Journal of clinical and diagnostic research

A Case of Sialolithiasis in a Minor Salivary Gland of the Buccal Mucosa

Sialolithiasis is a common disease of the major salivary glands. In contrast, Sialolithiasis of Minor Salivary Glands (SMSG) is very rare. Only 2% of all cases of sialolithiasis develop in minor salivary glands and sublingual glands. Furthermore, the clinical and imaging features of SMSG frequently differ from those encountered in major salivary glands; thus, hindering proper clinical diagnosis of SMSG. Histologically, SMSG is characterized by ductal ectasia (sometimes with deep cystic dilatation), acinar atrophy and periductal inflammation. Herein, we describe a patient suffering from SMSG in the left buccal region. Based on the clinicopathological findings of this case and a review of the literature, we propose that this entity should be included in the differential diagnosis of intra-mucosal nodules.

Plasma Cell Gingivits-A Conflict of Diagnosis

Plasma Cell Gingivitis (PCG) is a rare condition of the gingiva which is benign in nature. In this condition there is enlargement of the marginal and attached gingiva. It is not only unaesthetic in appearance but also causes difficulty in speech and mastication. Hence, it creates an area for plaque accumulation because of which there is difficulty in carrying out the routine oral hygiene procedures. The aetiology is unknown and is thought to be a hypersensitive reaction to an allergen. This condition is characterized by massive infiltration of the plasma cells into the sub-epithelial connective tissue layers. Here we are presenting two cases of PCG associated with swollen lips, which is an uncommon condition. These cases were treated by gingivectomy and followed up to six months.

Oral Manifestations of Job´s Syndrome in a Paediatric Dental Patient – A Case Report

Jeswin James, Anupam Kumar Thekkeveetil, Kannan Vadakkepurayil

Job’s syndrome or Hyperimmunoglobulin E Syndrome (HIES) is a rare primary immunodeficiency with marked increase in serum immunoglobulin E (IgE) levels and eczematous dermatitis. Individuals with HIES share characteristic facial features, with many oral manifestations like retained deciduous teeth, fissured tongue, missing permanent tooth buds, recurrent oral candidiasis, oral mucosal and gingival lesions. Two forms of disease have been identified based on the defective gene as autosomal dominant form and autosomal recessive form. The therapeutic strategies are usually directed towards prevention and management of recurrent infections which are refractory to the conventional strategies. About 200 cases of HIES have been reported so far, in the present case report authors present the oral manifestations of a paediatric dental patient affected with HIES.

Post-Traumatic Ectopic Nail: A Case Report and Review of Literature

Ectopic nail or Onychoheterotopia is an uncommon clinical entity. They are usually congenital; the acquired variety is very rare. The exact pathogenesis of the disease is not clear. They present as a nail like outgrowth, distinct from the classic nail units which is usually asymptomatic. The dorsal aspect of fingers and toes are mostly affected. We present a case of a 24-year-old male with post-traumatic ectopic nail of right middle finger. Complete surgical excision of the ectopic nail was done with its germinal matrix. The patient didn’t have any evidence of recurrence after one year of follow-up, with satisfactory cosmetic outcome. This article highlights the classic presentation of a case of ectopic nail with its surgical management and brief review of literature.

Abdominal Angina Treated by Urgent Percutaneous Angioplasty: An Excellent Alternative to Surgical Revascularisation

Chronic Mesenteric Ischemia (CMI) presenting as acute abdomen can be treated percutaneously. An endovascular intervention has surpassed surgical revascularization over the past decade due to its lesser perioperative complication rate. Trans-femoral approach of revascularising is limited by its difficulty in coaxial alignment of the guiding catheter and hence, brachial artery and recently the radial approach have been utilized for mesenteric artery revascularisation for over a decade. Here by we report a case of chronic mesenteric ischemia having total occlusion of two and 70% occlusion of one of the three mesenteric vessels. The patient had presented with acute abdomen which in turn was percutaneously revascularised via the left brachial artery for the two major abdominal visceral vessels being superior mesenteric artery and inferior mesenteric artery.

Ofloxacin Induced Angioedema: A Rare Adverse Drug Reaction

Gautam Rawal, Sankalp Yadav, Raj Kumar, Umar Rasool Wani

The Adverse Drug Reaction (ADR) to a commonly prescribed anti-microbial can pose a major public health problem. The authors report a rare case of 24-year-old young lady who presented with angioedema of lips after ingestion of Ofloxacin, prescribed to her for treatment of loose motions. Fluoroquinolones are widely prescribed antibiotics for various disease conditions. The history, clinical examination and normal laboratory parameters led to the diagnosis of ofloxacin induced hypersensitivity reaction and the patient was successfully treated with corticosteroids and antihistamines. The hypersensitivity reactions to fluoroquinolones are rare with an incidence of 0.4% to 2%. The pharmacovigilance program and self-reporting of all the ADR’s by the health care workers can help in ensuring the judicious use of the drug, drug safety and thus decrease the associated morbidity and mortality.

Epidermoid Cyst of the Sole - A Case Report

Epidermoid cysts are common benign subcutaneous lesion also termed as epidermal cysts. Epidermoid cyst are commonly seen in hairy regions of body like scalp, face and scrotum, can be single or multiple, but rarely can occur in glabrous skin of palm and sole. They are known to result from progressive cystic ectasia of the infundibular portion of hair follicle but the pathogenesis in palmo-plantar epidermoid cyst differs that is traumatic sequestration of epidermal elements into dermis. Here, we report a case of 30-year-old female presented with complaints of swelling in her left sole. On examination a palpable firm swelling was noted just below the 2nd web space left foot plantar region, on X-ray foot no osseous lesion or foreign body was detected. Swelling was excised and sent for histopathological examination which confirmed it as epidermoid cyst..

