was 512.38 (67.84) m for men and 457.27 (56.75) m for women with p=0.001. The 6MWD correlated with age (r=-0.44), height (r=0.43), weight (r=0.21) in univariate analysis. Stepwise multiple regression analysis showed age and sex to be independent predictors of 6MWD, R2 =0.307. The reference equation for healthy Western India population is 553.289 + (-2.11 x age) + (45.323 x sex; men=1 and women =0). Bland Altman analysis showed that the mean bias was 50.87m (95% limits of agreement 134.77 to – 33.0) for North Indian male equation, 50.75m (95% limits of agreement 105.72 to - 4.22) for South Indian equation and 122.72m (95%limits of agreement 254.11 to – 8.67) for Enright and Sherrill’s equation. Conclusions: The North Indian male, South Indian and Caucasian equations significantly over-estimated the predicted walk distance for our healthy population. Hence, there is a need to develop subgroup population specific reference equations.

Comparison of the Effects of Vaginal Royal Jelly and Vaginal Estrogen on Quality of Life, Sexual and Urinary Function in Postmenopausal Women

Fatemeh Seyyedi, Mahmoud Rafieian-Kopaei , Sepideh Miraj

Introduction: Several causes can disturb the quality of life in postmenopausal women. Stress, urinary incontinence is one of the factors that can influence the quality of life of women, since they evade social activities and limit their behavior. Vulvovaginal disorders adversely impacts sexual action, psychosocial health, and partner relationships. Aim: The aim of this study was to examine the therapeutic properties of vaginal cream of royal jelly and estrogen on quality of life, sexual and urinary problems in postmenopausal women. Materials and Methods: This study was a randomized controlled clinical trial that was done on 90 married postmenopausal women 50 to 65-year-old. A total of 90 women were randomly distributed to three groups and were treated with vaginal cream of royal jelly 15%, lubricant, and conjugated estrogens for three months. Before and after intervention, quality of life and vaginal cytology were evaluated. Data was analysed by SPSS 16 using ANOVA and Tukey tests. Results: The results expressed that vaginal royal jelly is considerably more effective than conjugated estrogens and lubricant in the improvement of quality of life, sexual and urinary function in postmenopausal women (p<0.05). Results of Pap smear showed that improvement of vaginal atrophy in conjugated estrogens group was better than other groups (p<0.001), and there was no significant difference between lubricant and royal jelly groups (p=0.89). Conclusion: The effectiveness of vaginal royal jelly in treatment of sexual and urinary problems of postmenopausal women is related to its estrogenic properties and could be suitable in promotion of life quality in postmenopausal women.

Helicobacter pylori in Cholecystectomy Specimens-Morphological and Immunohistochemical Assessment

Introduction: Helicobacter pylori (H.pylori) is associated with gastritis, peptic ulcer, gastric carcinoma and gastric lymphoma. Current literature describes presence of H.pylori in various extra-gastric locations and its association with many diseases. Apart from the conventional location of gastric and duodenal mucosa, H.pylori have been isolated and cultured from gallbladder. Aim: Analysis of cholecystectomy specimens to detect H.pylori by means of immunohistochemical staining. Materials and Methods: There were a total of 118 cholecystectomy specimens received in the Department of Pathology in three months duration. We have performed immunostaining for H.pylori in 45 consecutive cases of cholecystectomy specimen. Clinical and other investigational information were retrieved from the medical records department. For each case, routine Haematoxylin and Eosin stain was studied. Immunohistochemistry (IHC) was done using purified polyclonal Helicobacter pylori antiserum. Results: Majority of the patients had undergone laparoscopic cholecystectomy for the presenting complaint of right hypochondrial pain. Multiple pigmented stones were present in majority (27/45) of them. Immunostain for H.pylori was positive in ten cases. Six of these cases had pigmented gall stones, two had stones not specified and in two of the cases there were no stones. Conclusion: Helicobacter pylori is present in gall bladder and is commonly seen in association with stones. A more detailed study of cholecystectomy cases (both neoplastic and non-neoplastic) with serological, culture and molecular data of H.pylori is desirable to study the pathogenesis of cholecystitis, its association with gall stones and other gall bladder disorders.

Study of Basic Coagulation Parameters among HIV Patients in Correlation to CD4 Counts and Artrt Status

Introduction: HIV infection is known to cause coagulation abnormalities by various mechanism, especially during its late course. Aim: The objective of this study is to analyse platelet count, prothrombin time and activated partial thromboplastin time among HIV infected patients and to analyse these parameters with respect to their CD4 count and ART status. Materials and Methods: A case control study was conducted with 120 HIV infected patients and 40 normal individuals. The blood samples were collected after obtaining consent from the subjects. The blood samples were processed for platelet count, prothrombin time and activated partial thromboplastin time and CD4 count. The results were tabulated and analysed with statistical package. Results: The platelet count was significantly decreased in HIV infected patients compared to controls. Though HIV patients with CD4 count less than 200cells/mm3 showed a decreased platelet count compared to those with CD4 count greater than 200cells/mm3, it was not statistically significant. Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) was significantly prolonged in HIV patients, but only aPTT showed significant inverse correlation with CD4 count. None of the parameters showed statistical significance on comparing HIV patients on ART with those not on ART. Conclusion: Basic coagulation tests like platelet count, PT and especially aPTT can be used as prospective screening test to assess severity in HIV patients in resource limited settings where CD4 count is not available.

Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

Anuradha Raj, Renu Dhasmana, Ramesh Chander Nagpal

Introduction: Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim: To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods: In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age =20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (µm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results: There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus height on slit lamp and Optical coherence based tear meniscus area were similar in both sexes (p=0.5 and p=0.1). However, tear meniscus height on optical coherence tomography was significantly higher in females (p=0.04). Value of Schirmer’s and tear film break up time (r =0.2; p= 0.001) and Schirmer’s and tear meniscus height on slit lamp (r=0.6; p<0.001) had positive correlation. Tear meniscus height and tear meniscus area on optical coherence tomography had positive correlation (r =.9; p<0.001). Conclusion: On optical coherence tomography tear meniscus height and area significantly correlated. Despite higher values of Schirmer’s, tear film break up time, Slit lamp based tear meniscus height in younger age group the tear meniscus height and tear meniscus area with optical coherence tomography were lower.

Zinc Levels in Seminal Fluid in Infertile Males and its Relation with Serum Free Testosterone

Radhika Purushottam Kothari, Ajay Rajeshwar Chaudhari

Introduction: The role of zinc is critical to reproduction potential. Seminal zinc is thought to be derived almost exclusively from prostatic secretions. Sperm motility is significantly influenced by zinc. Zinc deficiency has been linked with male sterility and subfertility. Aim: To assess the influence of seminal plasma zinc on seminogram characteristics and whether endogenous testosterone affects the seminal levels of zinc. Materials and Methods: The semen samples were obtained from 150 male partners of infertile couples who attended the Reproductive Biology Unit of the Department of Physiology, within the age 21-50 years and semen samples were analysed for the routine seminogram parameters. All the subjects were classified into two main groups, A- the subjects with normal ejaculates (n=62) and B- the subjects with abnormal ejaculates, who were further sub divided into the following groups: i) Asthenoteratozoospermics (n=43); ii) Oligoasthenoteratozoospermics (n=24); and iii) Azoospermics (n=21). The seminal plasma zinc was measured spectrophotometrically. The sample for serum free testosterone was sent to Thyrocare laboratory. Results: The seminal plasma zinc was found to be significantly lower in the abnormal ejaculates than in the normal ejaculates. A statistically significant positive correlation was observed between the seminal plasma zinc and serum free testosterone (p<0.05, r=0.449). Statistically significant correlation was also found between seminal plasma zinc and all the seminogram parameters such as the sperm concentration, sperm motility and sperm morphology (p<0.05, r= 0.86, 0.87 and 0.86 respectively). Conclusion: Low seminal plasma zinc might be a significant causative factor in impairing sperm functions and its dependence on endogenous free testosterone, was observed from a positive correlation between the two.

Incidence of Postoperative Pain after Single Visit and Two Visit Root Canal Therapy: A Randomized Controlled Trial

Avinash A. Patil, Sonal B. Joshi, S.V Bhagwat, Sanjana A Patil

Introduction: Root Canal Treatment (RCT) has become a mainstream procedure in dentistry. A successful RCT is presented by absence of clinical signs and symptoms in teeth without any radiographic evidence of periodontal involvement. Completing this procedure in one visit or multiple visits has long been a topic of discussion. Aim: To evaluate the incidence of postoperative pain after root canal therapy performed in single visit and two visits. Material and Methods: An unblinded/ open label randomized controlled trial was carried out in the endodontic department of the Dental Institute, where 78 patients were recruited from the regular pool of patients. A total of 66 maxillary central incisors requiring root canal therapy fulfilled the inclusion and exclusion criteria. Using simple randomization by biased coin randomization method, the selected patients were assigned into two groups: group A (n=33) and group B (n=33). Single visit root canal treatment was performed for group A and two visit root canal treatment for group B. Independent sample t-test was used for statistical analysis. Results: Thirty three patients were allotted to group A where endodontic treatment was completed in single visit while 33 patients were allotted to group B where endodontic treatment was completed in two visits. One patient dropped-out from Group A. Hence in Group A, 32 patients were analysed while in Group B, 33 patients were analysed. After 6 hours, 12 hours and 24 hours of obturation, pain was significantly higher in Group B as compared to Group A. However, there was no significant difference in the pain experienced by the patients 48 hours after treatment in both the groups. Conclusion: Incidence of pain after endodontic treatment being performed in one-visit or two-visits is not significantly different.

Gender Based Differences in Risk Factor Profile and Coronary Angiography of Patients Presenting with Acute Myocardial Infarction in North Indian Population

Supriya Bajaj, Vijay Mahajan, Sumit Grover, Amit Mahajan, Nipun Mahajan

Introduction: Coronary Artery Disease (CAD) among women presents atypically with atypical chest pain, neck pain, nausea, fatigue and dyspnoea. Co-existing co-morbidities such as Diabetes Mellitus (DM) and hypertension along with difference in risk factor prevalence makes it necessary to have a gender specific approach. Aim: To study gender specific differences in diagnosing and treating Acute Myocardial Infarction (AMI) in North Indian population. Materials and Methods: Fifty consecutive men and women presenting with AMI were studied. A detailed history including symptoms, history of DM, hypertension, smoking and dyslipidaemia was obtained. ECG, evaluation of cardiac enzymes (CPK-MB, Troponin I), RBS, lipid profile, two dimensional transthoracic echocardiography and coronary angiography were performed. The data was statistically analysed. Results: Among 100 patients (50 males and females each), we found a later age at presentation (62 y vs 56.5 y) and higher prevalence of diabetes (52% vs 24%, p=0.004) and hypertension (46% vs 28%) among females but more dyslipidaemia (34% vs 26%), smoking (44% vs 0%, p=0.0) and higher BMI (25.58 vs 23.74, p=0.019) among males. More females presented with atypical symptoms (16% vs 6%) and were detected to have insignificant CAD (14% vs 2%) than males. Conclusion: North Indian women with presentation at a later age, with atypical symptoms, more incidences of risk factors such as diabetes and hypertension along with lesser dyslipidaemia and BMI than males need a higher index of suspicion while evaluating them for CAD. Misdiagnosis is more likely because of atypical presentation. A milder disease on angiography and a lower incidence of multiple vessel disease is a common finding. We recommend more and larger Indian studies to acquire more data so that this growing prevalence of CAD in women can be curbed.

Prevalence of Principal Rh Blood Group Antigens in Blood Donors at the Blood Bank of a Tertiary Care Hospital in Southern India

Introduction: Rhesus (Rh) antigen was discovered in 1940 by Karl Landsteiner and Wiener. Due to its immunogenicity along with A, B antigens, Rh D antigen testing was made mandatory in pre-transfusion testing. Presently there are more than 50 antigens in Rh blood group system but major ones are D, C, E, c, and e. Very few reports are available regarding their prevalence in India and no reports are available from Andhra Pradesh. Aim: To study the prevalence of principal Rh blood group antigens like D, C, E, c & e in the voluntary blood donors attending our blood bank. Materials and Methods: A prospective cross-sectional non interventional study was carried out on 1000 healthy blood donors from August 2013 to July 2014 at our blood bank. Donors were grouped and typed for ABO and Rh major antigens using monoclonal blood grouping reagents as per the manufacturer’s instructions. Statistical analysis was carried out using SPSS version 16. Comparison of categorical data between antigen positive and negative individuals was done using Chi-square test. Descriptive statistics for the categorical variables were performed by computing the frequencies (percentages) in each category. Incidence was given in proportion with 95% confidence interval. Results: A total of 1000 blood samples from donors were phenotyped. Among Rh antigens, e was the most common antigen (98.4%), followed by D-94.1%, C-88%, c-54.9% and E-18.8% with DCe/DCe (R1R1) (43.4%) being the most common phenotype and the least common phenotype is r’r’ (0.1%). Conclusion: Database for antigen frequency to at least Rh blood group system in local donors helps to provide antigen negative blood to patients with multiple alloantibodies, minimize alloimmunization rate, and thereby improve blood safety.

Saving the 2nd Molar from the 3rd Is it Really the Guilt of the Tilt?

Introduction: Clinicians often relate the distal caries in second molars to angulated third molars, which if left undetected can lead to gross decay that may further require removal of the tooth. Due to this fact, many third molars are advised for prophylactic removal to prevent decay in the second molar. But this approach would only be justified when the incidence of decay/loss of second molar due to third molar are reasonably high. We sought to determine incidence of caries experience and also sequel extraction in second molars associated with the third molars. Aim: The study was conducted to answer the basic question that whether the incidence of caries and subsequent extraction of second molar due to angulated third molars is high enough to justify the prophylactic removal of third molar or not. Materials and Methods: This study was conducted on radiographic records of 1187 patients. The effect of tilted third molar on the second molar was measured in relation with three parameters namely level & position of third molar with respect to second molar and the distribution among arches. Results: The results indicated that out of total number of teeth examined only 5.4% of maxillary and 9.6% of mandibular second molars were affected by tilted third molars. Further, only 2.2% of mandibular and 2.9% of maxillary second molars were indicated for extraction. The data was statistically insignificant. Conclusion: It was concluded that distal caries in second molars is not very common. It may be present in some cases of third molar impactions and prophylactic removal of these impacted teeth may not be considered appropriate.

Factors Affecting Happiness: A Cross-Sectional Study in the Iranian Youth

Amir Mehrdadi, Shahnaz Sadeghian, Ashraf Direkvand-Moghadam, Ataollah Hashemian

Introduction: Happiness is one of the most important concepts in the mental health that has an impact on different aspects of young people. Aim: The present study was conducted to identify the factors influencing happiness among young persons in Liam, Iran during 2014. Materials and Methods: A cross-sectional study was conducted among young population 15-29-year-old. Multistage cluster random sampling method was used to select the participants. Data were collected using two demographic and Oxford Happiness Inventory. SPSS software Package 14 was used to analyse the data. Results: A total of 500 young people, including 272 men and 228 women were enrolled. The Mean ± SD of the participants’ age was 20 ± 2.18 years. There was a significant relationship between the happiness score and location in urban and rural, employment status and physical activity. There was not a significant relationship between gender, marital status and education level with happiness score among participants. Conclusion: The age groups, type of occupation, physical activity and place of residence were factors associated with happiness in young persons. However, there was not significant relationship between gender, marital status and education level with a happiness score among study participants.

Self-Medication with Antibiotics among People Dwelling in Rural Areas of Sindh

Introduction: Self-medication with antibiotics is becoming increasingly common due to multiple factors. The public who are using these antibiotics generally do not have full information regarding their proper use, especially the dosages and possible side-effects. Hence, unregulated use of such medicines may cause dangerous adverse effects in the patients. Aim: The study was aimed to evaluate the prevalence and practice of self-medication with antibiotics among people dwelling in the rural areas of province Sindh. Materials and Methods: A cross-sectional survey was performed at Outpatient Department of Civil Hospital Karachi, from January to March 2015. Four hundred rural dwellers who lived in the outskirts of Karachi city area of province Sindh were recruited for the study in the aforementioned time period through non-probability convenience sampling. Results: The investigation reported a prevalence of 81.25% among rural dwellers of Sindh with regards to self-medication of antibiotics. The most common reason behind self-medication were economic reasons (88.0%). Amoxicillin (52.0%) was found to be the most self-prescribed antibiotic. Majority of the participants (74.7%) didn’t know about the phenomena of antibiotic resistance associated with inadequate use of antibiotics and only 25 subjects identified correctly that the situation would lead to increase resistance. Conclusion: The self-medication rates with antibiotic are higher in rural areas of Sindh. There is an urgent need for the government to enforce stricter laws on pharmacies dispensing medications, especially antibiotics, without prescriptions. Lastly, provision of cost effective treatment from public sector can significantly reduce self-medication with antibiotics among rural dwellers of Sindh.

Comparison of Retention of Clasps Made of Different Materials Using Three-Dimensional Finite Element Analysis

Introduction: Retention and esthetics are believed to play a crucial role in deciding the success of removable partial dentures. Aim: To compare retention of acetal resin and cobalt–chromium clasps. Materials and Methods: A finite element model was designed with an edentulous space between mandibular right second premolar and second molar. Occlusal rests were placed on distal fossa of the second premolar and mesial fossa of second molar. An undercut depth of 0.01inch was created on the mesiobuccal surface of the premolar and distobuccal surface of second molar. Three dimensional finite element model of clasp assembly was designed and assigned with the properties of two different materials namely acetal resin and cobalt–chromium in successive steps. A horizontal bar was constructed between the occlusal rests of the prosthesis. Later, variable amount of dislodging force, in increasing order, was applied at the centre of the horizontal bar and the force at which the clasp arm gets dislodged was noted with respect to each of the material. The obtained values were noted and then subsequently analyzed. Results: The amount of force required to dislodge acetal resin and cobalt–chromium clasps was found to be 0.02N and 2N respectively. Conclusion: The results obtained suggested that acetal resin clasp exhibited less retentive force than cobalt–chromium clasps.

Relevance of Haematologic Parameters in Obese Women with or without Metabolic Syndrome

Vijayashree Raghavan, Damini Gunasekar, Keshav Ramesh Rao

Introduction: Obesity is rapidly growing problem worldwide. It predisposes to a variety of serious ailments including heart disease, diabetes mellitus, degenerative joint disease, atherosclerosis, etc. This is probably related to proinflammatory state associated with obesity due to release of several inflammatory mediators by the adipose tissue. The mediators are also probably responsible for metabolic syndrome associated with obesity. Besides, they may also induce significant changes in haematological parameters associated with inflammation. Aim: Present study was undertaken to ascertain the relationship between obesity and leucocyte counts (particularly TLC and ANC) and find out if the changes induced in them are significant enough to be used as predictors of metabolic syndrome. Materials and Methods: This case-control study was carried out on 243 female subjects allocated to four groups based on WHO and IDF criteria: Control, Overweight, Obese and Obese with Metabolic Syndrome. From all the subjects, data pertaining to obesity related anthropometric measurements, lipid profile, fasting plasma glucose levels and complete blood counts were collected. These were analysed statistically. Results: There was a strong positive correlation between obesity related anthropometric measurements (BMI, BF, WC) and leucocyte counts – TLC and ANC – which were statistically highly significant; TNC and ANC also showed strong positive correlation with FPG. Mean values for TLC and ANC showed statistically significant difference between each and every group. The difference in the mean values of these parameters between obese and metabolic syndrome was highly significant. Both elevated FPG and BMI were independently associated with relative leucocytosis; when both of them were elevated simultaneously, the effect appeared to be potentiating. Conclusion: Increase in obesity associated anthropometric measurements (BMI, WC, BF) is associated with relative leucocytosis within the physiological range. The changes in TLC and ANC are significant enough to be used as predictors of onset of metabolic syndrome in obese subjects.

Body-Image Disturbance: A Comparative Study among Haemodialysis and Kidney Transplant Patients

Low Dose MDCT with Tube Current Modulation: Role in Detection of Urolithiasis and Patient Effective Dose Reduction

Introduction: Urolithiasis is one of the major, recurring problem in young individuals and CT being the commonest diagnostic modality used. In order to reduce the radiation dose to the patient who are young and as stone formation is a recurring process; one of the simplest way would be, low dose CT along with tube current modulation. Aim: Aim of this study was to compare the sensitivity and specificity of low dose (70mAs) with standard dose (250mAs) protocol in detecting urolithiasis and to define the tube current and mean effective patient dose by these protocols. Materials and Methods: A prospective study was conducted in 200 patients over a period of 2 years with acute flank pain presentation. CT was performed in 100 cases with standard dose and another 100 with low dose protocol using tube current modulation. Sensitivity and specificity for calculus detection, percentage reduction of dose and tube current with low dose protocol was calculated. Results: Urolithiasis was detected in 138 patients, 67 were examined by high dose and 71 were by low dose protocol. Sensitivity and Specificity of low dose protocol was 97.1% and 96.4% with similar results found in high BMI patients. Tube current modulation resulted in reduction of effective tube current by 12.17%. The mean effective patient dose for standard dose was 10.33 mSv whereas 2.92 mSv for low dose with 51.13–53.8% reduction in low dose protocol. Conclusion: The study has reinforced that low-dose CT with tube current modulation is appropriate for diagnosis of urolithiasis with significant reduction in tube current and patient effective dose.

Retrospective Analysis of Pattern of Cutaneous Adverse Drug Reactions in Tertiary Hospital of Pauri Garhwal

Deepak Dimri, Rangeel Singh Raina, Swati Thapliyal, Vijay Thawani

Introduction: Cutaneous Adverse Drug Reactions (CADR) are the common drug induced adverse reactions which usually have wide range of manifestations and severity. Aim: To describe the prevalence and clinical spectrum of CADR’s in a tertiary hospital of the Garhwal region in Uttarakhand, India. Materials and Methods: All patients suspected of having CADRs reported in the various out-patient departments, and in-patients of HNB Base & Teaching Hospital, from 1st January 2012 to 31st December 2014 were retrospectively analysed. Drug history was recorded in a format specified in Indian National Pharmacovigilance Programme. Results: Total 111 cases of CADRs were reported from Jan 2012 to Dec 2014. Mean age of patients was 33.34±18.7 years and maximum ADRs were reported in the age group of 20-39 years (36.9%). Female were affected more than male (W:M :: 66:45). Most of the ADRs were exanthematous eruptions (EE) type (33.3%). Medicine department reported maximum cases of CADRs (47.7%), followed by Dermatology. Most of the CADRs were reported with antimicrobial agents (69.4%). Significant associations of different types of various cutaneous reactions were observed in relation to the duration (in days) of ADRs (p = 0.038), types of outcome (p= 0.006), different departments (p= 0.014) and between different groups of medicines (p = 0.008). Conclusion: CADRs have proved a significant problem in healthcare for decades. Major bulk of CADR result from physician prescribed drugs. Hence, awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them.

Physico-Chemical and Bacterial Evaluation of Public and Packaged Drinking Water in Vikarabad, Telangana, India - Potential Public Health Implications

Introduction: Humanity highly depends on water and its proper utilization and management. Water has various uses and its use as thirst quenching fluid is the most significant one. Aim: To assess physical, chemical, trace metal and bacterial parameters of various public and packaged drinking water samples collected from villages of Vikarabad mandal. Materials and Methods: Public and packaged drinking water samples collected were analysed for various parameters using American Public Health Association (APHA 18th edition 1992) guidelines and the results obtained were compared with bureau of Indian standards for drinking water. Statistical Analysis: Descriptive statistics and Pearson’s correlations were done. Results: Among bottled water samples, magnesium in 1 sample was >30mg/litre, nickel in 2 samples was >0.02mg/litre. Among sachet water samples, copper in 1 sample was >0.05mg/litre, nickel in 2 samples was >0.02mg/litre. Among canned water samples, total hardness in 1 sample was >200mg/litre, magnesium in 3 samples was >30mg/litre. In tap water sample, calcium was >75mg/litre, magnesium was >30mg/litre, nickel was >0.02mg/litre. Among public bore well water samples, pH in 1 sample was >8.5, total dissolved solids in 17 samples was >500mg/litre, total alkalinity in 9 samples was >200mg/litre, total hardness in 20 samples was >200mg/litre, calcium in 14 samples was >75mg/litre, fluoride in 1 sample was >1mg/litre, magnesium in 14 samples was >30mg/litre. Total coliform was absent in bottled water, sachet water, canned water, tap water samples. Total Coliform was present but E. coli was absent in 4 public bore well water samples. The MPN per 100 ml in those 4 samples of public bore well water was 50. Conclusion: Physical, chemical, trace metal and bacterial parameters tested in present study showed values greater than acceptable limit for some samples, which can pose serious threat to consumers of that region.

Prevalence of Class D Carbapenemases among Extended-Spectrum ß-Lactamases Producing Escherichia coli Isolates from Educational Hospitals in Shahrekord

Mohammad-Sadegh Damavandi, Abolfazl Gholipour, Mohammad Latif pour

Introduction: Extended-spectrum ß-lactamases (ESBLs) are a set of plasmid-borne, various and quickly evolving enzymes that are a main therapeutic issue now-a-days for inpatient and outpatient treatment. Aim: The aim of this study was to determine multi-drug resistance (MDR) and ESBLs producing E. coli strains, prevalence of class D Carbapenemases among ESBLs producing Escherichia coli isolates from educational hospitals in Shahrekord, India. Materials and Methods: Uropathogenic Escherichia coli strains were isolated from patients with Urinary Tract Infections (UTIs). The agar disc diffusion test was used to characterize the antimicrobial sensitivity of the E. coli isolates. The ESBL positive strains were identified by phenotypic double-disk synergy test, by third-generation cephalosporin in combination with or without clavulanic acid. Multiplex PCR was carried out for detection of the three families of OXA-type carbapenamases including OXA-23, OXA-24, and OXA-48 in E. coli strains. Results: All bacterial isolates were susceptible to meropenem. Ninety isolates produced ESBL, 55 E. coli isolates from inpatients, and 35 isolates from outpatients, with a significant association (p< 0.05). The prevalence of OXA-23, OXA-24, and OXA-48 in the ESBLs producing isolates was respectively 21%, 18%, and 11% for inpatients, and 10%, 8%, and 6% for outpatients. Conclusion: ESBL-producing E. coli isolates are also a major threat in the clinical setting. The findings of this study indicated the high occurrence of ESBLs and multiple antibiotic resistance in E. coli isolates.

Beneficial Effect of Preferential Music on Exercise Induced Changes in Heart Rate Variability

R. Archana, R. Mukilan

Introduction: Music is known to reduce pain, anxiety and fear in several stressful conditions in both males and females. Further, listening to preferred music enhances the endurance during running performance of women rather than listening to non-preferred music. In recent years Heart Rate Variability (HRV) has been used as an indicator of autonomic nervous activity. Aim: This study was aimed to assess the effectiveness of preferential music on HRV after moderate exercise. Materials and Methods: This was an experimental study done in 30 healthy students aged between 20-25 years, of either sex. HRV was measured at rest, 15 minutes of exercise only and 15 minutes of exercise with listening preferential music in same participants. Data was analysed by One-Way ANOVA and Tukey HSD Post-hoc Test. Statistical significance was taken to be a p-value of less than 0.05. Results: Low frequency and high frequency component was significantly increased followed by only exercise. Music minimized increase in both high and low frequency component followed by exercise. However, only high frequency change was statistically significant. LF/HF ratio was significantly increased followed by only exercise. Music significantly minimized increase in LF/HF ratio. Conclusion: This study provides the preliminary evidence that listening to preferential music could be an effective method of relaxation, as indicated by a shift of the autonomic balance towards the parasympathetic activity among medical students.

