Journal of clinical and diagnostic research

A Curious Case of Pneumomediastinum caused after Diesel Aspiration

Jyoti Bajpai, Amritesh Mishra, Surya Kant, Darshan Kumar Bajaj

Subcutaneous emphysema and Pneumomediastinum can occur as an uncommon complication of inhalation of irritant. It is a rare complication of hydrocarbon ingestion. There are many causative factors like oesophageal, chest trauma and iatrogenic in nature. Other causes include assisted ventilation and medical or dental procedures as well as several diseases. It can also spontaneously occur due to coughing, vomiting, and forceful straining, such as in childbirth or strenuous exercise. However, subcutaneous emphysema and pneumo mediastinum as a consequence of ingestion of hydrocarbons use is very rare with only a few reported cases. Here, we report an uncommon scenario after accidental diesel ingestion masquadering as subcutaneous emphysema.

Successful Rapid Desensitization of Two Teenagers with Rituximab Hypersensitivity

Murat Cansever, Alper Ozcan, Ismail Dursun, Ekrem Unal, Fulya Tahan

Rituximab is one of the monoclonal antibodies that is used in the management of malignancies and auto-inflammatory disorders. Rituximab causes Hypersensitivity Reactions (HSRs) during infusions. The delay of treatment or loss of a highly efficient drug can be prevented by rapid drug desensitization method in patients who are allergic to rituximab. Although HSRs and desensitization protocols to mAbs have been well described in adults, the experience in the paediatric population is very limited. To best of author’s knowledge, this is the first case series describing a novel, rapid desensitization protocol against rituximab hypersensitivity in two teenagers with high-grade B cell non-Hodgkin’s lymphoma and steroid-resistant minimal change disease who developed hypersensitivity to rituximab. Here, authors present case reports of two patients who were desensitized successfully by using novel rapid desensitization protocol for rituximab.

An Atypical Outcome in a Case with Agenesis of Both Mandibular Central Incisors

The treatment of congenital agenesis of mandibular incisors is complex, and the absence of these teeth can cause functional, aesthetic, and psychological problems. This paper reports the treatment of an Angle Class I malocclusion associated with agenesis of both mandibular central incisors. Among various treatment alternatives, the chosen therapeutic approach was to consolidate space between the first and second premolars to make room for further implant and prosthesis placement. This orthodontic-prosthetic approach provided balanced occlusion, dental aesthetic, periodontal health, improved self-esteem, and a satisfactory smile to the patient. The treatment outcomes have remained stable during follow-up of 3 years and 1 month.

Pemphigus Vulgaris: Case Report and Review of Literature

Preeti Ahankare, Divyesh Wankhedkar, Sangeeta Patankar, Gokul Sridharan

Autoimmune mucocutaneous disorders of oral cavity constitute an important group of lesions that pose diagnostic, therapeutic and prognostic difficulties to the dental clinician. Pemphigus vulgaris is an autoimmune blistering condition that usually affects the oral mucosa and is characterised by autoantibodies directed against the desmoglein component of the keratinocytes. It manifests clinically as vesicles, bullae or desquamative gingivitis and histopathologically shows the presence of acantholysis. Immunofluorescent demonstration of IgG antibodies against desmoglein usually confirms the diagnosis. The resemblance in clinical appearance to other oral diseases mandates the inclusion of pemphigus vulgaris in the differential diagnosis of oral vesiculo-bullous lesions. Adequate knowledge of diagnostic and therapeutic modalities helps the clinician in appropriate management. This paper presents a case report of pemphigus vulgaris affecting both oral cavity and skin along with a brief review of literature.

Primary Bone Lymphoma of Humerus Culminated to Shoulder Disarticulation- Astray of Diagnosis

In the horizon of knowledge, there is dearth of documentation depicting the incidence of Primary Bone Lymphoma (PBL) being delayed/misdiagnosed as chronic osteomyelitis, which entails that this case report is of more magnitude. It is a case report of young female, having complaints of pain and swelling in left arm initially which was misdiagnosed as chronic osteomyelitis. Later on, she was diagnosed as PBL. Here, we want to discuss the clinical presentation of PBL, and to make aware from such grave pathology and to consider it in the differential diagnosis of chronic osteomyelitis.

Isolated Renal Zygomycosis, A Rare and Lethal Cause of Massive Renal Infarction- Report of Two Cases

Salapathi Shanmugam, B Rajeshwari, Sadiya Niamath, Mitra Ghosh

Zygomycosis (Mucormycosis) is an infection caused by a class Zygomycetes fungi. The fungal organisms classified as Mucorales order cause a spectrum of predominantly angio-invasive disease in immunosuppressed patients. While renal involvement is not so uncommon in disseminated infections, isolated renal involvement is rare. Here we report two cases of isolated renal mucormycosis who presented with abdominal pain. Radiological evaluation showed evidence of pyelonephritis. On histopathological examination complete renal infarction with thrombosed vessels caused by invasive fungal hyphae morphologically suggestive of Mucorales. Renal zygomycosis should be suspected in immunocompromised patients and in patients with abdominal trauma or following surgery with acute abdomen and persistent fever, despite negative urine and blood culture. We present the cases here for their rarity and clinical importance.

Impact of Periodontal Therapy in Patients with Sturge-Weber Syndrome

A 19 years old female patient, presented with the chief complaint of pain and swelling on her face. At physical examination, facial asymmetry and “port wine” spots on the left face were seen. Clinical examination: dental biofilm presence and dental calculus, spontaneous gingival bleeding, gingival hyperplasia, contour alteration and gingival tissue staining. Radiographic examination revealed radiolucent images and widening of the periodontal ligament space in the posterior region. This case emphasises the importance of dental follow-up of patients with Sturge-Weber Syndrome (SWS), demonstrating that careful periodontal treatment and orientation of oral hygiene care are fundamental to maintain the health and quality of life.

Multicystic Left Kidney and Contralateral Pelvic Kidney with Ectopic Ureter and Renal Failure in a Young Male: A Rare Association

Pritesh Jain, Debansu Sarkar, Dilip Kumar Pal

Multicystic Dysplastic Kidney (MCDK) is a relatively common cystic disease of kidney which may be associated with various urogenital abnormalities. Here, authors encountered a case of 16-year-old male who presented with left side abdominal pain and lump. On evaluation, he was found to be growth-retarded with chronic renal failure. Imaging studies revealed left MCDK with contralateral pelvic kidney with ectopic ureter opening in prostatic urethra. This patient also had calculus in right ectopic ureter near its opening in prostatic urethra. The calculus was surgically removed; however, he required dialysis as there was no improvement in renal function. This conglomeration of anomalies is extremely rare and a dilemma exists not only in diagnosis but also in therapeutic decision making. Every case of MCDK or ectopic ureter should be further investigated to detect associated abnormalities, for timely management.

CA-19-9 as an Emerging Marker of Ovarian Tumour: A Rare Entity

Tumour markers are widely used in clinical practice for diagnosis; follow-up, prognosis and to predict recurrence of certain malignancies. Markers for ovarian cancer include CA-125 antigen, CA-15-3 antigen, and Carcino-Embryonic Antigen (CEA). CA-19-9 antigen is usually elevated in malignancies including colorectal carcinoma, pancreatic adenocarcinoma but significantly raised levels of <10,000 U/mL were seen in advanced stage of gastrointestinal malignancy. A reported case of 60-year-old female who had abnormally high levels of CA19-9 in the blood associated with mucinous carcinoma right ovary invasive endocervical type. At one month post surgery CA 19-9 dropped significantly. There are few case reports which have shown an association of raised CA19-9 with benign pathology but the present case is first case showing such high levels of CA19-9 associated with mucinous carcinoma of ovary. This highlights the fact that although CA19-9 is a marker of gastrointestinal malignancy; thorough evaluation to rule out ovarian malignancy in suspected cases should be done.

Traumatic Fat Necrosis Complicated with a High Platelet Count and Anaemia in a Nigerian Neonate

Traumatic fat necrosis is a rare, temporary and self-limiting condition. It is believed to be caused by panniculitis, or inflammatory change in fat tissues following trauma, cold or ischaemic insult. We report the case of a baby who presented with firm nodular bean seed sized swellings on both sides of the cheek and back, noticed 26 days after a difficult vaginal delivery. A platelet count of 461,000 cell/mm3 was recorded in the patient. The traumatic and haematological aberrations resolved spontaneously, after few weeks. We report the case to increase the awareness of health providers on the occurrence of such complications and to emphasise the need to promptly detect and manage them.

A Case of Osseous Choristoma of Submental Region- Cone Beam Computed Tomographic Findings

Gunjan Sinha, Bhuvana Vijay, Priyanka Katyal

Soft tissue radiopacities of head and neck region are intriguing to the oral and maxillofacial radiologist. Osseous choristoma is seldom included in the list of probable differential diagnosis, since its occurrence in the region is a rare phenomenon. Here a case report of osseous choristoma in the submental region of a young male patient has been documanted. This case report highlights the nuances in the radiological interpretation of such radiopaque lesions.

Rehabilitation after Excision of Osteoma on the Supraorbital Border: A Rare Case Report

Osteoma is a benign, exophytic neoplasm composed of osteoids and bone tissue of uncertain origin. It can occur in any bone, but is more common in the bones of face and paranasal sinuses. Its involvement with the orbital cavity is rare. When this occurs, the lesion usually arises from the paranasal sinuses with extension to the orbit. This paper presents the case of a patient with a supraorbital border osteoma without the involvement of any sinus of the face. A 34-year-old patient sought care due to a volumetric increase and aesthetic defect in the supraorbital region. Information from anamnesis, clinical examination and imaging tests led to the diagnostic hypothesis of osteoma. Surgical excision of the lesion and reconstruction of the defect on the right supraorbital border with titanium mesh was performed. Histological analysis confirmed the initial hypothesis. Although rare, the primary involvement of the osteoma with the orbital cavity was evidenced. Reconstruction of the bone defect caused by the excision of the lesion with titanium mesh proved to be a satisfactory therapeutic option to restore the anatomical contour of the patient.

A Case Report of Fosphenytoin Induced Orofacial Dyskinesia in an 11-month-old Baby with Post-encephalitic Sequelae

George Mathew Panachiyil, Tirin Babu, Juny Sebastian, Mandyam Dhati Ravi

Fosphenytoin is used as an alternative phosphate ester prodrug to intravenous phenytoin for seizure treatment. Acute orofacial dyskinesia, secondary to phenytoin treatment is very uncommon. This case report gives the details of an 11-month-old baby girl, with post encephalitic sequelae, who developed orofacial dyskinesia during treatment with fosphenytoin. She was on fosphenytoin for the last 11 days. She presented with lip smacking movements on the 11^th day of administration of fosphenytoin. At the time of presentation of orofacial dyskinesia, she found it difficult to keep her tongue inside her mouth and the involuntary movements subsided following the withdrawal of the drug. In this case, it was a probable cause of the relationship between the patient’s symptoms and the use of fosphenytoin according to the causality assessment scales such as the Naranjo scale and the World Health Organisation (WHO) Uppsala Monitoring Centre causality assessment system. She had a score of six. Also, the reaction is not likely to be owing to coexisting diseases or drugs. Though fosphenytoin induced orofacial dyskinesia is infrequent, there is a need to consider the adverse effects of fosphenytoin as a differential diagnosis in all patients with a movement disorder in the course of fosphenytoin treatment.

Adult Onset Still’s Disease: A Rare Cause of Fever

Divendu Bhushan, Prashant Kumar, Abhishek Verma

Fever remains a challenge for physicians, more so when it lasts a month. Although infections remain the most common cause, non-infective causes should also be looked for. Adult Onset Still’s Disease (AOSD) is a rare cause of fever. It is a diagnosis of exclusion. Here, we present the case report of a young male patient, admitted with high grade fever, for more than a month and after excluding infective causes and common autoimmune diseases we kept the possibility of Still’s disease. He was treated with steroid pulse therapy followed by oral steroid. He was on follow-up for six months and is doing well.

Facial Nerve Paralysis Due to Aviation Barotrauma in a Child: A Case Report

Grant L Hom, Samantha Anne, A David Rothner

Facial nerve paralysis due to aviation barotrauma is a rare occurrence that has previously only been seen in adults. This case report describes the presentation of baroparesis in a female child, which posed unique challenges due to the transient nature of the occurrence. The majority of the child’s symptoms resolved during the flight, but she reported an aural fullness persisting for 12 days. She was referred to paediatric neurology and paediatric otolaryngology for a systematic review of the possible causes of her episode. Possible preventive measures are proposed for this type of episode.

Hereditary Gingival Fibromatosis: Report of Family Pedigree of Three Generations

Jaideep Mahendra, Vijayalakshmi Rajaram, Sujeetha Muthukumar, Sathish Rajendran

Gingival enlargement or gingival overgrowth can be defined as increase in the size of gingiva, caused due to a variety of etiological factors. One of the causes of gingival enlargement is hereditary gingival fibromatosis, which is a genetic disorder characterised by progressive enlargement of the free and attached gingiva. It may have a nodular enlargement, having stippled surfaces with no inflammation or may show inflamed surface. Clinically, gingiva may present dense or firm surface on palpation. It is commonly associated with mutation of Son of Sevenless-1 (SOS-1) gene, which is responsible for this disease. This case report focuses on a family, diagnosed with hereditary gingival fibromatosis in three consecutive generations. This report also discusses the diagnosis, treatment, histopathological features and the pattern of inheritance associated, which is emphasised through pedigree analysis.