Primary Liver Abscess with Anterior Abdominal Wall Extension Caused by Mycobacterium tuberculosis Complex

Tubercular liver abscess is generally secondary to some other primary foci in the body, most notably pulmonary and gastrointestinal system. To find primary tubercular liver abscess is rare, with prevalence of 0.34% in patients with hepatic tuberculosis. Abscess tracking into abdominal wall from spinal and para spinal tuberculosis is known, however primary liver tuberculosis rupturing into anterior abdominal wall has been reported only twice in literature. We report a case of 43-year-old female with direct invasion of the anterior abdominal wall from an isolated tubercular parenchymal liver abscess, caused by Mycobacterium tuberculosis complex, diagnosed primarily on smear for Acid Fast Bacilli (AFB), imaging and isolated by culture and BACTEC MGIT 960 KIT. We discuss here the diagnostic dilemma, management and outcome of primary tubercular liver parenchymal abscess with direct invasion into anterior abdominal wall.

A Rare Case of Anomalous Origin of First Lumbrical from the Tendon of Flexor Digitorum Superficialis to Index Finger

S Trivedi, BC Satapathy, M Rat Rathore, M B Sinha

Human hand is involved in variety of precision work which requires a combined effort of forearm muscles as well as intrinsic muscles of hand. Lumbricals along with interossei muscles connect the tendons of flexor and extensor muscles and thus play a key role in the characteristic movements of human hands. Lumbricals originate from long flexor tendon and is inserted into dorsal digital expansion. Any variation in the attachment of these muscles can lead to deviation from the normal actions of the fingers and their proximal extension into carpal tunnel and might lead to carpal tunnel syndrome. An extremely rare case of first lumbrical taking origin solely from first tendon of Flexor Digitorum Superficialis (FDS) and having proximal attachment extending into carpal tunnel was noticed bilaterally in cadaveric dissection. These variations are always challenging for clinicians and surgeons during hand surgeries.

Senior Loken Syndrome

Amarpreet Kaur, Shashi Kant Dhir, Geetika Goyal, Naveen Mittal, R.K. Goyal

Senior Loken Syndrome (SLS) is a rare genetic disorder having juvenile nephronophthisis and retinal degeneration progressing to blindness and end stage renal disease. The present case report is about two sisters who presented with decreased visual acuity and end stage renal disease. Both had decreased vision, pallor, deranged renal function test and chronic malnutrition. Investigations revealed anaemia, uraemia, raised creatinine, low Glomerular Filteration Rate (GFR). Ophthalmology examination revealed nystagmus, retinal examination depicted pale optic disc and pigmentary changes in the retina. Renal ultrasound showed grade III renal parenchymal changes and bilateral cortico-medullary cysts. These cases are presented to highlight the importance of timely recognition of renal derangement in patients with retinal disease to delay end stage renal disease.

Large Cell Calcifying Sertoli Cell Tumour of Testis-A Rare Case Report

Harresh Kumar, Nadeem Tanveer, Natasha Gupta, Kiran Mishra

Sertoli cell tumours of testes are classified into sertoli cell tumour NOS (not otherwise specified), sclerosing variant and large cell calcifying variant. So far, 90 cases of the large cell calcifying variant have been reported in literature. We describe a rare case of inhibin negative locally invasive large cell calcifying sertoli cell tumour of testis. A 62-year-old man presented with complaints of pain and swelling in right scrotum for 8 months. Ultrasound revealed a right testicular mass with internal vascularity and calcification. Gross examination of right inguinal orchiectomy specimen showed firm to hard mass with yellow areas and calcification seen on cut section. Microscopy revealed a tumour in the testis infiltrating the epididymis and rete testis and reaching up to the skin. Tumour cells were arranged in the form of solid nests, tubules and cords with neutrophilic stromal infiltrate and calcification. Tumour cells had abundant clear to eosinophilic cytoplasm, round nucleus with vesicular chromatin and conspicuous nucleoli. On immunohistochemistry, tumour cells were positive for pan cytokeratin, Epithelial Membrane Antigen (EMA), S-100 protein, desmin, vimentin, neuron specific enolase, and chromogranin. However, it was negative for inhibin alpha, OCT4, CD10, CD99, Melan A. Inhibin negative large cell calcifying sertoli cell tumour is a rare entity.

Coincidental Finding of Beta Thalassaemia Minor in a Patient of Lacquer Thinner Poisoning Presenting as Methaemoglobinemia

Charu Agarwal, Anisha Mohanpuria, Gurdeep Buxi, Vijay Kumar

Lacquer thinner, commonly used for removing household paints, is known to contain various aromatic hydrocarbons and naphtha; if ingested, may cause methaemoglobinemia. We report a case of 13-year-old girl who presented with episodes of vomiting, abdominal pain and numbness of limbs. Peripheral blood smear showed few fragmented erythrocytes and 10-12 nucleated red blood cells /100 white blood cells. Reticulocyte count was 15% with presence of Heinz bodies. There was a history of accidental ingestion of lacquer paint thinner. Levels of methaemoglobin were very high along with raised HbA2 levels. An impression of haemolytic anaemia, due to lacquer thinner paint poisoning, with methaemoglobinemia was given. Incidentally High Performance Liquid Chromatography (HPLC) revealed increased HbA2 levels i.e., heterozygous inheritance of beta thalassaemia minor. Patient responded well to methylene blue. Blood transfusion was performed and symptomatic treatment was given.

Giant Haemangioma Excision Under Cervical Epidural Anaesthesia: A Viable Alternative to General Anaesthesia.