Linear Odontometric Analysis of Permanent Dentition as A Forensic Aid: A Retrospective Study

Introduction: Sex determination in forensic anthropology is an essential step for medico-legal purposes and crucial for identification as the number of possible matches is reduced to 50%.Teeth are an excellent material for anthropological, genetic, odontological and forensic investigations as they are known to resist a variety of ante-mortem and post-mortem insults. Sexual dimorphism in tooth size and the accuracy of odontometric sex prediction is found to vary in different population and therefore it is necessary to determine specific population values in order to make identification possible. Hence, the present study was undertaken to evaluate the existence of sexual dimorphism in South Kerala population. Aim: To evaluate and estimate the degree of odontometric sexual dimorphism in all permanent teeth except third molars and the variations in odontometric dimensions between the left and right side teeth of the maxillary and mandibular arches in male and female groups. Materials and Methods: The MesioDistal (MD) and BuccoLingual (BL) measurements of 28 teeth were estimated from the preorthodontic casts of 132 subjects; male group (66 males) and female group (66 females) of age range 15-25 years using digital Verniers’ Caliper. The data obtained were analysed using SPSS version 17 and the Students’ t-test for two independent samples. Results: The MesioDistal (MD) and BuccoLingual (BL) parameters of all permanent teeth in the study group showed sexual dimorphism. Over 39% of the tooth variables showed reverse dimorphism. The comparison of mean values of MD and BL diameters of the maxillary and mandibular, right and left side teeth in male and female groups showed statistical significance in males whereas females show non-significant values in both MD and BL diameters. Conclusion: The study showed a varied percentage of sexual dimorphism and variation in the mean values of MD and BL dimensions in males, but not in females between right and left side teeth of the maxillary and mandibular arches of the study population.

Relationship of Anterior Alveolar Dimensions with Mandibular Divergence in Class I Malocclusion – A Cephalometric Study

Introduction: One of the major limiting factors in retraction of proclined teeth is the width of the alveolus both in maxilla and mandible. Aim: The objective of this study was to assess the maxillary and mandibular anterior alveolar dimensions and to correlate with mandibular divergence in Class I bi-dento-alveolar protrusion patients. Materials and Methods: Pretreatment lateral cephalograms (n=88) were analysed using a composite analysis with cephalometric software. Both maxillary and mandibular anterior alveolar widths and heights were measured and correlated with mandibular divergence. One-way analysis (ANOVA) and Pearson correlation test were used to compare and establish the significance between groups. Results: Segregation of the data based on variation in the bi-cortical widths and heights showed that lesser alveolar widths and greater alveolar heights were associated with the high angled subjects and greater alveolar widths and lesser heights were associated with low angled subjects. Conclusion: Patients with hyperdivergent mandible exhibited thin anterior alveolar width and greater alveolar height whereas low angled subjects had wider alveolar width and lesser alveolar height. Orthodontic treatment plan for retraction of anterior teeth must be based on these differences caused by variations in mandibular divergence.

Comparative Evaluation of Antimicrobial Activity of QMiX, 2.5% Sodium Hypochlorite, 2% Chlorhexidine, Guava Leaf Extract and Aloevera Extract Against Enterococcus faecalis and Candida albicans – An in–vitro Study

Introduction: Debridement and disinfection of the root canal system is a critical step in endodontic treatment. Most of the irrigants presently used in the endodontic treatment can have an impact on the microbes surviving in the biofilm but none of them are able to do all of the required tasks. Researches are going on its full swing in order to produce an endodontic irrigant having ideal properties. Aim: To compare the antimicrobial efficacy of different irrigants like QMiX, guava leaf extract, aloevera extract, 2.5% sodium hypochlorite and 2% chlorhexidine gluconate against Enterococcus faecalis and Candida albicans. Materials and Methods: The antimicrobial activity was determined using agar diffusion test. The solutions were divided into five groups: Group I- QMiX, Group II- Guava leaf extract and Group III-Aloevera extract, Group IV–2.5% Sodium hypochlorite and Group V-2% Chlorhexidine. The zones of inhibition of growth were recorded. Results: Statistical analysis was performed using one way ANOVA with post-hoc Tukey’s HSD. Values obtained were statistically analyzed (p<0.05). QMiX showed maximum inhibitory effect against Enterococcus faecalis and Candida albicans followed by, 2% chlorhexidine, 2.5% sodium hypochlorite, guava leaf extract and aloevera extract. Results obtained were statistically significant. Conclusion: Guava leaf extract showed significant inhibitory effects against Enterococcus faecalis and Candida albicans. QMiX demonstrated the best results among the tested solutions and can be considered as a potential alternative to existing root canal irrigants.

Peri-Implant Sulcus Fluid (PISF) Matrix Metalloproteinase (MMP) -8 Levels in Peri-Implantitis

René Thierbach, Kurtrt Maier, Timo Sorsa, Päivi Mäntylä

Introduction: Matrix Metalloproteinase (MMP) -8 plays crucial role in pathogenesis of periodontitis and is also a possible biomarker candidate in peri-implantitis. Aim: The aim of the study was to analyse MMP-8 levels in peri-Implant Sulcus Fluid (PISF) from peri-implantitis affected implants in smoking and non-smoking patients with different periodontal health status of natural teeth before and after peri-implantitis treatment. Settings and Design: Altogether 29 patients with peri-implantitis were recruited and divided into two study groups (11 with healthy periodontium or gingivitis, i.e. no marginal bone loss, and 18 with chronic periodontitis). Materials and Methods: PISF sample from one implant with peri-implantitis from each patient was collected at the baseline and six months after conservative and surgical peri-implantitis treatment, and clinical parameters were registered. Samples were analysed for MMP-8 with dento ELISA method applying a monoclonal antibody. Mucosal cell samples were also analysed for IL-1 gene polymorphism. PISF MMP-8 levels’ differences between periodontal diagnosis groups and between smokers’ and non-smokers’ were analysed. Also, IL-1 polymorphism profiles were compared between study groups. Results: PISF MMP-8 levels were higher at the baseline compared to and after the treatment when all sampled implant sites were analysed together (p = 0.001). MMP-8 levels’ distribution was broader in periodontitis patients’ PISF samples, and only in periodontitis patients’ group levels decreased statistically significantly after the treatment (p = 0.005). Smokers’and non-smokers’ PISF MMP-8 was at similar level both at the baseline and after the treatment. No difference between distributions of IL-1 genotypes was found between study groups. Conclusion: MMP-8 levels increase in peri-implantitis affected implants both in non-periodontitis and periodontitis patients, but levels still after treatment of the condition reflect intensified host response around implants and indicate challenges of controlling peri-Implantitis with any treatment modality.

Coronal Microleakage of the Resilon and Gutta-Percha Obturation Materials with Epiphany SE Sealer: An in-vitro Study

Arwa Ahmed Al-Maswary, Hatem Abdel-Hameed Alhadainy, Sadeq Ali Al-Maweri

Comparative Study of GeneXpert with ZN Stain and Culture in Samples of Suspected Pulmonary Tuberculosis

Monika Agrawal, Ashish Bajaj, Vinay Bhatia, Sarjana Dutt

Introduction: Tuberculosis remains one of the deadliest communicable diseases. There are number of tests available for the diagnosis of tuberculosis but conventional microscopy has low sensitivity and culture although gold standard, takes longer time for positivity. On the other side, Nucleic acid amplification techniques due to its rapidity and sensitivity not only help in early diagnosis and management of tuberculosis especially in patients with high clinical suspicion like immunocompromised patients, history of contact with active tuberculosis patient etc., but also curtail the transmission of the disease. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of Nucleic acid amplification assay (GeneXpert) using respiratory samples in patients with suspected pulmonary tuberculosis and compare with AFB smear microscopy (Ziehl Neelsen stain) and Acid Fast Bacilli (AFB) culture. Materials and Methods: We retrospectively reviewed the respiratory samples of suspected pulmonary tuberculosis (including Bronchoalveolar lavage and sputum) of 170 patients from Jan 2015 to Nov 2015 for ZN stain, culture and GeneXpert (Xpert® MTB/Rif assay). The sensitivity, specificity, PPV and NPV of GeneXpert and ZN microscopy were calculated using Liquid culture of Mycobacterium tuberculosis as gold standard. Results: A total of 170 patient samples were evaluated in final analysis. Of these, 14 samples were positive by all three methods used in our study. The overall sensitivity, specificity, PPV and NPV of GeneXpert were 86.8%, 93.1%, 78.5% and 96% respectively and for BAL sample, 81.4%, 93.4%, 73.3% and 95.7% respectively. The overall sensitivity and specificity of AFB smear microscopy were 22.2%, and 78.5% respectively and for BAL sample 22.2% and 100% respectively. For AFB negative samples sensitivity and specificity were 79.1% and 93.1% respectively. Conclusion: GeneXpert has a higher sensitivity than AFB smear microscopy in respiratory samples. GeneXpert can be a useful tool for early diagnosis of patients with high clinical suspicion of pulmonary tuberculosis. Positive GeneXpert, but culture negative results should be read cautiously and be well correlated with clinical and treatment history of the patient. The other major advantage of Gene Xpert is that it simultaneously detects Rifampicin resistance and is especially beneficial in patient with MDR and HIV associated tuberculosis and should be studied further.

Oral Health Status of Rural and Urban Population of Gurgaon Block, Gurgaon District Using WHO Assessment Form through Multistage Sampling Technique

Introduction: Oral health is an integral part of general health and well being. Poor oral health can affect a person physiologically and psychologically irrespective of age group. Aim: To assess the oral health status and treatment needs of urban and rural population of Gurgaon Block, Gurgaon District, Haryana, India. Materials and Methods: A descriptive cross-sectional study was conducted among 810 urban and rural subjects belonging to index age groups of 5, 12, 15, 35-44 and 65-74 years as recommended by WHO, in the city of Gurgaon, Haryana. The World Health Organization Oral Health Assessment Form (1997) was used for data collection in which clinical examination, soft and hard tissue findings as well as dentofacial anomalies were recorded. The subjects were selected by multistage random sampling and examined throughout the area by a house to house survey. Statistical Analysis: The data was collected and subjected to analysis through SPSS 21. Chi-square was used for compilation of results. Results: Of the total population 44.9% had dental caries with a mean DMFT of 1.61. Prevalence of periodontal diseases was 65%; 46% of the population suffered from malocclusions of which 21.19 % had the severe type. Dental fluorosis was found to be highly prevalent (46%) out of which 11.23% had moderate and 9.6% had severe type of fluorosis. Treatment was found to be required among 83% of population. Conclusion: The dental health care needs are very high both in rural and urban areas in spite of basic facilities available in urban areas. Hence professional and administrative attention is required both in urban and rural areas. Gurgaon Block can be used as a model district to find the effectiveness of programs in bringing down the oral diseases and maintenance of the oral health of the people on a long term basis.

Prevalence and Clinical Relevance of Schmorl’s Nodes on Magnetic Resonance Imaging in a Tertiary Hospital in Southern India

Devimeenal Jagannathan, Venkatraman Indiran, Fouzal Hithaya

Introduction: Schmorl’s Nodes (SN), which appear as defects in superior and inferior endplates of vertebrae, are commonly seen around the thoracolumbar junction. They may be asymptomatic or symptomatic. Their prevalence varies with respect to age, gender, regions involved and other associated disc or vertebral findings. Aim: SN is quite a common finding on the Magnetic Resonance Imaging (MRI) of the spine. The purpose of the study was to evaluate the prevalence of SN in the patients who underwent MRI whole spine in the radiology department, ascertain its clinical relevance and to compare the prevalence of SN in the study population with the prevalence in rest of the Indian and global population described already in the literature. Materials and Methods: Clinical history and MRI images of the patients who underwent whole spine MRI study in the Radiology Department during the period of 6 months from June to December 2015 were retrospectively reviewed. The prevalence of SN, their location and associated imaging findings were studied. Results: Of the 509 patients in the study, 47 had SN at one or more levels with prevalence of 9.2%. Maximum cases were seen in the 4th decade with least cases in the extremes of age. Twenty five patients had SN at thoracic levels. Twenty five patients had SN at lumbar levels. Twenty eight patients had SN at one intervertebral disc level. Other 19 patients had SN at multiple levels. Of the total 103 SN found, 57 were seen in the superior endplates and 46 in the inferior endplates. All SNs were in central position, except for one. Twelve of the 47 patients had disc degeneration at the same level as SN. Forty two of the 47 patients (89%) with Schmorl’s nodes had associated spinal disc degenerative disease at the same or different levels. Modic type II endplate changes were demonstrated at the same level in 10 of the 47 patients with SN. Thirty eight of the 47 patients presented with history of backache. Only 9 of these patients had come with history of trauma; of these only four had wedge compression fracture at the level of SN. Conclusion: Schmorl’s nodes in the studied South Indian population appear to show one of the lowest prevalence described on MRI, so far. Maximum number of SN occurred in the lower thoracic spine followed by the proximal lumbar spine. Schmorl’s nodes are commonly associated with degenerative disc disease of the spine, though not at the same level.

Incidence of Hypothyroidism in Meniere’s Disease

U.P. Santosh, M.S. Sudhakar Rao

Introduction: Meniere’s disease is a disorder of the membranous labyrinth of the inner ear manifesting as vertigo, tinnitus, sensory neural hearing loss and aural fullness of known or unknown origin. Some patients may present after years into typical forms. The endocrine disorders, especially hypothyroidism and the factors like inflammation, trauma, otosclerosis, autoimmunity explains the multifactorial causation for the basis of Meniere’s disease. Endolymphatic hydrops is the pathologic term named for the defective regulation of endolymph volume with respect to production and absorption. However, hyper production of endolymph cannot be excluded. The cause of Meniers disease is multifactorial so clinical features of repeated attacks of variable duration cannot be explained satisfactorily based on single causation. Aim: To study the incidence of hypothyroidism in Meniere’s disease and to assess the success rate of improvement in subjective symptoms after treatment. Materials and Methods: The study was carried out on total 35 out patients who were clinically diagnosed of Meniere’s disease and of these 35 patients, 12 patients were found to have hypothyroidism. All patients with hypothyroidism were treated with oral thyroxin supplements and they were evaluated clinically at 3 weeks, 3 months and 6 months interval for the improvement in subjective symptoms on outpatient basis. R esults: In our study, the subjective improvement of all symptoms was seen in all cases of Meniere’s disease with hypothyroidism after 12 weeks of treatment. Conclusion: The improvement in clinical symptoms after treatment demonstrates an association between Meniere’s disease and hypothyroidism which was found to be significant. Hence, clinicians should consider screening patients with Meniere disease for thyroid dysfunction who are not already taking supplements.

Antibiogram of Salmonella Isolates: Time to Consider Antibiotic Salvage

R. Sharvani, Hemavathi, DK. Dayanand, Poornima Shenoy, Pooja Sarmah

Introduction: Enteric fever is a major problem especially in developing countries. Timely and appropriate treatment plays a very important role in reducing the mortality. Fluoroquinolones and cephalosporins are the treatment options for enteric fever. Recent studies have shown that it is time to reconsider the use of earlier antibiotics. Aim: The study was aimed to know whether salvage is possible and to avoid treatment failures following fluoroquinolone usage. Materials and Methods: A one year retrospective data of Salmonella species isolated from 319 blood samples from our hospital and other diagnostic centers were studied. Demographic data, organism isolated and their changing pattern of antibiogram were analysed. Results: Out of 319 Salmonella isolates, 52.4% (167) was Salmonella typhi (S. typhi) and 47.6% (152) Salmonella paratyphi A (S. paratyphi A), with a male preponderance. Most of the salmonellae were isolated in the months of June and July, with the majority being in the 1-10 and 21-30 years age groups. Both species were highly susceptible to chloramphenicol (95.2% and 100%) followed by third generation cephalosporins (97% and 98%), cotrimoxazole (95.8% and 98.6%) and ampicillin (94.6% and 93.4%) respectively. Highest resistance was seen for nalidixic acid (90.4% and100%) among both S. typhi and S. paratyphi A isolates followed by ciprofloxacin (62.2% and 54.6%) respectively. MDR to first line drugs was observed in a small proportion of S. typhi (1.7%) only. Conclusion: The frequency of isolation of S. typhi and S. paratyphi A are in equal proportion and enteric fever is more prevalent in younger age group. It is ideal to adopt bivalent vaccination in Universal immunization schedule. The isolates show sensitivity to first line drugs, paving the way for salvage of the earlier drugs. Cephalosporins still remain the treatment of choice in MDR salmonella isolates.

Evaluation of IL-6, CRP and hs-CRP as Early Markers of Neonatal Sepsis

Introduction: Bacterial sepsis is a life threatening crisis with high mortality and morbidity in neonates. Due to non-specific clinical presentation, diagnosis of sepsis is still a challenge. It can be diagnosed by blood culture but it is time consuming. So, a reliable marker is needed for the diagnosis of neonatal sepsis so that early treatment can be initiated. Various cytokines, chemokines, acute phase reactants, cell surface markers and interferons have been evaluated to find out the effective marker for early diagnosis of neonatal sepsis. In this study, levels of IL-6, CRP and hs-CRP have been analysed which would favour the diagnosis of neonatal sepsis. Aim: This study aimed to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and to evaluate and analyze the above parameters as the early markers of neonatal sepsis in comparison with blood culture. Materials and Methods: Eighty neonates were included in this study of which 40 were clinically suspected cases of neonatal sepsis who met the inclusion criteria and the other 40 were normal healthy neonates that were taken as controls. After obtaining written informed consent from either parent of all neonates, venous blood samples were collected. Blood culture was performed by conventional method. Estimation of serum IL-6 was done by ELISA method and serum CRP and hs-CRP were done by immunofluorescence assay. Results: The CRP level >13.49 mg/l showed sensitivity and specificity of 80% and 65.70% respectively. The IL-6 >51.29 pg/ml showed sensitivity of 100% and specificity of 62.86% and hs-CRP showed sensitivity of 90% and specificity of 32.86%. Combination of IL-6 and CRP showed sensitivity and specificity of 100% and 75.71% respectively. Conclusion: Our study suggests that IL-6 is a highly sensitive marker and CRP is a more specific marker for the diagnosis of neonatal sepsis. hs-CRP is a less reliable marker. So, the combination of IL-6 and CRP are the better predictors of neonatal sepsis.

Absolute Lymphocyte Count as a Surrogate Marker of CD4 Count in Monitoring HIV Infected Individuals: A Prospective Study

Preeti Balkisanji Agrawal, Sharda Raju Rane, Meenal Vitthal Jadhav

Introduction: CD4 cell count has been proposed to be substituted by Absolute lymphocyte count in monitoring HIV infected individuals as methods of CD4 cell count and plasma viral estimation require expensive, specialized equipments and highly trained personnel. Aim: To assess the clinical utility of the Absolute Lymphocyte Count (ALC) to serve as a surrogate marker for predicting a CD4 count < 200 cells/µl in patients with HIV infection in resource poor countries. Materials and Methods: A prospective study of 61 patients with HIV/AIDS was conducted. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) of various ALC cut-offs were computed for CD4 cell count < 200 cells/µl for age < 30 or age = 30 years. Pearson correlation, Linear regression and Receiver Operating Characteristics (ROC), were used. Results: For patients aged = 30 years, sensitivity, specificity, positive and negative predictive value of ALC <1200 cells/µl to predict CD4 cell count < 200 cells/µl were 34.48%, 67.5%, 43.48%, 58.69% respectively. For subjects aged < 30 years, these values were 27.27%, 67.5%, 18.75%, 77.14%, respectively. A ALC < 1643 was found to have maximal sensitivity for predicting a CD4 cell count <200/ µl. Conclusion: Our data revealed good correlation between ALC and CD4 cell counts but ALC cut-off of 1200 was not a surrogate marker for CD4 cell count < 200 cells/µl. As we increase the cut-off to <1643/ µl it could be the cost-effective surrogate marker for CD4 cell counts < 200 cells/µl in resource limited settings.

Factors Contributing to Development and Reversal of LVH: A Pilot Study

Introduction: Left Ventricular Hypertrophy (LVH) often reflects as a physiological adaptation to chronic pressure overload. It has been identified as a strong independent risk factor of all-cause mortality and adverse cardiac events. Since not all subjects with hypertension develop LVH, understanding the clinical factors contributing to the development of LVH and the appropriate diagnostic and treatment strategies may help clinicians in conducting more definitive evaluation and managing the disease effectively. Aim: To assess the incidence of LVH in hypertensive subjects and the factors influencing its development and reversal. The study also evaluated the most effective diagnostic technique and therapy that could improve the disease symptoms and prognosis. Materials and Methods: The prospective study, conducted at Jagadguru Sri Shivarathreeshwara (JSS) Medical College JSS University, Mysore, India, included 50 patients with hypertension. Detailed history of the recruited subjects was collected from patient records and through physical examination. Demographic and clinical characteristics such as age, gender, BMI, and stage of hypertension (stage I HTN and stage II HTN) were also obtained. Funduscopic examination was done for all patients for evidence of hypertensive retinopathy. Echocardiography (ECHO), electrocardiography (ECG), and chest X-Ray were used for detection of LVH. The patients were reviewed after six months and reassessment of LVH was carried out. Statistical analysis was conducted using SPSS software and R 3.2 package. Results: Angiotensin-Converting Enzyme (ACE) inhibitors were found to be more effective in the treatment of LVH when compared to calcium channel blockers and beta blockers. ECHO was found to be the best method to diagnose LVH. In patients with stage I HTN, 47.1% had normal LVM. Around 53% of the subjects with stage I HTN and all with stage II HTN had abnormal LVM. Retinal changes were noted in 96.2% of abnormal LVM patients and 50% of normal LVM patients. A positive association between BMI and LVH (OR: 1.39) was also noted. Conclusion: BMI may positively influence LVH regression. The presence of retinopathy, in addition to LVH, suggests an increased chance of regression with anti-hypertensive treatment.

Obstetric and Perinatal Morbidity in Northern Tasmanian Aboriginal Population: A Retrospective Cohort Study

Introduction: Aboriginal and Torres Strait Islander women are at increased risk of maternal morbidity and mortality as compared to non-Aboriginals. Similarly, aboriginal babies are at increased risk of low birth weight and infant mortality. Aim: To investigate the independent association of aboriginality with Tasmanian maternal and neonatal morbidity. Materials and Methods: A retrospective analysis of all the births (gestation more than 20 weeks) from June 2013 to May 2014 was conducted at the Launceston General Hospital, Tasmania. The study compared 66 Aboriginal (4.2% of the total births) to 1477 non-aboriginal births for maternal and neonatal morbidity. Comparisons were made using logistic regression. The outcome measures were maternal and neonatal morbidity. Results: Significantly higher number of aboriginal women (49% vs 19%; OR 4.15 90%CI 2.52- 6.85) smoked and used illicit drugs (15% vs 2%; OR 9.24; 95%CI 4.28-19.96) than the non-aboriginal women (both p<0.001). Maternal morbidity was not significantly different between aboriginal compared to non-aboriginal women (OR 0.64; 95%CI 0.36-1.14; p=0.13; adjusted OR 1.00; 95%CI 0.52-1.93; p=0.99). Factors positively associated with maternal morbidity included: age (OR 1.28; 95%CI 1.13-1.46; p<0.01) and BMI (OR 1.50; 95%CI 1.33-1.70; p<0.01). The unadjusted OR of neonatal morbidity for aboriginality was 1.98 (95%CI 1.17-3.34; p=0.01) and adjusted was 1.45 (95%CI 0.77-2.72; p=0.25). Factors positively associated with neonatal morbidity included smoking (OR 2.24; 95%CI 1.59-3.14; p<0.01), illicit drug use 95%CI 1.49-(OR 3.26; 95%CI 1.49-7.13; p <0.01), hypertension (OR 2.49; 95%CI 1.61-3.84; p<0.01) and diabetes (OR 1.92; 95%CI 1.33-2.78; p<0.01). Conclusion: The composite Aboriginal maternal morbidity does not differ, however the increased rates of smoking and illicit drug use are largely responsible for neonatal morbidity. Along with strengthening strategies to decrease medical comorbidities in aboriginals, we recommend intensifying smoking and illicit drug cessation programs.

Hypovitaminosis D and Associated Cardiometabolic Risk in Women with PCOS

Sanjukta Mishra, Ashok Kumar Das, Swarnalata Das

Introduction: Women with Polycystic Ovary Syndrome (PCOS) frequently suffer from metabolic disturbances like insulin resistance, hypertension and atherogenic dyslipidemia. Accumulating evidences suggest that Vitamin D deficiency is common in PCOS and may be associated with metabolic and endocrinal dysfunctions in PCOS. Thus women with PCOS may be at elevated risk of cardiovascular disease. Aim: Present study aims to evaluate Vitamin D status and to assess its association with metabolic and endocrinal dysregulations in women with PCOS, which might help in early identification and prevention of future symptomatic cardiac disease. Materials and Methods: A total of 44 women with PCOS, diagnosed by Rotterdam criteria and 45 healthy control without PCOS, were evaluated for Vitamin D and cardiometabolic risk factors, including fasting plasma glucose, insulin resistance, dyslipidemia, hs-CRP. That apart, several endocrinal parameters of hyperandrogenism were also examined. Several correlation studies were determined to establish the role of Vitamin D as a cardiometabolic risk factor in PCOS. Results: Results were expressed as mean±SD and were statistically analysed using SPSS software version 16, unpaired student's t-test and Pearson’s correlation coefficient. We found lower levels of Vitamin D, which was statistically significant as compared to healthy controls. Hyperinsulinemia, rise in insulin resistance and marked dyslipidemia was observed in the present study. Another relevant finding was significant correlation of Vitamin D with insulin and Homeostatic Model of Assessment- Insulin Resistance Index (HOMA-IR). Conclusion: Hypovitaminosis D was prevalent in PCOS. This was related to metabolic and hormonal disorders in PCOS. Possibly this combined with impaired fasting glucose, IR and dyslipidemia, could account for Cardio vascular risks in PCOS. Further prospective observational studies and randomized control trials are required to explore the above hypothesis.

Carriage of Multidrug Resistant Bacteria on Frequently Contacted Surfaces and Hands of Health Care Workers

Introduction: Maximal contact between the patients and Health Care Workers (HCWs) happens in the Intensive Care Units (ICU). Control of nosocomial infections requires compliance with hand hygiene and contamination free surfaces. Aim: To determine the colonization of potential pathogens in the hands of HCWs and frequent contacted environmental surfaces. Materials and Methods: A cross sectional study was conducted between September 2012 and May 2013 at Sri Ramachandra Medical College and Hospital. A total of 327 samples were collected using Glove juice technique from hands and swabs from frequently contacted surfaces. A sum of 157 samples were collected by glove juice technique from the hands of HCWs which included Consultants (20), Internees (3), Residents (10), Staff nurse (102) and support staff (22). A total of 170 samples were collected through swabbing which included frequently touched surfaces of apron and dress (140 which included 10 consultants, 3 internees, 9 Residents, 101 Staff nurse and 17 support staff), 9 door handle, 4 key board, 12 tap handles and 5 monitors. The samples were inoculated into Blood agar, Chocolate agar and Mac-Conkey agar plates and incubated at 370C aerobically. The plates showing growth were further processed to identify the organisms by Gram staining and biochemical reactions. Antibiotic susceptibility testing was done for the isolates by Kirby-baur disc diffusion method as per CLSI guidelines. Results: Out of the 157 hand sampling done by glove juice method 67(42.7%) of them showed growth and 90(57.3%) showed no growth. The potential pathogens grown were 13 (8.3%), consisting of Methicillin Sensitive Staphylococcus aureus (MSSA) 6(3.8%), Methicillin Resistant Staphylococcus aureus (MRSA) 2(1.3%), Pseudomonas spp 4(2.6%) and Acenitobacter spp 1 (0.6%). The MRSA was seen in Consultant 1(5%; n=20) and Staff nurse 1(0.9%; n= 102). Among the 140 sampling from the dress of HCWs growth was observed in 69(49.3%) and growth was absent in 71(50.7%). The potential pathogens observed were 14(10%) and they are MSSA 5(3.6%), MRSA 1 (0.7%), Pseudomonas spp 2(1.4%), Acenitobacter spp 3(2.1%) Enterobacter spp 1(0.7%), Klebseilla pneumoniae 1(0.7%) and Candida spp 1(0.7%). One MRSA was isolated from staff nurse (0.9%; n=101). Similarly multi-drug resistant Klebsiella pneumoniae 1(0.9%; n=102). Out of the 30 environmental samples 16(53.3%) showed growth and in 14(56.7%) growth was absent. The potential pathogens isolated were 3(10%) which included MSSA 2(6.6%) and MRSA 1(3.4%) and were isolated from the monitor. Conclusion: Adherence to infection control practices among all categories of HCWs is must for control of HAI. Glove juice method is a simple, easy and practical technique for determination of colonization of hands of HCWs and can be adapted as a methodology for screening the hands of HCWs.