Why Journals Need Help from Interviewers to Stop Redundant Publications

Sunanda Das, Hemant Jain

Cheyne Stokes Breathing in a Case of Tubercular Meningitis with Hydrocephalus

Parag Papalkar, Sourya Acharya, Samarth Shukla

Development and Validation of a Survey Instrument on Drowning Prevention and Water Safety among Parents of Primary School Children

Noor Hamzani Farizan, Rosnah Sutan, Kulanthayan KC Mani

Introduction: Malaysia has limited educational material on drowning prevention and water safety. Currently, no formal regulations or acts applicable to drowning prevention were identified such as requiring lifeguards to be present in all public pools, pool fencing and wearing floatation devices for children when engaging in water activities. Limited awareness messages are available on drowning prevention, especially for parents. Assessment of parental knowledge, attitude and practice on childhood drowning and its preventive measures will assist in designing essential educational package for childhood drowning prevention and water safety. Aim: To design and evaluate the survey instrument examining knowledge, attitude and practice on drowning prevention and water safety among parents and guardians of primary school children. Materials and Methods: Prior to designing the questionnaire, documents analysis and literature reviewed were employed to provide an insight into the research topic. Six experts evaluated content validity with the score of Content Validity Index (CVI). The questionnaire was designed and cross-sectional study was conducted among 130 parents/guardians of primary school children in Selangor, Malaysia. Construct validity was estimated using Exploratory Factor Analysis (EFA); utilising principal components method and varimax rotation. The reliability of the questionnaire was evaluated by face validity and Cronbach’s alpha respectively. Results: An agreement obtained from the panel experts on the adequacy of the instrument; based on the I-CVI score =0.83 and scale-level content validity (S-CVI/Ave) characteristics of relevancy, clarity, simplicity and unambiguity of each item in the questionnaire =90%. Exploratory factor analysis resulted in 10 factor-solutions (69.4% total variance) constructed for attitude domain whereas nine factor-solutions (65.8% total variance) emerged for practice domain. The reliability for knowledge was KR20=0.58 whereas internal consistency using Cronbach’s alpha for attitude and practice was 0.81 and 0.84. Conclusion: The drowning prevention and water safety questionnaire developed is useful and reliable for quantifying parental knowledge, attitude and practice characteristic related to water safety and drowning prevention for their children.

Lactate Dehydrogenase as a Prognosticating Tool in Predicting NICU Stay and Oxygen Dependence in Meconium Stained Amniotic Fluid Neonates

Madhava K kamath, Mn Asha, Botcha SaiHari, M Sneha

Introduction: Lactate Dehydrogenase (LDH) is elevated in blood during hypoxia/ tissue damage. The LDH values are elevated in newborns born to Meconium Stained Amniotic Fluid (MSAF); the degree of elevation correlates with the amount of hypoxia. Hence, LDH values can be used to quantify the outcome in MSAF newborns. Aim: To assess the LDH level and relation of duration of Neonatal Intensive Care Unit (NICU) stay. To predict the duration of oxygen dependence in newborns born to MSAF using LDH level at birth. Materials and Methods: A prospective cross-sectional study was conducted between January 2018 to June 2018. Cord blood LDH in all MSAF newborns (118) was measured. The newborns were observed for prolonged NICU stay and duration of oxygen dependence. Re was assessed between high LDH level and prolonged NICU stay and duration of oxygen dependence. Results: The study showed a relation between higher level of cord blood LDH and prolonged NICU stay (p=0.08). It also depicted that as the cord blood LDH level increases, there is an increase in duration of oxygen supplementation to the newborns (p=0.8), however on further increase in LDH level the duration of oxygen given decreased. Conclusion: LDH levels can be used as a prognosticating tool in predicting NICU stay and oxygen dependence. However, larger studies are needed in the Indian population to conclude the same.

Role of Prostate-Specific Antigen (PSA) in Patients with Benign Prostate Hyperplasia

Priya Duvedi, Harjinder Singh, Gurdeep Kaur Bedi, Maninder Kaur

Introduction: Prostate-Specific Antigen (PSA) is an organ specific rather than cancer specific hormone. It is a single chain glycoprotein produced by epithelial cells of the prostate gland. Role of PSA in carcinoma of prostate is well defined but its role in other diseases of prostate is not very clear. Increased PSA levels are not essentially associated with prostate cancer, but can also be elevated in conditions other than cancerous lesions, such as prostate inflammation, bacterial prostatitis, Benign Prostate Hyperplasia (BPH) and Urinary Tract Infection (UTI). BPH is the most common benign tumours in men with prevalence ranging from 50% for men in their 50s to 90% for men in their 90s. Aim: To find the relation of serum PSA levels with age, Prostate Volume (PV) and PSA density in BPH patients. Materials and Methods: The present hospital-based, cross-sectional study was conducted on 162 BPH patients who consulted to the Urology Department of Rajindra Hospital, Patiala and were prescribed to undergo serum PSA evaluation. The serum PSA levels of these patients were estimated by the Enzyme-Linked Immunosorbent Assay (ELISA). Routine investigations included Complete Blood Count (CBC), serum urea, serum creatinine, Fasting Blood Glucose (FBG), serum PSA and ultrasonography of the kidneys, ureter, bladder and prostate. Correlations were evaluated using Pearson correlation coefficient. All the statistical graphs were plotted using Microsoft Excel 2009. The results p-value <0.001 were considered statistically significant. Results: No significant association (p=0.445) between serum PSA and age groups of BPH patients was observed. A significant correlation was observed between serum PSA and PV (r=0.59, p-value <0.001) and PSA density (r=0.56, p-value <0.001) in BPH patients. Conclusion: The present study indicates that there was no association between age specific reference range and serum PSA levels. And PV and PSA density should be considered while interpreting PSA level to improve the diagnostic parameters.

Study of Treatment Pattern and Treatment Satisfaction with its Impact on Quality of Life among Psoriasis Patients

Introduction: Psoriasis is an immune mediated dermatological disorder affecting physical, psychological and social functioning of the individual. Aim: This study explored the pattern of drug use, quality of life and treatment satisfaction in psoriasis patients and to ascertain whether the satisfaction varies among different treatments. Materials and Methods: This cross-sectional study was conducted among 50 psoriasis patients, age group more than 18 years of both the genders, attending the dermatology department in a tertiary care teaching hospital. Quality of life and treatment satisfaction of the psoriatic patients were assessed using Psoriasis Disability Index (PDI) and Psoriasis Treatment Satisfaction Questionnaire (PTSQ) respectively which contained various domains for topical, phototherapy and systemic treatment. Data was analysed with one-way ANOVA by SPSS software version 20.0. Results: Among the 50 patients, 44% received combination of topical and oral therapy and 24% received all three treatment regimens (topical, oral, phototherapy). Statistical significance was observed with PDI assessment with the duration of disease (with six months to one year, >one year) (p<0.001). Mean global satisfaction total score also showed statistical significance with phototherapy when compared with other therapies (p<0.01). Conclusion: Our study highlighted the effect of different dermatological therapy with high level of satisfaction with phototherapy which can be recommended by the clinicians to the patient who need it. The satisfaction levels of safety among all the three regimens were found to be equal and the Quality of life was impaired as the duration of disease progressed.

Evaluation of DNA Damage in Type 1 Diabetes Patients

Hivi Mohammed Mahmoud, Dhia J Altimimi

Introduction: DNA damage due to oxidative stress leads to progression of diabetic complications. The association between DNA damage and diabetes mellitus has prompted to study the extent of DNA damage and factors affecting this health problem in Type 1 Diabetes (T1D). Aim: To assess serum 8-hydroxy 2’deoxyguanosine (8-OHdG) levels as a DNA damage biomarker in T1D patients. Materials and Methods: The study was carried out between September 2017 and March 2018 at Duhok Diabetes Center, Duhok, Kurdistan Region (Iraq). Serum 8-OHdG levels of 132 T1D patients and 123 age and sex matched healthy control subjects were estimated using ELISA technique. The Insulin Autoantibodies (IAA), Islets Cell Antibodies (ICA) and Glutamic Acid Decarboxylase Antibodies (GADA) were assessed in T1D patients. Results: The results revealed that serum 8-OHdG levels were significantly raised in patients (6.02±2.05 ng/mL) as compared to healthy controls (2.03±1.63 ng/mL) (p<0.01). Mean 8-OHdG was also found to be significantly higher in patients with autoantibodies (6.20±2.12 ng/mL) as compared to patients without autoantibodies (5.7±1.93 ng/mL) (p=0.04). Moreover, the prevalence of DNA damage was found to be significantly higher in patients with autoantibodies (79.3%) as compared to patients without autoantibodies (40.0%) (p=0.02). Conclusion: The present study has indicated that DNA damage accompanied by autoantibodies is highly exhibited in patients with T1D. Antioxidant supplementation may be an effective public heath intervention to reduce DNA damage and oxidative stress.

Validation of Hemochroma PLUS: A Point of Care Testing Device for Haemoglobin Estimation

Introduction: Anaemia is a major public health challenge in India. Advent of Point of Care (POC) testing devices for haemoglobin estimation may be useful in the field settings, albeit after proper validation of these devices. Aim: To assess the validity of Hemochroma PLUS in haemoglobin estimation by comparing it with an automated laboratory analyser in rural Indian context. Materials and Methods: A cross-sectional study was conducted at a tertiary care rural teaching hospital during November-December 2017. Adults visiting the out-patient laboratory collection unit for a haemogram test were included in the study. Venous blood samples were collected by trained phlebotomists and tested using autoanalyser in the laboratory. Capillary blood samples were collected by a trained study coordinator using a lancet (Ez-life) and tested on a Hemochroma PLUS device. Haemoglobin measurement by both methods was compared using Bland-Altman analysis. The analysis was performed using STATA (14.2). Results: A total of 100 (53 females and 47 males) adults participated in the study. Mean (SD) age of the participants was 44.62 (16.92) years. Bland-Altman analysis revealed that the mean difference (95% confidence limits) was 0.3 (-2.0, 2.7) gm/dL. Hemochroma PLUS was found to have sensitivity of 84.90% and specificity of 82.98% in identifying anaemia. Conclusion: Hemochroma PLUS showed good agreement with the cell counter in current study. Further studies may be undertaken in different study populations and study settings. Hemochroma PLUS, has a potential as a POC tool for community-based anaemia screening and evaluation of anaemia control programmes.

Barriers to Sexual Health Communication in Breast Cancer Survivors: A Qualitative Study

Introduction: Sexual dysfunction following breast cancer treatment is common. However, it’s often been neglected. Patients often have difficulty to talk about sexuality issues with their partner. Health-care providers avoid entering this domain too. Identifying communication barriers around sexuality is important to solve sexual dysfunction in breast cancer survivors. Aim: To diagnose communication barriers regarding sexual health in breast cancer survivors. Materials and Methods: In this qualitative study, 13 breast cancer survivors and 12 key informants were interviewed in semi-structured face to face approach. The participants were selected through targeted sampling method and data were analysed using conventional content analysis approach by MAXQDA12.0 software. Results: Two main categories including“ relationship with partner” and “relationship with health care providers” were extracted from the interviews as barriers. Weakness of sexual discourse was the most important barriers between couples. In terms of patient-providers relationship, the most known barriers were neglecting patients’ sexual concerns and lack of a teamwork approach from the patients and providers point of view respectively. Conclusion: Health provider needs to acquire communication skills and knowledge about managing sexual disorders in breast cancer survivors.

Clinico-pathological Presentation of Gastroenteropancreatic Neuroendocrine Tumours and Immunohistochemical Study with Synaptophysin and Chromogranin

Jagan Balu, Subramanian Sankar, P Suresh, K Sreenivasan, Babu Elangovan

Introduction: Neuroendocrine Tumours (NETs) have lethargic clinical courses, the majority of the NETs take place in the gastrointestinal tract and most of Gastrointestinal Neuroendocrine Tumours (GNTs) cases are asymptomatic. The diagnosis is based on clinical features, biochemical analysis, imaging, and confirmation with histopathology. Aim: To analyse the clinico-pathological aspects, and immunohistochemical study with synaptophysin, chromogranin and Ki-67 index to grade the GNTs. Materials and Methods: In this prospective study, during March 2017 to June 2018 a detailed history for every enrolled patients was taken and thorough clinical examination was done for those diagnosed with gastroenteropancreatic neuroendocrine tumour, a database was created which accounts for data collection which included sex, age, and clinical appearance, past medical history, investigations, drug history, treatment and outcome. For immunohistochemical staining, three antibodies chromogranin A, synaptophysin, and staining of Ki-67, a widely-used proliferation marker was performed. Ki-67 index was calculated as the percentage of 2,000 tumour cells from the areas of highest nuclear labeling. Results: This study had 47 patients with clinical presentations and classical radiological appearance of NET of which 43 patients were diagnosed with NET using biopsy. Majority of patients were in age group of 41 to 60 (40.5%) and above 60 years of age (42.5%). Duodenum being the common site with 40% followed by stomach with 17% and pancreas with 15%. Most common grade of NET was Grade 1 (95%) followed by a Grade 2 (5%). Among 47 patients, 19 patients underwent duodenal polypectomy for duodenal polyp in the first part of duodenum. The positivity rate for synaptophysin, and chromogranin was 97% and 90.5%. Ki-67 index was <2% in 95% of the cases, it was <5% in 5% of the cases. Conclusion: In this study we analysed the clinicopathological details of 47 patients including immunohistochemical characteristics of 43 NET. NETs of the GIT known to be rare tumours, presents with increased incidence over the recent decades, most probably due to the increased awareness among the physicians and improved diagnostic techniques.