Samit Parua, Dipika Choudhury, Mridu Paban Nath

The cervical epidural anaesthesia is a safe anaesthetic technique with minimal morbidity and early postoperative recovery. Cervical epidural anaesthesia can be effectively used for neck, upper arm and chest surgeries. The technique avoids the adverse effects of general anaesthetics and airway instrumentation, especially in patients with cardio respiratory disorders. We preferred CEA for giant haemangioma neck excision in an adult female patient, having an associated laryngeal haemangioma, 10ml of 0.5% ropivacaine with 50µg Fentanyl (total 11 ml) was administered into the cervical epidural space through a 20G epidural catheter introduced via a 18G Tuohy needle at the level of C7-T1 space. Following initial dose a top up dose of 4ml 0.5% Ropivacaine was given after 60 minutes. The surgery lasted for 75 minutes. The cervical epidural anaesthesia allowed our patient to stay awake but comfortable, with stable haemodynamics and excellent postoperative pain relief with a continuous cervical epidural infusion of 0.25% Ropivacaine and 2µg/ml Fentanyl @ 2ml/h was achieved.

Primary Abdominal Pregnancy: A Case Report

Sunita Dubey, Mohit Satodiya, Priyanka Garg, Mamta Rani

Abdominal pregnancy is a potentially life threatening form of ectopic gestation with an incidence of 1% of all the ectopic pregnancies. Rarely, it may reach at advanced gestation and a viable fetal outcome is indeed a rare event. Most of them are terminated earlier due to poor fetal prognosis and higher chances of maternal mortality secondary to haemorrhagic shock following spontanous placental separation. A high index of suspicion is important for making a diagnosis of abdominal pregnancy and its timely management after correct diagnosis. We report a case of primary abdominal pregnancy in a 30-year-old gravida 3, para 2 at 7+2 weeks of gestation. She presented with haemorrhagic shock due to spontanous separation of gestational sac from the site of implantaion. She had persisitent nausea, vomiting, diarrhoea and always had an urge to defecate which never goes off even after she defecates. She underwent termination of pregnancy by dilatation and curattage without having any antenatal ultrasound. After 72 hours of the procedure, her symptoms were aggravated and she went into haemorrhagic shock. During laparotomy haemoperitoneum of 3litres, 1kg of clots were evident and size of the uterus was about 10-12 week, bilateral tubes and ovary were healthy. A ensac fetus of 10+2 weeks along with the separated placenta was lying in the abdominal cavity. Site of implantation was identified over sigmoid colon which was not bleeding. Patient was transfused with blood and blood products. She was discharged satisfactorily on 5th postoperative day. Hence, an Ultrasound should be done to rule out abdominal pregnancy before medical termination of pregnancy, especially in those with persistent Gastrointestinal Tract (GIT) symptoms as clinically uterus may correspond to the period of gestation in abdominal pregnancy.

High Flow AV Malformation (A-V Shunt) of Mandible: A Rare Life Threatening Entity

Intraosseous Arteriovenous Malformations (AVMs) in the head and neck region are very rare and potentially life threatening entities due to massive hemorrhage. These are the results of an embryonic abnormality of the vascular system. Depending on the blood flow and clinical presentations they are of different types like slow flow and high flow AVM. Here we present a case of high flow AVM involving mandible with a chief complain of gingival bleeding in a four year old girl child.

Prosthodontic Approach in Management of Prolonged Neonatal Intubation

Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation.

Transthoracic Biopsy Causes Massive Subcutaneous Emphysema in a Low Risk Patient

Fikri Selcuk Simsek, Yusuf Dag

Subcutaneous Emphysema (SE) can be defined as air leakage under skin from the respiratory or gastrointestinal system. It is frequently accompanied by pneumomediastinum. Thoracentesis, image-guided lung biopsies, pulmonary diseases and therapies resulting in necrosis can cause this pathology. The risk of pneumothorax and SE increased with the distance of the lesion to the pleura, and small size of the lesion. Although, our patient had low risk for SE, there were minimal pneumothoraces and massive SE. We consider that tumour necrosis and subcutaneous tissue may be related via transthoracic biopsy and this leads to massive SE.

Cystic Pheochromocytoma Presenting as Adrenal Cyst

Pheochromocytomas are usually solid tumours. But it can present as cystic lesions in the adrenal gland. Cystic lesions in adrenal gland with hypertension needs attention to rule out pheochromocytoma. If ignored, it may lead to hypertensive emergency, multisystem crisis and death. Early diagnosis with biochemistry, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) of abdomen, proper functional imaging like Meta Iodo Benzyl Guanidine (MIBG) scan is essential. Proper preoperative preparation is important to prevent hypertensive crisis during and after surgery. We are reporting a case of cystic pheochromocytoma in a young male.

Blunt Cardiac Rupture: A Diagnostic Challenge

Suraj Pinni, Vineet Kumar, Satish Balkrishna Dharap

Blunt Cardiac Rupture (BCR) is a life threatening injury. Majority of patients do not reach the hospital and in those who reach the emergency department, timely diagnosis and treatment is a challenge. The case is about a patient with multiple blunt injuries who presented in shock. Cardiac tamponade was suspected on clinical grounds and on evidence of mediastinal widening on radiograph. In the absence of songography, the diagnosis was confirmed by subxiphoid pericardial window. Emergency thoracotomy revealed a right atrial appendage rupture which was surgically corrected. The patient also underwent splenectomy for grade IV splenic injury. Liver injury, pubic diastasis and tibial spine avulsion fracture was managed conservatively. He recovered well. Systematic observance of trauma resuscitation guidelines can help salvage patients with life threatening complex injuries even in the absence of specialized imaging investigations.

Pancreatic Tuberculosis: A Puzzle for Physicians. A Rare Case and Review of Literature

Pancreatic Tuberculosis is an uncommon form of extra pulmonary tuberculosis that resembles malignancy of pancreas and serve as a diagnostic challenge for physicians. Conservative management with Anti Tuberculosis Therapy (ATT) will suffice for pancreatic tuberculosis whereas a malignancy may require major surgeries which may lead to significant morbidity. Here, we discuss the case of a female patient who presented with abdominal pain and vomiting and is a known case of chronic calcific pancreatitis. Radiological findings were that of malignancy of the pancreas. Enteroscopy showed pus flowing out from the duodenum. Endoscopic Ultrasound (EUS) guided Fine Needle Aspiration Cytology (FNAC) of the pancreas revealed acid fast bacilli. The patient was treated successfully with ATT. Timely diagnosis of this rare form of extra pulmonary tuberculosis can thus help avoid unwanted resections done for presumed malignancy, for which a high index of suspicion is needed.