Comparison of Myofibroblasts Between Solid/Multicystic Ameloblastoma and Unicystic Ameloblastoma: An Immunohistochemical Analysis

Introduction: Microenvironment is crucial for the maintenance of cellular functions and tissue integrity suggesting that cancer-induced changes in the stroma may contribute to cancer invasion and its biological behaviour. One of the major constituent of the tumour stroma is myofibroblasts. Myofibroblasts are differentiated host fibroblasts that express a-Sma as cytoplasmic microfilaments. They are considered as one of the modified stromal component which in recent years have been thought to have a role in the invasion and aggressive behaviour of odontogenic tumours too. Aim: To detect immunohistochemically the presence of myofibroblasts in solid/multicystic ameloblastoma and in unicystic ameloblastoma and to see if a relationship exists between the frequency and pattern of distribution of myofibroblasts and the behaviour of ameloblastomas. Materials and Methods: Ten cases each of solid/multicystic ameloblastoma and unicystic ameloblastoma were stained immunohistochemically for vimentin, a-sm a and desmin. The frequency and pattern of distribution of myofibroblasts in the two study groups were analysed and then compared with clinical and radiographic features of pain and cortical perforation respectively. Results: Immunohistochemical reaction for a-SMA (alpha Smooth Muscle Actin) showed positive cells in the stroma of both solid/multicystic and unicystic ameloblastomas. The mean number of myofibroblasts was more in unicystic ameloblastoma (UA) compared to Solid/Multicystic Ameloblastoma (SMA). Myofibroblasts expression was dense and arranged in the form of fascicles with indistinct cell borders in one case of follicular ameloblastoma, two cases of plexiform ameloblastoma and in a focal area of one case of type 1UA. In all other cases where the expression was noted, the myofibroblasts were spindle in shape with distinct cell boundaries. Conclusion: The results of the study indicate that myofibroblasts alone may not play a role in the behaviour of ameloblastomas. This calls for determining the role of various other stromal components in the biological behaviour of ameloblastomas. Our study could not establish a correlation between pattern of distribution of myofibroblasts and the behaviour of ameloblastomas.

Acute Respiratory Infections among Under-Five Age Group Children at Urban Slums of Gulbarga City: A Longitudinal Study

Vinod K. Ramani, Jayashree Pattankar, Suresh Kura layanapaapalya Puttahonnappa

Introduction: Among all illness, Acute Respiratory Infections (ARI) account for 30-60% of paediatric outpatient attendance and 20-30% of hospital admissions. Aim: To study the morbidity pattern of ARI among under-five-age group children and to assess the determinants. Materials and Methods: A longitudinal cohort study was conducted for a one year period, comprising a cumulative sample of 400 children from 3 urban slums of Gulbarga city. History of nasal discharge, cough, fever, sore throat, breathing difficulty, any discharge from ear alone or in combination, was used in the recognition of an ARI episode. Respiratory rate >60/minute (<2 month infants), >50(2-11 months) and >40(1-5 years) in a child with cough, cold or fever singly or in combination was considered the criteria for recognition of pneumonia. Results: Out of the 400 surveyed, ARI was detected among 109 children giving an incidence of 27.25%. Among these, Upper Respiratory Tract Infection (URTI) was found among 19.25% and Lower Respiratory Tract Infection (LRTI) among 8%. ARI was observed among 38.04% of infants, 37.84% of 2-3-year-old children, 36.87% of boys, 40.43% of children born to illiterate father’s, 35.77% of SES class IV & 40.79% of SES class V, and 41.89% of children with family history of respiratory illness. All these data were found to be statistically significant. High rates of ARI were also observed among 41.36% of children living in households with firewood fuel usage, 35.04% of children with pets in the household, 34.82% of children with delayed milestones, 53.85% of children with grade IV and 66.67% of children with grade V malnutrition. More episodes occurred during winter months of the year (Oct – Jan). During the follow-up phase of study done on a cohort of 112 children for a period of one year, an attack rate of 3.27 episodes/child/year was observed. Conclusion: Community education programs should focus on addressing specific issues viz. identification of respiratory illness, simple case management, proper immunization practices, breast feeding of infants & nutrition of child and reduction of domestic air pollution.

Single Incision Laparoscopic Assisted Appendectomy: Experience of 82 Cases

Abhay Kumar, Anant Narayan Sinha, Desh Deepak, NK Pandey, Nandani

Introduction: Single Incision Laparoscopic Surgery (SILS) is one of the most recent developments which have been made in the field of minimal assesses surgery. It has potential advantages of less postoperative pain and better cosmesis, but at the same time, this procedure is time consuming and it increases the cost of surgery. Aim: In this study, we evaluated the feasibility, safety and potential advantages of single incision laparoscopic assisted appendectomy. Materials and Methods: Single incision laparoscopic assisted appendectomy was done in 82 patients who were diagnosed with acute or chronic appendicitis. A single 10mm incision made over right lower quadrant was used for placing two 5mm trocars and appendisectomy was done as in open surgery, after delivering out the appendix from the incision. Results: Mean operative time was 32.56 ± 15.5 minutes. Mean post-operative pain scores as per visual analogue scalewere 6.5, 4.2 and 1.2 on 12 hours day 1 and day 2 after surgery respectively. Mean length of hospital stay was 1.4 ± 1.2 days. Conclusion: Single incision laparoscopic appendectomy is safe and feasible.

Trabeculectomy with Mitomycin-C in Patients with Iridocorneal Endothelial Syndrome: A Case Series

Iridocorneal Endothelial syndrome (ICE) is a rare ocular disorder characterized by abnormal endothelization of angle structure and iris producing characteristic manifestations including secondary angle closure glaucoma. We describe the clinical course of three patients with secondary glaucoma due to ICE syndrome who underwent trabeculectomy with mitomycin-C. At last follow-up, all patients had controlled IOP (<18 mm Hg) drug. Early postoperative period was accompanied by shallowing of anterior chamber diffuse vascularisation of bleb frequent episodes of high IOP which were managed successfully. Trabeculectomy with MMC offers a good treatment choice for the management of secondary glaucoma associated with ICE syndrome.

A Study on Spectrum of Hepatobiliary Dysfunctions and Pattern of Liver Involvement in Dengue Infection

Introduction: The most common arthropod-borne viral (arboviral) disease in humans is dengue. It is transmitted by female Aedes mosquitoes. These mosquitoes are widely distributed in subtropical and tropical areas of the world. Study of dengue infection and its complications are scarce from countries like India. Aim: In this prospective observational cross-sectional study, we intended to assess the frequency and degree of hepatobiliary dysfunction in adult patients with dengue infection presenting to a tertiary-care medical facility. Materials and Methods: The details of all patients with serologically proved dengue fever admitted to a tertiary care hospital in eastern India from July 2014 to June 2015 were prospectively reviewed. We collected data including routine blood count, Liver Function Test (LFT), Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), abdominal ultrasonography from 110 patients. Results: The maximum number of cases were seen in the age group between 46 years and 61 years and of all cases 55.5% were male and 44.5% were female. Pain abdomen and vomiting were the commonest presenting complaints next to fever which was present in all the cases. Elevated liver enzymes, abnormal values of PT and APTT, thrombocytopenia were observed more commonly in Dengue Shock Syndrome (DSS). Gall bladder wall thickening, thrombocytopenia were seen more commonly in both DSS and Dengue Haemorrhagic Fever (DHF). Plasma leakage such as ascites and pleural effusion on USG were seen more frequently in patients with DHF (76.9% and 73.1%) followed by DSS (72% and 68%) and DF (33.9% and 32.2%). Conclusion: Hepatobiliary derangement is seen more commonly in severe case of dengue infection. Early recognition of these parameters can also be used as a predictor for assessing the disease severity.

A Retrospective Epidemiological Study of Rhinosporidiosis in a Rural Tertiary Care Centre in Pondicherry

P. Karthikeyan, S. Vijayasundaram, Davis Thomas Pulimoottil

Introduction: Rhinosporidiosis is an age old endemic scourge which has affected various parts of the world, most notably India and Sri Lanka. Although a large body of literature exists regarding this problem, postoperative recurrence rates continue to vary, and the effect of public health education in the eradication of this disease has not been taken into account. Aim: The aim of this study was to find out the site, presentation and postoperative recurrence rate in patients with rhinosporidiosis. Materials and Methods: This was a retrospective study involving operated cases of rhinosporidiosis in the Department of Ear,Nose and Throat of a rural tertiary care referral centre over a period of 3 years. The behavioural pattern of the disease, its epidemiology, rate of recurrence and outcomes of surgical management were analysed. Results: A statistically significant correlation could be found between male gender and rural residential status and incidence of rhinosporidiosis. Bathing in rivers and ponds were found to be strongly associated with rhinosporidiosis (p=0.005). Almost all patients were found to be of low socioeconomic status. Nasal obstruction and epistaxis were the most common presenting complaints. Conclusion: Rhinosporidiosis is strongly associated with male gender, young and middle aged adults, agricultural occupations, rural residential status, a history of bathing in ponds and rivers and a low socioeconomic status. Post-surgical recurrence of rhinosporidial masses can be avoided with careful and complete clearance of the mass and cauterization of the base. Appropriate and consistent public health education helps to reduce the incidence of rhinosporidiosis in endemic communities.

Assessment of Blood Loss in Abdominal Myomectomy by Intramyometrial Vasopressin Administration Versus Conventional Tourniquet Application

Introduction: Myomectomy is an invasive surgical procedure. It can be associated with intraoperative and postoperative complications like excessive haemorrhage. There are various methods to control haemorrhage like pharmacological and as well as mechanical methods. Aim: This study was taken to compare intraoperative blood loss following abdominal myomectomy after receiving intramyometrial vasopressin or tourniquet application and to estimate postoperative reduction in haemoglobin & haematocrit values. Materials and Methods: The study was a randomised single blinded parallel group study. Total 48 patients were included in this study according to inclusion and exclusion criteria. All patients were divided into two groups i.e. ‘T’ and ‘V’ group, 24 in each group. ‘T’ group received conventional tourniquet application and ‘V’ group received intramyometrial vasopressin administration. The analyses in this study were both sided and p<0.05 was considered significant statistically. The Software used were Statistica version 6 (Tulsa, Oklahoma: Stat Soft Inc., 2001) and Graph Pad Prism version 5 (San Diego, California: Graph Pad Software Inc., 2007). Results: The blood loss in the tourniquet group was significantly higher (p=<0.001). Postoperative haemoglobin and haematocrit were lower in tourniquet group than vasopressin group. There was significant fall in haemoglobin and haematocrit in postoperative period in both group (p=<0.001) but it was more in tourniquet group. Total five patients (three in tourniquet group and two in vasopressin group) had received one unit whole blood transfusion. Conclusion: Intramyometrial vasopressin injection during myomectomy operation more effectively decreases the blood loss, need for blood transfusion and it causes less reduction in haemoglobin and haematocrit. Thereby it seems to be an effective method without having any risk of ischemic damage to the uterus.

Knowledge and Apprehension of Dental Patients about MERS-A Questionnaire Survey

Introduction: Middle East Respiratory Syndrome (MERS) is a disease caused by beta corona virus. From April 11th to 9th June 2014, World Health Organization (WHO) reported a total of 402 laboratory confirmed cases of MERS from KSA, out of which 132 cases were reported from Riyadh alone. Aim: The aim of this study was to assess the knowledge and apprehension of patients about MERS visiting Al Farabi College of Dentistry, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional questionnaire based survey was conducted which consisted of 10 self-prepared questions. A total of 404 patients participated in this study. Results: Three hundred and forty patients had heard about MERS. Nearly a quarter of the patients (25.74%) were apprehensive about undergoing dental treatment because of MERS. A little more than half of the patients (50.99%) knew that camel was a source of Middle East Respiratory Syndrome-Corona virus. Most of the patients (80.72%) were aware of the infection control measures to be followed by dentist and 138 patients claimed they took some precaution when present inside the dental college. Conclusion: Majority of the patients had heard about MERS and was aware of the infection control measures. However, some patients were apprehensive about undergoing dental treatment because of MERS. Further steps need to be taken to educate the patient's about transmission of MERS and infection control measures in a dental hospital.

Effect of Diode Laser on Bacteria Beyond the Apex in Relation to the Size of the Apical Preparation – An In–Vitro Study

Introduction: Microorganisms causing periapical infection are usually difficult to eradicate after conventional endodontic treatment or even in retreatment resulting in poor outcomes. So the purpose of the study was to assess whether disinfection of root canal with laser had any effect on bacteria in the periapex region. Aim: The aim of the present study was to evaluate the effects of a diode laser when activated in root canals with varying apical diameters, on the bacteria present beyond the apex of the teeth. Materials and Methods: Total 30 intact single rooted teeth were taken and decoronated to standardize the root to a length of 12mm. They were divided into three groups depending on last file size used for instrumentation at apex i.e., size 30, 40 and 50 respectively. The samples were then mounted on test tubes such that roots of teeth were in contact with fresh broth of Escherichia coli (ATCC 25922) and left for incubation. Later a diode laser (Ezlase 940, Biolase) was used for disinfection of root canals of the samples. Following this the bacterial inoculums from each test tube were cultured and CFU were obtained from which the mean log values were obtained. Statistical analysis was done using Kruskal Wallis ANOVA test to compare mean CFU in three groups. Mann-Whitney U test with Bonferroni correction was used to compare inter-group differences. Results: There was statistically significant difference in mean log values of CFU in all the three study groups. Inter-group comparisons showed that, Group A had significantly lower mean CFUs than Group B and C respectively. Conclusion: The study showed that intracanal irradiation with diode laser had an effect on the bacteria present beyond the apex, and it was influenced by the size of the apical preparation i.e., smaller apical size led to a greater reduction in the bacterial count.

A Study of Compliance to Antiretroviral Therapy among Hiv Infected Patients at a Tertiary Care Hospital in North Karnataka

Introduction: Compliance to Antiretroviral Therapy (ART) is a primary determinant of treatment success of HIV-AIDS. Many studies have shown inadequate compliance to ART in the Indian population. Aim: To assess the compliance to ART among HIV infected patients, to explore the factors affecting compliance and impact of compliance on CD4 count. Materials and Methods: A cross-sectional study was conducted with 200 adult patients attending ART center, KIMS, Hubli. The patients were randomly selected and compliance to ART over preceding 3 months was assessed. Reasons for non- compliance were assessed among those with inadequate compliance. Results: Mean age of the study population was 40.07±9.99 years. The sex ratio was 1.02:1 (M:F). Majority of patients were in WHO stage 1 with treatment, with CD4 count above 500/µl. Pulmonary tuberculosis was the most common opportunistic infection. Most of the patients were on long term ART, more than 5 years {81 (40.5%)}. Most of the patients were on ZLN regimen {97 (48.5%)}. Compliance over the preceding 3 months was 94.84± 14.93% for ART and 88.97±23.75% for opportunistic infection prophylaxis. There was no significant difference in compliance in relation to age group, sex, educational status, residence, religion, habits, HIV status of spouse or child, the regimen of ART and frequency of dosing. The compliance was better among those on long term treatment, i.e., those on treatment for more than 5 years compared to those who started ART in last 1 year (p=0.06). The most common reasons given by patients for non-compliance were going away from home, busy with other work and simply forgot. Better compliance was associated with higher CD4 count. Conclusion: Compliance to ART was inadequate in the studied population, which is a major obstacle to success of ART.

Comparative Evaluation of Microleakage Between Nano-Ionomer, Giomer and Resin Modified Glass Ionomer Cement in Class V Cavities- CLSM Study

Introduction: Marginal integrity of adhesive restorative materials provides better sealing ability for enamel and dentin and plays an important role in success of restoration in Class V cavities. Restorative material with good marginal adaptation improves the longevity of restorations. Aim: Aim of this study was to evaluate microleakage in Class V cavities which were restored with Resin Modified Glass Ionomer Cement (RMGIC), Giomer and Nano-Ionomer. Materials and Methods: This in-vitro study was performed on 60 human maxillary and mandibular premolars which were extracted for orthodontic reasons. A standard wedge shaped defect was prepared on the buccal surfaces of teeth with the gingival margin placed near Cemento Enamel Junction (CEJ). Teeth were divided into three groups of 20 each and restored with RMGIC, Giomer and Nano-Ionomer and were subjected to thermocycling. Teeth were then immersed in 0.5% Rhodamine B dye for 48 hours. They were sectioned longitudinally from the middle of cavity into mesial and distal parts. The sections were observed under Confocal Laser Scanning Microscope (CLSM) to evaluate microleakage. Depth of dye penetration was measured in millimeters. Statistical Analysis: The data was analysed using the Kruskal Wallis test. Pair wise comparison was done with Mann Whitney U Test. A p-value<0.05 is taken as statistically significant. Results: Nano-Ionomer showed less microleakage which was statistically significant when compared to Giomer (p=0.0050). Statistically no significant difference was found between Nano Ionomer and RMGIC (p=0.3550). There was statistically significant difference between RMGIC and Giomer (p=0.0450). Conclusion: Nano-Ionomer and RMGIC showed significantly less leakage and better adaptation than Giomer and there was no statistically significant difference between Nano-Ionomer and RMGIC.

Seroprevalence of Cysticercus Antibodies in Japanese Encephalitis Patients in Upper Assam, India: A Hospital Based Study

Saurav Jyoti Patgiri, Himangshu Mazumdar, Lahari Saikia

Introduction: Co-infection of Japanese Encephalitis (JE) and Cysticercosis is attributed mainly to the common epidemiological features between the two diseases. Not much is known about the clinical implications of one infection over the other. Aim: The study aimed at establishing whether JE-Cysticercosis co-infection is prevalent in the Upper Assam districts and to explore additional details about such co-infections both clinically and epidemiologically. Materials and Methods: The present study was a retrospective cross-sectional hospital based study conducted between July 2013 and June 2014 and included 272 Acute Encephalitis Syndrome (AES) patients. Out of this, 137 JE positive and 135 non-JE Acute encephalitis patients were taken as cases and controls respectively. The diagnosis of JE and Cysticercosis was established by ELISA. Statistical Analysis: EpiInfo ver. 7 was used for statistical analysis. Chi-square was used and p-value < 0.05 was considered to be statistically significant. Results: The association of Cysticercosis with JE was found to be statistically significant (14.6%, p = 0.0019) in the cases with reference to the controls (3.7%). Moreover, the co-infections were found to be more common in case of adults (19.32%, p = 0.0360); with males having a greater odds (5.25, p = 0.0008) of harbouring the parasite as compared to females. Conclusion: The study proves that the association of Cysticercosis and JE holds true in this region.

Comparative Analysis of GCF Resistin Levels in Obese Subjects with and without Periodontal Disease

Introduction: Resistin is an adipocyte derived hormone that has been shown to play a substantial role in the development of insulin resistance. Resistin acts as a pro-inflammatory molecule and stimulates the synthesis and secretion of pro-inflammatory cytokines. Recent studies have reported the association of Gingival Crevicular Fluid (GCF) resistin levels with periodontal condition. Aim: The aim of this study was to assess and compare the GCF resistin levels in obese subjects with periodontal health and disease and to correlate the disease severity with GCF resistin levels. Materials and Methods: Ninety subjects of both the sexes with age between 20–45 years were selected for the study and were categorized into four groups: 25 obese or overweight subjects with generalized chronic periodontitis (Group-I), 25 obese or overweight subjects with healthy periodontium (Group-II), 25 non-obese subjects with generalized chronic periodontitis (Group-III) and 15 non obese subjects with healthy periodontium (Group-IV). The demographic variables like age, Body Mass Index (BMI), Waist Circumference (WC) were recorded and the clinical periodontal parameters such as Plaque Index (PI), Gingival Index (GI), and Clinical Attachment Level (CAL) were also assessed in all the groups. GCF was collected and assessed for resistin levels. Results: The mean GCF resistin levels in Groups I, II, III & IV were 15.14, 9.06, 12.74 and 5.41 ng/dl respectively and the difference in mean GCF resistin level was statistically significant with the p-value<0.001. The mean GCF resistin levels in Group-I was higher compared to Group II and III and the differences in mean GCF resistin levels were statistically significant. GCF resistin levels were positively correlated with BMI, WC and CAL in Group I and CAL correlated with GCF resistin in Group III and this correlation was statistically significant. Conclusion: From our study we report that obese subjects with periodontitis have more GCF resistin levels compared to non-obese subjects with healthy periodontium.

HIF-1a and GLUT-1 Expression in Atypical Endometrial Hyperplasia, Type I and II Endometrial Carcinoma: A Potential Role in Pathogenesis

Introduction: Hypoxia-Inducible Factor 1a (HIF-1a) is one of the major adaptive responses to hypoxia, regulating the activity of glucose transporter -1 (GLUT-1), responsible for glucose uptake. Aim: To evaluate the immunohistochemical expression of both HIF-1a and GLUT-1 in type I and II endometrial carcinoma and their correlation with the available clinicopathologic variables in each type. Materials and Methods: A retrospective study was conducted on archival blocks diagnosed from pathology department between April 2010 and August 2014 included 9 cases of atypical hyperplasia and 67 cases of endometrial carcinoma. Evaluation of both HIF-1a and GLUT-1 expression using standard immunohistochemical techniques performed on cut sections from selected paraffin embedded blocks. Statistical Analysis: Descriptive analysis of the variables and statistical significances were calculated by non-parametric chi-square test using the Statistical Package for the Social Sciences version 12.0 (SPSS). Results: HIF-1a was expressed in epithelial (88.9%, 52.2%, 61.2% and 50%) and stromal (33.3%, 74.6%. 71.4% and 83.3%) components of hyperplasia, total cases of EC, type I and II EC, respectively. GLUT-1 was expressed in the epithelial component of 88.9%, 98.5%, 98% and 100% of hyperplasia, total EC cases, type I and II EC, respectively. The necrosis related pattern of epithelial HIF-1a expression was in favour of type II (p=0.018) and grade III (p=0.038). HIF-1a H-score was associated with high apoptosis in both type I and total cases of EC (p=0.04). GLUT-1 H-score was negatively correlated with apoptotic count (p=0.04) and associated with high grade (p=0.003) and advanced stage in total EC (p=0.004). GLUT-1 H-score was correlated with the pattern of HIF-1a staining in all cases of EC (p= 0.04). Conclusion: The role of HIF-1a in epithelial cells may differ from that of stromal cells in EC; however they augment the expression of each other supporting the crosstalk between them. The stepwise increase in H- score of GLUT-1 in the studied cases implies its potential role in carcinogenesis of EC. HIF-1a may promote GLUT-1 expression in EC especially surrounding areas of necrosis. The differences between type I and type II EC regarding HIF-1a and GLUT-1 expression may confirm the differences in their aetiopathogenesis.

DNA Damage Analysis in Children with Non-syndromic Developmental Delay by Comet Assay

Introduction: Majority of the developmental delays in children are non-syndromic and they are believed to have an underlying DNA damage, though not well substantiated. Hence the present study was carried out to find out if there is any increased DNA damage in children with non-syndromic developmental delay by using the comet assay. Aim: The present case-control study was undertaken to assess the level of DNA damage in children with non syndromic developmental delay and compare the same with that of age and sex matched controls using submarine gel electrophoresis (Comet Assay). Materials and Methods: The blood from clinically diagnosed children with non syndromic developmental delay and controls were subjected for alkaline version of comet assay – Single cell gel electrophoresis using lymphocytes isolated from the peripheral blood. The comets were observed under a bright field microscope; photocaptured and scored using the Image J image quantification software. Comet parameters were compared between the cases and controls and statistical analysis and interpretation of results was done using the statistical software SPSS version 20. Results: The mean comet tail length in cases and control was 20.77+7.659µm and 08.97+4.398µm respectively which was statistically significant (p<0.001). Other comet parameters like total comet length and % DNA in tail also showed a statistically significant difference (p < 0.001) between cases and controls. Conclusion: The current investigation unraveled increased levels of DNA damage in children with non syndromic developmental delay when compared to the controls.

Study of Twenty One Cases of Red Cell Exchange in a Tertiary Care Hospital in Southern India

Introduction: Red Cell Exchange (RCE) is removal of a patient’s red blood cells while replacing with donor red blood cells either manually or using automated systems. RCE is beneficial in patients with Sickle Cell Disease (SCD) either during sickling crisis or prior to major surgical procedures to bring down the sickling percentage as high sickling percentage during prolonged anaesthesia may lead to vaso-occlusive crisis. It is also employed in patients infested with malaria and babesiosis where parasitic index remain high despite medical management. RCE is also tried as an adjuvant therapy in certain poisons like nitrobenzene and carbon monoxide when first line management fails. Aim: To study the effectiveness, clinical outcome, challenges and complications of RCE in various clinical scenario and to understand how this procedure can be effectively utilized in the management of patients in Indian scenario. Materials and Methods: This retro prospective study was conducted in tertiary care center in southern India which analyzed 21 RCE procedures performed on patients with different clinical conditions. Of the 21 RCE performed, 18 procedures were performed on patients with case of sickle cell disease, Two procedures were performed on patients infested with severe falciparum malaria and one procedure was performed on a patient with nitrobenzene poisoning. All procedures were performed using Spectra Optia® Apheresis System - Terumo BCT. Results: All the 18 patients who underwent the RCE for sickle cell anaemia were admitted for hemi-arthroplasty for avascular necrosis of the head of femur. The average initial HbS levels were between 73-85% and post RCE it was brought down to 22-29% and was achieved in a single sitting in all the cases. Among the two patients infested with severe falciparum malaria, RCE helped in reducing the infestation rate. In case of nitrobenzene poisoning, RCE helped in improvement of oxygen saturation and patient showed significant improvement. Conclusion: RCE is a safe and clinically effective therapeutic modality with very minimal to nil side effects. RCE is possibly underutilized therapy in developing world like India due to various reasons like inadequate awareness/ technical expertise, lack of equipments and facilities to identify the clinical conditions per se etc.

Hospital Based Prospective Observational Study to Audit the Prescription Practices and Outcomes of Paediatric Patients (6 months to 5 years age group) Presenting with Acute Diarrhea

Tapobrata De, Santosh Kondekar, Surbhi Rathi

Introduction: Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons. Aim: To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome. Materials and Methods: This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome. Results: In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery. Conclusion: In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery.