Effect of Caries Detecting Dye on Microleakage of Composite Resin Restorations Bonded with Total-etch and Self-etch Adhesive Systems

Lim Ern Hui, Manuel S Thomas, Vinod Jathanna, Amitha Juanita Lewis, N Srikant

Introduction: Caries detecting dyes are solutions employed to differentiate the infected portion of carious dentin from the remineralizable affected dentin. However, it is important that these agents should not interfere with the adhesion of permanent restorative materials. Aim: The purpose of this study was to evaluate the effect of caries detecting solution on microleakage of composite resin restoration bonded with two adhesive systems. Materials and Methods: Class V cavity of standardised dimension was prepared on forty intact extracted molars. Out of this, 10 teeth each were randomly selected for the four study groups. Group 1: composite restoration after etch and rinse technique without any prior exposure to caries disclosing solution; Group 2: placement of the restoration as mentioned in group 1 after exposing the cavity with caries detecting solution; Group 3: cervical restoration with composite after the use of self-etch adhesive system, with no exposure to caries detecting dye; Group 4: Similar to group 3 except that caries disclosing agent was applied onto the class V cavity before the placement of the composite restoration. The amount of dye penetrated was evaluated using fluorescent microscope. The microleakage scores were recorded and data obtained were subjected to statistical analysis using the chi-square test. Results: No significant difference was detected between the groups (p>0.05). However, Group 3 (self-etch without dye) showed the least percentage of microleakage with none of the restorations showing grade 3 leakage score. Conclusion: All study groups showed microleakage, but there was no statistically significant difference between the leakage scores. However, the highest leakage was seen in the total etch group where caries detecting dye was used.

Role of HCV Infection in Psoriasis: A Clinical and Immunohistochemical Study

Introduction: Psoriasis is a common inflammatory skin disorder in which different infections play an important role in its pathogenesis. It was proposed that Hepatitis C Virus (HCV) is involved in psoriasis pathogenesis, and may contribute to its severity. This hypothesised role of HCV in psoriasis emerged through investigating serum HCV antibody and plasma HCV RNA levels, however till date, no study investigated HCV protein in skin of psoriasis patients. Aim: To investigate the role of HCV in aetiopathogenesis of psoriasis through evaluation of HCV protein immunohistochemical expression in lesional skin biopsies of HCV positive psoriatic patients compared to non-psoriatic patients and controls. Materials and Methods: Twenty HCV positive psoriatic patients (32-65 years) in addition to 20 age and sex matched HCV positive non-psoriatic patients (31-58 years) and 20 healthy control subjects (36-57 years) were included in this case-control study. Psoriasis Area Severity Index (PASI) score was used to evaluate psoriasis severity. Skin biopsies were taken from all groups and were stained with Haematoxylin and Eosin stain (H and E) and immunohistochemically by HCV protein monoclonal antibody. Results: HCV protein immunoreactivity was significantly decreased in HCV positive psoriatic patients than non-psoriatic patients (p=0.02), however, its percentage and H-score mean values were significantly elevated in psoriatic than non-psoriatic HCV positive cases (p=0.044 and p=0.03 respectively). HCV protein expression was positively associated with psoriasis severity (p=0.032) and its cutaneous load was positively associated with disease duration (p=0.05). Conclusion: Not the presence of HCV infection, but its cutaneous load may have an active role in pathogenesis of psoriasis. This cutaneous load was positively associated with disease duration. Moreover, HCV infection is associated with psoriasis severity.

Effectiveness of Dynamic Balance Training with and without Visual Feedback on Balance in Ambulatory Stroke Patients

Khushboo C Valodwala, Anjan R Desai

Introduction: Stroke is one of the most common neurological disorders leading to chronic disability. Following stroke, patients lose functions of the motor, sensory and higher brain cognitive abilities to various degrees which lead to diminished balance. Balance can be improved with the help of various interventions. Aim: To compare the effectiveness of conventional physiotherapy, wobble board training with and without visual feedback and also check the effectiveness of individual training in ambulatory stroke patients. Materials and Methods: In the present experimental study, total of 51 patients were included; 17 patients per group with Berg Balance Score (BBS) of 41-56, Brunstrom’s recovery stage of 3 or above for the lower limb and Mini Mental Scale Examination (MMSE) score of 24 or more. They were randomly allocated in three groups. Subjects were asked to perform set of exercises for five days a week with total duration of four weeks. Pre and post intervention assessment was carried out by using BBS and Timed Up and Go (TUG). Paired t-test was used within group comparison; ANOVA and post-HOC were applied between the groups. Results: All the three interventions were effective for balance training. All the groups had a significant change for both outcome measures following four weeks of interventions, with p<0.05. The third group showed a significant improvement in balance compared to the two other groups, with p<0.05. The wobble board with visual feedback proved to be significantly effective. Conclusion: This study concludes that all the three interventions are effective, but wobble board training with visual feedback (Sensamove Miniboard) is more effective for balance training than other two interventions.

Approach Towards Misplaced or Malposition IUCD: Lessons Learned

Neha Varun, Abhinav Jain, Aruna Nigam, Sana Noor, Nidhi Gupta, Sumedha Sharma

Introduction: Intrauterine Contraceptive Devices (IUCD’s) are the effective, economical, long-acting and reversible type of contraceptive method used worldwide. But, it is associated with complications like increased bleeding, perforation and rarely transmigration of IUCD to adjacent organs. Dislocated IUCD is the terminology used to define the IUCD with an abnormal position within the uterus (malposition) or a transmigrated IUCD with an extra-uterine location (misplaced). Aim: This study was conducted with the aim to find out the incidence of dislocated IUCD requiring operative interventions, to study the various clinical presentations of this condition, investigations needed to localise the IUCD and the preferred surgical intervention for its retrieval. Materials and Methods: This study was a cross-sectional retrospective study conducted in a medical college over a period of two years from June’ 2016 to June’ 2018. Records from the medical record department and family planning department of the hospital were reviewed to identify the patients with the diagnosis of dislocated IUCD, who underwent operative interventions for its retrieval. A total of 20 such patients have been included in the study. Results: Total number of IUCD inserted during study period in the institute was 482 and surgical intervention for dislocated IUCD was required in only 4.1% (20/482) patients. Out of these 20 patients, in 16 patients minimally invasive approach and in four patients long artery forceps under anaesthesia was utilised for the retrieval of dislocated IUCD. Mean age (range) was 27.5 (22-35) years and parity was 3 (1-3). Most common presenting complaint was missing thread (65%). A 3.52% (17/482) of the patients had an IUCD within the uterine cavity (partial perforations or IUCD embedded in the uterine wall) and 0.6% (3/482) had misplaced IUCD (transmigrated IUCD). Among the study group, in 80% (16/20) patients IUCD’s were inserted in the postpartum phase and in 20% (4/20) as an interval IUCD. Among the misplaced IUCD group, all patients had an operative laparoscopy and none required a laparotomy. Among the malpositioned IUCD, 76.47% (13/17) had an operative hysteroscopy for the removal of IUCD and in 23.5% (4/17) patients IUCD was removed using long artery forceps under anaesthesia. No surgery-related intra-operative or post-operative complications were observed. Conclusion: Minimally invasive approach proved to be the preferred diagnostic and the therapeutic modality for the dislocated IUCD. Dislocated IUCD requiring operative interventions is a very rare complication of this long acting contraceptive method. Thus, this condition should not be a reason to deny IUCD insertion and every attempt should be made to lower down its failure and complication rates.

A Comparative Study of Serum Uric Acid and Serum Magnesium Level in Diagnosed Cases of Various Renal Disorders

Introduction: Estimation of serum uric acid and magnesium along with other sensitive markers of renal function (serum creatinine and urea) are very effective to determine extent of renal impairment. Aim: To compare the serum uric acid and magnesium level between controls and patients with various renal diseases and also to evaluate any correlation of these two parameters with severity of impairment (creatinine and urea). Materials and Methods: Serum uric acid and magnesium estimation in 20 controls and 50 cases (28 males and 22 females; age 14-64 years) with various renal diseases (five cases of acute glomerulonephritis, 10 cases of acute renal failure, eight cases of acute pyelonephritis and 27 cases of chronic renal failure) were done during a period of one year in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India. Results: The serum magnesium and uric acid in control group were found within normal range with no significant variations observed in different age and sex. Both the parameters were found to be raised above their standard normal value in all 50 cases and also the parameters in the study showed positive correlation with serum creatinine and urea, so result of this study was significant (p-value <0.001). Conclusion: Estimation of serum uric acid and magnesium are sensitive for the establishment of diagnostic and prognostic aspect in various renal diseases.

Growth Charts for Egyptian Children with Achondroplasia

Introduction: Achondroplasia (ACH) is a dominant autosomal genetic disorder. The patients present with disproportionate short stature with short limbs and normal size torso due to abnormal bone growth. Growth charts are important tools that reflect patients’ growth status and help in monitoring effectiveness of the treatment. Aim: To construct new reference growth charts for height, weight and head circumference for Egyptian patients with ACH. Materials and Methods: This cross-sectional study included 327 patients (186 males and 141 females) aged one to eight years. Patients were divided into seven groups of male and female patients. Patients were compared with controls matching age and sex. All measurements were taken using standardised equipment and as per the international recommendations. Values were statistically analysed using independent Student’s t-test and growth curves were plotted for mean±SD values. Results: Height measurements were lower than those of the controls in both sexes and at all age groups. As compared to the established control data, weight measurements were below average in males. However, in females, the measurements overlapped with the controls until the age of six years and afterwards progressive failure to gain weight was observed. Relative macrocephaly in both male and female patients at all age groups compared to the matched controls was observed. Conclusion: Authors recommend that the use of new growth charts specific for patients with ACH for optimal patients care and early detection of concomitant factors affecting growth.

Effects of Intravenous Ondansetron and Granisetron on Haemodynamic Changes during Spinal Anaesthesia in Non-obstetric Population: A Randomised Double-blind Study

Introduction: Two commonly used antiemetics in the perioperative period may attenuate the spinal anaesthesia induced hypotension by attenuating the Bezold-Jarisch Reflex (BJR). Aim: To evaluate and compare the efficacy of intravenous administration of ondansetron and granisetron five minutes prior to spinal anaesthesia on incidence of spinal anaesthesia induced hypotension and bradycardia. Materials and Methods: Ninety patients scheduled for elective infraumbilical non-obstetric surgeries under spinal anaesthesia were enrolled for the study, after obtaining written informed consent. Patients were randomised to receive 4 mg ondansetron (group O), 1 mg granisetron (group G) or normal saline (control group) intravenously, five minutes prior to spinal anaesthesia. Changes in haemodynamics were noted after spinal anaesthesia to identify the number of episodes of hypotension and bradycardia necessitating treatment with ephedrine, atropine or both. The obtained data was analysed with one-way ANOVA or Chi-square test with post-hoc comparison to find out pairwise difference. Statistical significance was considered as p<0.05. Results: The incidence of hypotension was highest in control group (46%) in contrast to 23% in granisetron and ondansetron group, however the difference did not reach the level of statistical significance (p=0.07). The usage of atropine was similar among the groups, whereas consumption of ephedrine was significantly different among the three groups (p=0.037) with granisetron group consuming the least dose of ephedrine to treat spinal anaesthesia induced hypotension. Conclusion: We conclude that pretreatment with ondansetron, granisetron do not reduce the incidence of spinal anaesthesia induced hypotension and bradycardia.

The Relationship of Birth Weight, Feeding and Gestational Age with Serum Copper and Zinc in Premature Neonates

Introduction: Zinc and copper have a main role as nutrients in the growth and development of neonates. Aim: To evaluate the relationship of birth weight, feeding, and Gestational Age (GA) with serum copper and zinc in preterm neonates. Materials and Methods: This cross-sectional study has evaluated 107 preterm infants with Birth Weight (BWT) less than 2500 g that were hospitalised in neonatal intensive care unit for at least 10 days from January 2014 to March 2016 in Shiraz, Iran. Zinc and copper serum levels were compared in very low BWT (=1500 g) and low BWT (1500-2500 g) in newborns and were investigated in regard to the type of nutrition, BWT, and GA. Zinc and copper levels were estimated using Flame-Atomic Absorption Spectrophotometry. Multiple linear regression analysis and Pearson’s correlation coefficient (r) test were used. Results: The mean plasma zinc levels in low BWT and very low BWT groups were 83.9±17.1 µg/dL and 48.2±10.4 µg/dL, respectively (p<0.001). The mean serum copper levels in low BWT and very low BWT groups were 70.48±15.4 µg/dL and 82.7±12.03 µg/dL respectively (p<0.001). There was a significant inverse correlation of serum copper with BWT (r=-0.525, p-value<0.001) and GA (r=-0.572, p-value<0.001). However, there was a positive correlation of the zinc level with BWT (r=0.758, p=0.001) and GA (r=0.741, p-value=0.001). Conclusion: Serum zinc is directly related to GA and LBW. Consequently, supplementation with zinc in premature neonates and LBW is necessary, but not copper.

Impaired High-density Lipoprotein Antioxidant Activity and Serum Paraoxonase-1 Activity in Type II Diabetic Patients

Raveenan Mingpakanee, Natchon Charoensa, Yoknapa Phrawisat

Introduction: High-Density Lipoprotein (HDL) plays an important role in preventing Cardiovascular Disease (CVD) and atherosclerosis. Numerous studies report the atherogenic role of oxidised-LDL (ox-LDL) in development of CVD. HDL associated enzyme, Paraoxonase-1 (PON1) inhibits LDL oxidation. Decreased HDL-cholesterol is commonly found in Type II Diabetic (T2DM) patients; which makes them susceptible to CVD. Aim: To investigate the antioxidant activity of HDL and serum PON1 in T2DM patients. Materials and Methods: In the present cross-sectional study, 20 T2DM patients and 20 non-diabetic volunteers (aged 30 to 60 years) were recruited. LDL and HDL were isolated from all participants by sequential ultracentrifugation. Total Cholesterol (TC) and Triglyceride (TG) concentrations in plasma and lipoprotein fractions were measured by enzymatic assay. The antioxidant activity of HDL against LDL oxidation was calculated as percentage inhibition, while serum PON1 activity was measured spectrophotometrically using paraoxon substrate. An independent Student’s t-test was used to analyse the difference between the T2DM group and the control group. The p-value <0.05 was considered to be statistically significant. Results: T2DM patients showed significantly elevated TC, TG and LDL-C levels (p-values <0.05) and reduced HDL-C levels (p-values <0.05) in comparison to control participants. The antioxidant activity of HDL against LDL oxidation and serum PON1 activity was lowered in T2DM. Furthermore, LDL isolated from T2DM was found to be prone to oxidisation. PON1 activity was also correlated with the percentage inhibition of HDL. Conclusion: T2DM patient exhibit impaired HDL antioxidant ability, which increases the risk of developing CVD. Therefore, the assessment of HDL function should be a novel target for CVD risk assessment.