Multidisciplinary Restoration of Traumatized and Displaced Maxillary Central Incisor by Bent Wire System-A Novel Approach

Management of traumatic injuries to teeth is a challenge to dental practice, as it occurs when dentists are least prepared for it. The direction and the force of the object or the fall significantly affects the diagnosis, treatment plan and therefore the outcome of the treatment. These traumatic injuries may present with different clinical situations which demand immediate attention and assessment by the clinician. The maxillary central incisor crown fractures are the most common variant of trauma, because of the anterior and protrusive positioning. This case report describes the novel method to produce expansion of the dental arches to correct the post-traumatic displacement of the central incisor along with aesthetic and functional rehabilitation of Ellis Class IV fracture of permanent maxillary central incisor.

A Case of Surgical Site Infection Caused by Mycobacterium fortuitum, following Herniorrhaphy

NS Madhusudhan, A Malini, Mima Maychet B Sangma

Rapidly Growing Mycobacteria (RGM) are opportunistic pathogens found in the environment. Mycobacterium fortuitum, M. chelonae and M.abscessus are the important human pathogens of this group. They cause wound infections, disseminated cutaneous disease, pulmonary infection in patients with cystic fibrosis or bronchiectasis, bone and joint infections and keratitis. Infections due to these Non-Tuberculous Mycobacteria (NTM) are increasingly reported. Post laparoscopic wound infections, mesh site infections and other surgical site infections due to M. fortuitum and M. chelonae have been reported. Usually wound infections due to atypical mycobacteria have delayed onset and do not respond to conventional antibiotics. Identification of RGM can be done by a set of cumbersome biochemical tests, High Performance Liquid Chromatography (HPLC), molecular methods using DNA probes or by Polymerase Chain Reaction (PCR). We here report a case of post-herniorrhaphy wound infection due to M. fortuitum which was identified by molecular method (HAIN mycobacterial species system). This case report underscores the importance of examining Ziehl-Neelsen (ZN) stain of all exudates with sterile culture on day one for non fastidious bacteria. Timely identification can lead to prompt therapy of patients preventing further complications.

Neurofibromatosis Type 1 Presenting with Ophthalmic Features: A Case Series

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder involving multiple systems and affects approximately 1 out of 3000 persons. Ocular manifestations are lisch nodules, plexiform neurofibroma, optic pathway gliomas. The proper diagnosis of NF-1 is a crucial task for a clinician due to the various clinical manifestations including vision and life threatening malignancies in few patients, which may arise in the different phases of life. The authors report three cases of NF-1, presenting with ophthalmic symptoms in teenager boys. On further ophthalmic and paediatric evaluation the diagnosis of NF-1 was confirmed on the basis of clinical criteria. This series also describe the abnormal facial features like telecanthus and broad nose which has been reported rarely. Case 1 was kept under regular follow-up and Case 2 and Case 3 were planned for the debulking surgery for plexiform neurofibroma of upper eye lid. A multidisciplinary approach is required to diagnose and treat such patients keeping in mind the myriad of clinical manifestations and life-long follow-up is required.

Clinical Instrument Refurbishment-A Chair side Technique

Rohan Pulgaonkar, Suma Liz Panicker, Prasad Chitra

Evaluation of an Electronic Periodontal Probe Versus a Manual Probe

Introduction: Diagnosis of periodontal diseases requires reco-rding of clinical and periodontal variables. Possible measurement errors in recording the periodontal findings are dependent on the measurement method. Aim: The purpose of the trial was to investigate an electronic, pressure-calibrated probe compared with a standard, manual measurement probe used to take periodontal variables. Materials and Methods: The study included 25 subjects suffering from periodontal disease. Their findings were taken by two users on a randomized basis using a standard probe and an electronic, pressure calibrated probe, at an interval of 24 hours. The recorded clinical variables contained Pocket Depth (PD), Attachment Level (AL), Bleeding on Probing (BOP), the complete time needed to take the findings and the sensation of pain experienced by a Visual Analogue Scale (VAS). The data were statistically analyzed using the paired t-test. Results: The measurement values (24 patients) for PD (p=0.03) and BOP (p=0.01) indicated a significant difference (paired t test, p>0.05), while there was no statistical difference for AL (p=0.064). A classification of PD into groups of 1-3mm, 4-6mm and =7mm showed that the manual method measured higher values than the electronic method (p=0.001). The measurement values did not reveal any significant differences (p>0.05) with respect to the total time needed to take findings and the measurement time for PD/AL. There was a significant difference (Wilcoxon-test, p<0.05) in VAS values (p=0.048) and in terms of the time needed to record the findings for BOP (p=0.004). Conclusion: It can be assumed that the electronic probe should mainly be used in the supportive periodontal therapy. Present study showed that the use of a standard manual probe is essential to review conspicuous or unclear measurement values, or when treating deep pockets higher than 7mm.

Modified Technique for Making Auto-polymerized Polymethylmethacrylate Resin Custom Tray

Custom made tray for dental impression is designed to provide a uniform space for the impression material and thereby improve the accuracy of the resultant working cast. Auto-polymerized acrylic resins have been the most commonly used material for the fabrication of these trays. The custom tray produces more accurate and reliable results for inter-abutment distance at the occlusal and gingival level than stock trays. This article describes a modified technique for fabrication of auto-polymerized Polymethylmethacrylate (PMMA) resin trays.