Alveolar and Skeletal Chin Dimensions Associated with Lower Facial Height Among Different Divergent Patterns

Introduction: Alveolar and skeletal chin dimensions with facial height have an impact on diagnosis and treatment planning in orthodontic patients and serves as a reference landmark for facial aesthetics. Aim: To evaluate the alveolar and skeleton chin dimensions among different divergent patterns, to evaluate the lower face height in different divergent growth patterns, to give an estimate to the oral surgeon for any adjunctive procedure. Materials and Methods: The study includes a total sample of 45 non-growing individuals (26 males and 19 females) from the archival records of the Orthodontic Department with age ranging between 18-25 years, classified into different divergent patterns based on the mandibular plane angle. The sample was divided into three groups, of which 15 patients in each group were evaluated: Group-1: Normodivergent, Group-2: Hypodivergent and Group-3: Hyperdivergent patterns respectively. Standardized digital lateral cephalograms and antero-posterior cephalograms of these patients were obtained in Natural Head Position (NHP). Results: The results of the retrospective cephalometeric study were statistically analyzed by using ANOVA and Tukey’s multiple post hoc test which showed that hard tissue chin measurement were greater in hypodivergent group (13.7mm) and the increased lower facial height showed statistically significant difference in high mandibular plane angle group (59.6mm). In antero-posterior cephalograms the transverse width showed statistically significant difference in normodivergent group (32.60mm). Conclusion: The anterio-posterior width of the symphysis was higher in hypodivergent growth pattern, whereas vertical height of the symphysis was greater in hyperdivergent group. The lower facial height among three groups showed statistically significant difference among hyperdivergent group. In comparison of all the three groups in Anterio-Posterior (AP) cephalograms, statistically significant difference was noted in normodivergent group when compared with the other two groups.

Effect of Atorvastatin on the Disease Activity and Severity of Rheumatoid Arthritis: Double-Blind Randomized Controlled Trial

Introduction: HMG-CoA (3-hydroxy-3- methylglutary lcoenzyme A) reductase inhibitors (statins) have anti-inflammatory properties which may be particularly useful in rheumatoid arthritis to suppress disease activity and inflammatory factors. Aim: The purpose of this clinical trial was to determine anti-inflammatory properties of statins in rheumatoid arthritis. Materials and Methods: Eighty Iranian patients with rheumatoid arthritis, aged between 19 to 75 years were recruited to take part in this randomized, double-blind placebo-controlled trial. Subjects were randomly allocated to two groups to take atorvastatin or placebo 40 mg daily as an adjunct to current disease-modifying anti-rheumatic drugs (DMARDs) treatment. Disease Activity Score-28 (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), swollen joint count (SJC) & tender joint count (TJC) were assessed before and after three months intervention. Results: Analysis was based on intention to treat. DAS28 significantly declined in the atorvastatin group in comparison with placebo (p< 0.001). SJC, TJC, CRP and ESR also were significantly dropped in the atorvastatin group in comparison with placebo. Conclusion: It can be concluded that atorvastatin can suppress RA activity and inflmmatory factors in RA patients for high to moderate grade of inflmmation.

The Mouthwash War - Chlorhexidine vs. Herbal Mouth Rinses: A Meta-Analysis

Sunayana Manipal, Sajjid hussain, Umesh Wadgave, Prabu Duraiswamy, K. Ravi

Introduction: Mouthwashes are often prescribed in dentistry for prevention and treatment of several oral conditions. In the recent times the use of naturally occurring products what is otherwise known as grandmothers remedy are used on a large scale. This has now called for a newer age of mouth washes but is the new age mouth washes at par with the gold standard or even better than them this study investigates. Aim: The aim of the present study was to compare the effect of two broad categories of mouth washes namely chlorhexidine and herbal mouth washes. Materials and Methods: Eleven randomized control studies were pooled in for the meta-analysis. The search was done from the Pub Med Central listed studies with the use keywords with Boolean operators (chlorhexidine, herbal, mouth wash, randomized control trials). The fixed effects model was used for analysis. Results: This meta-analysis brings to light, the fact that a wide range of newer herbal products are now available. As with a plethora of herbal mouthwashes available it is the need of the hour to validate their potential use and recommendation. This study found that only two studies favor the use of herbal products and four studies favor the use of chlorhexidine, of the 11 studies that were analyzed. Conclusion: More studies are required under well controlled circumstances to prove that herbal products can equate or replace the ‘gold standard’ chlorhexidine. Herbal products are heterogeneous in nature, their use should be advised only with more scientific proof.

Epidemiological Data and Survival Rate of Removable Partial Dentures

Introduction: The use of removable partial denture (RPD) is considered as low-cost and common treatment option to rehabilitate edentulous areas. Aim: This study aimed to investigate the epidemiological data of patients rehabilitated with removable partial denture (RPD) in order to assess treatment survival rate and failures. Materials and Methods: Epidemiological data and medical records of patients treated with RPD between 2007 and 2012 at the RPD discipline of a Brazilian University (Aracatuba Dental School- UNESP) were evaluated as well as dental records of patients who underwent RPD treatments (fabrication or repairs) between 2000 and 2010. Factors such as gender, age, presence of systemic disease, main complaint, edentulous arch, period and cause of denture replacement and the prosthesis characteristics were recorded. The chi-square test was used to assess the differences between the variables and the Kaplan Meyer to assess the survival of the RPDs evaluated. Results: A total of 324 maxillary RPD and 432 mandibular RPD were fabricated. Most of the patients were women aging 41 to 60-year-old. The number of mandibular RPD Kennedy class I (26%) was statistically higher for the maxillary arch (p<.05). There was no association between main complaint to gender or the presence of systemic disease. The lingual plate was the most common major connector used in the mandible (32%). The main reason for altering the design of replaced RPDs were changes during treatment plan. Conclusion: The number of patients who require RPD is large; most of RPDs are Kennedy Class I. A good treatment plan is very important for achieving a positive treatment outcome, and it is strictly related to the survival rate.

Comparative Evaluation of Shear Bond Strength and Fluoride Release of Conventional Glass Ionomer with 1% Ethanolic Extract of Propolis Incorporated Glass Ionomer Cement –Invitro Study

Attiguppe Ramashetty Prabhakar, Deepti V. Balehosur, Nadig.Basappa

Introduction: Atraumatic restorative treatment is a minimal intervention approach which involves manual removal of caries followed by restoration using adhesive restorative material. Due to incomplete manual caries excavation, there is a high chance of secondary caries under the restoration. Hence, many antibacterial agents have been incorporated in cement to enhance their antibacterial effect. Propolis is one of the natural medicines that has highlighted application in dentistry. Aim: The current study evaluated the shear bond strength and fluoride release of Glass Ionomer Cement (GIC) combined with 1% Ethanolic Extract of Propolis (EEP). The research hypothesis was that the incorporation of 1% EEP in GIC has an effect on shear bond strength and fluoride release. Materials and Methods: A study was conducted among two groups. Group A conventional GIC (control), Group B GIC incorporated with 1% EEP (experimental). Shear bond strength: Thirty samples were prepared. Dentinal surface was restored and bond strength was assessed using a universal testing machine. Fluoride release: Thirty samples were prepared and stored in distilled water at a constant temperature until the time of measurement. The fluoride release was assessed by ion selective electrode after 1st day and 7th day. Data obtained by shear bond strength analysis was subjected to statistical analysis using an unpaired t-test and the data obtained by the fluoride release analysis was subjected to an unpaired t-test and paired t-test. Results: Result showed that there was no statistically significant difference in shear bond strength between the groups (p-value 0.77). A statistically significant difference was noticed in fluoride release among the groups after 1st and 7th day (p-0.001). However, the release was lesser in both the groups after the 1st day. Conclusion: A 1% EEP incorporated GIC enhanced the fluoride release without causing a significant effect on shear bond strength of GIC.

Dental Awareness among Parents and Oral Health of Paediatric Cancer Patients Receiving Chemotherapy

Aarushi Gupta, Mohita Marwaha, Kalpana Bansal, Anupam Sachdeva, Ajay Gupta

Introduction: Dental care is often overlooked by the parents of children receiving treatment for cancer including chemotherapy who are in a phase of severe immunosuppression. Aim: (i) To study dental attitudes of parents of children receiving chemotherapy towards importance of dental care. (ii) To evaluate oral hygiene status and compare it with healthy controls. Materials and Methods: A questionnaire assessing the awareness towards dental care was given to the parents of 47 paediatric patients suffering from cancer receiving chemotherapy and to parents of 47 paediatric patients reporting to outpatient Department of Pedodontics at SGT Dental College. Oral examination was also carried out for both the groups and DMFT/dmft, plaque and gingival index were noted. Results: Parents had a varying opinion regarding dental health of their child. The caries status of children in the control group was greater than children in the study group. The mean plaque index of children in the control group (1.40) was greater than children in the study group (1.34) which was statistically significant according to Mann-Whitney U test. The gingival health of children in the study group was better than children in the control group which was also not statistically significant. Conclusion: This study highlights need for a periodic referral of the child cancer patients to the paediatric dental clinic in hospitals for the timely dental care.

Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques

Introduction: Inadequate vestibular depth results in poor plaque control owing to an insufficient width of keratinized gingiva. Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers. Aim: To evaluate the patient perceptions related to pain and discomfort on the 1st, 3rd and the 7th day post vestibuloplasty and also assess the healing outcomes related to the treatment of inadequate vestibular depth either with the diode laser or the scalpel. Materials and Methods: Twenty patients who had inadequate vestibular depth and required vestibuloplasty were assigned randomly to undergo the procedure either with the scalpel or the laser. The data obtained was analysed for intergroup comparison with an independent paired t-test and intragroup comparison was determined by a paired t-test. Results: Intragroup comparison within the laser group for VAS scores of pain and discomfort within all the reported days exhibited a significant difference (p<0.05). Inter group comparison revealed that the patients in the laser group had lower VAS cores for pain and discomfort compared to the scalpel group (p<0.05). Analysis of the three pointer scale for healing revealed that the patients in the laser group exhibited better healing outcomes on the 1st, 3rd and the 7th day compared to the scalpel group. Conclusion: Observations from the study highlight the opinion that laser can be a safe and effective alternative to traditional vestibuloplasty performed with the scalpel.

Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley- A Hospital Based Study

Introduction: Rickettsial infections are being increasingly recognized as a cause of acute febrile illnesses and should be considered a distinct possibility in patients presenting with suggestive clinical features. Their diagnosis remains a challenge in a country like ours where tests like immunofluorescence assay cannot be routinely done. Results of serological tests, when correlated with patients clinical profile can aid in the timely diagnosis of scrub typhus. Aim: To find out the extent to which scrub typhus contributes to Pyrexia of Unknown Origin (PUO) in patients admitted to or attending the OPD of our hospital using simple tests like Weil-Felix Agglutination Test (WFT) and Enzyme Linked Immunosorbent Assay (ELISA). Materials and Methods: A cross-sectional study was carried out in the Department of Microbiology, Government Medical College and Hospital, Srinagar, over a period of eight months (1st March to 31st October 2015). Serum samples from patients suffering from Pyrexia of Unknown Origin (PUO) were processed for the detection of Scrub typhus. A total of 162 samples were included in the study. These were subjected to WFT using OX-K strain. The serum samples were diluted 1/20 to 1/640 and a titre of = 1:160 was considered as positive. The samples were also tested for IgM and IgG antibodies for scrub typhus by ELISA and tube agglutination test was done to detect typhoid fever and brucellosis. Results: Of the 162 serum samples tested 22.8% tested positive scrub typhus by WFT. IgM ELISA and IgG was positive in 8 (4.9%) and 15 (9.3%) samples respectively. Sensitivity, specificity, positive and negative predictive values of WFT; taking IgM ELISA as a reference standard were 75%, 79.9%, 16.2% and 98.4% respectively. Conclusion: Scrub typhus is prevalent in our state and the results of WFT supplemented by those of ELISA can aid in its diagnosis. However the results of these tests should always be regarded in light of the clinical condition of the patient.

Assessment of Treatment of Community Acquired Severe Pneumonia by Two Different Antibiotics

Karimeldin MA Salih, Jalal Ali Bilal, Widad Eldouch, Ali Abdin

Introduction: Pneumonia is common presentation in the emergency room and is still a cause of morbidity and mortality. The rationale of this study was to test the trend of paediatricians to achieve rapid response facing severe pneumonia, the lack of agreed on plan for the management of community acquired pneumonia (CAP) and the few experiences regarding injectable form of ß-lactam antimicrobial. Materials and Methods: This is a prospective case control study, purposive randomized sampling, three patients were excluded since their information was incomplete, 132 patients were randomly divided into groups, one group named control group (penicillin according to the guidelines of WHO 2013), 33 patients; second group treated by ß-lactam inhibitors (Augmentin IV) 50 patients; and third group treated by 3rd generation cephalosporin (ceftriaxone) 49 patients. The study was conducted at the main tertiary care and paediatrics teaching hospital in Khartoum capital of Sudan. The study was completed within the duration from 2010 to 2011. Results: Both group showed more or less similar results regarding response, as well as the failure rate however, the Augmentin and ceftriaxone groups showed a little bit better survival than the control group. Conclusion: Antibiotics decrease the mortality rate among the pneumonia patients provided that it is given early in the disease.

Comparison of Taste Threshold in Smokers and Non-Smokers Using Electrogustometry and Fungiform Papillae Count: A Case Control Study

Introduction: Smoking in long term is not only responsible for cancerous changes but is also one of the reasons of altered taste sensation in smokers. These taste changes are hypothesized to be due to reduction in density of fungiform papillae on the dorsum of the tongue. Aim: The aim of this study was to assess the relationship between fungiform papillae count, blood Red Cell Distribution Width (RDW) and electrogustometric thresholds in smokers and non-smokers. Materials and Methods: Fungiform papillae count was assessed using digital photography and imaging software while electrogustometric thresholds were assessed using modified Transcutaneous Electric Nerve Stimulation (TENS) machine in 30 smokers and 30 non-smokers. The subjects also underwent RDW evaluation. The data collected was analyzed using Pearson’s correlation coefficient. Results: Fungiform papillae counts in smokers were less than those of non-smokers and an inverse relationship was detected between smoking and fungiform papillae count. Electrogustometric thresholds were more in smokers than non-smokers and showed direct relationship with smoking. RDW was significantly more in smokers compared to non-smokers. An inverse relationship was observed between fungiform papillae count and RDW. Conclusion: Our results suggest that smokers have a high taste threshold because of decrease in the number of fungiform papillae on the tongue and RDW values do show an inverse relationship with fungiform papillae density which depicts subclinical nutritional deficiency bringing atrophic changes in tongue.

Global DNA Methylation Level among Ciprofloxacin-Resistant Clinical Isolates of Escherichia coli

Thiyagarajan Yugendran, Belgode Narasimha Harish

Introduction: Fluoroquinolone resistant clinical isolates belonging to the family Enterobacteriaceae, is a major public health concern in India. Data analysis in JIPMER hospital revealed 10% rise in fluoroquinolone resistance within a span of three years suggestive of the possible involvement of mechanism/s other than QRDR capable of imparting fluoroquinolone resistance. DNA methylation regulates gene expression. Moreover, methylated cytosine is a mutational hotspot. Thus, DNA methylation can alter bacterial gene expression profile as well as facilitate the bacteria in accumulating mutations possibly leading to increased antimicrobial resistance. Therefore, the present study was carried out to identify the potential involvement of DNA methylation in ciprofloxacin resistance. Aim: To elucidate and compare the methylation level of genomic and plasmid DNA among clinical isolates of E. coli sensitive and resistant to ciprofloxacin. Materials and Methods: The study included 40 clinical E. coli isolates of which, 30 were ciprofloxacin-resistant and 10 were sensitive to ciprofloxacin. Genomic DNA (gDNA) and plasmid DNA were extracted and quantified. Methylation levels were elucidated using 5-mC DNA ELISA kit (Zymoresearch, California, USA) as per kit protocol and guidelines. Statistical Analysis: Spearman correlation 2-tailed test was used. A p-value <0.05 was considered significant. Results: The MIC values of sensitive and resistant strains against ciprofloxacin ranged from 0.125 µg/mL – 0.75 µg/mL and 8 µg/mL - >256 µg/mL respectively. No difference was found in plasmid DNA methylation level but, the gDNA methylation level of the resistant strains significantly differed from that of the sensitive strains. Based on Spearman correlation test gDNA methylation level of bacteria was found to be inversely proportional to its MIC against ciprofloxacin with p= -0.956 (p-value < 0.0001). Conclusion: The influence of DNA methylation over plasmid-mediated quinolone resistance needs to be further confirmed by bisulphite DNA sequencing of the plasmid-borne genes. Extensive usage of ciprofloxacin has led to rise in ciprofloxacin resistance possibly induced by DNA methylation. Thus rational usage of ciprofloxacin in a clinical setting is essential to combat the further development of ciprofloxacin resistance. Hypomethylated genes and adenine methylation needs to be identified to fill up gaps in knowledge concerning the involvement of DNA methylation in fluoroquinolone resistance exhibited by E. coli.

Arterial Compliance and Autonomic Functions in Adult Male Smokers

Sukhmani Saini, Yogesh Saxena, Rani Gupta

Introduction: Smoking is known to augment sympathetic activity and may lead to increased arterial stiffness. Several studies have reported association of increased sympathetic activity and arterial stiffness to cardiovascular risks among smokers. Pulse Wave Velocity (PWV) of peripheral arteries, instead of aorta can be used as a non-invasive indicator of arterial stiffness. Aim: To measure non-invasively, the autonomic functions and peripheral arterial stiffness in smokers, and to find out whether the aforementioned factors are modified by the level of physical activity in these smokers. Materials and Methods: This cross-sectional analytical study was conducted in the Department of Physiology, HIMS, Dehradun, over a period of 12 months (2013-2014) on 100 adult males (20-40 years); 50 smokers and 50 non-smokers. The parameters analysed include relevant anthropometric and cardiovascular parameters, Pulse Wave Velocity (PWV), sustained Hand Grip Test (HGT) and Heart Rate Variability (HRV) domains. Data interpretation and analysis was carried out using SPSS 17.0. Comparison of the above mentioned parameters amongst groups was done with unpaired t-test. The relationship of pack-years & physical activity with vascular functions was assessed by Pearson’s correlation. Interaction of various grades of smoking and physical activity with Cardiovascular System (CVS) parameters was assessed by one-way ANOVA. Results: Smokers had higher values of PWV (5.7±0.5m/s) as compared to non-smokers (4.8±0.4m/s) (p<0.001). ?DBP during HGT was lower (7±3.18mmHg) among smokers as compared to non-smokers (19.4±3.5mmHg) (p<0.001). Smoking (pack-years) was positively related to PWV (r= .03) but showed a weak negative relationship with change in Diastolic Blood Pressure (?DBP) (r= -0.084, p=0.56) showing that, more the frequency of smoking, the more was arterial stiffening and the lesser was the sympathetic response to the HGT. The smokers had significantly higher sympathetic activity; Low Frequency (LF) & Low Frequency: High Frequency ratio (LF: HF) (p<.001) whereas High Frequency (HF) was significantly lower (p<.001) showing a decline in parasympathetic activity. Conclusion: Smokers demonstrated higher peripheral PWV and higher intrinsic sympathetic activity and this increase in intrinsic sympathetic activity may lead to increased arterial stiffness. Interaction of autonomic function and PWV with levels of physical activity and grades of smoking showed no significant differences, suggesting the fact that increased physical activity or reduced smoking may not have any effect on the endothelial dysfunction or CVS morbidity caused by smoking.

Histopathological and Radiographic Analysis of Dental Follicle of Impacted Teeth Using Modified Gallego’s Stain

Introduction: In the WHO classification of odontogenic tumours, hard tissue formation has been considered as a sub-classification however, this parameter has not been much explored in dental follicle in literature. Epithelial-mesenchymal interactions play an important role in odontogenesis and its associated pathologies; therefore research on dental follicle should also include mesenchymal components along with epithelial components. Additionally, special stains to identify the nature of such depositions in dental follicle have been less explored. Modified Gallego’s stain is such an example which has not been tried in odontogenic lesions which makes this study unique. Aim: Aim of this study was to study histopathological variations in dental follicle, the nature of calcification and depositions using Modified Gallego’s stain and to correlate histological features of dental follicle with pericoronal width radiographically. Materials and Methods: A prospective histological study of the dental follicles of 50 impacted teeth was carried out to microscopically evaluate the dental follicular tissues for pathological changes, and to correlate it with pericoronal radiolucency. Impacted teeth with pericoronal radiographic width less than 3mm were included in the study and symptomatic teeth were excluded. Further Modified Gallego stain was used to differentiate the nature of hard tissue formation in dental follicle tissues. Results: Dental follicle histologically showed pathological changes resembling dentigerous cyst, ameloblastoma, odontogenic fibroma (Simple and WHO Type), clear cell odontogenic tumour, neurofibroma, neurilemmoma and mucoepidermoid carcinoma. Conclusion: The dental follicle surrounding an impacted tooth has the potential to differentiate into a wide variety of tissue types, and thus shows the potential for cyst and tumour development which was observed in this study in most of the specimens with normal follicular width radiographically.

Influence of Custom Trays, Dual-Arch Passive, Flexed Trays and Viscosities of Elastomeric Impression Materials on Working Dies

Mansi Arora, Shivani Kohli, Rupali Kalsi

Introduction: Dual arch impression technique signifies an essential improvement in fixed prosthodontics and has numerous benefits over conventional impression techniques. The accuracy of working dies fabricated from dual arch impression technique remains in question because there is little information available in the literature. Aim: This study was conducted to compare the accuracy of working dies fabricated from impressions made from two different viscosities of impression materials using metal, plastic dual arch trays and custom made acrylic trays. Materials and Methods: The study samples were grouped into two groups based on the viscosity of impression material used i.e. Group I (monophase), whereas Group II consisted of Dual Mix technique using a combination of light and heavy body material. These were further divided into three subgroups A, B and C depending on the type of impression tray used (metal dual arch tray, plastic dual arch tray and custom made tray). Measurements of the master cast were made using profile projector. Descriptive statistics like mean, Standard Deviation (SD) were calculated for all the groups. One way analysis of variance (ANOVA) was used for multiple group comparisons. A p-value of 0.05 or less was considered statistically significant. Results: The gypsum dies obtained with the three types of impression trays using two groups of impression materials were smaller than the master models in dimensions. Conclusion: The plastic dual arch trays produced dies which were the least accurate of the three groups. There was no significant difference in the die dimensions obtained using the two viscosities of impression materials.

To Analyse the Erosive Potential of Commercially Available Drinks on Dental Enamel and Various Tooth Coloured Restorative Materials – An In–vitro Study

Introduction: With the enormous change in life style pattern of a common man through the past few decades, there has been proportional variation in the amount and frequency of consumption of drinks. An increased consumption of these drinks will concurrently increase enamel surface roughness by demineralization, resulting in hypersensitivity and elevated caries risk. Aim: The present study was designed to evaluate the erosive potential of commercially available drinks on tooth enamel and various tooth coloured restorative materials. Materials and Methods: Extracted human teeth were taken and divided into four groups i.e. tooth enamel, glass ionomer cement, composite and compomer. Four commercially available drinks were chosen these were Coca -Cola, Nimbooz, Frooti and Yakult. The pH of each drink was measured. Each group was immersed in various experimental drinks for a period of 14 days. The erosive potential of each drink was measured by calculating the change in average surface roughness of these groups after the immersion protocol in various drinks. The data analysis was done by One Way Anova, Post-Hoc Bonferroni, and paired t –test. Results: Group II-GIC showed highest values for mean of change in average surface roughness and the values were statistically significant (p<0.001) with tooth enamel, composite and compomer (p=0.002). Coca-cola showed the highest erosive potential and Yakult showed the lowest, there was no statistical significant difference between the results shown by Yakult and Frooti. Conclusion: Characteristics which may promote erosion of enamel and tooth coloured restorative materials were surface texture of the material and pH of the drinks.

Between the Cup and the Lip: Missed Dental Appointments

Sandeep Tandon, Reena Duhan, Meenakshi Sharma, Suraj Vasudeva

Introduction: Missed appointments are an issue which have been very commonly noticed but overlooked in Indian dental society. Almost every dentist, general or specialized, private or public, has faced this problem in routine practice but very less research has been conducted on this issue in Asian countries. Aim: The aim of this study was to determine the frequency and distribution of missed dental appointments among children and the reasons behind the non-attendance in department of paediatric and preventive dentistry. Materials and Methods: Patients under 15 years of age who reported during the period March through August 2014 were included in this study. Attendance data and demographical data for patients was obtained from patient records and the hospital database. The type of treatment patients were to receive was gathered from the appointment diaries of staff, postgraduate students and undergraduates. A structured questionnaire regarding the most frequent reasons given by patients for not attending the scheduled appointment was also prepared. The data were analysed using descriptive analysis. Results: Of the total 2294 patients 886 patients failed to come on their scheduled appointment. Percentage of patients who missed their appointments was 38.6%. A 38.2% of them required primary teeth pulp therapy. No significant differences was found between genders regarding the prevalence of missed dental appointments. Only 40% dentist witnessed that the most common reason for their patients to miss dental appointment was "no leave from school". Illness was the second frequent excuse heard by dentists (5/20= 25%) from their patients and attendants. Conclusion: Missed dental appointment was found to be a common issue in paediatric age group. Counseling and motivation is required to be done at first dental visit to reduce the chances of missed appointment.

Evaluation of Platelet and Red Blood Cell Parameters with Proposal of Modified Score as Discriminating Guide for Iron Deficiency Anemia and b-Thalassemia Minor

Harish Chandra, Vikas Shrivastava, Smita Chandra, Anil Rawat, Ruchira Nautiyal

Introduction: Iron Deficiency Anaemia (IDA) and ß-Thalassaemia Minor (BTM) are considered to be important cause of microcytic hypochromic anaemia. Studies have evaluated various red cell parameters which are easily available on electronic cell counters for discrimination of IDA and BTM in different ethnic populations. The analysis of previously established red cell discriminative indices with new cut-off have also been done by studies which may be relevant in their set of population for differentiation. Aim: The study was conducted to propose a modified score considering the established red blood cell indices with a new cut off and to formulate index taking into consideration Red Blood Cell (RBC) and platelet parameters for early differentiation of IDA and BTM. Materials and Methods: The prospective study included cases with MCV< 80 fl and new modified score of 11 was proposed by statistically analysing the previous discriminative indices with new cut-off by giving score 0 for IDA and score 1 for BTM. The summation of all scores gave modified 11 T score. A new cut off for differentiation of IDA and BTM was proposed in the study by using ROC curve and analysing AUC which statistically corresponded to highest accuracy. An attempt to formulate a new index using the RBC and platelet parameters was also made for initial discrimination. Results: The study included 153 cases and in addition to red blood cell parameters, mean platelet volume and platelet distribution width also showed statistical significant difference between IDA and BTM (p<0.05). Modified new 11 T score was 87.6% specific for BTM while proposed index showed 80.4% negative predictive value for BTM and correctly identified 75% of cases. Conclusion: The proposed new index and modified 11T score may be used for initial discrimination of BTM and IDA especially in resource limited regions. Apart from RBC parameters, mean platelet volume and platelet distribution width may also be useful in early differentiation. It is essential to determine cut off of every index in given population for differentiation of these two conditions.

Effectiveness of Peer Group and Conventional Method (Dentist) of Oral Health Education Programme Among 12-15 year Old School Children - A Randomized Controlled Trial

Swathi Vangipuram, Abhishek Jha, Rekha Raju, Mamtha Bashyam

Introduction: Oral Health Education (OHE) in schools is routinely delivered by the dentist. Another approach which can be cost-effective, easily accessible and equally effective is the trained group of peer students. Aim: The objective of the present study was to assess and compare the effectiveness of peer–led and conventional method (dentist-led), OHE on oral health status, oral health knowledge, attitude and practices among 12-15 year old government school children in Bengaluru South Zone-I at baseline, 3 months and 6 months. Materials and Methods: The study population comprised of 450 subjects, 150 each in peer, dentist and control group. At baseline, a pre-tested 14 item questionnaire was used to assess the existing oral health knowledge, attitude and oral hygiene practices of the subjects. Clinical examination included recording of plaque index and gingival index, by a pre-calibrated examiner. OHE was provided by the peer group and dentist (using power-point presentation, chalk and talk presentation, using charts, posters, booklets and tooth brushing demonstration models). Data was analyzed using Kruskal Wallis and Chi-square test. Results: Both the peer-led and dentist-led OHE intervention were effective in improving oral health knowledge, attitude, oral hygiene practices and oral health status at three and six months when compared to control group. The adolescents in the peer-led group, however, exhibited statistically better oral health behavior than their counterparts in the dentist-led group and control group. Conclusion: The two educator-led strategies (peer group and dentist) had a modest effect on the outcome variables included in the study, the results provide some evidence to show that the peer-led strategy may provide a feasible and almost equally effective alternative to the traditional dentist led strategy of oral health education.