Inter-arm Systolic Blood Pressure Difference: A Surrogate for Diagnosis of Peripheral Arterial Disease

K Senthil Kumar, VP Sundaravadivel, Saraswathi Ilango, K Madhan Srinivasan

Introduction: Single arm measurement of Blood Pressure (BP) is routinely done in clinical practice. Significant difference in the inter-arm BP is related to various risk factors of cardiovascular disease Prevalence of Peripheral Arterial Disease (PAD) is high, but the awareness about the disease and its symptoms are relatively low. Aim: To assess the prevalence of inter-arm difference in systolic blood pressure in people without any cardiovascular risk factors and to relate the inter-arm BP difference with both symptomatic and asymptomatic peripheral arterial disease. Materials and Methods: It was a comparative study in which 260 subjects in the age group of 40-70 years participated. Systolic Blood Pressure (SBP) inter-arm difference was measured and SBP Inter-Arm Difference (IAD), non-invasive Doppler test was done to diagnose PAD. The results were analysed using t-test. Results: It was found that 33.08% (86 out of 260) of the subjects had inter-arm SBP difference above 10 mmHg. The total number of subjects diagnosed with PAD were 33.84% (88 out of 260). The odds of patients with IAD to have PAD is 102.6 times higher than patients without IAD {OR=102.6 (42.46-247.94)}. The odds of patients with 15-20 mmHg IAD to have PAD was 6.53 times higher than patients with 10-15 mmHg IAD {OR=6.53 (1.49-28.57)}. IAD in SBP is significantly related to PAD. Conclusion: It is important to diagnose the PAD at the earlier stage and also measurement of BP on both the arms is one of the cost-effective tool for screening patients with risk factors for PAD.

Rosuvastatin is Superior Compared to Simvastatin and Atorvastatin to Induce Endothelial Progenitor Cells Migration

Introduction: Statins have shown to improve Endothelial Progenitor Cells (EPCs) function, however no comparison has been done between various statins effectivity to induce EPCs migration. Aim: This study compared simvastatin, atorvastatin and rosuvastatin treatment on impaired EPCs from Coronary Artery Disease (CAD) patients. Materials and Methods: EPCs were isolated, cultivated and divided into untreated group (control), simvastatin (dose 0.1, 0.25, 0.5 mM), atorvastatin (0.1, 0.25, 0.5 mM), rosuvastatin (0.1, 0.25, 0.5 mM). EPCs migration was evaluated with boyden chamber assay. ANOVA, pearson correlation and linear regression test were done using SPSS 25.0. Results: This research showed that simvastatin, atorvastatin, and rosuvastatin increased EPCs migration in dose dependent manner (p<0.05). Regression test showed that simvastatin treatment was responsible for 92.9% of EPCs migration, while atorvastatin was 75.5% and rosuvastatin was 65.6%. Rosuvastatin treatment dose 0.5 mM have the highest EPCs migration effect (195,750.00±5,809.48) compared to simvastatin (123,750.00±9,367.50, p=0.001) and atorvastatin (156,375.00±12,392.03, p=0.001) at the same dose. Conclusion: Rosuvastatin treatment has higher EPCs migration effect compared to simvastatin and atorvastatin. This suggests that rosuvastatin might be preferable to improve EPCs migration in CAD patients.

Comparison of Total and Ionic Calcium in Hypothyroidism

Introduction: Thyroid hormones are involved in various functions of human body such as metabolic activities, homeostasis of electrolytes and minerals like calcium and potassium. The blood calcium level is believed to increase glucose uptake of cells by acting as a messenger under the influence of thyroid hormone. Some studies report alteration in calcium levels with respect to the thyroid status, while other studies report alteration in ionic calcium and normal levels of total calcium levels in hypothyroidism. Aim: To estimate and find the correlation between total and ionic calcium levels in hypothyroidism. Materials and Methods: The study was conducted on 35 healthy controls (Groups A) and 35 hypothyroid subjects (Groups B) of age group 20-45 years. Blood samples were analysed for Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4) by Chemiluminescence Immunoassay (CLIA), serum albumin by Bromocresol Green (BCG) method and calcium levels by the Arsenazo method. Independent student’s t-test and Pearson’s correlation were used to analyse the results. A p-value <0.05 was considered as statistically significant. Results: The study confirmed the direct correlation between blood total (r-value 0.32, p-value <0.001) and an ionic (r-value 0.03, p-value <0.001) calcium levels in hypothyroid patients. Significant differences (p value <0.001) were observed in FT4 and TSH levels between hypothyroid and control group. However, no significant (p-value=0.498) difference was found between the albumin levels between the groups, which indirectly reflects the values of total and ionic calcium. Conclusion: This study concluded that both total calcium and ionised calcium were decreased in patients with hypothyroidism when compared to those with euthyroid status. Thus the study highlights the need for hypothyroid patients to be screened for serum calcium levels to prevent hypocalcemia and its related complications.

Estimation of Coverage Interval of Serum ß-Carotene among Bengali Population

Sanghamitra Chakraborty, Indranil Chakraborty

Introduction: The reference interval guides the clinician in interpreting the clinical test reports and classifying the subjects as healthy or diseased. The reference values of the common laboratory analytes vary due to immense diversity in race, ethnicity, genetic pattern and food habits. Recommendations from international body’s mandates for every laboratory to establish its own reference values for the population it serves for correct interpretation of test results. A series of recent research indicates the protective role of the antioxidant vitamin ß-carotene against both exogenous and endogenous free radicals. These free radicals mediated damage to intracellular organelles and cell membrane lead to mutations, coronary artery disease, autoimmune diseases and malignancy. Aim: To determine the coverage interval of serum ß-carotene in Bengali population and to compare them with the reference interval of other population. Materials and Methods: The present non-interventional, cross-sectional study was conducted in Medical College and Hospital, Kolkata, from January 2012 to January 2013. Based on IUPAC clinical division technical report with 0.95 confidence interval, 0.95 coverage interval and coverage uncertainty of 0.049, 71 individuals were included in the study. Blood samples were collected from 71 (34 male and 37 female) healthy volunteers (postgraduate trainee students, DMLT students, nursing staff and undergraduate students) at random as per recommendation of IUPAC Clinical Chemistry Division for calculation of coverage interval. The ß-carotene levels were measured by Bradley and Hornbeck (1973) method spectrophotometerically. The Kolmogorov-Smirnov test was used to check for normal distribution. Results: The mean age and weight of the study population 28.49±9.49 years and 62.9±11.58 kg respectively. The mean concentration of serum ß-carotene was found to be 140.12 µg/dL (2.62 µmol/L) which was much higher than other populations. Conclusion: The study conducted to determine the coverage interval of ß-carotene, a replica of reference interval with small number of values, from the general healthy population. The reference values of Bengali population was found to be, much higher than Kuwaiti, European, Chinese, Vietnamese and Thailand populations.

DNA Damage and Vitamin D Status among Type 2 Diabetic Patients

Ardawan F Ali, Dhia J Altimimi

Introduction: DNA damage has been associated with the progression of diabetes and deficiency of vitamin D that leads to increase DNA damage. The possible modulation of this damage by vitamin D supplementation is not well reported in Type 2 Diabetes Mellitus (T2DM) patients. Aim: To assess the extent of DNA damage in T2DM patients and to ascertain its association with serum 25-hydroxyvitamin D levels. Materials and Methods: The study was conducted at Duhok Diabetes Center, Duhok, Kurdistan Region (Iraq). This study consisted of 2 inter-related parts: the first part was a cross-sectional study conducted on patients with type 2 diabetes (n=204) and healthy individuals (n=154). The second part was a quasi-interventional study that enrolled 25 patients with type 2 diabetes and 19 healthy individuals. The demographic parameters including age, gender and BMI was recorded and DNA damage marker through serum 8-Hydroxy Guanosine (8-OHdG) levels, and Vitamin D status of serum 25-hydroxyvitamin D {25(OH) D} was measured. Descriptive statistics were adapted to present data in means±SD. Independent t-test and un-paired student t-test were used to assess differences in serum analyte among groups for continuous data. Categorical data was assessed by using q-square test for association between two groups, and one-way ANOVA test for association among more than two groups. Level of statistical significance (p-value) was set at <0.05. Results: In the study population, 52 (25%) T2DM patients and 12 (7.8%) healthy individuals had vitamin D deficiency {25(OH)D<10 ng/mL}. The mean serum 8-OHdG levels were significantly elevated in diabetic patients as compared to healthy individuals, (p<0.01). Based on the 8-OHd G cut-off point (<4.0 ng/mL), 178 (84.8%) of T2DM patients had DNA damage as compared to 44 (28.5%) healthy individuals. In the diabetic group, 8-OHdG inversely correlated with 25(OH)D (r=-0.22, p=0.01), after 3 months of vitamin D supplementation, with 47.7% increased 25(OH)D levels (p=<0.01); the mean values for 8-OHdG levels decreased by 13.7% (p=0.13). In the healthy individuals, 57.3% showed increased 25 (OH)D levels (p=<0.01); the mean values of 8-OHdG are decreased by 2.6% (p=0.36). Conclusion: The high prevalence of DNA damage observed in the studied population, particularly type 2 diabetic patients appear to be associated with vitamin D insufficiency and deficiency. Vitamin D supplementation may be an effective public heath intervention to reduce DNA damage and prevent acquired genetic disease.

A Prospective Randomised Study of Comparison between Conventional and Accelerated Fractionation Radiotherapy in Treatment of Head and Neck Cancers

M Hemanth, BV Subramanian, Pranabandhu Das, J Swapna, AY Lakshmi

Introduction:Treatment of locally advanced lesions of head and neck cancers include combined modality approach such as surgery, Radiotherapy (RT) and chemotherapy. The prognosis of patients with locally advanced head and neck squamous cell cancer (LAHNSCC) is poor and five year survival rate with conventional RT is 40-50%. Hence the realisation that conventional fractionation may not be the best fractionation for all situations have led to the concept of altered fractionation in RT. Aim: To compare feasibility, tolerability and efficacy of accelerated fractionation with conventional fractionation schedules in RT of head and neck cancers in terms of response to treatment, acute and late radiation induced toxicities and disease free survival. Materials and Methods: During the time period between March 2015 and March 2017, 68 patients with squamous cell carcinoma of head and neck were recruited into the study and divided into two arms, arm A (five fractions per week) and arm B (six fractions per week). Concurrent chemotherapy with weekly cisplatin 40 mg/m2 was given to patients in both the arms who were medically fit for chemotherapy. Results: Final analysis was done in 62 patients (32 patients in arm A and 30 patients in arm B). On first follow-up, 68% had complete response in conventional RT arm, 96% had complete response in accelerated RT arm (p=0.003). At median follow-up of 17 months, loco-regional control rates were 86% in conventional RT arm compared to 90% in accelerated arm. Disease free survival was slightly more in accelerated RT arm compared to conventional arm. This difference was not statistically significant (p=0.59). Acute complications were slightly more in the accelerated RT arm than those of conventional fractionation arm. Grade 2 and grade 3 skin reactions were higher in accelerated arm compared to conventional arm (89% vs. 61%; p=0.38). Acute grade 2 and grade 3 mucositis was also higher in accelerated arm compared to conventional arm (99% vs. 75%, p=0.49). Radiation induced late morbidity did not differ significantly between the groups. Conclusion: Accelerated fractionation can be considered as an alternative treatment strategy to conventional fractionation which is radiobiologically superior and is beneficial for centers where the patient load is much higher than the facility available.

Morphometric Assessment of Chronic Inflammatory Cells in Colonic Biopsies of Patients with Irritable Bowel Syndrome

Introduction: Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder which has a complex pathophysiology including the role of inflammation being recently studied. Aim: To assess the role of mast cells and Intraepithelial Lymphocytes (IELs) in IBS patients by morphometry. Materials and Methods: In this study, 148 cases of IBS using the Rome III criteria and 28 controls were taken. IBS patients were divided into two subgroups of Post Infectious (PI) and Non Post Infectious (NPI) subgroups on the basis of past history of episodes of gastroenteritis. All of them underwent full length colonoscopy and biopsy from the descending colon. Histopathology of these two were compared with special attention to morphometric count of IELs by “pin hole” method and mast cells using toluidine blue highlighting. Results: Biopsies were unremarkable in 23(15.54%) patients, whereas 125 (84.46%) patients were diagnosed as Non Specific Colitis (NSC). The difference in IEL counts and mast cell counts were extremely significant (p<0.0001) in controls vs patients, controls vs PI-IBS patients and PI-IBS vs NPI-IBS subgroup whereas the difference was significant (p<0.001) in controls vs. NPI-IBS subgroup. Conclusion: The present study concluded that mast cells and IELs show a significant difference between IBS and non IBS cases, and could have an important role to play in the pathophysiology of IBS.