Effects of Swimming Exercise on Learning and Memory in the Kainate-Lesion Model of Temporal Lobe Epilepsy

Introduction: An aerobic exercise (Ex) augments neurogenesis and may ameliorate learning and memory deficits in the rat Kainic Acid (KA) model of temporal lobe epilepsy in the short-term but whether it reverses learning and memory deficits after a substantial period of delay remains unclear. Aim: This study tests the hypothesis that aerobic Ex attenuates the learning and memory deficits associated with kainate seizures in the long-term. Materials and Methods: A total of 60 rats were subjected to chemical lesioning using KA and to an Ex intervention consisting of a 30 days period of daily swimming for 15 min, immediately after KA lesioning (immediate exposure) or after a 60 days period of normal activity (delayed exposure). We evaluated spatial learning on a T-maze test, expressed as percentage of correct responses. We evaluated memory on a passive-avoidance test, expressed as time spent in a compartment in which the rats were previously exposed to an aversive stimulus. Results: Ex increases the percentage of correct responses, percentage bias, and number of alternations, associated with the T-maze testing for the normal control, sham-operated control and kainate-lesioned animals after both immediate and delayed exposures to Ex. Ex decreased the time exposed to the aversive stimulus in the smaller compartment of the two-compartment passive-avoidance test, also for the normal control, sham-operated control and kainate-lesioned animals after both immediate and delayed exposures to Ex. Conclusion: These finding suggest that, after temporal lobe epileptic seizures in rats, swimming exercise may attenuate the learning and memory deficits, even if the exercise treatment is delayed.

Stafne’s Bone Cavity: A Note on Classification

Astha Chaudhry

Increased Urinary Frequency Due to P. Falciparum Infection - A Case Report

Ravi Bhatia, Dinesh Rajwaniya

Current Status of Role of Serum Amylase and Lipase to Triage Blunt Pancreatic Trauma?

Abhishek Mahajan

Haemostatic Profile in Patients of Myeloproliferative Neoplasms-A Tertiary Care Centre Experience

Introduction: Patients of MPN commonly present with abnormalities in laboratory coagulation tests that are consistent with hypercoagulable state. Some individuals with MPN exhibit a pattern of exclusive bleeding or thrombotic events; many others have both bleeding and thrombosis during the course of the disease. Aim: This study was undertaken to assess the haemostatic defects and platelet functions in patients of MPN. Materials and Methods: One year prospective study was conducted at a tertiary care centre in North India in Department of Pathology in collaboration with Department of Clinical Haematology. All recently diagnosed cases of MPN along with 30 age and sex matched controls were included. Patients on antiplatelet drugs, antimyeloproliferative treatment, vitamin K agonists or antagonists, OCPs, Platelet count <1,00,000/µl, high grade fever, liver disease, pregnancy were excluded from this study. All the patients underwent screening investigations like CBC, peripheral smear evaluation, BT, PT, aPTT, Protein C and S measurement (clot based assay) and aggregation studies with ADP (5µM) (Optical Aggregometry with AGGRO/LINK 8 software and CHRONOLOG 700 aggregometer). Results: In present study, 50 cases were included. There was an occult prothrombotic state, suggested by significantly (p<0.001) reduced levels of Protein C and Protein S, but no patient presented with frank thrombosis while 8 out of 50 patients had haemorrhagic manifestations ranging from subdural haematoma to pin point petechial haemorrhages. Patients of CML-CP, ET, PV, PMF, MPN-NOS showed significantly reduced maximal aggregation with ADP (5µM) when compared to control (p<0.001). MPV also showed a statistically significant increase in these patients. Conclusion: Thrombohaemorrhagic complications significantly affect the morbidity and mortality of MPN patients. This can be assessed by the use of platelet aggregation studies, Protein C and S activities and other coagulation studies. Timely diagnosis of these prothrombotic/haemorrhagic states can decrease the morbidity in these patients.

Blood Contamination of the Small Bore Peripheral Intravenous Catheter in Neonates

Vani Krishnamurthy, Srinivasa Murthy Doreswamy, Sushma Krishnagowda

Introduction: Peripheral Intravenous Catheters (PIV) are extensively used in sick neonates for administration of medicines and nutrition. When these PIVs are used on intermittent basis, they are flushed with saline in order to keep the hub of the catheter free from blood. Presence of blood in the hub of the catheter can be potentially dangerous as it could facilitate infection. Aim: The aim of this study was to find the magnitude of blood contamination of PIV catheter hub after routine flushing. Materials and Methods: We measured the volume of 24 g PIV by filling it with saline and thereby measuring its volume. The PIVs which were in situ for at least 6 hours and removed were used for this study. These catheters were flushed with 0.2 ml of saline and the RBC count was calculated. Results: A total of 94 PIVs were studied, out of which 84% showed blood tinged residual flush and 15% of them had visible blood clot. All (100%) of the catheter studied showed RBCs on microscopic examination. The median RBC count was 36960/cu mm and the interquartile range was 10000 – 113920/cu mm. The highest RBC count was 2080000/cu mm. Conclusion: Blood contamination of the small bore PIVs after flushing is universal in neonates.

Large Scale 7436-bp Deletions in Human Sperm Mitochondrial DNA with Spermatozoa Dysfunction and Male Infertility

Introduction: Mitochondria and mitochondrial DNA are essential to sperm motility and fertility. It controls growth, development and differentiation through oxidation energy supply. Mitochondrial (mtDNA) deletions or mutation are frequently attributed to defects of sperm motility and finally these deletions lead to sperm dysfunction and causes infertility in male. Aim: To investigate the correlation between large scale 7436-bp deletions in sperm mtDNA and non-motility of sperm in asthenozoospermia and Oligoasthenoteratozoospermia (OAT) infertile men. Materials and Methods: The present prospective study was carried out in Human Genetic Division, Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences, Sevagram from June 2014 to July 2016. We have studied 110 asthenozoospermia and OAT infertile men whose semen profile indicated abnormal motility and 50 normal fertile controls. Of 110 infertile men, 70 had asthenozoospermia and 40 had OAT. Fractionations of spermatozoa were done in each semen sample on the basis of their motility by percoll gradients discontinuous technique. Long-range PCR was used for detection of 7436-bp deletions in sperm mtDNA and was confirmed by primer shift technique. Results: Overall eight subjects (8/110; 7.2%) of which six (6/70; 8.57%) asthenozoospermia and two (2/40; 5%) OAT had shown deletions of 7436-bp. In 40% percoll fraction had more non-motile spermatozoa than 80% percoll fraction. The non-motile spermatozoa in 40% percoll fractions showed more mtDNA deletions (7.2%) than the motile spermatozoa in 80% percoll fraction (2.7%). The sequencing of flanking regions of deleted mtDNA confirmed 7436-bp deletions. Interestingly, no deletions were found in control subjects. Conclusion: Though, the frequency of 7436-bp deletions in sperm mtDNA was low in infertile cases but meaningful indications were there when results were compared with controls. It is indicated that large scale deletions 7436-bp of mtDNA is associated with abnormal sperm motility. The 7436-bp deletions of mtDNA in spermatozoa may be one of the important causes of dysfunction and non-motile sperm.