The Comparative Efficacy of Different Files in The Removal of Different Sealers in Simulated Root Canal Retreatment- An In-vitro Study

Aruna Kanaparthy, Rosaiah Kanaparthy

Introduction: Root canal treatment enjoys a high success rate all over the world and has saved billions of teeth from extraction. However, there are instances of failure, the main causes being insufficient cleaning and inadequate obturation. In such cases the most conservative treatment option would be non-surgical retreatment. It requires regaining access to the entire root canal system through removal of the original root canal filling thus permitting further cleaning and re- obturation. Removal of gutta-percha and sealer becomes a critical step to gain access to the root canal system, remove necrotic tissue debris, bacteria and infected dentin. Aim: To compare and evaluate the efficacy of manual hand Hedstrom files and two rotary retreatment file systems ProTaper Universal retreatment files and MtwoR (retreatment) files in the removal of root canal filling material during root canal retreatment and the influence of the type of sealers zinc oxide eugenol and AH plus on the presence of remaining debris in the reinstrumented canals in the apical, middle and coronal third. Materials and Methods: Sixty single rooted human premolar teeth were divided into 3 Groups of 20 teeth each Group I (20 Teeth): prepared using hand K Files, Group II (20 Teeth): prepared using ProTaper rotary system and Group III (20 Teeth): prepared using Mtwo rotary system. In groups- IA, IIA, IIIA: (10 teeth each) Obturation was done using Zinc Oxide Eugenol sealer and gutta percha. In groups- IB, IIB, IIIB: (10 teeth each) obturation was done with AH Plus sealer and gutta percha. All the teeth were subjected to retreatment. Groups IA and IB with Hedstrom files, Groups IIA and IIB with ProTaper retreatment files and for Groups IIIA and IIIB with Mtwo retreatment Files. The roots were longitudinally split and were observed under a stereomicroscope for remaining amount of filling material on the canal walls. Statistical analysis was done using One–way Anova (Analysis of variance) test and Tukey HSD Test. Results: MtwoR files showed statistically significant difference in the removal of filling material in the apical third and ProTaper R in the coronal and apical thirds. Better cleaning efficacy was seen in canals obturated with zinc oxide eugenol sealer. MtwoR files showed better removal of filling material than ProTaper R followed by Hedstrom files, even though there was no statistically significant difference. Conclusion: None of the instrument group showed complete removal of the filling material. It was easier to remove zinc oxide eugenol sealer than AH plus sealer.

Challenges in using Symptoms Based Screening Tools while Assessing Neuropathic Pain Component in Patients with Chronic Low Back Pain

Kapil Gudala, Babita Ghai, Dipika Bansal

The Prevalence and Affecting Factors on Self-Medication Among Students of Kermanshah University of Medical Science in 2014

Introduction: Self-medication is an increasingly growing health problem, which has many adverse effects on human and the cost used in the production of medications. Aim: The current study was conducted to estimate the prevalence of self-medication among student of Kermanshah University of Medical Sciences in 2014. Materials and Methods: In a descriptive-cross-sectional study, 364 students of Kermanshah University of Medical Sciences were recruited through stratified random sampling method. Data collection was done by researcher-made questionnaire, entered to SPSS22 software and analysed by descriptive and inferential statistics. Results: Of the 364 students, prevalence of self-medication was 123 (33.7%) the mean age was 21.63±1.92, among them 64.2% took the medication from the pharmacy and 34.95% have faced complications of self-medication. The main cause of self-medication among students were the history of a disease of taking medication (44.71%), deemed no importance of the disease (34.95%), and easy accessibility of the medication (20.32%). Conclusion: With regard to the high prevalence of self-medication among the students, it is suggested to provide educational programs on the adverse effects of self-medication, and appropriate measures to control and prevent easy access to the medications.

Normal Proximal Coronary Artery Diameters in Adults from India as Assessed by Computed Tomography Angiography

Manjappa Mahadevappa, Madhav Hegde, Ravi Math

Introduction: The normative data of coronary artery size among Indians are sparse. It is often essential to know the coronary dimensions especially during interventions such as stenting to choose the appropriate size of the stent and to decide the very need for stenting. In current practice it is the luminal angiography which is most widely employed to assess the coronary artery size. However, luminal angiography is not very accurate in estimating the epicardial coronary artery size as it does not take into account the mural thickness of the arterial wall. Hence it is prudent to assess coronary artery size by other methods such as Computed Tomography (CT) coronary angiography, quantitative coronary angiogram, Magnetic Resonanace (MR) angiogram, etc. In this study we chose computed tomography as it demonstrates mural thickness along with lumen of the vessels and hence measures the diameter more accurately. Aim: To establish normative data for diameters of the proximal coronary artery segments during life by using MDCT in a cohort of individuals without any structural heart disease. Materials and Methods: Between October 2012 and April 2013, 168 consecutive patients who did not have any structural heart disease underwent CT coronary angiography for evaluation of Coronary Artery Disease (CAD) with atypical symptoms with low pretest probability. Patients who were found to have no coronary artery disease on CT-CAG were recruited in this study. The baseline clinical status and demographic data were obtained from the hospital records. Results: In our study we found that the mean indexed diameter to BSA among females for LMCA 2.32±0.12mm, LAD 1.95±0.15mm, LCX 1.73±0.20mm and RCA 1.84±0.22mm. For males the values were LMCA 2.33±0.13mm, LAD 1.94±0.16mm, LCX 1.74±0.21mm, and RCA 1.79±0.20mm. These values are comparable to other studies. Conclusion: We attempted to establish normative data for normal proximal coronary artery dimensions among South Indian population. Coronary artery dimensions in Indians (in-dexed to BSA) for proximal major epicardial coronary arteries are similar to that reported in the West.

Intra-Operative Fluid Management in Adult Neurosurgical Patients Undergoing Intracranial Tumour Surgery: Randomised Control Trial Comparing Pulse Pressure Variance (PPV) and Central Venous Pressure (CVP)

Shalini Cynthia Sundaram, Serina Ruth Salins, Amar Nandha kumar, Grace Korula

Introduction: Fluid management in neurosurgery presents specific challenges to the anaesthesiologist. Dynamic para-meters like Pulse Pressure Variation (PPV) have been used successfully to guide fluid management. Aim: To compare PPV against Central Venous Pressure (CVP) in neurosurgical patients to assess hemodynamic stability and perfusion status. Materials and Methods: This was a single centre prospective randomised control trial at a tertiary care centre. A total of 60 patients undergoing intracranial tumour excision in supine and lateral positions were randomised to two groups (Group 1, CVP n=30), (Group 2, PPV n=30). Intra-operative fluid management was titrated to maintain baseline CVP in Group 1(5-10cm of water) and in Group 2 fluids were given to maintain PPV less than 13%. Acid base status, vital signs and blood loss were monitored. Results: Although intra-operative hypotension and acid base changes were comparable between the groups, the patients in the CVP group had more episodes of hypotension requiring fluid boluses in the first 24 hours post surgery. {CVP group median (25, 75) 2400ml (1850, 3110) versus PPV group 2100ml (1350, 2200) p=0.03} The patients in the PPV group received more fluids than the CVP group which was clinically significant. {2250 ml (1500, 3000) versus 1500ml (1200, 2000) median (25, 75) (p=0.002)}. The blood loss was not significantly different between the groups The median blood loss in the CVP group was 600ml and in the PPV group was 850 ml; p value 0.09. Conclusion: PPV can be used as a reliable index to guide fluid management in neurosurgical patients undergoing tumour excision surgery in supine and lateral positions and can effectively augment CVP as a guide to fluid management. Patients in PPV group had better hemodynamic stability and less post operative fluid requirement.

Evaluation of Risk Factors Associated with First Episode Febrile Seizure

Indar Kumar Sharawat, Jitender Singh, Lesa Dawman, Amitabh Singh

Introduction: Febrile seizure (FS) is the single most common type of seizure seen in children between 6 months to 5 years of age. The purpose of our study was to identify the risk factors associated with the first episode of febrile seizures, which would help in the better management and preventive measures in children at risk for FS episodes. Aim: To evaluate the risk factors associated with the first episode of febrile seizures in Indian children. Materials and Methods: This was a hospital based, case control study. The purpose of this study was to identify the risk factors associated with the first FS episode in children. Seventy (70) children between age 6 months to 5 years with their first episode of FS were compared with 70 children with fever but without seizures based on various risk factors. Results: The mean age was 24.90±16.11 months in cases and 26.34±16.93 months in controls. Male: female ratio was 2:1. A positive family history was found in 31.4% of first degree and 11.4% in second degree relatives. Mean maximum temperature was 102.06±1.1ºF and URI (upper respiratory infection) was most common cause of fever. Antenatal complication was significantly higher in the case group. RBC (Red Blood Cells) indices like lower mean haemoglobin, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Haemoglobin concentration) and higher RDW (Red Cell Distribution Width) values were seen in patients. Serum sodium, Serum calcium and random blood sugar values of the cases were significantly lower than those of controls (p<0.05). Conclusion: Our study shows that male gender, family history of febrile seizures, peak body temperature, underlying cause of fever, antenatal complications, low serum calcium, sodium, blood sugar and microcytic hypochromic anaemia are the risk factors associated with the occurrence of first episode of febrile seizure and, thus, preventive measures in removing these risk factors could lead to a decrease in incidence of FS.

Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study

Neil Rohra, Harpreet Singh Suri, Kewal Gangrade

Introduction: High energy intra-articular fractures involving the tibial plateau causes various problems related to management like wound dehiscence, severe comminution leading to malalignment and delayed complications like varus collapse, implant failure and arthritis of knee joint. Aim: This study was done to determine functional, radiological outcome and the complications of Schatzker V and VI tibial plateau fractures treated with bipillar plating with dual plates with a regular follow-up of atleast 3 years. Materials and Methods: Total 34 cases of tibial plateau fracture type V and VI treated with dual plating were studied from January 2011 to December 2013 in KIMS Hospital were followed for minimum of 3 years. The patients were operated through an anterolateral approach for lateral plate and a medial column plate was put through a minimally invasive medial approach or an open posteromedial approach. Results: Total 34 patients were evaluated postoperatively thoroughly for functional outcome using The Knee Society Score and radiological outcomes by Modified Rasmussen Assessment criteria which showed 29 patients (85.29%) had excellent and 5 patients (14.71%) had good objective knee society score. 24 patients (70.59%) had excellent, 8 patients (23.53%) had good and 1patient (2.94%) were each of poor and fair functional knee society score. Eleven patients (32.35%) had excellent, 21patients (61.76%) had good and 2 patients (5.88%) had fair radiological outcome. Conclusion: We conclude that open reduction and internal fixation of high-energy tibial plateau fractures with dual plates via 2 incisions gives excellent to good functional outcome with minimal soft tissue complications. Thus, a minimally invasive approach should be used which helps in preventing soft tissue problems and helps in early wound healing. Fixation done by bipillar plating is important for early mobilization of knee joint. Early mobilization leads to better range of movements and thereby better functional outcome.

Cord Blood Levels of Insulin, Cortisol and HOMA2-IR in Very Preterm, Late Preterm and Term Newborns

Introduction: Alteration in the glucose homeostasis is still the major cause of morbidity and mortality in the newborns. Intrauterine undernutrition plays an important role in causing adult insulin resistance and diabetes but the exact cause is still unknown. Aim: To estimate the plasma glucose, serum insulin and cortisol levels at birth in newborns at different gestational age. Materials and Methods: The present cross-sectional study conducted from December 2014 to June 2015 included 58 newborns enrolled as per the inclusion criteria and further categorized into Group I (very preterm; n=19; gestational age < 32 weeks), Group II (late preterm; n=20; gestational age between 32-37 weeks) and Group III (full term; n=19; gestational age >37 weeks) newborns. Venous Cord Blood (VCB) was collected and plasma glucose was analysed by GOD-POD (Glucose Oxidase-Peroxidase) method in auto analyser whereas serum insulin and cortisol were analysed by ELISA (Enzyme Linked Immunosorbent Assay). HOMA2-IR (Homeostatic Model Assessment) calculator was used to assess insulin resistance. All parametric data was expressed as mean±SD and analysed using ANOVA with Tukey’s as the Post-Hoc test. Correlation analysis was done using Pearson’s correlation co-efficient with scatter plot as the graphical representation. Results: Significantly increased insulin and HOMA2-IR levels were found in group I (13.7±4.7µIU/mL and 1.6±0.58 respectively) when compared to group II (8.3±2.9µIU/mL and 0.93±0.2 respectively) and group III (8.3±2.1µIU/mL and 1.03±0.26 respectively). A positive correlation between cortisol levels and gestational age (r = 0.6, n = 58, p < 0.001) and a negative correlation between insulin and gestational age (r = -0.654, n = 58, p < 0.001) was observed in the study population. Conclusion: Increased levels of insulin and HOMA2-IR as seen in the very preterm newborns signify the predisposition of these newborns to development of diabetes in later stages of life. The inverse association of cortisol and insulin with gestational age suggests that cortisol could also be responsible for impaired ß cell function and insulin sensitivity.

Knowledge, Attitude and Practice of Diabetic Retinopathy amongst the Diabetic Patients of AlJouf and Hail Province of Saudi Arabia

Bandar Krayem Al Zarea

Introduction: Diabetes Mellitus (DM) is a metabolic disorder which is characterized by elevated blood sugar levels. It is a non-communicable disease and currently, a major disease of concern in terms of public health. Aim: To assess the knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of Saudi Arabia. Material and Methods: Patients diagnosed with diabetes mellitus visiting to Ministry of Health hospitals were incorporated in this study. Self administered questionnaires were used to assess knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients. The data collected was entered in a pre-designed proforma and analysed using SPSS version 20.0 Results: This study incorporated 439 diabetic individuals out of which 251 (57.17%) were male patients and 188 (42.82%) were females. Majority of the diabetic patients (75.62%) were aware that diabetes can cause eye disorders, 73.80% of patients replied that diabetic individuals should go for regular eye check-ups and 65.10% of patients were aware that they should visit an ophthalmologist in the event of eye problem. Out of 439 diabetic 302 patients (68.79%) were aware that timely treatment can prevent or delay damage of eyes in diabetic patients and about 95% of all the participants went for regular ocular examinations. Conclusion: Majority of the diabetes patients were aware that diabetes can cause eye disease and it is necessary for the diabetic individuals to consult the ophthalmologist for the prevention of the same.

Comparison of Preoperative Topical Dexamethasone Phosphate Versus Ketorolac Tromethamine in Maintaining Intraoperative Mydriasis During Small Incision Cataract Surgery

Ashok Kumar Sharma, Hans Raj Sharma, Rajni Sharma, Amrita Singh

Introduction: Intraoperative miosis is one of the many challenges which a surgeon can face during cataract surgery. It may leads to impaired view and difficulty in delivering the nucleus. Also, it increases the chances of more serious intraoperative and postoperative complications. Therefore, maintaining adequate pupillary dilatation is of utmost importance during cataract surgery. Aim: To study the efficacy of topical dexamethasone phosphate (0.1%) and topical ketorolac tromethamine (0.4%) in maintaining pupillary dilatation during cataract surgery. Materials and Methods: A total of 200 patients were studied. These were randomly divided into two groups of 100 each. Group1 was given topical dexamethasone phosphate (0.1%) and Group 2, topical ketorolac tromethamine (0.4%). Medications were started 1-day before surgery in the form of one drop to be instilled every 6 hours. Pupillary diameter was measured in the horizontal meridian; 4 readings were taken - before making the incision, after nucleus delivery, following cortical clean-up and after Intraocular Lens (IOL) implantation. Results: The two drugs showed no statistically significant difference in pupillary diameter at the commencement of surgery (p=0.435). The difference between the two drugs was statistically significant, for the mean pupillary diameter which changed from the start of surgery to after cortical clean-up. At this stage, ketorolac group showed a tendency towards larger mean pupillary diameter than dexamethasone group (6.70 ± 0.85mm and 6.32 ± 0.84mm, respectively, p=0.002). Again, ketorolac group patients had larger pupillary diameter after IOL implantation than dexamethasone group patients (the mean was 6.16± 0.97mm and 5.75 ± 0.73mm, respectively, p=0.001). Conclusion: Both ketorolac tromethamine (0.4%) and dexamethasone phosphate (0.1%) are effective in maintaining adequate mydriasis during cataract surgery, but the comparative analysis of the two drugs concludes that, ketorolac is definitely a better option in preventing surgically induced miosis.

Association of Vitamin B12 Deficiency and Use of Reverse Osmosis Processed Water for Drinking: A Cross-Sectional Study from Western India

Ekant Surendra Gupta, Sanket Pranjivan Sheth, Jaishree Deepak Ganjiwale

Introduction: Prevalence of Vitamin B12 deficiency has increased in community in recent time. Possibility is raised for new and yet unidentified factors being associated with this increased prevalence. One of these factors frequently questioned is use of Reverse Osmosis (RO) processed water for drinking. Aim: We aimed to study association of use of RO processed water for drinking with Vitamin B12 deficiency. Materials and Methods: This cross-sectional study was done at tertiary care centre of Western India. Total 250 participants were recruited after excluding those participants with known factors responsible for Vitamin B12 deficiency. Information about gender, type of diet, milk intake and duration, dairy product intake, use of RO water and Vitamin B12 level was collected. Results: Total 70 (28%) participants out of 250 were having Vitamin B12 deficiency. Forty (50.6%) of 79 participants using RO water were Vitamin B12 deficient against 30 (17.5%) of 171 using other sources. Logistic regression analysis showed independent association between use of RO water and Vitamin B12 deficiency. Although association of male gender, milk quantity of less than 100 ml per day and duration of RO water intake with occurrence of Vitamin B12 deficiency was found statistically significant in univariate analysis, logistic regression analysis did not show significant association. Conclusion: Use of RO processed drinking water was associated with Vitamin B12 deficiency. This being cross- sectional study, further longitudinal studies with large sample size and taking confounding factors into consideration, are required to establish this association.

Caregiver Burden among Adults Caring for People Living with HIV/AIDS (PLWHA) in Southern India

Introduction: In India, family caregivers provide bulk of care to People Living With HIV/AIDS (PLWHA). Caregiver burden refers to the physical, emotional and financial hardships associated with providing care to a diseased individual. Attending to the needs of PLWHA can place a significant burden on family members. This may adversely affect their Quality of Life (QOL). Aim: The main aim of our study was to assess the caregiver burden and QOL among the family members of PLWHA in Southern India. We also determined the impact of caregiver burden on QOL. Materials and Methods: This facility based cross-sectional study was carried out at Kasturba Medical College (KMC) Mangalore. The study was conducted over a period of 18 months starting from October 2013. A total of 360 caregivers participated in our study. The data were collected by face-to-face interview. Caregiver burden was assessed using the Zarit Burden scale. WHOQOL-BREF scale was used to assess the QOL of caregivers. The collected data was entered and analysed using SPSS version 11.5. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of caregivers was 36.09± 10.18 years. Most of the caregivers were females 279 (77.5%). Majority of caregivers 184 (51.1%) belonged to Middle/Lower Middle socioeconomic class (Kuppuswamy class III). Majority of PLWHA 155 (43.1%) had Stage 2 disease. Mean CD4 count of the patients was 405.2± 240 cells/µL. In our study 88(24.4%) caregivers had moderate to severe burden and 36(10%) had very severe burden. Physical domain of QOL showed maximum score of 60.28±13.08, while a minimum score of 51.88 ± 14.20 was seen in social domain. With increase in caregiver burden, the mean QOL scores decreased which was statistically significant. Conclusion: Our study highlights the need to counsel the caregivers on how to deal with PLWHA in the family. Family care plays a major role in the general wellbeing of PLWHA. Majority of national HIV programmes all over the world focus mainly on PLWHA. National programmes should immediately address the mental health issues of caregivers thereby reducing caregiver burden. More studies on this topic have to be conducted in developing countries.

Effect of Triage Training on Concordance of Triage Level between Triage Nurses and Emergency Medical Technicians

Introduction: The transfer of care occurs frequently between emergency medical technicians and emergency ward nurses during which emergency medical technicians transfer the patients from the society to the hospital. This transfer of care often occurs under crowded conditions and in high acuity which would pave the way for a disruption of communication. Aim: This study aimed to investigate the effect of training Emergency Severity Index (ESI) triage on concordance of triage level between emergency medical technicians and triage nurses. Materials and Methods: This interventional study was conducted on all triage nurses and emergency medical technicians in Iranshahr City in winter of 2014. Five triage nurses and 30 emergency medical technicians were included into the study using census. To collect data, Personal Information Form (PIF) and ESI Triage Criterion were used. During the project implementation, patients were separately classified before and after triage training by emergency medical technicians and triage nurses. To analyse the data, kappa coefficient under SPSS 16 statistical software was used. R esults: According to the study results, Cohen’s kappa concordance coefficient showed that triage concordance between emergency medical technicians and triage nurses before training was 0.20 which was at an unfavorable level. After training, Cohen’s kappa concordance coefficient reached 0.62, which showed a desirable level of concordance as well as a significant difference after training. Conclusion: It is recommended to train and use common triage system to facilitate transfer or delivery of care between emergency medical technicians and triage nurses.

Evaluation of the Serum Levels of Nitric Oxide among Diabetic Patients and its Correlation with Lipid Profile as well as Oxidative Stress in North Indian Setting

Sanjeev Kumar, Arvind Trivedi, Neetu Verma, Ajay Panwar, Pradeep Kumar

Introduction: Diabetes mellitus is a disease with a rapidly increasing prevalence, needs continue research for novel methods to both prevent and treat this disorder. Obesity and decreased physical activity are the major risk factor for the development of diabetes. Recently the emphasis is focused on oxidative stress in pathogenesis of this disease. Aim: To assess the serum levels of Nitric Oxide (NO) among diabetic patients and its correlation with lipid profile as well as oxidative stress in north Indian setting. Materials and Methods: This was a cross-sectional study. Subjects suffering from type 2 diabetes for more than 1 year and age between 30 to 50 years with hyperuricaemia were included in the study. The patients were divided into three groups: Group I- Type 2 diabetics with dyslipidemia and hyperuricaemia, Group II- Type 2 diabetics with dyslipidemia and normouricaemia and Group III- Type 2 diabetics with normolipidemia and normouricaemia. Results: The nitric oxide level was significantly lower in Group I and Group II than Group III. The oxidative stress parameters had poor correlation with NO level in all the groups. Conclusion: Our data suggests that there is definite role of Nitric Oxide (NO) in pathogenesis of type -2 diabetes mellitus with dyslipidemia and hyperuricaemia.

Evaluation of the Efficacy of Curcumin in the Treatment of Oral Lichen Planus: A Randomized Controlled Trial

Introduction: Oral Lichen Planus (OLP) is a chronic immunological, mucocutaneous disease with a wide range of clinical appearances. The treatment of oral lichen planus is often difficult and disappointing. Aim: We have studied the efficacy of curcumin, a low molecular weight flavonoid with anti-inflammatory and anti-oxidant activities, in the treatment of OLP. Materials and Methods: In this study, a randomized, double-blind, placebo-controlled trial was conducted with a total of 20 OLP patients. The patients were randomly divided into two groups, each treated with curcumin tablets at a dose of 2000 mg/day or placebo for a period of four weeks. Furthermore, the patients of both groups received routine treatment for OLP (i.e. Mouthwash Dexamethasone 0.5 mg and suspension Nystatin 100,000 Units). The baseline data were recorded for each patient. Patients were evaluated on day 14 and after completing the course of treatment. Pain and burning sensation were measured based on the Visual Analogue Scale, and the Thongprasom Index was used for clinical improvement and healing. Mann-Whitney and independent t-test were used to compare the responses between the two groups, p-value < 0.05 was considered statistically significant. Results: Our analyses demonstrated no significant difference between the curcumin and placebo treated groups. Conclusion: In conclusion, curcumin had no detectable effect in the treatment of OLP. However, a higher dose of curcumin administration and other forms of curcumin with improved bioavailability may be considered in future studies.

Prevalence of Diabetes, Obesity and Dyslipidaemia in Persons within High and Low Income Groups Living in North and South Trinidad

Introduction: Diabetes Mellitus, obesity and dyslipidaemia are metabolic disorders characterized by similar risk factors, complications and outcomes including stroke, insulin resistance, MI and even death. Studies have indicated that impoverished and low income areas of developing countries are more prone to increasing obesity which when uncontrolled can lead to diabetes mellitus and dyslipidaemia. Aim: The study was aimed to compare the prevalence of diabetes mellitus, obesity and dyslipidaemia in high and low income groups of North and South Trinidad, to determine factors that contribute to its prevalence and to observe any associations between the three aforementioned diseases. Materials and Methods: The cross-sectional study was conducted on 200 participants who visited the two major hospitals at south and north Trinidad where the mean differences between fasting glucose, lipid profile, BMI, waist and hip ratio and blood pressure of both diabetic and non-diabetic participants were obtained via questionnaires and then analysed using SPSS. Results: Residents of south Trinidad showed a higher proportion of persons with diabetes and dyslipidaemia at 68.6% and 52% when compared to 28.6% and 27% respectively for the north population. Those from north Trinidad showed a higher prevalence of obesity at 45.9% with higher income levels. About 17.3% participants smoked or were exposed to cigarettes in north compared to 9.8% of participants whom smoked or were exposed to cigarettes in south. North had 2% of alcohol consumed daily and 3.9% consumed alcohol daily in south. In north, 21.4% of participants were stressed when compared to 18.6% from south. Conclusion: A significant correlation was established between cholesterol, LDL and triglycerides which lead to the conclusion that obesity is caused by dyslipidaemia. Also, our study concluded that stress and dyslipidaemia are income related.

Morphological Variations and Biometrics of Ear: An Aid to Personal Identification

Introduction: The morphological characteristics and dimensions of external ear vary in different human ethnic races which can be utilized in forensics for personal identification of living or deceased. Aim: To determine uniqueness of morphological and biometric variations of both ears for individualization among North East (NE) and North West (NW) subpopulation of India. Materials and Methods: The study was conducted on randomly selected 80 students, 40 from each subgroup. Nine ear parameters were recorded twice using digital Vernier’s caliper by single investigator and two indices (Ear Index and Lobule Index) were calculated for both the ears. Morphological ear shapes and lobule attachment were also noted. Pearson’s coefficient correlation test was performed on cross-tabulations to evaluate significant relationship between different variables. Results: Of the total 35% free and 65% attached ear lobes were noted in both population groups. Oval ear shape was most commonly noted followed by triangular, rectangular and round in both populations. On comparing anthropometric measurements of ears in two populations it was found that except the tragus length and lobule index all other values were noted more in NW population. No statistical difference was found in ear and lobular indices of males and females although the left ear index and lobule index were found to be higher than right in both populations except in NW females where right lobule index was recorded more than left. Conclusion: The results obtained can be used in anthropological and forensic sciences for the inclusion and exclusion of persons for identification on the basis of ear variations.