Sociodemographic, Clinical, Laboratory, Diagnostic, Therapeutic and Public Health Aspects of Cutaneous Leishmaniasis in Southwestern Iran

Hamid Kassiri, Iman Khodkar, Ahmad Jalali, Masoud Lotfi

Introduction: Cutaneous Leishmaniasis (CL) is caused by protozoa of the genus Leishmania and can be transmitted by sand fly bites. It is an important health problem in many parts of Iran as well in Dasht-e-Azadegan County, Khuzestan Province. Aim: To identify the epidemiologic status of CL with emphasis on trend of its incidence rate in Dasht-e-Azadegan County. Materials and Methods: This investigation was a descriptive and analytical study. A total of 1093 cases were considered for the study who were reffered to the health centre during the duration of four years (2014-2017). Giemsa staining was used for preparing the expanded smear. Epidemiologic characteristics and clinical information of CL cases were collected by the means of a checklist and analysed by means of chi-square and t-tests. The p-values <0.05 were considered as statistically significant. Results: Most cases were in the age group of below 10 years. Highest disease frequency was observed in students (30.1%). The majority (57.8%) had one lesion. The hand was most commonly involved (38.9%). About 73.8% of patients used topical injection along with cryotherapy for treatment. In over half of the cases (92.4%), the wound size was less than or equal to one centimetre. There was a significant difference between the residential areas, age groups, genders, occupation, month of reporting, lesion sites on the body and number of ulcers with the prevalence of active lesions. Conclusion: Cutaneous leishmaniasis is considered as an important health problem in this county. So it is necessary to take certain measures for controlling the disease and reducing its incidence.

High Sensitivity C-Reactive Protein and Tread Mill Test Responses in Patients with Type 2 Diabetes Mellitus

Deepa S Sajjannar, Sanjeev L Sajjannar

Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of Cardiovascular Disease (CVD) with >50% mortality risk. In cases where a resting Electrocardiograph (ECG) fails to detect the abnormal cardiac function, serum High-Sensitivity C-Reactive Protein (hsCRP) levels and Tread Mill Test (TMT) variables are prescribed independently for the CVD risk prediction. A possible link between TMT variables and underlying inflammation needs to be substantiated clinically. Aim: Evaluation of correlation between serum hsCRP levels and TMT variables in patients with T2DM. Materials and Methods: Over a period of three months, Thirty T2DM patients without clinical evidence of Coronary Artery Disease (CAD) were evaluated for complete haemogram, fasting and post prandial blood sugar, lipid profile, and serum hsCRP levels. Standard multistage maximal exercise test was conducted on a motorized treadmill according to Bruce protocol. Spearmen’s correlation coefficient was used for statistical analysis. Results: T2DM patients with higher serum hsCRP levels had lower exercise tolerance (r=-0.067; p=0.0001) and serum hsCRP levels increased with the duration of T2DM (r=0.55; p=0.002). Serum hsCRP levels and Heart Rate Recovery (HRR) at the end of first (r=-0.57) and second (r=-0.67) minute were statistically significant and showed negative correlation. Conclusion: The results suggested a possible role of inflammation in the stress test responses in patients with T2DM without overt heart disease. Incorporating both serum hsCRP levels and TMT for the assessment and evaluation of T2DM patients can improve the predictive risk for CVD.

Triage of Children with Severe Acute Malnutrition and its Outcome: Single Centre Cross-sectional Study

Abhishek Abhinay, Dhilip Kumar, Sunil Kumar Rao

Introduction: World Health Organisation (WHO), Emergency Triage, Assessment and Treatment (ETAT) guidelines categorised three most common presentations of sick children at admission; these are Respiratory distress and Hypoxemia, Severely impaired circulation or Shock and Seizures with Altered consciousness. Limited data is available on triage in sick children with Severe Acute Malnutrition (SAM). Aim: To describe the triage of children with SAM at time of hospitalisation and its outcome. Materials and Methods: This was a prospective cross- sectional study, conducted on malnourished children recruited from September 2017 to August 2018, over one year period at Department of Paediatrics, Banaras Hindu University. The inclusion criteria were children aged 6 to 60 months fulfilling the WHO criteria of SAM. Triage of SAM children was done in paediatric emergency by resident on duty and A (airway), B (breathing), C (circulation, coma and convulsion), D (severe dehydration) model was used to identify the presence of emergency sign. Outcome was defined as discharge and/or death. Criteria used to indentify the clinical status were taken from WHO-ETAT2016. The demographic characteristics, clinical information is presented as frequencies with percentages. All data were entered into excel sheet and analysed by using SPSS version 18. Results: There were 122 SAM children, out of these, almost two third children (63.2%) were male and most common affected age group of children was less than 3 year (77%). The common emergency sign was hypoxemia (37.96%) followed by dehydration (32.40%), hypoglycemia (21.29%), shock (18.51%), severe respiratory distress (18.5%), and convulsion (10.18%). SAM children with fatal outcome were 11.29 times more likely to have shock (0.001), 10.2 times more likely to have dehydration (<0.001), 7.2 times more likely to have severe respiratory distress (<0.001). There was presence of three or more emergency signs in SAM children who died. Conclusion: Early recognition of clinical signs of shock, severe respiratory distress and dehydration would identify SAM children who are at risk of early death on arrival to facility.

Role of MDCT in Detection and Characterisation of Focal Liver Lesions

Shreshtha Jain, Sachin Khanduri, Jigar Kirit Shah, Poonam Yadav, Anvit Krishnam

Introduction: Multiphasic Computed Tomography (CT) has become the primary imaging modality for detection and characterisation of focal liver lesions. CT has assumed primary role in evaluating hepatic masses. Aim: To assess the imaging features of focal liver lesions on Multidetector Computed Tomography (MDCT) and its comparative evaluation with histopathological results. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis in a tertiary care hospital for a period of 18 months. Adult patients of age group 20-60 years with focal hepatic lesions on abdominal imaging (USG), all patients presenting with deranged liver function or known cases of liver mass lesions were included in the study and Quadriphasic Contrast Enhanced Computed Tomography (CECT) scan was done for them followed by biopsy. All the values for the arterial phase, venous phase, portal phase and delayed phase were recorded and analysed along with the histopathological and biochemical analysis report. Results: As detected by MDCT, out of 84 focal liver lesions, benign focal liver lesions were 72(85.7%) and malignant lesions were 12 (14.3%). The diagnostic accuracy (efficiency) of MDCT was found to be 90.5% with predicted value (95% CI: 84.20-96.75%). For the hepatocellular carcinoma cases, highly significant agreement (p<0.001) was found between MDCT and biopsy techniques. The overall sensitivity, specificity, PPV, NPV and diagnostic accuracy for malignant lesions was found to be 83.3%, 97.2%, 83.3%, 97.2% and 95.2% respectively. Conclusion: This study indicates MDCT to be highly sensitive in classifying the hepatic lesions into clinically relevant categories, making diagnosis and evaluation of lesion. It opens up new possibilities of early detection of liver lesions and its management.

Role of Serum Cystatin C Levels in Preterm Neonates with Respiratory Distress Syndrome in Diagnosing Neonatal AKI

Parvez Ahmed, Mohd Ashraf, Anisa Riyaz

Introduction: Despite major advances in perinatal and neonatal care in Respiratory Distress Syndrome (RDS) prevention and treatment, a considerable number of these neonates suffer from RDS along with Acute Kidney Injury (AKI), and concomitant occurrence of RDS and AKI in neonates is associated with poor outcome. Aim: To determine Serum Cystatin C (sCysC) level and Serum Creatinine (sCr) level in preterm neonates with RDS, and to find correlation, if any, between the sCysC level and sCr level in diagnosing neonatal AKI in them. Materials and Methods: After dividing the preterm neonates into three groups based on Gestational Age (GA): (24-27 weeks; five each in cases and controls; 28-33 weeks; 15 each in cases and controls; and 34-37 weeks; 20 each in cases and controls), two case-control analyses were conducted. In the first one, sCysC levels were compared between neonates with RDS and the control group. In the second one, sCysC levels were compared between neonates having RDS and AKI (RDS-AKI subgroup), neonates having RDS but no AKI (RDS-no AKI subgroup), and the healthy control group. Student’s Independent t-test was used for statistical analyses. Results: Out of 80 preterm neonates, 40 had RDS and 40 were healthy without RDS taken as controls. There were 10 neonates with AKI (RDS-AKI sub-group), and 30 neonates with RDS without AKI (RDS-no AKI sub-group). No significant differences in sCr levels were found among the RDS and control subgroups on day 3^rd and day 30^th of life (p=0.151 and 0.658). Serum Cystatin C levels in the RDS-AKI subgroup were significantly higher than in both the RDS-no AKI subgroup and the control group on day-3 (p<0.001). Statistically significant differences in birth weights were observed among the RDS-AKI, RDS-no AKI and control subgroups as depicted in (p=0.025). Conclusion: sCysC is an independent predictor of AKI in preterm neonates with RDS.

In Vitro Design of Preclinical Models for Chemotherapy Combinations in Human Breast Tumours

Randa Mohammed Dhahi

Introduction: Globally, breast cancer persists a main cause of mortality. Because the number of possible drug combinations is basically unlimited, a strategy for the design of combination chemotherapy regimen of two anti-breast cancer drugs and determining the most promising combinations is crucial for improving the therapeutic outcomes and overcome the multi-therapeutic approach and holds the promise of delivering therapy to those in need. Aim: To assess the activity of combination of Doxorubicin and 5-fluorouracil on Human Breast Cancer Cell line (MCF-7). Materials and Methods: The cytotoxicity of Doxorubicin (DOX) and 5 fluorouracil (5FU) drugs or their combinations were evaluated by using 3-(4,5-Dimethylthiazol-2-yl)-2, 5 Diphenyltetrazolium Bromide (MTT) viability assay against human breast cancer cell line MCF-7. Then, the combination effect proposed by Chou TC et al., based on IC50 values obtained from drugs alone and their combination was evaluated by Combination Index (CI) to determine the nature of synergism, antagonism and additivity action of drug combinations as: synergistic effect is recorded if CI <1, additive effect if CI=1, or antagonism if CI >1, the median-effect dose (Dm) also studied. Dose-Reduction Index (DRI) was also calculated to indicate the level of dose reduction for each drug in synergistic combination. Experiments were achieved with triplicate samples. The MTT assay data were expressed as mean±Standard Deviation (SD). The IC50 values for each drug were computed by GraphPad Prism 5.2 software (GraphPad Software Inc., USA). Dose-effect curve parameters, CI values, Fa-CI, DRI-Faplot were calculated by CompuSyn program. Results: The proliferation of MCF-7 cells was inhibited by 5 FU and DOX anti-cancer drugs in a dose-dependent effect. The DOX at (0.1) nM was antagonistic according to CI value which was 2.82283, while at (1) nM, the CI was 0.39429 that indicate strong synergistic action. Conclusion: This study confirmed the favourable effect of 5 FU in combination with DOX for treatment of breast cancer cell MCF-7 better than the single drug treatment.

Clinical Score for Risk Stratification in Febrile Thrombocytopenia

AG Manoj, K Prabhakar, A Raveesha, BT Hamsa, A Anitha

Introduction: The monsoon and peri-monsoon season often entail, a high patient influx with fever and thrombocytopenia. In severe cases, blood transfusion is necessary, but as there are no guidelines or a precise laboratory cut-off for platelets at which transfusion is requisite, unwarranted blood transfusions adversely affect the patients and overwhelm blood banks. Kshirsagar P et al., developed a risk assessment score system for febrile thrombocytopenia to aid in determining therapeutic intervention. Validation of this scoring system on a larger sample size is imperative, taking into consideration both aetiology and comorbidities. Aim: To validate clinical scoring system developed by Kshirshagar P et al., and to correlate etiology, comorbidities and platelet count with clinical score and outcome in patients with febrile thrombocytopenia. Materials and Methods: The prospective observational study was conducted in a tertiary centre in Kolar. Patients >18 years with temperature >99°F and platelet count <1,50,000/cumm, were scored according to Kshirshagar P et al., scoring system and then categorised into low (=7), moderate (8-15) and high-risk (16-26) groups. Based on pulse, temperature, respiratory rate, blood pressure, platelet count, central nervous system, respiratory, haematological, hepatic and renal complications, the outcome was assessed for each group. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20 software. Non parametric Chi-square, unpaired Student’s t-test and one-way ANOVA were applied in comparative analysis results between different groups. The p-value <0.05 was considered as statistically significant. Results: Between June-December 2017 (monsoon period) 465 patients were admitted with febrile thrombocytopenia. Based on the clinical score, 199 patients (43%) were in low risk group, 240 (52%) in moderate and 26 (5%) in high risk group. All the patients in high risk group had extended hospital stay and required ICU support. In our study, nine high-risk patients died, highlighting the significant association between high risk group and outcome (p-value <0.001). Elderly (p-value <0.024) and patients diagnosed with dengue or undetermined cause (p-value <0.003 and p-value <0.016) also had high risk score and poor outcome thereby validating the clinical scoring system. No significant relationship (p-value=0.35) between the initial platelet presentation and outcome of the patient was observed. During the course of the study, 135 patients had platelets transfusion and at least 16% of these platelet transfusion could have been avoided if the risk score were calculated in the early phase of treatment development. Conclusion: Total risk score can predict the severity of illness, the need for transfusion and the probable outcome. The scoring system is easily reproducible and can be used at bedside to evaluate patients with febrile thrombocytopenia and help plan its management, including the need for platelet transfusion. This score also helps to prognosticate patients’outcomes to optimise care and survival rate of the patients.