Validation of Malaysian Versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE) and 8-Morisky Medication Adherence Scale (MMAS-8) Using Partial Credit Rasch Model

Introduction: The Diabetes Mellitus (DM) is a common silent epidemic disease with frequent morbidity and mortality. The psychological and psychosocial health factors are negatively influencing the glycaemic control in diabetic patients. Therefore, various questionnaires were developed to address the psychological and psychosocial well-being of the diabetic patients. Most of these questionnaires were first developed in English and then translated into different languages to make them useful for the local communities. Aim: The main aim of this study was to translate and validate the Malaysian versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE), and to revalidate 8-Morisky Medication Adherence Scale (MMAS-8) by Partial Credit Rasch Model (Modern Test Theory). Materials and Methods: Permission was obtained from respective authors to translate the English versions of PDSMS, MUSE and MMAS-8 into Malay language according to established standard international translation guidelines. In this cross-sectional study, 62 adult DM patients were recruited from Hospital Kuala Lumpur by purposive sampling method. The data were extracted from the self-administered questionnaires and entered manually in the Ministeps (Winsteps) software for Partial Credit Rasch Model. The item and person reliability, infit/outfit Z-Standard (ZSTD), infit/outfit Mean Square (MNSQ) and point measure correlation (PTMEA Corr) values were analysed for the reliability analyses and construct validation. Results: The Malay version of PDSMS, MUSE and MMAS-8 found to be valid and reliable instrument for the Malaysian diabetic adults. The instrument showed good overall reliability value of 0.76 and 0.93 for item and person reliability, respectively. The values of infit/outfit ZSTD, infit/outfit MNSQ, and PTMEA Corr were also within the stipulated range of the Rasch Model proving the valid item constructs of the questionnaire. Conclusion: The translated Malay version of PDSMS, MUSE and MMAS-8 was found to be a highly reliable and valid questionnaire by Partial Credit Model. The Malay version was conceptually equivalent to original version, easy to understand and can be used for the Malaysian adult diabetic patients for future studies.

First Line Anti-TB Drug Resistance in an Urban Area of Odisha, India

Dasarathi Das, Prakasini Satapathy, Biswanath Murmu

Introduction: Drug resistance is a major cause for increasing the global burden of Tuberculosis (TB). However in countries with larger geographical areas and different climatic conditions like India the prevalence of drug resistance varies from place to place. Information on anti-TB drug resistance patterns particularly among newly diagnosed cases is crucial for planning an effective TB control program. Aim: To determine the prevalence of resistance against first line anti-TB drugs and Multi Drug Resistance (MDR) in Mycobacterium tuberculosis isolates. Materials and Methods: The prospective study was carried out in National Reference Laboratory (NRL) of Regional Medical Research Centre (RMRC), Bhubaneswar. During this period from January to September 2014, sputum specimens were collected from 850 suspected pulmonary TB patients attending Designated Microscopy Center (DMC) of Capital Hospital, Bhubaneswar, Odisha. Sputum specimens were subjected to Acid Fast Bacilli (AFB) smear microscopy and further processed for isolation on solid Lowenstein Jensen (LJ) medium. Drug Susceptibility Testing (DST) on isolates with first line anti-TB drugs was performed as per Revised National Tuberculosis Control Programe (RNTCP) guidelines. Results: Out of all the 850 suspected pulmonary TB patients subjected to AFB microscopy and solid LJ culture, isolation of Mycobacterium tuberculosis was successful only in 161 (117 new and 44 previously treated) pulmonary TB patients. On DST by the RNTCP approved proportion method, prevalence of MDR- TB among 0.85% new and 4.54% previously treated cases was observed. Prevalence of mono resistance to streptomycin, isoniazid, rifampicin and ethambutol observed among new and previously treated cases were 3.41%, 2.56%, 0, 0.85% and 2.27%, 13.6%, 2.27%, 0 respectively. Only one patient from each category showed resistance to both streptomycin and isoniazid in previously treated as well as in new case. Conclusion: The study reports an unchanged low level of MDR-TB prevalence among new cases in an urban area of Odisha over a decade. This could be due to the success of Directly Observed Treatment Short-course (DOTS) in effective treatment of drug-susceptible TB in the state and non-transmission from primary Drug Resistance (DR) TB cases.

Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist’s Perspective

Sapna Patel, B.R. Rajalakshmi, G.V.Manjunath

Introduction: The Autopsy aids to the knowledge of pathology by unveiling the rare lesions which are a source of learning from a pathologist’s perspective Some of them are only diagnosed at autopsy as they do not cause any functional derangement. This study emphasizes the various incidental lesions which otherwise would have been unnoticed during a person’s life. Aim: The aim of this study was to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death. It was also aimed to highlight various incidental and interesting lesions in autopsies. Materials and Methods: A retrospective study of medicolegal autopsies for six years was undertaken in a tertiary care centre to determine the spectrum of histopathological findings including neoplastic lesions related or unrelated to the cause of death and to highlight various incidental and interesting lesions in autopsies. Statistical Analysis: Individual lesions were described in numbers and incidence in percentage. Results: The study consisted of a series of 269 autopsy cases and histopathological findings were studied only in 202 cases. The commonest cause of death was pulmonary oedema. The most common incidental histopathologic finding noted was atherosclerosis in 55 (27.2%) cases followed by fatty liver in 40 (19.8%) cases. Neoplastic lesions accounted for 2.47% of cases. Conclusion: This study has contributed a handful of findings to the pool of rare lesions in pathology. Some of these lesions encountered which served as feast to a pathologist are tumour to tumour metastasis, a case with coexistent triple lesions, Dubin Johnson syndrome, von Meyenburg complex, multilocular cystic renal cell carcinoma (MCRCC), Autosomal dominant polycystic kidney disease (ADPKD), liver carcinod and an undiagnosed vaso-occlusive sickle cell crisis. Autopsy studies help in the detection of unexpected findings significant enough to have changed patient management had they been recognized before death.

Cardiovascular Abnormalities in Egyptian Children with Mucopolysaccharidoses

Introduction: The Mucopolysaccharidoses (MPS) are rare inherited metabolic disorders. They are characterized by the progressive systemic deposition of glycosaminoglycans (GAGs). GAGs accumulate in the myocardium and the cardiac valves. Enzyme Replacement Therapy (ERT) is available for MPS I, II, and VI. However, ERT does not appear to improve cardiac valve disease in patients with valve disease present at the start of ERT. Aim: To evaluate the cardiac involvement in Egyptian children with MPS. Materials and Methods: Echocardiograms (ECG) were done for 34 patients. Both quantitative and qualitative Glycosaminoglycans (GAGs) in urine and enzyme assay confirmed the diagnosis. Mitral, tricuspid and aortic valves were evaluated for increased thickness, regurgitation and/or stenosis, left ventricular chamber dimensions, septal and posterior wall thicknesses. Results: The patients’ age ranged from 0.9-16 years (median age 4 years). They included 19 cases of MPS I (55.9%), 3 cases of MPS II (8.8%), 2 cases of MPS III (5.9%), 6 cases of MPS IV (17.6%) and 4 cases of MPS VI (11.8%). Heart murmur was heard in 9 of the participants (9/34) (26%). However, 15 patients (15/34) (44%) revealed cardiac lesions on ECG examinations. Mitral regurge (47%), followed by pulmonary hypertension (40%), were the most frequent findings. Conclusion: The absence of Cardiac murmurs does not exclude the heart involvement. Cardiac valve dysfunction may not be reversible. Regular ECG should be routinely warranted in children with MPS and early ERT are recommended.

Profile of Amblyopia in School going (5-15 years) Children at State Level Referral Hospital in Uttarakhand

Manisha Gupta, Sudhir Kumar Rana, Sanjiv Kumar Mittal, R.N.P. Sinha

Introduction: Amblyopia is one of the common causes of childhood visual impairment. The prevalence of amblyopia usually varies according to the age group of the studied population and the factors prevailing in that region. The upper limit of the critical time when the amblyopia can develop is around eight years of age and it can be permanent if corrective measures are not taken in time. Aim: The purpose of study was to know the profile and pattern of amblyopia in children aged 5-15 years with refractive error in Uttarakhand and to compare it with national and regional (South Asian) studies. Materials and Methods: In present retrospective cross- sectional study, 360 children from 5-15 yrs of age who attended the OPD during the period between September 2014 to February 2015, had undergone detailed Ophthalmic examination. The children having vision < 6/12 with out organic lesion were included in the study. The children with strabismus, previous ocular surgery and ocular diseases were excluded. Statical Analysis done by - Percentage, ratio, Chi-Square test (IBM SPSS Version 23). Results: The percentage of amblyopia was 8.6% (n=31) with insignificant gender variation (p-value>0.05). Amblyopia due to astigmatism (combined) 41.93% (n=13) followed by Hypermetropia was 32.25% (n=10) and least in myopia i.e. 25.8% (n=8). In 51.61% cases age of presentation was 5-10 years while rest belonged to > 10 years of age. Binocular amblyopia was more (58.06%) then unilateral amblyopia (41.93%). Conclusion: Refractory errors are second most common cause of paediatrc amblyopia. Amblyopia and associated strabismus can have devastating psychosocial and economical fall outs. Our study emphasizes the need of more visual screening of school children and prescribing them correct spectacles at appropriate time.

Accuracy of Pelvic Mass Score in Pre-operative Determination of Malignancy in Adnexal Masses

Lakshmi Mohan, Arun Rao, Sonali Ullal, Gowtham Krishna

Introduction: Suspicious adnexal masses are common clinical problems in gynaecological practice. A reliable diagnostic tool for the early detection of the ovarian malignancy is essential. Aim: To validate a new scoring system –Pelvic Mass Score (PMS) in predicting the nature of the adnexal mass pre-operatively. Materials and Methods: A prospective observational study was carried out in 100 consenting women with an undiagnosed adnexal mass requiring operative intervention. Among them 62 patients had mass with a feeding vessel in which the Doppler velocimetry study values were available. The PMS was determined in these 62 patients. A score of 29 or more was taken as suggestive of malignancy. The results were compared with the histopathological diagnosis to confirm malignancy. The chi-square test was applied to test the significance. Results: Among the 62 patients with vascular mass, 31 had histopathological diagnosis of malignancy. The statistical analysis of the data with PMS with 29 as cut-off revealed 100% sensitivity and 100% Negative Predictive Value (NPV) as there was no false negative case detected. But the specificity and Positive Predictive Value (PPV) was poor; 45.2% and 64.6% respectively. Based on the Receiver Operating Characteristic (ROC) curve, if we redefine cut-off as 69, specificity increases to 80.6% with a sensitivity of 90.3%, the PPV and NPV being 82.35 and 89.29 respectively. Conclusion: The present study concludes that, in suspicious vascular adnexal masses PMS can be used as a reliable diagnostic score to predict malignancy if we redefine the existing cut-off of 29 to 69.