Outcome Analysis of Hemiarthroplasty vs. Total Hip Replacement in Displaced Femoral Neck Fractures in the Elderly

Vipin Sharma, Bhanu Awasthi, Krishna Kumar, Navneet Kohli, Punit Katoch

Introduction: Management of displaced fracture neck femur in the elderly population is frequently done by Hemiarthroplasty or Total Hip Replacement (THR). It avoids high rates of nonunion and avascular necrosis which usually occur after internal fixation of neck femur fractures in this age group. Aim: The present study aimed to evaluate patient function and complications following hemiarthroplasty and total hip replacement in elderly population with displaced femoral neck fractures. Materials and Methods: Patients above 60 years of age with displaced fracture neck femur were studied over the period of four years. All the clinical parameters and co-morbid conditions were noted at the time of presentation. The patients associated with co-morbid conditions and underlying pathology were excluded from study. Garden’s classification was used for classification of neck femur fractures. After due informed consent patients of displaced fracture neck femur were randomized by simple randomization and allocated for hemiarthroplasty or THR. Antibiotics were given preoperatively at the time of induction and postoperatively for 5-7 days. Surgery was carried out by Modified Gibson approach. Any complications during pre and postoperative period were noted. Follow-up of patients was done 1 month, 3 months, 6 months and 1 year interval with the help of Harris hip score. Results: Total 80 patients were enrolled in the study group, with 40 patients in each group. The mean age of patients was 73 years in hemiarthroplasty group and 78 years in THR group. Female to male ratio was 55:45. Mean operative time was 35 minutes in hemiarthroplasty group and 45 minutes in THR. Average intraoperative blood loss was 200cc and 300cc in hemiarthroplasty and THR respectively. The mean hospital stay was 14 days in both the groups. Superficial wound infection was noted in hemiarthroplasty group while in THR group deep wound infection (n=1) and prolonged ICU stay (n=1) were noted. The mean Harris hip score was better in THR group as compared to Hemiarthroplasty group at one year follow-up. Conclusion: In elderly patients with fracture neck femur hemiarthroplasty takes less operative time, less blood loss per operatively and few complications postoperatively as compared to THR. The functional outcome at one year is better with THR as compared to hemiarthroplasty.

Pilot Study to Assess the Quality of Life, Sleepiness and Mood Disorders among First Year Undergraduate Students of Medical, Engineering and Arts

Ruchi Singh, Rhea Shriyan, Renuka Sharma, Shobha Das

Introduction: College students, who are in a phase of transition from adolescence to adulthood, face numerous challenges. Due to stress overload, students easily fall prey to mood disturbances like stress, anxiety and depression compromising their quality of life. Aim: Present study was undertaken to see the effect of choice of professional course on quality of life and mood of the first year students of medical, engineering and arts students. Materials and Methods: A cross-sectional study was conducted amongst 150 students, 50 participants from each stream. Enrolled subjects were administered questionnaires pertaining to their quality of life (WHOQOL-BREF), mood disorders (DASS-42) and sleepiness (ESS). Results: Medical students showed significantly higher levels of stress (p-value=0.0001), depression (p-value=0.002) and anxiety (p-value=0.002), 30% of medicos labelled their quality of life as very good compared to 48% and 50% of engineering and arts students. A 38% of medical student’s reported daytime sleepiness compared to 12% engineering and 6% arts students. Conclusion: Present study shows that medical students are maximally vulnerable to mood disorders and have a poor quality life. As the student community forms the backbone of any nation, we as, educators should try to strengthen each individual by promoting not only physical and mental development but also aiming for overall holistic development.

Quantification of Various Inflammatory Cells in Advanced Atherosclerotic Plaques

Veronica Soundra Veena Paul, Christina Mary Priya Paul, Sarah Kuruvilla

Introduction: Atherosclerosis, the pathological basis of coronary artery disease is being extensively studied as understanding of the complex processes involved in the formation and progression that can provide an insight into prevention and treatment of the same. This is an autopsy study to identify and quantify various inflammatory cells in advanced atherosclerotic plaques. Aim: This study aims at identifying and categorizing the various inflammatory cells present in advanced atherosclerotic plaques, noting their distribution in the plaque, quantifying them using histomorphometry and comparing them across plaques of different AHA types. Materials and Methods: Post-mortem angiogram was performed on 3 heart specimens obtained at autopsy of random Road Traffic Accident (RTA) cases which revealed evidence of coronary artery disease. End-arterectomy was done and the arteries with atherosclerotic plaques were cut into serial sections and made into tissue blocks. Sections from these blocks were stained with H & E stain and the plaques were classified based on AHA classification. 50 advanced atherosclerotic plaques of AHA Type IV and V were chosen for this study and were screened for inflammatory cells, first with H & E stain and then with different immunohistochemical stains for T-lymphocytes, B-lymphocytes and neutrophils. The T-lymphocytes thus identified was further sub-typed into CD4+ and CD8+ cells again using IHC markers and the percentage area of each was measured using histomorphometry. Then, these values were compared between AHA Type IV and AHA Type V lesions. Results: It was found that the inflammatory cells found in advanced atherosclerotic plaques were predominantly T-lymphocytes as evidenced by their CD3 positivity and they were found to be distributed mainly around the shoulder region and fibrous cap of the plaque. When categorized further, it was found that CD8+ T-cells were always more than CD4+ T-cells in advanced lesions. Meloperoxidase stain for neutrophils was negative in all the plaques examined. The difference in the amount of inflammatory cells between AHA type IV and Type V was not statistically significant. Conclusion: The study of the amount of inflammatory cells in atherosclerotic plaques and understanding their role in the pathophysiology of advanced plaques may have therapeutic implications.

Assessment and Evaluation of Anatomic Variations of Retromolar Pad: A Cross Sectional Study

Introduction: The retromolar pad also called piriformis papilla is a mucosal elevation located in the retromolar area covering the retromolar triangle. After molar loss, the bony alveolar process and surrounding soft periodontal tissue remodel, mainly resorb and blend with retromolar pad. It is a key intraoral landmark in prosthodontics. Aim: The aim of this in-vitro study was to analyze the various anatomical shapes and sizes of retromolar pad in 150 completely edentulous patients between 55 to 70 years of age group. Materials and Methods: The study was conducted on 150 completely edentulous patients. The shapes of retromolar pad on the left and right side were seen and divided into pear, triangular and round shape. The comparison of the mean longitudinal diameter and transverse diameter on the right and left sides was done. The data was evaluated statistically. The chi-square test was used for the comparison between the proportions with the help of standard deviation, t-test was used for comparison between the left and the right side and ANOVA test was used for comparison between the various shapes of the retromolar pads. Results: The result showed that there was statistically significant difference among different shapes of retromolar pad and there was significant difference in mean transverse and longitudinal diameter on right and left side, the mean value of the longitudinal diameter on left and right side was 8.81 and 8.69 whereas the mean value of the transverse diameter on left and right side was 6.79 and 6.82 respectively and p-value obtained for both was 0.550 and 0.814 respectively. Conclusion: The study conclude that there are three different shapes of retromolar pad among which pear and triangular shaped retomolar pad provides more stability in lower denture because of increase surface area.

Correlation Between Stereoacuity and Experimentally Induced Graded Monocular and Binocular Astigmatism

Varsha Kulkarni, Neelam Puthran, Bhavna Gagal

Introduction: Stereopsis, the highest grade of binocular single vision, is affected by various factors, such as mis-alignment of visual axes, refractive errors especially anisometropia and astigmatism, both of which may result in amblyopia. There are very few studies in literature regarding the relationship between stereoacuity and refractive errors, especially astigmatism. Aim: The present study was conducted to determine the correlation between stereoacuity and experimentally induced graded astigmatism in emmetropes. Materials and Methods: A randomized study was conducted on 2000 individuals of either gender, between the ages of 8-35 years, at tertiary care centre attached to a medical college during the period of August 2012 to August 2014, All subjects were emmetropic with normal binocular single vision. Participants were randomly divided into four groups of 500 individuals each. Two groups were subjected to induced myopic astigmatism, either uni-ocularly or binocularly, using + 1.0 D and + 2.0 D cylinders at varying axes i.e., 450, 900 and 1800. Similarily, the remaining two groups were subjected to induced hypermetropic astigmatism, using - 1.0 D and - 2.0D cylinders at varying axes i.e. 450, 900 and 1800. Near stereoacuity was determined by the Titmus Fly Stereo Test, both before and after induction of astigmatism. Statistical analysis was done using paired t-test and ANOVA. Results: The mean stereoacuity in emmetropes was 28.81±4.97 seconds of arc. There was a decrease in stereoacuity with increase in dioptric power of astigmatism (p<0.001). Oblique astigmatism reduced the stereoacuity maximally, while stereoacuity was least affected at 180o axis. Hypermetropic astigmatism caused more deterioration in stereoacuity than myopic astigmatism. A gross reduction in stereoacuity was noted in induced monocular astigmatism as against binocular astigmatism. Conclusion: This study suggests that stereoacuity is significantly affected by even minor degrees of monocular or binocular astigmatism.

Evaluation of the Effect of Tracheal Tube Orientation on Success of Intubation through Intubating Laryngeal Mask Airway

Swati Chhatrapati, Anjana Sahu, Subhhash Sadashiv Auti, Swapnil Ganesh Aswar

Introduction: Polyvinyl Chloride Endotracheal Tube (PVC ETT) can be used as an alternative to Fastrach Silicone Wire-Reinforced Tube (FTST) for intubation through Intubating Laryngeal Mask Airway (ILMA) as the latter is expensive and has low volume high pressure cuff. Aim: To evaluate the effects of orientation of PVC ETT (normal curve and reverse curve) on the success of intubation through ILMA, haemodynamic response and postoperative sore throat. Materials and Methods: Sixty healthy adult patients of ASA physical status I & II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were randomly divided into two groups. In Normal (N) group (n=30), the tracheal tube was inserted with its natural curve following the 90º curvature of ILMA. In Reverse (R) group (n=30), the tracheal tube was inserted with its natural curve directed opposite to the curvature of ILMA. The time taken to intubate, number of attempts, and maneuvers required for successful endotracheal intubation along with haemodynamics and oxygen saturation were noted. Postoperative sore throat was evaluated using a Verbal Analogue Scale (VAS) (0-10). Qualitative data was analysed by Chi-Square test and Fishers exact test. Quantitative data was analysed by unpaired t-test and Mann-Whitney test. Results: Placement of ILMA was successful in all patients. Total Intubation Time (mean±SD) in Group N was 12.53±1.78 seconds and in Group R was 11.97±1.33 seconds (p>0.05). Tracheal intubation through ILMA was successful in all patients. First attempt success rate in R Group (26 patients, 86.7%) was higher than N Group (22 patients, 73.3%) (p>0.05). Four patients (13.3%) in R Group and 8 patients (26.7%) in N Group required 2nd step of Chandy’s maneuver during second attempt for successful intubation. Incidence of sore throat 6 hours postoperatively was statistically significant (median value 2.00 in N Group vs. 0.00 in R Group) between two groups. Conclusion: PVC ETT with reverse orientation increases first attempt success rate of intubation through ILMA with less immediate postoperative laryngeal morbidity.

The Factors Responsible for Endodontic Treatment Failure in the Permanent Dentitions of the Patients Reported to the College of Dentistry, the University of Aljouf, Kingdom of Saudi Arabia

Azhar Iqbal

Introduction: The endodontic failure is a common problem in dentistry. The success of endodontic and re-endodontic treatment depends on many factors. These includes periodontal disease, root fractures, residual necrotic pulp tissue, presence of peri-radicular infection, broken instruments, mechanical perforations, root canal underfillings, root canal overfillings, missed canals or unfilled canals. Aim: The present research was aimed at evaluating the different factors responsible for endodontic treatment failure in permanent dentitions of the patients. Materials and Methods: In the present in vivo cross-sectional study, 90 patients, who reported in endodontic section of Department of Conservative Dentistry, with post endodontic treatment pain, tenderness to percussion, swelling and sinus tract in their permanent dentitions were considered as endodontic failure cases, and were considered for endodontic re-treatment. The teeth with vertical root fracture and badly broken down unrestorable teeth were excluded from the present study. The study subjects were divided into three groups on the basis of their age. Informed consent was taken from the study subjects and the approval was taken for this study from the college ethical committee. Results: The results were obtained as frequencies and percentages after analysing the collected informations by using SPSS version 10 computer soft ware. The majority of the endodontic failures were noted in the age group III (41.11%) and minimum endodontic failures were found in the age group I (24.44%). According to the tooth type, the majority of the endodontic failures were noted in maxillary molars (44.4%), mandibular molars (20%) and maxillary premolars (15.5%). The endodontic treatment performed by the general dental practitioners (GDPs) showed the most failure rate (78.8%). The factors which were most responsible for endodontic failures were underfilled canals (33.3%), unfilled and missed canals (17.7%). Conclusion: This study concluded that endodontic failures are more related with the lack of knowledge on the part of the operator, complex anatomy of the teeth involved and lack of referral of such patients to the specialists.

Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand

Introduction: A number of cases of Leishmaniasis have been reported from non-endemic sub-himalayan regions of India. Due to low clinical suspicion and atypical presentation, cases may go undetected or there may be a delay in diagnosis. Aim: The aim of the study was to evaluate clinico-haematological parameters and bone marrow findings so that a high degree of suspicion could be made in unsuspected cases of Visceral Leishmaniasis (VL) and Leishman Donovan (LD) body negative bone marrow smears. Materials and Methods: A retrospective study was conducted at a tertiary care centre serving the kumaon region of Uttarakhand from 2010 to 2014. Forty bone marrow aspirates were included, which were sent on clinical suspicion of VL. Twenty cases were positive for LD bodies. Their clinico-haematological features including bone marrow findings were studied in detail and compared with rest of the 20 LD negative cases. Five LD negative cases were also positive for rk39. Results: Twenty LD positive cases were evaluated. Splenomegaly was the most common sign present in 17 cases (85%). Anaemia, leucopenia and lymphocytosis were present in all the cases (100%). Pancytopenia was seen in 17 cases (85%). Microcytic hypochromic blood picture was the most common finding in 11 cases (55%). Bone marrow was normocellular in 7 cases (35%), hypercellular in 7 cases (35%). Erythropoesis was micro-normoblastic in 11 cases (55%). Overall, there were 25 cases of VL (20 LD positive, 5 LD negative). Increased plasma cells, lymphocytes and histiocytes were seen in 17 cases (68%) of VL. Conclusion: In non-endemic region where clinical suspicion is low, bone marrow findings can be a strong indicator for VL even though marrow is negative for LD bodies. If required other ancillary investigations can also be ordered. This study also emphasizes the need for epidemiological work up in this region.

Clinical Response of Levodopa Carbidopa Combination in Patients with Idiopathic Parkinsonism

Abhijith Lalesh Merajoth, Pradeep Sadasivan Pillai, Thomas Iype

Introduction: Parkinson’s disease is the most common form of a group of progressive neurodegenerative disorders. The use of levodopa as dopamine – replacement therapy is highly effective in ameliorating the symptoms of the disease and remains the standard drug with which other therapies are compared. Aim: To study the change in Unified Parkinson’s Disease Rating scale (UPDRS) scores in patients receiving levodopa and carbidopa treatment (levodopa- carbidopa combination). Materials and Methods: Study was conducted in Department of Neurology, Government Medical College, Trivandrum, India on 75 patients. All patients diagnosed with Idiopathic Parkinson’s disease (PD) satisfying inclusion criteria were enrolled into the study. Informed written consent was taken from all patients. Baseline UPDRS scores were recorded followed by reassessment at the end of six month. Data was analysed using paired t-test with help of SPSS-16 statistical software. Results: Baseline UPDRS was collected and after 6 months of treatment, it was reassessed. Baseline total score was 49.8; the follow-up score was 39.5. A decrease in score was seen in various components of UPDRS. Conclusion: Upon statistical analysis this difference was found to be significant, which implies that, there is improvement in patient’s condition. Improvement was noted in Mentation, behaviour, mood, activities of daily living and motor functions. Hence there is positive treatment response for levodopa carbidopa therapy in patients with idiopathic PD.

Parasite and the Circulating Pool- Characterisation of Leukocyte Number and Morphology in Malaria

Reshma Gopal Kini, Jayaprakash Chandrashekhar

Introduction: Haematological changes are the most common complications encountered in malaria. There is significant correlation between several of the haematological parameters and the clinical profile, prognosis and mortality in malaria. White cell counts and differentials are among the most basic and primary investigations done in a patient presenting with fever of short duration. Aim: This study analyzes the numerical and morphological changes in White Blood Cells (WBCs) in peripheral blood in patients with acute malaria in endemic region in an effort to get a picture of specific changes that could be identified by basic investigations. Materials and Methods: This study was conducted in tertiary care hospital in a region endemic for malaria. EDTA anticoagulated venous blood samples from 600 patients diagnosed with vivax and falciparum malaria was analysed in Coulter counter LH 500 for the white cell count and differentials. Morphological changes were looked for in Leishman stained peripheral blood smear. Comparison with age matched healthy controls was done by ANOVA with Bonferroni test wherever applicable. Results: Patients with malaria showed significant leucopenia, neutrophilia, lymphocytopenia, monocytosis and eosinopenia. Lymphocytopenia was more severe in the falciparum group as compared to the vivax group. A higher White Cell Count (WCC) was seen in patients with higher haemoglobin levels in vivax group. The total leukocyte count showed a negative correlation with neutrophil count in falciparum malaria and a strong positive correlation with neutrophil count in vivax malaria. Band neutrophils were seen in 10% of the patients with falciparum and 1.1% of patients with vivax malaria. Atypical plasmacytoid lymphocytes were the only notable morphological finding. Conclusion: Changes in leukocyte number and morphology in the peripheral blood are common. A combination of monocytosis and eosinopenia in a patient presenting with fever should alert the observer to the presence of malaria and should prompt a repeat blood smear examination in case of initial negative results for the parasite.

A Study of Physicochemical Properties of Subcutaneous Fat of the Abdomen and its Implication in Abdominal Obesity

Introduction: The lower abdominal obesity is more resistant to absorption as compared to that of upper abdomen. Differences in the physicochemical properties of the subcutaneous fat of the upper and lower abdomen may be responsible for this variation. There is paucity of the scientific literature on the physicochemical properties of the subcutaneous fat of abdomen. Aim: The present study was undertaken to create a database of physicochemical properties of abdominal subcutaneous fat. Materials and Methods: The samples of subcutaneous fat from upper and lower abdomen were collected from 40 fresh autopsied bodies (males 33, females 7). The samples were prepared for physicochemical analysis using organic and inorganic solvents. Various physicochemical properties of the fat samples analysed were surface tension, viscosity, specific gravity, specific conductivity, iodine value and thermal properties. Data was analysed by paired and independent sample t-tests. Results: There was a statistically significant difference in all the physicochemical parameters between males and females except surface tension (organic) and surface tension (inorganic) of upper abdominal fat, and surface tension (organic) of lower abdominal fat. In males, viscosity of upper abdominal fat was more compared to that of lower abdomen (both organic and inorganic) unlike the specific conductivity that was higher for the lower abdominal fat as compared to that of the upper abdomen. In females there were statistically significant higher values of surface tension (inorganic) and specific gravity (organic) of the upper abdomen fat as compared to that of lower abdomen. The initial and final weight loss of the lower abdominal fat as indicated by Thermo Gravimetric Analysis was significantly more in males than in female Conclusion: The difference in the physicochemical properties of subcutaneous fat between upper and lower abdomen and between males and females could be responsible for the variant behaviour of subcutaneous abdominal fat towards resorption.

A Growth and Nutritional Study of HIV Seropositive Children from West Bengal under Direct Care of Medical Caregivers

Arpita Chattopapadhyay, Subhashis Bhattacharyya, Subhashish Dhar

Aim: To evaluate the nutritional status of HIV seropositive children, aged 2-10 years with age – matched controls and examine the role of nutritional intervention and HRT on their growth indices. Materials and Methods: It was a cross-sectional study done at a HIV Clinic of a teaching hospital. Fifty six seropositive children (age 2-10 year) classified as cases, and 60 seronegative age - matched controls were taken. Demographic and anthropometric characteristics were collected via valid instruments. HIV grading and adherence to HRT were assessed by using validated questionnaires. Results: Of the cases majority (87.5%) were infected by vertical transmission from mother to child, the remaining were infected by blood transfusion out of which 1.78% were haemophiliacs and remaining were thalassaemics. The prevalence of underweight among cases was 64.3%, compared to prevalence of 61% among controls. The prevalence of stunting was 44.6% among cases, while the prevalence of severe stunting was 14.3%. The prevalence of wasting among cases was 30.35%, while 7% cases were severely wasted. Only 23.33% controls were wasted. There was a significant difference in the Height- for-age between cases and controls, in the age of 4 years, 5 years and 6 years (p-value <0.05). Conclusion: There was a significant difference in the Heightfor-age between cases and controls, in the age of 4 years, 5 years and 6 years, indicating the need for proper nutritional intervention and timely HIV antiretroviral therapy to prevent stunting.

A Comparative Study to Evaluate the Efficacy of Vaginal vs Oral Prostaglandin E1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion

Introduction: Missed miscarriages, occurring in upto 15% of all clinically recognized pregnancies are a cause of concern for the patients. Though many researchers in the past have compared the surgical and medical approaches in management of such patients, only a few have executed an appraisal of two routes of misoprostol at equal dosages in treatment of first trimester missed miscarriages. Aim: To compare the efficacy of misoprostol by vaginal and oral route, for the management of first trimester missed abortion; and to recognize the utility of misoprostol for cervical dilation prior to any surgical termination of pregnancy. Materials and Methods: A randomized prospective trial, comparing the efficacy of misoprostol, by vaginal and oral routes, for termination of first trimester missed abortion was conducted in the Department of Obstetrics and Gynecology, Government Multi-Specialty Hospital, Chandigarh over one year. Hundred subjects satisfying the inclusion criteria from 213 consecutive women presenting to the institute with first trimester missed abortion were hospitalized. The study participants were randomly assigned to one of the two treatment groups, using sequentially numbered envelopes, to receive 400mcg misoprostol vaginally or orally to a maximum of three doses six hours apart, and outcome documented. Patients were followed up on Day 14 and 6 weeks after discharge. Primary outcome evaluated was drug-induced complete expulsion of Products of Conception (POCs). Secondary outcomes measured were induction expulsion interval, number of doses required, classification of failures, cervical canal permeability in women requiring surgical evacuation, side effects, hemoglobin drop, duration and amount of post-abortal bleeding, time of resumption of menses, experience with side effects, patient satisfaction and acceptability to treatment. Results: Both routes were highly effective (vaginal=92%, oral= 74%, p=0.032), safe and acceptable with tolerable side effects. The mean time to expulsion was longer (13.24hrs) in the oral than vaginal group (10.87hrs). All 4 unsuccessful cases in vaginal group and 12 of 13 in oral group had permeable cervices prior to surgical evacuation. Most women labeled the side effects as tolerable in both the groups. Overall acceptance rate to treatment was high in both the groups A and B (76% and 70%). Conclusion: Vaginal misoprostol is more effective than oral misoprostol for first trimester missed abortion.

Microbiological Characterization of Haemophilus influenzae Isolated from Patients with Lower Respiratory Tract Infections in a Tertiary Care Hospital, South India

Padmaja Ananth Shenoy, Kiran Chawla, Shashidhar Vishwanath, Dipika Shaw

Introduction: Haemophilus influenzae is responsible for wide range of localized and invasive lower respiratory tract infections (LRTI) with the highest burden of disease in low and middle income countries. Aim: The aim of the present study was to characterize the H.influenzae isolates from suspected LRTI. Materials and Methods: A prospective study was conducted over a period of one and half years (December 2012 to May 2014) including patients with LRTI. H.influenzae was isolated from lower respiratory specimens following standard procedures. Complete characterization of the isolates was performed by bio typing, capsular serotyping, molecular genotyping and antibiotic susceptibility testing. The predisposing factors and clinical presentation were studied in the infected patients. Results: A total of 8995 samples were received during the study period, out of which growth was significantly observed in 2848 (31.7%) samples. Among the various respiratory pathogens, H.influenzae was isolated from 175 (6.14%) patients. Majority (78.9%) of the patients presented with acute exacerbations of chronic obstructive pulmonary disease. The isolates most frequently were of Biotype II (35.42%). Only four of the 50 isolates subjected to capsular serotyping were typeable and were of type b, e and f. All the 50 isolates tested were found to be non-typeable by PCR for capsular genotyping. Maximum resistance was found against ampicillin (9.71%). Conclusion: H.influenzae was found to be a significant cause of LRTI. Majority of the isolates were found to be non typeable strains. Non typeable H. influenzae isolates should not be neglected as they can colonize the respiratory tract in COPD patients and can lead to biofilm formation and treatment failure.

Knowledge and Awareness of Familial Hypercholesterolaemia among Registered Medical Practitioners in Tamil Nadu: Are They Suboptimal?

Nandhini Rangarajan, Shanthi Balasubramanian, Jing Pang, Gerald F Watts

Introduction: Familial Hypercholesterolaemia (FH) is the most common monogenic disorder causing premature Coronary Artery Disease (CAD). However, the majority of people with FH are undiagnosed and under treated. Aim: To determine awareness, knowledge and practices of registered medical practitioners regarding FH in India. Materials and Methods: Physicians from a southern state of India (Tamil Nadu) who see the general cases were requested to complete a structured online survey questionnaire based on the outcomes on screening, diagnostic and service aspects of FH. Results: A total of 133 physicians were surveyed, 27.9% perceived themselves to have above average familiarity with FH and 71.4% correctly described FH. 41.4% of physicians were unaware and unsure whether they had FH patients under their care. The awareness of specific aspects of FH were as follows: heritability 35.3%, prevalence 31.6%, typical lipid profile 34.6%, CVD relating to FH13.5%, genetic testing 33.1%, cascade screening 41.4%, preventive, management and referral services for FH 12.8%, 49.6% of them thought that the age for screening young people for FH should be 13 to 18 years. 84.2% selected GP’s as the most effective health care provider for the early detection and care of FH as being useful. 69.2% selected interpretive commenting on lipid profile to highlight patients at risk of FH. 91.7% and 19.5% of physicians identified statins as monotherapy and statin with ezetimibe as combination therapy for FH, respectively. Conclusion: The study identified substantial deficit in the awareness and knowledge of FH among primary care physicians in Tamil Nadu. Extensive and continuous medical education programs are required to close the gap in coronary prevention.

Immediate Effects of Bhramari Pranayama on Resting Cardiovascular Parameters in Healthy Adolescents

Maheshkumar Kuppusamy, Dilara Kamaldeen, Ravishankar Pitani, Julius Amaldas

Introduction: In yoga, Pranayama has a very important role in maintaining sound health. There is some strong scientific basis on constant physiological changes produced when pranayama is practiced for long duration. Still, there exists a dearth of literature on the effect of Bhramari pranayama (Bhr.p) on physiological systems. Aim: To assess the immediate effect of Bhramari pranayama (Bhr.P) practice on the resting cardiovascular parameters in healthy adolescents. Materials and Methods: Sixty apparently healthy adolescents of both sex participated in the study. They were randomly divided into Bhr.P (n-30) and control (n-30) group. Informed consent was obtained after explaining the detailed procedure of the study. Bhr.P group practiced Bhramari pranayama for 45 min (5 cycles) and control group was allowed to do normal breathing (12-16 breath /min). Heart rate (HR) was assessed by radial artery palpation method and blood pressure was recorded in supine position after 5 minutes of rest by sphygmomanometer. Results: The HR reduced significantly (p-0.001) in Bhr.P group. BP indices, Pulse Pressure (PP), Mean Arterial Pressure (MAP), Rate Pressure Product (RPP) and Double Product (DoP) significantly decreased after Bhr.p practice compared with control. Pre and Post inter group analysis also showed that significant reduction in HR and BP indices in Bhr.P group. Conclusion: Present study showed that Bhr.P practice produces relaxed state and in this state parasympathetic activity overrides the sympathetic activity. It suggests that Bhramari pranayama improves the resting cardiovascular parameters in healthy adolescents.