Assessment of Remnant Lipoprotein Cholesterol (RLP-C) Levels and its Correlation with Carotid Intima Media Thickness in Insulin Resistant Type 2 Diabetes Mellitus Patients

VM Vinodhini, Karini Keerthi, JS Kumar, Gnanasambandam Subramaniyam

Introduction: Remnant lipoproteins are Triglyceride (TG) rich lipoproteins products of partially metabolised chylomicrons and Very Low Density Lipoproteins (VLDL). Remnant Lipoprotein Cholesterol (RLP-C) levels are related to the risk of ischaemic heart disease. It has been hypothesized that Carotid Intima Media Thickness (CIMT) measurements could aid in the prediction of Cardiovascular Disease (CVD). Aim: To evaluate the levels of RLP-C in Insulin Resistant (IR) Type-2 Diabetes Mellitus (T2DM) patients and correlate the levels of RLP-C with CIMT, IR, TG and High Density Lipoprotein (HDL). Materials and Methods: The present cross-sectional study was conducted in the Department of Internal Medicine, SRM Medical College and Research Centre, Tamil Nadu, India. A total of 80 (aged 30 to 65 years) T2DM, men and women, aged 30-65 years, were included in the study. Serum lipids (Total Cholesterol (TC), TG, HDL-C and LDL-C), and serum insulin were measured. Insulin Resistance (IR) was estimated by the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR). Based on HOMA-IR values, the individuals with HOMA-IR >2.5 were categorised as IR and HOMA-IR<2.5 as Insulin sensitive. RLP-C was calculated by using the formula: RLP-C=TC-(HDL-C+LDL-C). CIMT was measured in patients who had IR by using B Mode Ultrasonography (USG). Statistical analysis was done using Student’s t-test and Pearson correlation analysis. Results: Among the insulin resistant diabetic patients, a positive correlation was observed between IR and serum TG (r=0.0448). In these subjects, RLP-C was positively correlated with serum TG (r=0.5191) and negatively correlated with HDL-C (r=-0.0542). A positive correlation was also observed between RLP-C and CIMT (r=0.513) in these patients with IR. Conclusion: Type 2 diabetic patients with IR are characterised by high RLP-C and TG levels and low HDL-C levels. Estimation of RLP-C may help to identify individuals at high risk of atherosclerosis. The calculation of RLP-C can be easily done from the already existing conventional lipid profile at no additional cost.

Cerebro-Placental Ratio in Women with Hypertensive Disorders of Pregnancy: A Reliable Predictor of Neonatal Outcome

Introduction: About 10 million women develop pre-eclampsia per year. Intra-Uterine Growth Restriction (IUGR) is a common complication of Hypertensive disorders of pregnancy, due to failure of normal placental invasion and development. Identification of the pregnancies at risk for preventable perinatal morbidity and mortality is a primary goal of obstetric care. Doppler flow studies are an important adjunct to fetal biometry in identifying the fetus at risk of adverse outcome. Cerebro-Placental Ratio (CPR) incorporates data of both Umbilical artery and Middle cerebral artery and is a better index than using either of them alone for predicting adverse perinatal outcome. Aim: To determine the role of CPR in women with Hypertensive disorders of pregnancy, so as to assess the fetus at greater risk of adverse perinatal outcome. Materials and Methods: This cohort study was done in JSS Hospital, Mysore on subjects satisfying inclusion and exclusion criteria. The study period was from November 2016 to November 2018. A total of 128 antenatal women of >32 weeks of gestation were selected for the study; preliminary data were recorded and subjected to ultrasound scan. Association between CPR and other categorical variables were analysed using chi-square test. Pearson’s Correlation coefficient was used to show correlation between CPR and other quantitative variables. Results: Among pregnancy-related hypertension, pre-eclampsia was the most common cause (71.1%), followed by eclampsia (20.3%). The five minute APGAR score was =7 in 21.8% while the rest had a score of >7 (78.2%). There was significant association between CPR and the Ultrasonographic gestational age, birth weight and fetal outcome. Lower APGAR score at 5th minute was associated with abnormal CPR values, especially the babies with APGAR score of =7 at 5 minutes. Conclusion: Abnormal CPR is valuable in predicting the outcome of hypertensive disorders in pregnancy. Perinatal outcomes namely, preterm delivery, caesarean section and fetal compromise like low birth weight, lower APGAR at 5 minutes, requirement of NICU care can be predicted with lower CPR.

Adverse Events Associated with Plateletpheresis: A Tertiary Care Hospital Experience in Southern India

Bonagiri Shanthi, V Sudhir Kumar, K Mahesh, B Murali Krishna

Introduction: Platelet transfusions play a major role in preventing major haemorrhage and improve survival in severe thrombocytopenic patients. Generally, apheresis procedures are well tolerated. Systemic reactions are mainly vasovagal reactions and citrate toxicity is also one of the common reaction. Aim: To identify the profile of platelet donors associated with adverse events resulting from plateletpheresis donation. Materials and Methods: This retrospective study was carried out for a period of three years. A total of 615 Single Donor Platelet (SDP) apheresis procedures were performed during study period. Both continuous and intermittent flow centrifugation cell separators (Fresenius Kabi and Trima Accel) were used for performing the procedures. Predonation donor platelet count and other procedure variables were analysed in relation to the adverse events noted using the Pearson correlation. Results: Age range of SDP varied from 19 years to 48 years. Platelet counts of the donors ranged from 1.6 to 4.5 lac/dL. Amongst the selected 615 donors, 15 (2.43%) had citrate related toxicity reactions, 2 (0.32%) had a vasovagal reactions, 8 (1.3%) had mild haematomas. Increase in the amount of Acid Citrate Dextrose (ACD) volume used (r=0.99, p-value <0.005), was associated with increased duration of the procedure and low donor platelet count. Among the donors who suffered adverse events, 22 (88%) were first-time platelet donors and 3 (12%) were repeat donors. Conclusion: The overall rate of acute adverse events, among healthy SDP in our study was very low. However, in the study citrate toxicity increased in donors with platelet count <2.5 lac/dL. Precautions and close monitoring in such cases helps in decreasing the severity of citrate toxicity.

A Simple Methodology to Better Appreciate Structures in Mandibular Angle Fractures Using 3-Dimensional Reconstruction Software

Arjunan Kumaran, Wen Chao Chew, Chor Hoong Hing, Winston Tan, Thiam Chye Tan

Introduction: In Singapore, fractures of the mandible are common and of which, 32% occur at its angle. Current Two-Dimensional (2D) imaging methods are lacking in accuracy, leading to increased surgical morbidity. Aim: To determine the Length (L), Diameter (D), Width (W) and Height (H) measurements in fractured and non-fractured mandibles by using Three-Dimensional (3D) Computed Tomography (CT). Materials and Methods: A single centre retrospective CT based study of 23 subjects (46 mandibular angles and M3s) was conducted and subjects below 16 years, conservatively managed fractures, mandibles without M3s and cases with inadequate CT scan data were excluded. Intraosseous M3 L and D and mandibular H and W were measured and ratios L/H and D/W were calculated. Results: Average mean (Standard Deviation, SD) L, D, H and W was 8.58 (2.089), 11.63 (2.156), 29.17 (4.830) and 16.94 (1.967) mm respectively. Average mean L/H and D/W were 0.30 (0.070) and 0.69 (0.126) respectively. There was a trend towards greater osseous volume occupied horizontally in fractured mandibles. Measurements demonstrated good reliability (CA 0.999-1.000) and good intra and inter-observer variability (ICC 0.998-1.000, p<0.001). Conclusion: A 3D reconstruction with OsiriX offers greater insight at little additional cost. However, this can be further streamlined and automated.

Detection and Characterisation of Heteroresistant Vancomycin Intermediate Staphylococcus aureus (hVISA) using Phenotypic and Genotypic Methods

Introduction: Vancomycin remains the drug of choice to treat infections caused by Methicillin Resistant Staphylococcus aureus (MRSA). Frequent therapeutic failures arise due to the emergence of strains with reduced susceptibility to vancomycin and difficulty in detecting these isolates. Therefore, improvements in screening and confirmatory tests to detect these isolates are required. Aim: To detect heteroresistant Vancomycin Intermediate Staphylococcus aureus (hVISA) isolates among Methicillin Resistant Staphylococcus aureus (MRSA) and Methicillin Sensitive Staphylococcus aureus (MSSA) obtained from various clinical samples and to study the phenotypic and genotypic charecteristics of these strains. Materials and Methods: This study was carried out in the Department of Microbiology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India. A total of 468 non-duplicate S.aureus strains obtained from various clinical samples during a period of two years from September 2014 to November 2016 were included in the study. MRSA isolates and hVISA/VISA isolates were detected by screening and confirmatory methods (MRSA screen by cefoxitin disc, hVISA/VISA screen by brain heart infusion agar with 6 µg vancomycin and hVISA/VISA confirmation by PAP-AUC method). Agr polymorphism in hVISA/VISA was analysed by duplex PCR. Accessory gene regulator (Agr) dysfunction in these strains was studied by their colony spreading property in soft agar and autolytic property by Triton X-100 induced lysis. The results were analysed using IBM SPSS (version 21.0) software. Results: Out of 468 S.aureus strains, 114 (24%) strains were detected as MRSA and 33 (7.0%) were hVISA/VISA strains. Among MRSA detected, 11 (9.5%) strains were confirmed as hVISA/VISA. All hVISA/VISA isolates showed reduction in autolytic activity. Colony spreading property was appreciated in 13 (39%) of these isolates. Out of the 33 hVISA/VISA strains, majority belonged to agr I, III and II and the least number of isolates belonged to agr IV. Conclusion: It was concluded that hVISA/VISA strains have diverse virulence properties and are detected in both MRSA and MSSA strains. Therefore, surveillance of these strains among S.aureus isolates having vancomycin MIC’s =1.5 µg/mL in laboratory settings is needed.

Effects of Video Assisted versus Supervised Group Training on Nursing, Anaesthesiology, and Operating Room Student’s Clinical Skills: A Pilot Study

Fatemeh Darban, Esmat Nouhi, Enayatollah Safarzai, Sakineh Sabzevari

Introduction: The nursing principles and skills training are considered to be the cornerstone of clinical education. Since traditional training techniques leads to lack of practical learning of students, the use of new educational methods seems to be necessary. Aim: To compare the effects of video assisted and supervised group training on nursing students’ clinical skills. Materials and Methods: The present quasi-experimental study was conducted in 2016 on 56 students of the Iranshahr University of Medical Sciences who were randomly assigned to two groups of control and intervention. The data were collected using a clinical skills checklist. The intervention was performed in 12 sessions for both groups. Participants in the video preparation group collectively produced a video about the correct implementation of a skill and received feedback from their instructor. Those in the group training practised the same skill supervised by the instructor. At the end of the intervention, the participants took the Objective Structured Clinical Evaluation (OSCE). Data were then analysed by using independent t-test in SPSS, version 16.0. Results: A significant difference (p<0.05) was observed in the mean total score of clinical skills in the intervention group (17.0±0.4) and the control group (15.8±0.7). Conclusion: In the “Principles and Skills” course, video preparation group training can be employed to increase the nursing students’ practical learning.

Effect of Mahamantra Chanting on Autonomic and Cognitive Functions-An Interventional Study

Introduction: Stress is a major health issue which leads to several potential negative health and well-being outcomes. Early interventions like yoga, meditation and music can reduce stress induced morbidity and mortality. “Chanting is considered as one form of bakthi yoga which improves concentration and memory, relieves stress and depression and helps one to get rid of anxiety” says Upanishad. Aim: To find the effect of Mahamantra chanting in reducing stress among women nursing professionals. Materials and Methods: In this study, subjects (n=30) with moderate to severe stress levels (PSS=14) were recruited and grouped into mahamantra (n=15) and control groups (n=15). Physiological parameters like Heart Rate Variability (HRV), serum cortisol levels and cognitive functions using Auditory (ART) and Visual Reaction Time (VRT) were measured. Mahamantra intervention was given (n=15) to one group while the control group (n=15) did not participate in the mahamantra chanting. Results: This study showed significant increase in parasympathetic tone (LF/HF ratio) (p<0.05), shortened ART (p=0.05), VRT (p=0.01) and significant decreased serum cortisol levels (p=0.05) among subjects who underwent Mahamantra intervention. Conclusion: The study results highlight the beneficial effects of simple mahamantra chanting intervention in reducing stress among nursing professionals with moderate to severe stress.

Influence of Number of Implants and Connection Systems on Stress Behaviour of Mandibular Implant-retained Overdentures: Photoelastic and Strain Gauge Analysis

Introduction: The consensus statement recommends at least two implants to support a mandibular overdenture for edentulous patients. However, to reduce cost and time of treatment, the concept of single implant-retained overdentures provides another option. Nonetheless, the optimal number of implants required to retain a mandibular overdenture is still under evaluation. Aim: To evaluate the biomechanical behaviour of overdentures supported by 1 or 2 implants with different types of connections and submitted to compression, by using Photoelastic (PA) and Strain Gauge Analysis (SGA). Materials and Methods: Based on one cast of an edentulous mandible, the specimens were divided in four groups of one specimen each for the PA and four groups of five specimens each for the SGA, divided by the type of connection (morse taper and external hexagon) and the number of implants (1 or 2). For PA, the photoelastic implant/prosthesis cast assembly was positioned in a circular polariscope associated with a universal testing machine (DL3000, INSTRON/EMIC) applying compression. The tension generated was photographed and analysed qualitatively (number of high-intensity (pink-green transition) and moderate (green/red) fringes). For SGA, two strain gauges were positioned on the mesial and distal aspect of each implant and the electrical signals were captured by a data acquisition device (ASD2001). The data were submitted to three-Way ANOVA and the Bonferroni Test (α=0.05) as post-hoc test for multiple comparisons. Results: Through PA, the greatest number of tension fringes in both connection types was presented by the two-implant supported overdentures when compared with the single-implant supported overdentures. Through SGA, a statistical difference was verified between the connections in groups with one implant (p<.001), with the morse taper having the lowest microstrain values. The lowest tension values in both types of connections were presented by the overdentures with one implant (p<.001). Conclusion: It was concluded that the number of implants directly influenced the distribution of tension in both forms of analysis, being greater for the overdentures supported by two implants. In addition, biomechanically, the single-implant mandibular overdentures may be suggested as an alternative treatment modality for the rehabilitation of edentulous patients, principally when being used with the morse taper system.

Relationship Between Carotid Wall Thickness and Airflow Limitation in Chronic Obstructive Pulmonary Disease in Absence of Known Risk Factors of Atherosclerosis

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterised by chronic airway inflammation and concomitant systemic inflammation and associated with various comorbidities. Though cardiovascular complications have been most widely discussed, many studies over past two decades have identified stroke and carotid atherosclerosis to be associated with COPD. Some studies have postulated carotid atherosclerosis as a risk factor for impending stroke as well as a marker for cardiovascular complications. Aim: To evaluate carotid atherosclerosis in terms of carotid wall thickness (intima media thickness) in patients of COPD in absence of identifiable risk factors for carotid atherosclerosis. Materials and Methods: Patients admitted for acute exacerbation of COPD were screened for presence of carotid atherosclerois. Sixty seven patients were selected for study after meeting the inclusion criteria and after stabilisation of exacerbation were investigated by Color Doppler study of neck vessels and pulmonary function test. Distribution of data was tested for normalcy upon which parametric tests were used. Pearson correlation and one-way Anova tests were used using SPSS software. Results: Study included subjects more than 45 years (N=67). Mean age was 61.91±9.07 (Median=63.00). Airflow limitation was found to be of Grade IV in 55.2%, Grade III in 22.4% and Grade II in 22.4% of cases. Mean Carotid Intima Media Thickness (CIMT) was 1.19±0.35 mm. Strong inverse and significant correlation between FEV1-% Predicted (N=67, Mean 42.3, SD=14) and CIMT was found (Correlation coefficient (R) -0.696, p-value <0.001). FEV1/FVC % (N=67, Mean=58.4, SD=8.1). No significant correlation was seen with Body Mass Index (BMI) and Total Blood Cholesterol. Conclusion: Our study concluded that carotid atherosclerosis, quantified as CIMT, is inversely correlated to severity of airflow limitation in patients with COPD. The correlation is significant and studied in absence of factors which are known to be independent risk factors for atherosclerosis.

Antithyroid Antibodies and Fertility Outcome in Euthyroid Women Undergoing In Vitro Fertilisation

Aheibam Bidya Devi, Sudha Prasad, Bidhan Chandra Koner

Introduction: Antithyroid Antibodies (ATA) are suspected to cause poor outcome of In Vitro Fertilisation (IVF) even in the absence of thyroid dysfunction. Aim: To study the effect of ATA on fertilisation rate, implantation rate and clinical pregnancy rate in euthyroid women undergoing IVF. Materials and Methods: The study was a prospective cohort study conducted at an IVF centre of a Medical College. A total of 81 euthyroid patients planned for IVF were recruited and divided into two groups depending upon the presence of ATA. All of them underwent the standard stimulation protocol. The results were compared using unpaired t-test for continuous variables and Chi-square/Fishers’-exact test for categorical variables. Results: The prevalence of ATA was 20.99% (17/81) in our study population. The fertilisation rate was significantly lower (p<0.05) in women with ATA (66.3% versus 78.9%). However, no statistically significant difference was observed in implantation rate (18.2% versus 26.8%) and clinical pregnancy rate (31.3% versus 39.3%). Conclusion: The presence of ATA was associated with a lower fertilisation rate even in euthyroid state in women undergoing IVF. However, the implantation and clinical pregnancy rate were not correlated with the presence of such antibodies.

Effect of Two-month Problem-Based Learning Course on Self-directed and Conceptual Learning among Second Year Students in an Indian Medical College

Introduction: A medical graduate is expected to fulfil the roles of a clinician, communicator, life-long learner, professional, leader and researcher. A Problem-Based Learning (PBL) course was introduced to enhance student skills in knowledge acquisition, problem-solving, clinical reasoning, communication, leadership, self-directed learning and working in teams. Aim: To assess the effect of a two-month PBL course for second-year MBBS students on self-directed and conceptual learning. Materials and Methods: The single group interventional study was conducted in the months of February and March 2017 at an urban private medical college in Southern India. Fifty-seven fourth semester MBBS students underwent a two-month PBL course, with two-hour sessions every week. The students were divided into eight groups, each with two faculty facilitators. Two problems, each with two triggers were discussed. The students completed a Self-Rating Scale of Self-Directed Learning (SRSSDL) before and immediately after the PBL course. At the end of each problem, students had to submit a Concept Map (CM) which was graded independently by two faculty. The mean and standard deviation of the pre and post-PBL SRSSDL scores was calculated. Differences in CM sub-scores were estimated using repeated measures ANOVA. Multiple regression analysis was used to estimate the strength of association between the CM scores and gender, attendance and tutor rating. Results: The average post-PBL SRSSDL total and sub-scores were higher than the pre-PBL scores. The mean CM score obtained by the students was 11.3±2.9 (12.6±2.3 for female and 9.8±2.9 for male students, respectively). The layout and graphics scores were significantly higher than the scores for detail. The average attendance of the students was 6.3±1.2 and mean tutor rating was 50.4±9.4. Tutor rating and female gender showed significant positive associations with CM scores. Conclusion: This study provides some evidence that a short-term PBL course positively influences self-directed and conceptual learning among undergraduate medical students.

Role of Nuclear Morphometry in Screening of Cervical Pap Smear

Introduction: In India, cervical cancer is the second most common cancer that leads to death in women after breast cancer. Pap smear examination is the primary test for screening cervical cells. Application of techniques like Nuclear Morphometry can be useful in providing an objective and reproducible diagnosis. Aim: This present study was conducted to find the significance of nuclear morphometry pattern in differentiating between Atypical Squamous Cells of Undetermined Significance (ASC-US), Atypical Squamous Cells-Cannot Exclude High Grade Lesion (ASC-H), Low Grade Squamous Intraepithelial Lesion (LSIL), High Grade Squamous Intraepithelial Lesion (HSIL) and Squamous Cell Carcinoma (SCC). Atypical Squamous Cell: Squamous Intraepithelial Lesion (ASC:SIL) ratio was also calculated. Materials and Methods: A total of 163 cases including 85 epithelial cell abnormality (ASC-US, ASC-H, LSIL, HSIL) and malignant cases (SCC), 78 reactive cases and 20 normal control were observed over a period of 5 years for which morphometric analysis was done. Cell area, cell perimeter, nuclear area, N:C ratio and nuclear diameter were noted. The mean and standard deviation were calculated and the results were compared between the different groups. Student’s t-test was used as the test of significance. Results: Majority of the cases diagnosed as reactive were in 4th decade and as epithelial cell abnormality were in 5th decade. It was observed that there was gradual increase in nuclear area, diameter and N:C ratio from normal cell to dysplastic cell to SCC. However, mean cell area and mean cell perimeter decreased gradually for all the lesions except for ASC-H compared to LSIL and HSIL. On comparing different groups, all five parameters observed were found to be statistically significant (p<0.01). Conclusion: Nuclear morphometry if applied along with pap smear examination can aid in differentiating and diagnosing the borderline cases and early diagnosis of squamous intraepithelial lesion.

Comparative Analysis of Serum Levels of Total Carbohydrates and Protein Linked Carbohydrates in Normal and Diabetic Individuals

Introduction: Non-enzymatic glycation and enzymatic glycosylation of proteins have been proposed as a major factor in the pathogenesis of diabetic complications by altering structure-function of proteins. Though focus of previous research is primarily focussed on glycated adducts as glycated haemoglobin (HbA1c), Advanced Glycation End Products (AGEs) and glycated albumin. The effect of enzymatic glycosylation has been overlooked in monitoring of diabetes. Aim: The present study examines the relationship between glycemic status and serum levels of protein linked total carbohydrate using inexpensive and rapid methods. Materials and Methods: The present case-control study was conducted on 145 subjects that were divided into three groups i.e., normoglycemic controls (n=54), mild-moderate hyperglycemia (MHG) (n=44) and severe hyperglycemia (SHG) (n=47). Serum was subjected to precipitation and then precipitate was re-dissolved in urea/thiourea buffer. Protein content of re-dissolved precipitate was measured using Bradford assay. Serum total carbohydrate and carbohydrate content in resuspended pellet (mg carbohydrate per gram of protein designated as Carbohydate Protein Ratio or CPR) was measured using phenol-sulfuric acid method. Statistical analysis was done using SPSS statistics (V21.0) and Microsoft excel software, viz. Student-t-test for comparison of significant mean, binary logistic regression was used to measure Odds Ratio (OR). In all tests of significance, two sided p value have been reported and results were considered significant if p<0.05. Results: Serum total carbohydrate and CPR were significantly increased in MHG (p<0.001 and p=0.02, respectively) and SHG (p<0.001 and p<0.001, respectively) compared to controls. CPR levels increased with increase in glycemia i.e., lowest in controls, higher in MGH and highest in SHG. We also observed a statistically significant upward trend from 1^st quartile through 4^th quartile for CPR in SHG (p<0.001). Likewise OR for 4^th quartile compared with inter-quartile range (IQR) as reference was statistically significant for SHG {OR (95%CI)=5.27 (2.09-13.25); p<0.001}. Conclusion: Glycated Haemoglobin (HbA1c) concentrations and self monitoring of blood glucose are widely used for monitoring of long term and short term glycemic control respectively, although overall glycation and glycosylation status of circulating or tissue proteins could also be affected by glycemic status of an individual. Therefore, it is desirable that an assay or biomarker would provide assessment of overall glycation/glycosylation process in between immediate and long term control. In this preliminary case-control study we found protein linked carbohydrates (PLC) levels and carbohydrate protein ratio (CPR) to be significantly elevated in SHG compared to controls (p<0.001 and p<0.01, respectively). The alterations in PLC levels and CPR may be attributed to difference in glycemic status between these two groups. The method used in current study is inexpensive, rapid and technically less demanding thus suitable for regions having limited resources.

Potential Sources of Exposure and Urinary Bisphenol A Concentration in Children

Introduction: Bisphenol A (BPA) is a synthetic compound used in the plastics and epoxy resins industry for manufacturing various consumer products including plastic baby bottle, toys and protective lining of infants’ food cans. Recent studies reports adverse effects of BPA on human health resulting in hormone abnormalities, obesity, asthma, cardiac, kidney and behavioral disorders. Aim: To measure urinary concentration, estimate daily intake of BPA in children, and investigate the association between urinary BPA levels and consumption frequency of dietary sources. Materials and Methods: The cross-sectional study included apparently healthy 292 children, aged 2-16 years. Urinary concentrations of BPA were measured using high performance liquid chromatography (HPLC). Dietary intake and frequency of consumption of probable dietary sources of BPA were recorded using structured questionaire were assessed. ANOVA test was used to show the statistical difference between the estimated levels of urinary BPA and the frequency of consumption of the dietary sources. Student’s t-test was used to analyse statistical difference in daily intake of BPA amongst male and female children. p-value <0.05 was considered statistical significant. Results: BPA was detected in 215 (73.63%) children under study. The total urinary Bisphenol A ranged from 0.3 to 18.9 ng/mL with mean 1.29+2.09 ng/mL, median 0.67 and geometric mean 0.68 ng/mL. A significant positive association was observed between urinary BPA levels and frequently used canned soft drinks (p-value=0.014) and fast food (p-value=0.05). The geometric mean of estimated daily intake was 0.015 µg/kg/day, which is much lower than the tolerable daily intake. Estimated BPA intakes showed no significant difference between males and females (p-value=0.216). Conclusion: The consumption of canned soft drinks and fast food are the most common sources of exposure amongst children. The study reports minimal average daily intake of BPA and overall low exposure leading to the low urinary BPA concentration. However further studies are required to address other potential sources of BPA exposure in children.

Prognostic Factors on Survival of Rasoul-e-Akram Hospital Patients with Colorectal Cancer: A Survival Analysis

Introduction: Colorectal Cancer (CRC) also called colon cancer or intestine cancer is characterised by cancerous growth of cells in the rectum, colon and appendix. CRC is the fourth most common form of cancer after skin, gastric, bladder and prostate cancers among Iranian population, since 6-8 people per 10,000 people suffer from this disease. Aim: To evaluate the prognostic factors on survival of patients with CRC, in Rasool-e-Akram Hospital in Tehran, Iran. Materials and Methods: The population under study included patients with CRC, admitted between 30 March 2010 to 29 March 2013, in Rasoul-e-Akram teaching hospital affiliated with Iran University of Medical Sciences, Tehran, Iran. The event was death from CRC and any other cause. Possible prognostic variables were selected from documents. A multivariate Cox regression model was performed to study the concurrent effect of parameters on survival after taking into account the parallel effect of residual factors. Results: In this research 80 patients were studied. With respect to inclusion and exclusion criteria 68 patients were enrolled and data related to 68 patients were exposed to statistical analysis. Median and mean age of patients were equal to 55.5 and 55.0 years, respectively with standard deviation of 13.9 years. Only “Logarithm of White Blood Cell” showed a significant effect on survival of patients with CRC. Conclusion: The results of our study showed the effect of WBC on survival of patients with CRC. Accordingly the increased one unit of log WBC increased the death hazard by 21.22 times in CRC patient.