Association of Apo A5 Gene Promoter Region -1131T C Polymorphism (rs662799) to Plasma Triglyceride Level in Patients with Type 2 Diabetic Nephropathy

Introduction: Diabetic Nephropathy (DN), a serious complication of Type 2 Diabetic Mellitus (T2DM), is progressive and susceptibility to DN varies among T2DM patients. ApoA51131T>C polymorphism revealed that is strongly associated with triglyceride levels and proposed as a predisposing factor for DN. Aim: The purpose of this study was to investigate the association -1131T>C ApoA5 gene polymorphism with serum lipids levels in Type 2 diabetic (DM) patients with or without DN in north of Iran (Mazandaran province). Materials and Methods: This study comprised patients with established T2DM (n=161) and controls (n=58). Genotyping of APOA5 -1131T>C polymorphisms was performed by PCR– RFLP. Diabetic patients were divided into two groups: with nephropathy (DN+, n = 90) and without nephropathy (DN-, n = 71). Lipids and lipoproteins were assessed by enzymatic methods. Results: The genotype frequencies were 63.8 % TT, 31 % TC, 5.2 % CC in controls, 33.8% TT, 52.1 % TC, 14.1 % CC in DN- and 44.4 % TT, 36.7 % TC, 18.9 % CC in DN+ patients. The TC genotype and the CC genotype were overexpressed among DN+ and DN-population in comparison to the control group. The highest and the lowest TG levels in both diabetic patients and controls belonged to CC+TC and TT genotypes, respectively. Furthermore in both patients TG increased with this order: TT< TCConclusion: These results suggest that APOA5 -1131T>C polymorphisms influence lipid levels in type 2 diabetic patients.

Assessment of White Spot Lesions and In-Vivo Evaluation of the Effect of CPP-ACP on White Spot Lesions in Permanent Molars of Children

Introduction: As hindrance of remineralisation process occurs during orthodontic therapy resulting in decalcification of enamel because number of plaque retention sites increases due to banding and bonding of appliances to teeth. Aim: The present analytic study was undertaken to assess the occurrence of white spot lesions in permanent molars of children with and without orthodontic therapy and to evaluate the effect of Casein PhosphoPeptide-Amorphous Calcium Phosphate (CPP-ACP) on white spot lesions in post-orthodontic patients in a given period of time. Materials and Methods: The study comprised of examination of 679 first permanent molars which were examined to assess the occurrence of smooth surface white spot lesions in children of 8 to 16 years age group. Group I comprised subjects without any orthodontic treatment and Group II comprised of subjects who had undergone orthodontic therapy. The sample size was calculated using the epi-info6 computer package. Treatment group included 20 post-orthodontic patients examined with at least one white spot lesion within the enamel who received remineralizing cream (GC Tooth Mousse, Recaldent, GC Corporation.) i.e., CPP–ACP cream two times a day for 12 consecutive weeks. Computerized image analysis method was taken to evaluate white spot lesions. These frequency and percentages were compared with chi-square test. For comparison of numeric data, paired t-test was used. Results: Of the total 278 (49.6%) first permanent molars showed occurrence of smooth surface white spot lesions out of 560 in Group I and 107 (89.9%) first permanent molars showed presence of white spot lesions out of 119 debanded first permanent molars of children examined in Group II. CPP-ACP therapy group showed reduction in severity of codes which was found to be highly significant after 12 weeks and eight weeks on gingival-third, p-value (<0.001) and significant after eight weeks and four weeks on middle-third according to ICDAS II criteria and computerized image analysis. Conclusion: CPP-ACP therapy minimum for 12 weeks is highly recommended as post-orthodontic treatment need in management of smooth surface white spot lesions on teeth undergoing fixed orthodontic therapy according to the present study.

Unusual Case of Cerebral Venous Sinus Thrombosis in Patient with Ulcerative Colitis in Remission

Ulcerative colitis (UC) is an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Cerebral venous sinus thrombosis along with deep vein thrombosis, pulmonary embolism and arterial thrombosis have occasionally been reported as a complication in the active phase of UC being attributed to its pro-thrombotic state. This paper depicts a 38-year-old female with a history of UC in remission who developed sudden onset headache, blurring of vision and seizures. Subsequent diagnosis of cerebral venous sinus thrombosis was made with MRI venography and treated with low molecular weight heparin with complete resolution of symptoms. The highlights of this case underscore the importance of evaluating cerebral venous sinus thrombosis as a cause of acute onset neurological deterioration in a setting of inflammatory bowel disease. It also emphasizes on the hypothesis that the risk of venous thrombosis or other hypercoagulable states have no direct relationship with the disease activity or flare-up.

Restoring Anterior Aesthetics by a Rotational Path Cast Partial Denture: An Overlooked Technique

Deeksha Sharma, Bala Saraswati Bhat, Himanshu Arora

Giant Leiomyosarcoma of the Urinary Bladder

The bladder leiomyosarcoma is a rare and agressive mesenchymal tumour, and adult women of reproductive age have a higher incidence of developing the bladder leiomyosarcoma. The pathophysiology of the disease is not certain, and its main symptoms are hematuria, dysuria and abdominal pain. There are not considerable amount of cases described in the literature. We report a case of a giant leiomyosarcoma of the urinary bladder in a 31-year-old woman.

Malposition of Subclavian Venous Catheter Leading to Chest Complications

Madhur Kumar, Amarjit Singh, Kuldeep Singh Sidhu, Avleen Kaur

Although Central Venous Catheter (CVC) placement is a relatively simple procedure but its insertion and maintenance are associated with significant risks. Malposition (defined as any CVC tip position outside the superior vena cava) may be associated with catheter insertion and may require immediate intervention. It may result in complications like haemothorax, pleural effusions, pneumothorax, sepsis, thrombosis and cardiac tamponade. This case report presents timely detection of the complication after placement of CVC. Everyone should be aware of the complications and monitor consistently appropriate position of catheter tips.

Chronic Uterine Inversion Presenting as a Painless Vaginal Mass at 6 Months Post Partum: A Case Report

Eram Ali, Manisha Kumar

Uterine inversion is an abnormal protrusion of internal surface of relaxed uterus through the vaginal orifice. Its causes can be broadly classified as puerperal and non-puerperal with puerperal uterine inversion more common than non-puerperal uterine inversion. Acute inversions occurring immediately, or within 24 hours post-partum are the most common type. Chronic Uterine Inversions (CUI) occurring more than four weeks after the delivery are rare identities. There differential diagnosis includes prolapsed fibroids and endometrial polyp. Chronic nature of these inversions makes the restoration of the normal position of the uterus per vaginally difficult contrary to acute inversions which can be reposited more easily. We hereby present a case of 28-year-old lady who presented with a painless vaginal mass at 6 months post-partum. She was diagnosed as a case of CUI based on clinical and sonographic examination. Inverted uterus was successfully restored through per abdominal approach. The presentation of CUI as a painless vaginal mass at delayed post-partum period is rare and therefore reported.

Acute Type A Aortic Dissection Missed as Acute Coronary Syndrome

Mohammad Mostafa Ansari-Ramandi, Mohammad Javad Alemzadeh-Ansari, Ata Firoozi

Although the aortic dissection is not common, its outcome is frequently fatal, and many patients with aortic dissection die before referral to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar to myocardial ischemia. A 66-year-old male referred to our hospital with suspicion of aortic dissection after echocardiography while evaluating for his high blood pressure. He had symptoms of acute coronary syndrome two years before and had done coronary angiography. On presentation to our hospital he had a high blood pressure. On reviewing his past medical history and examining, in the film of coronary angiography, the dissection flap in ascending aorta was identified. Although type A aortic dissection is a catastrophic condition with high mortality and requires prompt surgical treatment but in some cases it may be misdiagnosed as acute coronary syndrome. Sometimes against its high mortality when left untreated, patients survive and are diagnosed later in life incidentally. So it is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with chest pain and the predisposing factors.

Isolated Primary Schwannoma of Urinary Bladder

Yateesh Srinivasa, Suresh Bhat, Fredrick Paul

Primary schwannoma of urinary bladder is a very rare tumour. It usually occurs in association with Von Recklinghausen’s disease. It arises from Schwann’s cells in the nerve sheath. We report here a very rare case of primary schwannoma of urinary bladder managed by complete transurethral resection.

Pseudoaneurysms Masquerading as Malignant Bone Tumours

Suman Byregowda, Ajay Puri, Ashish Gulia, Aruna Prabhu, Amit Janu

Swelling around the knees can be due to both neoplastic as well as non neoplastic aetiology. One of the rare cause for the same is pseudoaneurysm. Pseudoaneurysms can mimic a bone tumor or a soft tissue sarcoma. Pseudoanuerysms result because of the gradual growth occurring due to constant arterial pressure and development of a reactive fibrous capsule. Inappropriate diagnosis and management of these lesions may result in major morbidity and rarely mortality. We present two cases of pseudoaneurysms around the knees which were misdiagnosed as osteogenic sarcomas. These cases also stress on the importance of multidisciplinary care in preventing avoidable morbidity, mortality and providing safe and optimal care to the patients.

Caesarean Scar Ectopic Pregnancy: Report of Two Cases

Akshaya Kumar Mahapatro, Kundavi Shankar, Thankam Varma

Cases of Caesarean Scar Ectopic Pregnancy (CSEP) are becoming increasingly common at tertiary care hospitals because of increase in rate of CS. This condition is often complicated by life threatening bleeding, uterine rupture, which might require hysterectomy leading to permanent infertility. Management can be medical, surgical or combined depending on the clinical presentation. It includes systemic methotrexate or local uterine artery chemoembolisation, dilatation and curettage, excision of trophoblastic tissue either by laparoscopy or laparotomy with uterine repair. We report two such cases managed medically in our hospital. Both the cases presented to us were asymptomatic except amenorrhoea and were diagnosed by transvaginal sonography. First case was managed with systemic methotrexate followed by Dilatation and Curettage (D&C). Second case was managed with systemic methotrexate alone successfully.

Idiosyncratic Presentation of Cemento–Osseous Dysplasia – An in Depth Analysis Using Cone Beam Computed Tomography

Bone dysplasias comprise of a condition where the normal bone is replaced with fibrous tissue. Periapical Cemento-Osseous Dysplasia (PCOD) is a benign fibro-osseous condition where bone tissue is supplanted with fibrous tissue and cementum-like material. This condition affects mostly mandibular anterior region and rarely occurs in the maxilla. PCOD is seen above 30 years of age and has slight female predilection. Generally the teeth related to such lesions appear to be vital and are usually asymptomatic. These lesions are mostly seen during routine radiographic examination whose presentation may vary from complete radiolucency to dense radiopacity. The advent of Cone Beam Computed Tomography (CBCT) has brought a massive change in the field of dentistry which has become an important tool for diagnosis. Hence we hereby present an unusual case of cemento-osseous dysplasia in an unfamiliar location with an atypical presentation.The shape of the pathology was completely idiosyncratic and different from an orthodox lesion of COD, as the lesion was observed to grow out of the palatal surface with a prominent palatal expansion. This case highlights the importance of CBCT in radiographic diagnosis and in evaluating the characteristics of such lesion, which present with high diagnostic dilemma.

Basaloid Squamous Cell Carcinoma of Scalp From A Pre-Existing Cylindroma Metastasising To Brain: A Rare Case Report

Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer and accounts for 90% of head and neck malignancies. Intracranial metastases of SCC are extremely rare. We are reporting a case of 55-year-old female with history of recurrent swelling over right side of forehead which was previously reported as cylindroma. CT scan of head revealed irregular lytic areas in right frontal bone suggestive of erosion. There were multiple small, rim enhancing lesions in bilateral parietal regions. Clinically it was diagnosed as malignant adnexal tumour. Wide excision of the lesion revealed features of invasive basaloid squamous cell carcinoma, probably a malignant transformation of the pre-existing cylindroma.

Synthetic Cannabinoid Induced Acute Tubulointerstitial Nephritis and Uveitis Syndrome: A Case Report and Review of Literature

Ayse Sinangil, Vedat Celik, Alev Kockar, Tevfik Ecder

Tubulointerstitial Nephritis with Uveitis (TINU) syndrome is a rarely seen syndrome. The interstitial nephritis may be with the concurrent uveitis and can also develop before or after uveitis. The syndrome can resolve after elimination of the culprit destructive factors, such as drugs, toxins and immune reaction. Synthetic cannabinoids have emerged as drugs of abuse with increasing popularity among young adults. Recent literature has documented reports of acute kidney injury in association with the use of synthetic cannabinoids; however, there is no report of TINU syndrome development secondary to using of synthetic cannabinoids. Herein, we report a 42-year-old male with TINU syndrome associated with smoking synthetic cannabinoid.

Appendicular Tourniquet: A Cause of Intestinal Obstruction

Intestinal obstruction is one of the common surgical emergencies seen in daily practice. Postoperative adhesions are notorious for being the most common cause for intestinal obstruction. Occasionally, laparotomy findings do come as a surprise to surgeons. Here one such case is discussed. A patient was operated on with suspicion of intestinal obstruction secondary to postoperative adhesions. However, laparotomy revealed the appendix to be inflamed, curled around the terminal ileum and acting as a tourniquet.

Penile Epidermal Cyst: A Case Report

Veerapandian Kumaraguru, Ravi Prabhu, Narayanasamy Subbaraju Kannan

Epidermal cysts also known as epidermoid cysts, is one of the common benign tumours presenting anywhere in the body. However, epidermal cyst in the penis is very rare. This condition in children is usually congenital due to abnormal embryologic closure of the median raphe; hence, it is termed as median raphe cysts (MRCs). Penile epidermal cysts may occur in adults following trauma or surgery due to epidermal elements being trapped within closed space. During wound healing, trapped squamous epithelium, undergoing keratinisation leads to cyst formation. Here, we report a rare case of patient with a penile epidermoid cyst whose main complaints was discomfort during coitus.

A Rare Case of Fetus within a Fetus

Sonali Ullal, Pulastya Sanyal, Nutan Kamath, Sadashiva Rao

We present a case of a 45-day-old baby brought to our paediatric outpatient department with complaints of abdominal distension. The prenatal ultrasonographic examination showed a large cystic intrabdominal mass with internal calcifications.

An Unusual Combination of Biliary Cystadenoma and Renal Angiomyolipoma- A Case Report

Sheeja Sainulabdeen, Renu Thambi, Sylvia Syriac, Anil Kumar

Hepatobiliary cystadenomas are mucinous cystic neoplasms arising in the liver, extrahepatic bile ducts or gall bladder. Extrahepatic cystadenomas are rare neoplasms requiring complete excision as there is a chance for recurrence and malignant transformation. Angiomyolipoma (AML) belongs to the perivascular epithelioid cell group of neoplasms, and kidney is the commonest site involved.We report a case of an unusual combination of extrahepatic biliary cystadenoma with angiomyolipoma in an adult female without evidence of tuberous sclerosis. The patient presented with abdominal discomfort and on ultrasonological examination showed a cyst close to liver suggestive of hydatid disease and an incidental mass in kidney which was diagnosed as angiomyolipoma. Histopathological examination revealed biliary cystadenoma of liver and renal angiomyolipoma. Clinical and radiological evaluation did not show any manifestations of tuberous sclerosis. Such an unusual incidence of two separate neoplasms in a patient without syndromic association was not obtained even after extensive literature search.

Subcutaneous Panniculitis-Like T-Cell Lymphoma: A Rare Tumour

Subcutaneous Panniculitis like T cell Lymphoma (SPTCL) is an uncommon variant and poorly differentiated type of cutaneous T cell lymphoma. Here we describe the case of a 19-year-old female who presented with swelling of left half of the face with no regional lymphadenopathy and hepatosplenomegaly which was initially misdiagnosed as a benign cutaneous condition by various practitioners. Histopathological examination revealed diffuse infiltration of subcutaneous plane by small to medium sized atypical lymphocytes. Immunohistochemistry showed CD3, CD8 and ßF-1 positivity; CD20, CD56, Epstein Barr Virus (EBV) and TCR-d negativity. Clinical profile, histopathology and immunohistochemical analysis yielded a diagnosis of SPTCL. Thus cases with atypical and nonresolving dermatological lesions should raise a suspicion of SPTCL as diagnosis against other benign conditions.

Left-Sided Persistent Superior Vena Cava with Superior Hemiazygos Arch

Lokadolalu Chandracharya Prasanna, Huban R. Thomas, Aswin Das, Rakesh Kumar

Persistent Left-side Superior Vena Cava (PLSVC) is the congenital central venous anomaly draining into the right atrium in 82-90% of cases via coronary sinus produce no haemodynamically significant consequences. In few cases it may drain into the left atrium directly or through the pulmonary veins resulting in right to left shunt. During routine undergraduate dissection, we found a PLSVC formed by the union of left subclavian and left internal jugular veins behind the left sternoclavicular joint was terminated into the right atrium through a larger coronary sinus ostium. Before its termination, PLSVC received a left hemiazygos vein formed by the continuation of the superior and inferior hemiazygos veins. A larger but thin communicating vein was noted between the right superior vena cava and PLSVC. Prior knowledge about such variations is essential in all the intervention procedures on right atrium through the left subclavian approach and also like in our case, the larger coronary sinus ostium if found during transthoracic echocardiography should be considered as an indication for the diagnosis of PLSVC.

Chronic Myeloid Leukaemia Presenting as Bilateral Retinal Haemorrhages with Multiple Retinal Infiltrates

Chronic Myeloid Leukaemia (CML) causes retinopathy manifesting as venous dilation and tortuosity, perivascular sheathing, retinal haemorrhages, microaneurysms, cotton-wool spots and optic nerve infiltration. Retina is the most commonly involved intraocular structure in CML. However, retinal involvement is a rare form of presentation of CML and few cases have been reported. We report a case of CML presenting as unilateral sudden visual loss. Fundus showed multiple white centered retinal haemorrhages in both eyes with unilateral macular oedema. Blood work-up showed raised WBC count, high platelet count and low Haemoglobin. Cytological analysis of bone marrow biopsy confirmed Philadelphia chromosome. After a course of Imatinib, visual acuity improved and haemorrhages resolved with normalization of macular thickness. In our case, patient presented early, leading to early detection producing better visual prognosis. This highlights the importance of detailed hematological work up in patients with retinal involvement to rule out leukaemic retinopathy.

Acute Myocardial Infarction with Left Ventricular Failure as an Initial Presentation of Takayasu’s Arteritis

Amrish Saxena, Tushar R Sontakke, Deepankar Mishra, Shilpa Saxena, Pankaj Banode

Takayasu’s Arteritis (TA) is an uncommon chronic inflammatory and stenotic disease of medium and large-sized arteries characterized by a strong predilection for the aortic arch and its major branches. We report a rare manifestation of TA in a 16-year-old female with no previous history of heart disease who presented with heart failure. She was found to have hypertension and discrepancies of pulses in upper and lower limbs. She developed ST elevated anterior wall myocardial infarction (MI) during hospitalization. Her aortography revealed narrowing of descending thoracic, upper abdominal and infrarenal aorta with significant stenosis of both renal arteries. She was diagnosed as a case of TA on the basis of her clinical profile and arteriography. Her coronary angiography did not reveal any stenosis or occlusion or aneurysm in coronary arteries or at coronary ostia which is in contrast to patients of TA with MI reported in the literature who had focal or diffuse stenosis or aneurysm in the coronaries.

Early Onset Neonatal Septicaemia Caused by Pantoea agglomerans

Pantoea agglomerans is an opportunistic pathogen causing infection in the immunocompromised patients. It is a plant pathogen and a rare human pathogen causing neonatal sepsis, joint infection, urinary tract infection and bloodstream infections. Neonatal Gram negative septicaemia may have an unusual presentation of subtle generalised neonatal seizures without any other cardinal features of sepsis. An appropriate diagnosis is therefore the key to proper management. P. agglomerans being an unusual cause of neonatal sepsis should be diagnosed early with proper antibiogram for clinical cure. Here, we report a case of neonatal sepsis caused by P. agglomerans in a tertiary care hospital in Eastern India.

Masson’s Haemangioma Presenting as a Fibrolipoma

Astha Sarda, Murugappan Nachiappan

Masson’s haemangioma, also known as intra vascular papillary endothelial hyperplasia, is a rare benign condition which usually occurs due to traumatic vascular stasis. It is almost always associated with thrombus formation in the lumen of a vessel. Its significance lies in the fact that it can be easily misdiagnosed as a soft tissue sarcoma due to its clinical similarity to the same. Here, we present a case of Masson`s haemangioma in a 29-year-old male misinterpreted as fibrolipoma.

Postpartum Vaginal Stenosis Due to Chemical Vaginitis

Gurcharan Kaur, Maruti Sinha, Ridhima Gupta

Acquired vaginal stenosis is a rare obstructing anomaly, which can be caused by use of chemicals in the vagina. A 21-year-old gravida 1 para 1, presented with secondary amenorrhea and inability to have sexual intercourse, after normal spontaneous vaginal delivery complicated by post partum bleeding. The delivery was conducted by untrained traditional birth attendant at home. The wash cloth soaked with caustic soda was packed in the patient’s vagina and was left in situ for 10 days, which ultimately led to the severe scarring and stenosis of the vagina. Patient underwent surgical management and the extensive vaginal adhesions were excised and a patent vagina was reconstructed. Patient then reported successful vaginal intercourse without dyspareunia. Post partum vaginal stenosis due to chemical vaginitis is rare. These cases can be prevented by adequate training of untrained health care workers.

A Case of Coronary Cameral Fistula with Associated Aneurysm: Role of ECG Gated 256- Slice Dual Source Multidetector Computed Tomography in Diagnosis

Umesh Kumar Mittal, Lalit Garg, Harmeet Kaur Rissam, Sunil Kumar Puri

We report an interesting case of coronary cameral fistula with associated aneurysmal dilatation of coronary artery. The complete evaluation including anatomical relationships with surrounding vascular and non-vascular structures can be achieved with ECG gated multi-detector computed tomography (MDCT). MDCT has many advantages over echocardiography and digital subtraction catheter angiography, because of its ability to demonstrate the fistula separate from surrounding cardiovascular structures along with any aneurysm or obstruction in its course. Thus, MDCT is emerging as the initial non-invasive imaging technique for comprehensive preoperative evaluation of these rare congenital anomalies for cardiovascular surgeons to achieve better operative assessibity and outcome.

Obsessive-Compulsive Symptoms in an Adolescent Appearing after Cerebellar Vermian Mass Resection

Harshal Sathe, Sagar Karia, Avinash De Sousa, Nilesh Shah

Obsessive compulsive symptoms have been reported in frontal lobe tumours and basal ganglia lesions. We report herewith a case of an adolescent who had a vermian cystic mass for which he underwent excision surgery. Three months postsurgery family members noticed that he started with repeated hand washing and abnormal walking pattern. Also, he developed bedwetting in sleep at night. He was given clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and Nocturnal enuresis following a cerebellar mass removal which improved with fluoxetine and impiramine respectively.

ST-Elevation Myocardial Infarction 33 Days after Lung Transplant in a Patient with Non-Significant CAD before Transplantation: A Case Report

Acute myocardial infarction after lung transplantation is not well illustrated in the literature. We present a patient with documented non significant Coronary Artery Disease (CAD) in coronary angiography before lung transplant who was referred to our hospital with acute Myocardial Infarction (MI) 33 days following lung transplantation.

Herpes Simplex Encephalitis: An Uncommon Presentation

Nidhi Kaeley, Sunil Bansal, Rohan Bhatia, Sohaib Ahmad

Herpes Simplex Virus (HSV) encephalitis is an uncommon illness, with about 2 cases per 250,000 per year. Most are caused by HSV-1, with 10% having HSV-2 as the aetiologic factor. We present a case of Herpes simplex type1encephalitis in a 70 year old male with an uncommon presentation. The patient was a known case of endogenous depression with no medical records and on no treatment for the same, reported with acute changes in mental state for the past five days. He was talking irrelevantly, had hallucinations and was unduly aggressive and violent. He was subjected to a thorough clinical and diagnostic work-up which included cerebrospinal fluid analysis, CT head and MRI brain. MRI brain was suggestive of mild subdural effusion which hinted towards infectious cause of encephalitis. The cerebrospinal fluid viral serology panel detected herpes simplex type 1 virus (HSV1) that was later confirmed by CSF Polymerase Chain Reaction (PCR) technique. Hence, acyclovir was initiated by intravenous route at a dosage of 10mg/kg body weight and continued for two weeks. This case holds significance in view of the fact that organic causes must be excluded in suspected cases of psychiatric illness especially in the absence of fever. Also, CSF-PCR testing plays a pivotal role in diagnosing herpes simplex encephalitis.

Ectodermal Dysplasia: Management of Knife-Edged Irregular Ridge and Its Rehabilitation with Hybrid Implant Prosthesis

Ectodermal Dysplasia Syndrome (EDS) is mainly X-linked inherited disorder with male predominance. According to Lyon hypothesis, female patients may show partial expression of EDS. Oral findings include hypodontia, rarely anodontia, protuberant lips, hyposalivation, conical teeth and loss of vertical dimension. The alveolar process fails to develop in the three dimensions. Such patients present a challenge to dental treatment due to an irregular residual ridge. This case report presents oral, functional and aesthetic rehabilitation of a 21-year-old female diagnosed with EDS using implants in the anterior maxilla at the sites of the canines bilaterally. Following, implant placement, it was noted that implant in the region of right canine was labially inclined compared to implant in the region of left canine, but both were centered in the ridge. To manage non-parallelism, one-piece titanium framework was fabricated using computer numeric controlled (CNC) machine. Subsequently, tooth and gingival shade ceramics were fired to simulate natural teeth and compensate for gingival deficiency respectively. The treatment described here restored patient's aesthetics, function, self-confidence and status in society.

Fixed Appliance with Expansion Screw for the Treatment of Primary Anterior Crossbite

Sanchit Paul, Ashwin Rao, Paul Chalakkal, Saranya Mony

Anterior crossbite occurring during the primary dentition stage needs immediate correction so that functional, aesthetic and skeletal complications may be avoided in the future. This article describes a fixed appliance with an expansion screw that was successfully used for the treatment of primary anterior crossbite. Crossbite correction was achieved in about six weeks. A detailed description with regard to fabrication of the appliance has also been discussed.

Degloving Injury of Bowel: An Unheard Complication of Surgical Abortion

Sonia Chawla, Sandhya Jain, Amita Suneja, Kiran Guleria

Unsafe abortion is one of the leading causes of maternal mortality. Various types of intestinal injury in form of haematoma, perforation, contusion and transection have been reported. Degloving injury of intestine is one of the rarest complications. We report a case of 32-year-old lady Gravida 4, para 3 admitted with history of induced surgical abortion by a quack with degloving injury to bowel. Though there was no fecal soiling of peritoneal cavity but large segment of bowel was lost. She was managed by end ileostomy and discharged in stable condition.

Schimidt Syndrome: An Unusual Cause of Hypercalcaemia

Nisha Jose, George Prashanth Kurian

Autoimmune polyglandular syndrome type 2 also known as Schmidt syndrome. It is a rare disorder involving a combination of Addison’s disease with autoimmune thyroid disease with or without type 1 diabetes mellitus. In this case report one such patient with this rare syndrome is described who presented with hyperpigmentation of knuckles, palms and soles with significant weight loss for 2 months. At presentation she also had severe hypercalcaemia. Severe hypercalcaemia is rare and hypercalcaemia at the initial presentation of Addison’s disease is also unusual. The mechanism of hypercalcaemia in addisons and management of this patient is discussed.

Superficial Ulnar Artery Associated with Anomalous Origin of the Common Interosseous and Ulnar Recurrent Arteries

Occurrence of vascular variations in the upper limb is not uncommon and is well described in the medical literature. However, occurrence of superficial ulnar artery associated with unusual origin of the common interosseous and ulnar recurrent arteries is seldom reported in the literature. In the present case, we report the anomalous origin of common trunk of common interosseous, anterior and posterior ulnar recurrent arteries from the radial artery, in a male cadaver. Further, ulnar artery had presented superficial course. Knowledge of anomalous arterial pattern in the cubital fossa reported here is clinically important during the angiographic procedures and plastic surgeries.