Significance of Copper, Zinc, Selenium and Fluoride in Squamous Cell Carcinoma of Cervix- A Pilot Study

GS Meghana, R Kalyani, ME Sumathi, SR Sheela

Introduction: Cervical cancer is one of the common cancers in females especially in developing countries. HPV 16 and 18 are responsible for 90% of cervical cancers. Some trace elements like Copper, Zinc, Selenium and Fluoride also has role in pathogenesis in cervical cancer. Aim: To study the association of plasma copper, zinc, selenium and fluoride in squamous cell carcinoma of cervix. Materials and Methods: This was a case control study conducted in a tertiary health care centre at Kolar, Karnataka, India. Thirteen each of cases and controls were considered for the study. Six mL of venous blood was collected in Heparin tubes. Plasma was separated. Plasma copper and zinc was estimated by colorimetric method. Plasma selenium was estimated by inductively coupled plasma–mass spectrometry. Plasma fluoride was estimated by Ion Selective Electrode. Data was analysed using SPSS version 22 and was analysed as mean, and standard deviation. Using student’s t-test, p-value <0.05 was considered as statistically significant. Results: Plasma copper was 118±49.9 µg/dL in cases and 100±23.2 µg/dL in controls with p-value of 0.25. Plasma zinc levels were 58.4±11.7 µg/dL in cases and 65.4±31.9 µg/dL in controls with p-value of 0.46. Cu/Zn ratio was 2.1±1.08 µg/dL in cases and 1.8±0.88 µg/dL in controls with p-value of 0.42. Plasma selenium was 0.36±0.05 µg/dL in cases and 0.40±0.11 µg/dL in controls with p-value of 0.21. Plasma fluoride was 0.30±0.05 mg/L in cases and 0.24±0.02 mg/L in controls with p-value of 0.02. Conclusion: Plasma copper, copper to zinc ratio and fluoride was increased in cases while plasma zinc and selenium was decreased. However it was not statistically significant except for fluoride levels.

Serological Diagnosis of Indian Tick Typhus in and around Puducherry: Application of Indirect Immunofluorescence Assay

Introduction: In the past, tick typhus caused by Rickettsia conorii has been reported from different parts of India. However, during the last two decades, reports are few and far between with only some case reports and very few seroprevalence studies. Aim: To estimate the seroprevalence of Indian tick typhus among febrile patients of Puducherry and surrounding Tamil Nadu, employing Indirect Fluorescence Antibody (IFA) test, which is considered as the ‘gold standard’ serological test for diagnosing rickettsial diseases. Materials and Methods: This study was conducted during the period February 2018 to March 2019 at Mahatma Gandhi Medical College and Research Institute and Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, India. The study included 114 febrile patients who provided both acute and convalescent serum samples. Forty ante-natal women and 23 voluntary blood donors were included as healthy controls. All sera were examined for IgG antibodies to Rickettsia conorii by IFA test (Fuller Laboratories, Fullerton, California, USA). Mean±Standard deviation with 95% confidence interval was calculated for age of the patients and duration of illness using Graph Pad Quick Calcs Software, USA. Chi-square and Fisher’s-exact tests were performed and p-value =0.05 was considered as statistically significant. Results: Out of 114 febrile patients screened for Spotted Fever (SF) IgG IFA, 27 were positive in IgG IFA with titres ranging from 1:128 to 1:2048 (23.68%). Among the control group (n=63), only one participant was seropositive for R. conorii IgG IFA (1.59%). Statistical difference in seropositivity between the febrile patients and healthy controls was quite significant (p=0.0001). Conclusion: Due to large number of false positivity, presence of IgM antibodies in acute SF is of doubtful significance. Presence of significant titres of Spotted Fever Group (SFG) IgG antibodies in IFA (=1:128) in acute serum or four fold increase in titres in paired sera are the recommendation of Centre for Disease Control and Prevention (CDC) to confirm SF.

Prevalence and Molecular Characterisation of Methicillin-Resistant Coagulase Negative Staphylococci (MR-CoNS) Isolated from Nasal Carriers of End Stage Renal Disease Patients- A Prospective Study

Introduction: Patient-to-patient transmission of resistant strains has caused a rapid increase in the prevalence of antimicrobial resistance in recent years. Infection has become a major cause of morbidity and is the second most common cause of death in patients receiving haemodialysis. Compared to methicillin-resistant Staphylococcus aureus (MRSA) transmission, less is known regarding the epidemiology of methicillin-resistant coagulase-negative staphylococci (MR-CoNS) in health care facilities. Patients receiving haemodialysis are at particular risk for the development of invasive infections caused by MR-CoNS. Aim: To detect the prevalence of antibiotic resistance genes among nasal carriage of MR-CoNS from End Stage Renal Disease (ESRD) patients and hospital personnel. Materials and Methods: This cross-sectional prospective study was conducted over a period of two months (August-September 2013) at the nephrology unit of a tertiary care hospital, Chennai, Tamil Nadu, India. A total of 145 anterior nasal swabs were collected from 115 patients and 30 hospital personnel. Screening of methicillin resistance was done by using phenotypic and genotypic method. Speciation of MR-CoNS was done by conventional biochemical methods. Molecular detection of various antibiotic resistant genes and staphylococcal cassette chromosome mec (SCCmec) type (I-V) was determined by PCR based method. Results: Among 79 MR-CoNS isolates, S.epidermidis was the predominant species and highest resistance was seen towards co-trimoxazole (29; 36.7%) followed by tetracycline (18; 23%), gentamycin (17; 21.5%), fusidic acid (14; 18%) and linezolid (2; 2.5%). Among the SCCmec types, type IV (n=27) was the predominant type followed by type I (n=18) and type V (n=15), while 17 isolates had two types including I+V (n=8), IV+III (n=6), II+V (n=3). Conclusion: The findings of our study strongly suggest the need for the establishment of infection control program measures in order to prevent and reduce MR-CoNS infections in ESRD patients.

A Study to Compare Transurethral Resection of the Prostate and Inguinal Hernioplasty as Combined and Separate Procedures

R Ponniah Iyyappan, Anjana Vasudevan, A Ravi, Harihara Sudhan

Introduction: Chance of recurring hernia depends greatly on type of surgical procedure and hernia. Practising Transurethral Resection of Prostate (TURP), hernioplasty as combined procedure is not infrequent although separate process is more followed. The combined approach of surgery could save repeated anaesthesia complications and decrease recovery time. Aim: We appraise the result of TURP and inguinal hernia repair performed sequentially in a single session and compared to one when they are done separately. Materials and Methods: This was a prospective study conducted from April 2015 to August 2017 at Sri Ramachandra Institute of Higher Education and Research, formerly Sri Ramachandra University, Porur, Chennai. All patients with inguinal hernia and benign prostate hypertrophy, over the age of 18 years, were divided into two groups, of 25 patients each. The first group underwent TURP and inguinal hernioplasty sequentially in a single session and the second group underwent TURP followed by inguinal hernioplasty as two separate procedures with a gap of at least seven days. A detailed history, mode of presentation and clinical examination was done for all patients. Patients below 18 years or with a history of abdominal surgery or with other types of hernia were excluded from this study. Data were analysed by using SPSS version 19.0 (IBM, USA), using mean, percentage, frequency and standard deviation, ANOVA, paired t-test. Results: Group 1 had higher mean prostate volume (48.66±7.172) and post void residual (223.64±46.644) than Group II (32.34±32.654 and 190.84±44.534 respectively), which was significant. Comorbidities were insignificant between the groups. Mean operative time was longer for Group II (147.64±15.413) but not significantly higher than Group I (143.40±23.836). The mean length of hospital stay was significantly longer in Group II (9.44±1.557) than Group I (6.04±2.051). Patients in both groups had no significant difference in minor complication such as bleeding and clot retention. Conclusion: Combined TURP and inguinal hernioplasty is safe and an effective operative.

Protective Impact of Fruits and Vegetable Intake on Cardiovascular Risk Factors-A Review

Harmeet Kaur, Bani Tamber Aeri

Consumption of fruits and vegetables is essential for maintaining good health and the longevity, as they are rich in vitamins, minerals, dietary fiber, and phytochemicals. High consumption of fruit and vegetable prevents several non-communicable and chronic diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal diseases, and obesity. Despite these positive benefits associated with high intake of fruits and vegetables, the World Health Organisation (WHO) estimates 6.7 million deaths worldwide attributable to inadequate fruit and vegetable consumption in 2010. An inadequate intake of fruit and vegetables is considered to be a cause for around 11% of Ischaemic Heart Disease (IHD) deaths, 9% of stroke deaths and about 14% of gastrointestinal cancer deaths. Further it is stated to be among the top ten risk factors for mortality globally. The present review paper is an attempt to highlight the protective impact of fruit and vegetable intake on cardiovascular risk factors.

Light Emitting Diode Lighting Flicker, its Impact on Health, and the Need to Minimise it

Sunil Batra, Chandrakant S Pandav, Sonia Ahuja

The existing technologies in Light Emitting Diode (LED) lighting sometimes cause flicker at frequencies that may have adverse health effects. Although, not always obvious to the human eye, it can make a difference in certain circumstances. Moreover, the flicker rate of many LED lights available in the market is much greater than conventional lights. This flicker has the potential to exert harmful effects on health. The various adverse effects of flicker include eye strain, fatigue, headache, migraine, blurred vision as well as photo epilepsy in sensitive individuals. In order to resolve the problem of high flicker, the foremost step is to develop a global standard for measuring flicker and then to have regulations for acceptable flicker limit. With the growing concern over LED flicker rate, many global lighting standards and specification communities have developed or are in the process of developing flicker measurement standards. In India, currently, there is no regulatory body to check the LED quality parameters with regard to flicker rate. Despite the fact that LED lighting products with high flicker rate carry a risk of flicker-induced health problems, a wide range of such products have penetrated the Indian market. The aim of this article was to summarise the information from the available literature about different types of flicker, methods to quantify flicker and potential health impact of flicker.

Diabetes Mellitus and Oxidative Stress: A Co-relative and Therapeutic Approach

Kailash Chandra, Pradeep Singh, Shridhar Dwivedi, SK Jain

Oxidative stress is one of the factors that lead to Type 2 Diabetes Mellitus (T2DM), a serious and a fast growing health problem worldwide. Numerous studies report that the pancreatic ß-cells play an important role in T2DM progression but the underlying molecular mechanism has not been fully deciphered. The biochemical changes in diabetes mellitus lead to disturbance in oxidative milieu which in turn leads to several macro and microvascular complications in patients. Diabetes mellitus represents an ideal disease to study the adverse effects of oxidative stress and its treatment. The literature search performed using the terms: diabetes mellitus, the effect of oxidative stress on ß-cells, role of oxidative stress in diabetes mellitus and antioxidant therapy based randomised human clinical trial have been reviewed. The present review is a brief account of the different characteristics of oxidative stress in diabetes and proposes their probable clarifications. The review also highlights the beneficial effects of anti-oxidant therapy in diabetic patients by elimination of the excess reactive oxygen species efficiently and summarises the present knowledge on the role of oxidative changes in diabetes mellitus and their effect on ß-cell function that may help in development of new therapeutic strategies for this disease.

Pyridoxine: The ‘Ba.Six’ of use in Nausea and Vomiting of Pregnancy

Abbas Hassan, Arun Kumar Dubey, Malpe Surekha Bhat

Over the centuries, the dietary and biochemical essentiality of pyridoxine in the humans has been well established. Apart from various physiological functions, pyridoxine is therapeutically important in Nausea and Vomiting of Pregnancy (NVP). Pyridoxine on its own or a combination of pyridoxine (vitamin B6) (pregnancy category A) and doxylamine (category B), previously available as Bendectin, is the only medication that is specifically labeled for the treatment of NVP by the Food and Drug Administration. Although various reports claims the efficacy of pyridoxine in NVP, there are a very few studies on its mechanism of action in relieving the symptoms. Therefore, the present review was aimed at revisiting relevant previous data and providing the necessary background to discuss the chemistry, pharmacochemistry, status in pregnancy and mechanism/s of action in NVP of this B-complex vitamin in detail.

Malnutrition in Liver Cirrhosis: A Review

Sumit Rungta, Amar Deep, Suchit Swaroop

Malnutrition is a frequent and integral component of acute and chronic diseases and is most common in patients with cirrhosis and increase the severity of disease. Therefore, every hospitalised patient should have an assessment of their nutritional status. Patient with advanced liver disease commonly have malnutrition but its assessment is confounded by many of the usual indicators of nutritional status. The majority of cirrhotic patients unintentionally follow a low calorie diet, a fact that is attributed to various side-effects observed in cirrhosis. Protein Calorie Malnutrition (PCM) occurs in 50% to 90% of liver cirrhosis patients and progresses as liver function crumbled. This article is based on a selective literature review of protein and sodium recommendations. Higher intake of branched-chain amino acids and as well as vegetable proteins has shown benefits in liver cirrhotic patients. Sodium restrictions are necessary to prevent ascites development.

Mucinous Adenocarcinoma of Gall Bladder- A Rare Histopathological Variant Presented as Perforation

Sunil Vitthalrao Jagtap, Jyoti S Tele, Snehal Rameshsing Rajput, Swati S Jagtap

Mucinous adenocarcinoma of gall bladder is a malignant tumour which is a very rare histopathological variant. We report a case of an 80-year-old female presented with pain in abdomen since 3 days with increasing severity and nausea since 1 day. On ultrasonography, area of altered echotexture in caudate lobe of liver was noted. Acute calculus perforated cholecystitis type II with associated peri-gall bladder collection; abscess and peri-gall bladder inflammatory changes were noted. Sub-total cholecystectomy was performed which showed perforated gall bladder with mass lesion and on histopathology, reported as mucinous adenocarcinoma of gall bladder. We are presenting this case for its rarity and clinical, radiological and histopathological findings.