An Unusual Case of Myelitis with Myositis

Neera Choudhary, Prashant Makhija, Vinod Puri, Geeta Anjum Khwaja, Ashish Duggal

The Chikungunya virus belonging to genus alphavirus and family togaviridae causes an arthropod-borne self-limiting febrile illness in humans. Neurological complications are rare with myelitis being even a rarer presentation. We report here a patient with Chikungunya fever who developed acute transverse myelitis with myositis during the convalescent period.

Clear Cell Adenocarcinofibroma Ovary – A Rare Histopathological Variant with Unusual Presentation

Manjit Kaur, Navtej Singh, Amrit Pal Singh Rana

The clear cell adenocarcinoma of ovary is a distinctive tumour. Stroma rich variants (adenocarcinofibroma) of these types of tumours are uncommon. We report a rare case of clear cell adenocarcinofibroma of ovary in 37 years of female presenting with bilateral ovarian masses. The tumour contained fibrous component and was radiologically indistinguishable from soft tissue malignancy. The serum level of CA-125 was raised. Histopathology and immunohistochemistry revealed the rare microscopic type of ovarian tumour. Because of differences in the clinical course as well as management, possibility of this unusual type of carcinoma must be ruled out.

Acute Painful Neuropathy in a Girl with Type 1 Diabetes: Long Term Follow-Up

Devi Dayal, Dhaarani Jayaraman, Naveen Sankhyan, Pratibha Singhi

Acute Painful Diabetic Neuropathy (APDN) is a reversible neuropathy that occurs in patients with diabetes usually after a fast improvement in glycaemic control. The condition is extremely rare in children with Type 1 Diabetes (T1D). We describe a 12-year-old girl T1D who developed APDN shortly after diagnosis of T1D. Neurological examination, nerve conduction studies showed severe asymmetric lower limb sensorimotor neuropathy. She was treated with carbamazepine and benfotiamine (vitamin B1 analogue), and NSAID analgesics and showed complete recovery 9 months after the onset. The treating physicians should recognize and understand this entity in view of the current recommendations for quick achievement of glycaemic targets in T1D, the need to provide relief from severe pain and to lay emphasis on complete recovery.

Persistent Left Superior Vena Cava: A Rare Case with Clinical Significance

Gautam Rawal, Raj Kumar, Sankalp Yadav, Deepak Verma

Persistent Left Superior Vena Cava (PLSVC) is a rare congenital vascular anomaly (incidence of 0.3-0.5% of the general population) which being mostly asymptomatic in its presentation, is usually detected incidentally. There are many practical clinical implications associated with it including arrhythmias. We report a rare case of PLSVC with absent Right Superior Vena Cava (RSVC) (isolated PLSVC), in a 55-year-old lady who had complete heart block followed by sepsis and was diagnosed to have this condition during the permanent cardiac pacemaker implantation and central venous catheter insertion showing an abnormal path of the catheter/pacing leads. The authors also give an insight into its clinical relevance.

A Case of Recto-Vesico-Cutaneous Fistula Following Perineal Injury by Wild Boar

Pravin D. Bhingare, Umesh Ravikant Shelke, Yogesh A. Bang

It is very uncommon for a boar to become aggressive in nature against human unless they are cornered. A wild boar attacked a 24-year-old male from behind in perineal region. At presentation, he had continuous dribbling of urine and fecal matter from perineal wound. On CT-scan, a well defined tract delineated by contrast was seen between postero-lateral aspect of bladder and anterior wall of rectum, and there was contrast extravasation through perineal wound. After resuscitation, fistula was repaired through abdominal approach, and perineal wound was debrided. Emergency physician should be aware of such cases as increasing deforestation and shifting of humans to sub-urban area, have resulted in increased incidences of wild boar attack. Prompt stabilization of patient, treatment of infection with proper antibiotics, prevention of tetanus and rabies infection and emergency surgical interventions are necessary to reduce morbidity and mortality from such trauma.

A Case of Erythroderma Secondary to Hypereosinophilia

Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterised by marked peripheral eosinophilia and end organ damage attributable to eosinophilia without secondary cause. Early recognition and treatment are essential to prevent morbidity and mortality. Cytoreduction with Steroids, Hydroxyurea and Imatinib are the main stay of treatment. Molecular studies like Fip1-like-1 fused with platelet derived growth factor receptor alpha (FIP1L1-PDGFRa) etc., are recommended in view of therapeutic implication. In this paper we report a rare case of HES developing in a lady 6 months after surgical removal of lymphangioma of spleen, which in itself is rare.

Primary Non-Hodgkin´s Lymphoma of the Ovary – A Case Report

Richa Bhartiya, Nawanita Kumari, Mahasweta Mallik, Ran Vijoy Narayan Singh

The ovarian lymphoma is rare. Lymphoma presenting as an ovarian mass with initial manifestation is even rarer. We report a case of primary Non-Hodgkin’s Lymphoma (NHL) of left ovary in a 52-year-old female presented with distension of abdomen and lower abdominal back pain. USG and CT-scan imaging suggested provisional diagnosis of ovarian tumour. The diagnosis of malignant lymphoma was made by histopathological examination of the excised tissue along with immunohistochemistry by using LCA, CD20, cytokeratin & CD3. The tumour was classified as diffuse large B cell lymphoma. Rarity of this lesion warrants its mention.

Primary Nasopharngeal Yolk Sac Tumor: A Case Report

Yolk sac tumour also known as primitive endodermal tumour is the most common malignant germ cell tumour (GCT) in the paediatric age group. Most common sites of involvement are ovaries and testes, but rarely can occur in the extragonadal sites. In the head and neck region, yolk sac tumours have been reported in the nasopharynx, sinonasal tract, orbit, ear and parotid gland. Nasopharynx is an uncommon site for yolk sac tumour and very few cases of nasopharngeal pure yolk sac tumour have been reported so far. Yolk sac tumours are highly malignant and have a poor prognosis. This is a case of pure GCT in a three-year-old female child who presented with a rapidly growing nasopharyngeal mass. Histopathological examination followed by immunohistochemistry and serum AFP study clinched the diagnosis of yolk sac tumour. The tumour responded well to chemotherapy as evidenced by decrease in serum AFP levels.

Urinothorax: A Rare Postoperative Complication of Adrenalectomy

Urinothorax is a rare condition defined by the presence of urine in the pleural cavity. Here we report a case of a patient with left sided transudative pleural effusion which developed following left adrenalectomy with perisplenic collection. The pleural fluid to serum creatinine ratio was found to be greater than one which confirmed the diagnosis. The objective of this case report was to describe this rare case and to alert the physicians to include urinothorax in their differential diagnosis of transudative pleural effusion especially following abdominal surgery.

Unusual Presentation of Light Chain Deposition Disease: A Case Report

Disha Arora, Mayank Uppal, Vindu Amitabh, Usha Agrawal

Light Chain Deposition Disease (LCDD) is a rare disease characterized by deposition of monoclonal non-amyloid light chains in multiple organs. We report an unusual histologic manifestation of LCDD in a 55-year-old female patient, who presented with nephrotic syndrome and an increased serum creatinine. This case of LCDD had features of cast nephropathy on biopsy which is diagnostic of myeloma kidney, when the patient was clinically asymptomatic. Serum electrophoresis showed no abnormal band. There was no other evidence of a B-cell clonal disorder or amyloidosis. Following chemotherapy, improvement in renal function correlated with a reduction in circulating light-chain levels.

Acute Bilateral Tuberculous Pneumonia in a Patient with Systemic Lupus Erythematosus

Raghavendra Rao, Rama Bhat, Nitin Bhat, Savio D’Souza, Venkata Chenchaiah

Pulmonary tuberculosis is a common infection associated with immunocompromised state. It usually presents with fibrosis or fibrocavitary lesions in the lung. We report a case of bilateral tuberculous pneumonia of acute presentation in a young lady who was being treated for systemic lupus erythematosus.

Carcinosarcoma of the Larynx- A Rare Site Entity

Carcinosarcoma is a very rare lesion reported in many organs including larynx. The larynx appears to be highly unusual site, only a few cases have been described in the literature. Carcinosarcoma is a mixed tumour. It is composed of both malignant epithelial and mesenchymal elements. We report a case of Carcinosarcoma of the larynx in 45-year-old male. He presented with complaints of hoarseness of voice, difficulty in breathing and swallowing. The growth was pedenculated arising from left vocal cord. Diagnosis was confirmed by histopathology. Keywords: Carcinoma, Mesenchyme, Sarcoma

A Tumour in Disguise in the Right Palm- Monophasic Synovial Sarcoma

Synovial sarcoma is one of the poorly differentiated malignant soft tissue tumour occuring commonly among young adults in the extremities. We report a 50-year-old female presenting with a soft tissue mass in the right palm. On examination, a single firm and non tender swelling was noticed adjacent to the thenar muscles. Radiology suggested a benign soft tissue lesion. The swelling, clinically thought to be a lipoma, was excised and sent for histopathological examination. Microscopy showed a highly cellular tumour arranged in nests, cords and pseudo glandular pattern separated by dense fibrocollagenous tissue. An interesting and baffling finding was the presence of a distinct mucin vacuole in many of the tumour cells. A diagnosis of soft tissue sarcoma with epithelial features was considered and a panel of immunohistochemical stains done. Tumour cells showed strong positivity for cytokeratin 7, vimentin, EMA & Bcl2. CD 99 and S100 were focally positive. CD 34 and CEA were negative. In view of the above microscopic and immunohistochemical findings, a diagnosis of monophasic synovial sarcoma of epithelial type was rendered. This case is being documented for the rare morphological appearance of mucin vacuoles in a monophasic epithelial type synovial sarcoma.

Rapid Maxillary Expansion to Correct Palatal Fracture Malunion: A Case Report

Mid palatal fractures are usually present in conjunction with Le Fort I maxillary fractures. Literature on isolated mid palatal fractures as seen in this case is relatively rare. A novel approach for the management of this case was undertaken. A rapid maxillary expander was used to separate palatal segments which healed well. The patient’s crossbite and open bite was corrected with elastic use. The protocol of management of malunion of isolated mid palatal fractures is simple with reduced costs, morbidity and higher rates of acceptance. We report a case of a 26-year-old male patient involved in a road traffic accident leading to an isolated mid palatal fracture which is a rare entity. Due to lack of specialized care, the fracture fragments united inadequately resulting in deranged occlusion, open bite and reduced masticatory efficiency.

Mucormycosis in a Diabetic Ketoacidosis Patient: A Case Report

Siddanagouda Biradar, Shivraj N Patil, Deepak Kadeli

Mucormycosis is the name given to several different diseases caused by fungi of the order mucorales. It is commonly seen in patients with decreased immunity like patients with chronic renal failure, organ transplantation, neutropenia and most commonly in those with poorly controlled diabetes. We present a case of 55-year-old diabetic man who presented with headache and fever diagnosed with pulmonary and maxillary sinus mucormycosis presenting as diabetic ketoacidosis.

Chondromyxoid Fibroma of Radius: A Case Report

Rajakumar M. Bagewadi, Savitri Mallikarjun Nerune, Surekha B. Hippargi

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumour accounting to less than 1% of bone tumours. It is most commonly seen in lower extremity involving tibia. CMF of radius is rare. We report a rare case of CMF of proximal radius in a 37-year-old female who presented with swelling and pain over right elbow. Wide local excision of proximal radius along with radial head was done and above elbow POP slab was applied for one month. Elbow range of movement exercises started after one month.

Self Mutilating Behaviour in Severe Meningococcal Infection; An Interesting Association

Neisseria meningitidis most commonly manifests as asymptomatic colonization in the nasopharynx of healthy adolescents and adults. It may rarely present as invasive disease which may be either bacterial meningitis or meningococcal septicaemia. Hereby we report a case presented with fever and rashes, irritability followed by self mutilating behaviour who was diagnosed as a case of invasive meningococcal infection. He responded well to treatment with intravenous ceftriaxone and self mutilating behaviour was subsided completely after treatment. Necrosed tissues of fingers were amputated. With best of our knowledge, no similar case of self-mutilation associated with meningococcal infection has been reported yet.

Leukemoid Reaction in Chikungunya Fever

Prabhat kumar, Riyaz Charaniya, Ratnakar Sahoo, Ghazal Tansir, Gargi Sasmal

Chikungunya is a viral illness caused by an arbovirus which is transmitted by Aedes mosquito. Fever and polyarthralgia are hallmark of this viral illness. Viral infections are generally associated with leucopenia and bacterial infections with leukocytosis. Leukemoid Reaction (LR) is defined by reactive increase in leukocyte count of more than 50,000/cu mm with increase in mature leukocytes on peripheral blood. Leukocytosis is common in Chikungunya but leukemoid reaction has not been reported in medical literature. Our patient presented with high grade fever and symmetrical polyarthritis. Blood investigation showed Leukemoid reaction and after extensive work up a diagnosis of chikungunya was made.

Pulmonary Artery Aneurysm Thrombosis with Combined Pulmonary Fibrosis and Emphysema: A Case Report

Mitali Bharat Agrawal, Nilkant Tukaram Awad

We report a rare case of Pulmonary Artery Aneurysm (PAA) thrombosis with Combined Pulmonary Fibrosis and Emphysema (CPFE) with pulmonary hypertension. A 75-year-old male presented with haemoptysis, dyspnoea, clubbing and bilateral fine end inspiratory rales on examination. He was diagnosed to have PAA thrombosis with CPFE on the basis of computed tomographical angiography and high resolution computed tomography. He was then managed conservatively with pirfenidone for the interstitial lung disease.

Temporal Lobe Encephalitis Need not Always be Herpes Simplex Encephalitis: Think of Tuberculosis

Jagadesh Madireddi, Gowtham Reddy, Weena Stanley, Mukhyaprana Prabu

Historically, temporal lobe encephalitis is considered as a pathognomonic feature of Herpes simplex encephalitis. This rule may not always be true and we believe that clinicians should keep their differential open. We here report once such. Case of a 36-year-old Indian male who developed altered sensorium following a prodrome of headache and fever. Examination and imaging suggested Temporal Lobe Encephalitis (TLE). Herpes encephalitis was considered and he was started on anti-virals awaiting lumbar puncture reports. Cerebrospinal fluid (CSF) analysis for Herpes Polymerase Chain Reaction (PCR) turned out to be negative. Later, to our surprise PCR for tuberculosis (TB) was positive. CSF was 100% lymphocytic and Adenosine deaminase was 12. He was started on 5 drug anti-tuberculosis regimen following which he showed a significant clinical improvement. Given the prevalence of tuberculosis in the sub-continent, clinicians must be aware of this diagnostic possibility when a patient with TLE does not respond to anti-virals. Apart from disease specific therapy, multi-disciplinary approach involving speech therapy is warranted. An early aetiological characterization of TLE has both diagnostic and prognostic implications, failing which patient may succumb.

Remote Cerebellar Haemorrhage after Burr Hole Drainage of Chronic Subdural Haematoma: A Case Report

Mehmet Sabri Gürbüz, Numan Karaarslan, Sevki Gök, Celaleddin Soyalp

Remote cerebellar haemorrhage (RCH) is an unusual complication of supratentorial neurosurgical procedures. Even the rarer is cerebellar haemorrhage occurring after supratentorial burr hole drainage of Chronic Subdural Haematoma (CSDH). The exact mechanism is still unclear despite some possible causative factors such as rapid evacuation of haematoma and overdrainage of CSF (Cerebrospinal Fluid). We report a 80-year-old male patient who developed cerebellar haemorrhage after burr hole drainage of left frontoparietal chronic subdural haematoma and discuss the possible aetiological mechanisms through the review of the current literature.

Oculomotor Nerve Palsy as a Rare Presentation and First Sign of Multiple Myeloma

Bijnya Birajita Panda, Sucheta Parija, Jyotiranjan Mallick, Susanta Pujahari

Acquired oculomotor nerve palsy has varied aetiologies like vascular (diabetes, heart disease, atherosclerosis and posterior communicating artery aneurysm), space occupying lesions or tumours, inflammation, infection, trauma, demyelinating disease like Multiple sclerosis, autoimmune disorders such as Myasthenia gravis, postoperatively as a complication of neurosurgery, cavernous sinus thrombosis etc. Cranial Nerve palsies as one of the first symptoms of multiple myeloma have been reported sparsely in literature. We report a case of a 60-year-old woman who developed sudden onset right-sided pupil sparing oculomotor nerve palsy along with a tender swelling at right sternoclavicular joint. Cranial and orbital magnetic resonance imaging and cerebrospinal fluid examination demonstrated no abnormalities. Immunological investigations and histopathological analysis of sternoclavicular joint swelling confirmed the diagnosis of IgG type multiple myeloma. After confirmation of diagnosis we started her with appropriate chemotherapy, after which the palsy resolved within one month. The cause of the palsy was probably due to nerve ischemia due to hyper viscosity of the serum.

The Clinical Effectiveness of Post-Brushing Rinsing in Reducing Plaque and Gingivitis: A Systematic Review

Introduction: Dental plaque is the major etiological factor associated with the development of gingivitis. Hence, maintenance of oral hygiene is very essential. Aim:To systematically review the literature on the effects of a post toothbrushing rinsing on plaque and parameters of gingival inflammation. Materials and Methods: A literature review was performed in PubMed Central and Cochrane library, embase, google scholar were searched up to February 2015 to identify appropriate studies. The primary outcome measure was plaque and gingival inflammation reduction. Results: Out of the total 56 titles appeared, 08articles fulfilled the criteria and were selected for the review. One article which was hand searched and one article which was through e-mail was included. A statistically significant reduction in overall plaque and gingivitis was noted when different mouth rinses were compared to the control (p<0.05). It was seen that chlorhexidine is the best antiplaque and antigingivitis agent but due to its side effects after continuous use, was not indicated for long term use. Probiotic was superior to chlorhexidine in terms of reduction of gingival inflammation. Conclusion: There are relatively few studies evaluating the association between post toothbrushing rinsing and gingivitis. A clear effect was observed, indicating that different mouthrinses (chlorhexidine, probiotic, herbal, essential oil mouthrinse) when used as an adjunct to mechanical means of oral hygiene, provides an additional benefit with regard to plaque and gingivitis reduction as compared to a placebo or control.

Oral Manifestations and Molecular Basis of Oral Genodermatoses: A Review

Kiran Kumar, A.S. Shilpasree, Meenakshi Chaudhary

Genodermatoses refers to group of inherited monogenic disorders with skin manifestations. Many of these disorders are rare and also have oral manifestations, called oral genodermatoses. This article provides a focused review of molecular basis of important genodermatoses that affects the oral cavity and also have prominent associated dermatologic features. In several conditions discussed here, the oral findings are distinct and may provide the first clue of an underlying genetic diagnosis. The article also emphasises on the prenatal diagnosis, genetic counselling and the treatment oral genodermatoses.

An Evaluation on Medical Education, Research and Development of AYUSH Systems of Medicine through Five Year Plans of India

Janmejaya Samal, Ranjit Kumar Dehury

Introduction: Indian system of medicine has its origin in India. The system is currently renamed as AYUSH, an acronym for Ayurveda, Yoga & Naturopathy, Unani, Sidha and Homeopathy. These are the six Indian systems of medicine prevalent and practiced in India and in few neighboring Asian countries. Objective: The primary objective of this review was to gain insight in to the prior and existing initiatives which would enable reflection and assist in the identification of future change. Materials and Methods: A review was carried out based on the five year plan documents, obtained from the planning commission web portal of Govt. of India, on medical education, research and development of AYUSH systems of medicine. Results: Post independence, the process of five year planning took its birth with the initiation of long term planning in India. The planning process embraced all the social and technology sectors in it. Since the beginning of five year planning, health and family welfare planning became imperative as a social sector planning. Planning regarding Indian Systems of Medicine became a part of health and family welfare planning since then. During the entire planning process, a progressive path of development could be observed as per this evaluation. A relatively sluggish process of development was observed up to seventh plan however post eighth plan the growth took its pace. Eighth plan onwards several innovative development processes could be noticed. Despite the relative developments and growth of Indian systems of medicine these systems have to face lot of criticism and appraisal owing to their various characteristic features. In the beginning the system thrived with great degree of uncertainty, as described in 1st five year plan, however has progressed ahead with a vision to be a globally accepted system, as envisaged in 11th five year plan. Conclusion: A very strong optimistic approach in spreading India’s own medical heritage is the need of the hour. The efforts are neither completely insufficient nor sufficient enough; hence a continuous endeavor for the revival and dissemination of India’s own medical inheritance for the welfare of the society at large is highly desirable.

Tobacco Use Cessation and Prevention – A Review

Tobacco use is a major preventable cause of premature death and disease, currently leading to over five million deaths each year worldwide. Smoking or chewing tobacco can seriously affect general, as well as oral health. Oral health professionals play an important role in promoting tobacco free-lifestyles. They should counsel their patients not to smoke; and reinforce the anti-tobacco message and refer the patients to smoking cessation services. Dentists are in a unique position to educate and motivate patients concerning the hazards of tobacco to their oral and systemic health, and to provide intervention programs as a part of routine patient care. Tobacco cessation is necessary to reduce morbidity and mortality related to tobacco use. Strategies for tobacco cessation involves 5 A’s and 5 R’s approach, quit lines and pharmacotherapy. Additionally, tobacco cessation programs should be conducted at community, state and national levels. Various policies should be employed for better tobacco control. Governments should implement the tobacco control measures to reduce the prevalence of tobacco use and exposure to tobacco smoke. In addition, there should be availability of leaflets, brochures, continuing patient education materials regarding tobacco cessation.

The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms “professionalism” AND “duty” AND “assessment” OR “professionalism behavioural” AND “professionalism–cognitive” were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.

Molecular Characterization of Clear Cell Lesions of Head and Neck

Anshi Jain, Devi Charan Shetty, Saurabh Juneja, Nidhi Narwal

The salivary glands, oral mucosa and jaws constitute a group of lesions which are heterogeneous in nature and are odontogenic, salivary or metastatic in origin. This group of tumours is termed as Clear Cell Tumours. Fixation artifacts are one of the most important reasons for the cell to appear clear but clearing of cells may also result from cytoplasmic accumulation of water, presence of glycogen within the cell, intermediate filaments, immature zymogen granules, or a paucity of cellular organelles. Clear cell Odontogenic neoplasms predominantly include odontogenic carcinoma, ameloblastoma and calcifying epithelial odontogenic tumour. Clear cell tumours of salivary gland origin are almost invariably malignant in nature but they do include two benign lesions. Very frequently, surgical pathologist encounters clear cells in many malignant neoplasms, the nature and sources of which are undetermined on the basis of conventional histopathology. This review will selectively discuss the clinicopathological features of neoplasms which at times may pose a diagnostic challenge and dilemma due to clear cell changes.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part I: Clinical Perspective, Anatomy and Imaging Techniques

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

Rapid evolution in technology in the recent years has lead to availability of multiple options for cardiac imaging. Availability of multiple options of varying capability, poses a challenge for optimal imaging choice. While new imaging choices are added, some of the established methods find their role re-defined. State of the art imaging practices are limited to few specialist cardiac centres, depriving many radiologists and radiologist in-training of optimal exposure to the field. This presentation is aimed at providing a broad idea about complexity of clinical problem, imaging options and a large library of images of congenital heart disease. Some emphasis is made as to the need of proper balance between performing examination with technical excellence in an ideal situation against the need of the majority of patients who are investigated with less optimal resources. Cases of congenital cardiac disease are presented in an illustrative way, showing imaging appearances in multiple modalities, highlighting specific observations in given instance.

Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature

Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.

Ocular Features and Visual Outcome in Children with Moyamoya Disease and Moyamoya Syndrome: A Case Series

Moya Moya Disease (MMD) is characterised by idiopathic vasculopathy affecting the terminal internal carotid arteries resulting in the formation of extensive collaterals at the base of the brain, leptomeninges and parenchymal regions with resultant infarcts and bleeds. Four children presented with clinico-radiological features suggestive of Moyamoya disease/syndrome. This includes global developmental delay, recurrent seizures, transient ischaemic attacks and impaired vision. The first patient had vision of 6/15 in both eyes with bilateral optic disc pallor. Second case also had bilateral optic disc pallor with arteriolar attenuation, but had vision of perception of light only in both eyes. The third child had vision of 6/60 with alternate divergent squint and clinical features suggestive of Neurofibromatosis 1 (NF 1). Fourth patient presented with poor fixation in both eyes with bilateral total cataract. He underwent bilateral cataract surgery with intraocular lens implantation and vision improved to 2/60 with good fixation. We also describe their medical and neurosurgical interventions in this report.

Alarming Skin Tatoo with Periodontal Link: Sturge Weber Syndrome

Satyam Dutt, Preeti Dhawan, Vivek Gaurav, Keerti Chandail

“The Unkindest Cut of All”: Parry-Romberg Syndrome – An Unwonted Affair

Saryu Gupta, Manoj Mathur

Spot Diagnosis of a Daedalian Genetic Disorder: Bardet-Biedl Syndrome

Bharath Chhabria, Ram Nampoothiri, Vikas Suri, Sanjay Jain

Management of Idiopathic Gingival Enlargement

Harikrishna Reddy, Hemachandra Babu, Kishori Gadewar, Praveen Kumar

Odontogenic Myxoma of Mandible with Unusual (Sunburst) Appearance: A Rare Case Report

Swati Goel, Manish Goel, Ajit D. Dinkar

Unusual Origin of Right Renal Artery: A Report of Two Cases

Kajal Patel, Shruti Gandhi, Pranjal Modi

ECG In Evaluation for Pulmonary Thromboembolism- Occam’s Razor or Hickam’s Dictum?

Ram V. Nampoothiri, Arjun Lakshman, Ashish Bhalla, Subhash Varma

Management of Adult Transverse Malocclusion with Surgically Assisted Rapid Palatal Expansion

Salvaging the Mutilated Internally Resorbed and Perforated Maxillary Incisor-One Year Six Months Follow-Up

Vrinda Dhirawani, Shiv Mantri, Bonny Paul, Gargi Tiwari, Arushi Agrawal

Orthodontic Catastrophe: A Rare Vision

Sumita Mishra, Smruti Bhusan Nanda, Sangram Panda

Specific Age and Gender Prevalence of Hepatitis C Virus Infection in Iran

Mohammad Saeid Rezaee-Zavareh, Seyed Moayed Alavian

Study on Tribal Under-Five Children: Few Concerns

Manas Pratim Roy

Use of Different Sizes of Head- Ring for Positioning During Induction of Anaesthesia in Paediatric Spine Surgeries

vipin kumar singh, rajiv Ratan singh yadav, sateesh verma

Atypical Jejunal Perforation due to Cotton Threads Bezoar in a Postpartum Woman Associated with Pica

Prevalence of Multiple Antibiotic Resistant Nasal Carriage MRSA Among Healthy Population of Border Villages in Amritsar Region, Punjab, India

Harsh Kumar, Amritbeer Kaur, Nitin Kishor, Umesh Goutam, Rajdeep Palaha

Antibiotic usage - Ectopic Impacted Lower Third Molar

INCI Rana Karaca, Hacer Ulutürk, Dervis Yilmaz

Correction: 2016 Mar: 10(3): TC10–TC12

Johannes Gossner,Digital Mammography in Young Women: Is a Single View Sufficient? (Published in Journal of Clinical and Diagnostic Research. 2016 Mar: 10(3)): TC10–TC12. In this article a change has been done in abstract. There was a typo error in the word under Conclusion heading of Abstract. The word "throughout" is now replaced with "throughput".

Correction: 2014 Mar: 8(4): AC06-AC09

Sheetal Bhimprasad Joshi, P. Vatsalaswamy, B.H. Bahetee, Variation in Formation of Superficial Palmar Arches with Clinical Implications.(Published in Journal of Clinical and Diagnostic Research. 2014 April : 8(4)): AC06-AC09. In this article few corrections have been done. In [Table/Fig-1] the percentage mentioned against the type C of the superficial palmar arch has been corrected to 3.8%. The percentage against type E has been added as 2%. The legend has been redrafted as 'The superficial palmar arch classification by Coleman and Anson'.