Oral Health Status of Tibetan and Local School Children: A Comparative Study

Introduction: India has seen a large influx of refugee populations throughout history and the Tibetan immigration is one among them. Understanding the health status and needs of immigrants is imperative because of their growing numbers and their input to the health of the nation. The oral health professionals face many challenges while confronting refugees and immigrants from cultures different from their own. Earlier studies have shown that children, especially refugees and immigrants have had a higher prevalence of unmet oral health needs. Aim: The purpose of this study was to assess and compare the oral health status of 11-13 year old Tibetan and non-Tibetan school children in Bylakuppe, Karnataka, India. Materials and Methods: A stratified cluster sampling of 11-13 year old Tibetan and non-Tibetan school children (431 and 434 respectively) formed the study participants for this study. Assessment of dental caries, periodontal disease and malocclusion was done in accordance with criteria laid down by WHO in oral health assessment survey basic methods, 1997. Data was collected by a single trained examiner. The results obtained were analyzed by SPSS version 18. The data was statistically analyzed by using chi-square test and independent t test. The level of significance was set at 5%. Results: The prevalence of caries was found to be higher among the Tibetan school children when compared to the non-Tibetan school children (71% and 53.9% respectively). The mean number of sextants with healthy gingiva (2.49±2.40) and calculus (1.63±2.28) was higher among the non-Tibetan school children. The mean Dental Aesthetic Index score was found to be higher for Tibetan school children than the non-Tibetan school children (26.57±4.62 and 23.52±4.36 respectively). Conclusion: The prevalence of caries, periodontal disease and malocclusion were found to be higher among immigrant Tibetan school children as when compared to non-Tibetan school children. The high level of unmet needs in the study population highlights the need for a comprehensive dental care programme in Bylakuppe.

Influence of Hypertension on pH of Saliva and Flow Rate in Elder Adults Correlating with Oral Health Status

Introduction: One of the most prevalent systemic conditions seen in the elderly individuals is hypertension, but very sparse knowledge regarding the influence of hypertension on oral health in known. Aim: Therefore, this study was carried out to evaluate the relationship between hypertension and salivary pH, flow rate and its effect on oral health status. Materials and Methods: The study included 40 elderly individuals above 60 years of age, of which 20 individuals (control group) were normotensive without using any medication and 20 individuals (study group) were hypertensive using anti-hypertensive medication. Stimulated and unstimulated saliva samples were collected from all individuals and pH was measured using saliva pH strips, flow rate was measured using calibrated test tubes and was correlated with oral health status. Then the values were sent for statistical analysis where unpaired t-test, chi-square test were used. Results: The results showed that there was no significant association of hypertension with stimulated and unstimulated flow rate, rather there was a significant association of hyper-tension with stimulated salivary pH i.e., there was a significant decrease in the pH of stimulated saliva. The study also revealed a significant association with presence of bleeding on probing and periodontal pockets in individuals who were hypertensive and using anti-hypertensive medication. Conclusion: Hence, it is a necessity to monitor blood pressure for reconstruction and maintenance of oral health in older adults. More longitudinal studies are to be carried out to explore further relationship between oral health and hypertension in older adults.

Assessment of Dental Nutrition Knowledge among Nutrition/Dietetics Students

Introduction: Diet and nutrition plays an important role in signifying the health of an individual. Oral health is the most important aspect of the body when it comes to food intake and its health benefits. It is important for the nutrition/dietetics students to be aware of the health modalities related to oral aspect. Aim: The aim of the present study was to assess knowledge towards the effect of diet and nutrition on oral health among nutrition/dietetics students of Udaipur city, Rajasthan, India. Materials and Methods: A descriptive cross-sectional study was conducted among all the nutrition and dietetics students of Udaipur city. A self-administered, pretested 14 item questionnaire was given to 180 students to assess their knowledge about dietary factors related to caries, anti-cariogenic foods, frequency and duration of sugar intake etc. One-way analysis of variance and independent sample t-test were utilized for statistical analysis. Confidence level and level of significance were set at 95% and 5%, respectively. Results: The mean score for knowledge was 28.92±1.72. Mean knowledge scores for III, II and I year students were 29.91±1.94, 29.56±1.27 and 27.30±1.66 respectively. When post-hoc Bonferroni test was applied, mean knowledge score was found to be at a higher end among III year as compared to I year (p=0.03) students. Conclusion: This study highlights about low dental nutrition knowledge among nutrition/dietetics students. Health profess-ionals should have more information outside their immediate fields. Inter-professional team members should work in collaboration with each other to improve patient outcomes.

Antibacterial Effect of Aloe Vera Gel against Oral Pathogens: An In-vitro Study

Introduction: Natural herbal remedies have shown promising anti-microbial property and fewer side effects compared to synthetic anti-microbial therapy. Aloe Vera is a medicinal plant used for management of various infections since ancient times as it has anti-inflammatory, anti-microbial, and immune-boosting properties. Aim: The aim of the present study was to determine the anti-microbial and inhibitory activities of various concentration of Aloe Vera Gel (AVG) against oral pathogenic bacteria. Materials and Methods: Subgingival calculus and aspiration of periapical abscess and periodontal abscess was done in 20 patients and the sample transferred to thioglycolate broth, which was incubated in Mutans Sanguis agar, blood agar and cultured in anaerobic gas chamber. The colonies formed were identified further by gram staining methods and biochemical fermentation tests (IMViC). Each isolated colony of identified bacteria were cultured separately in Muller-Hilton broth and incubated at 37°C for 24 hours. Anti-microbial activity of the AVG was tested by the disc diffusion method and minimum inhibitory concentration was determined by broth micro-dilution method. Result: Various staining and biochemical tests confirmed that the sample contained Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), Clostridium bacilli (C. bacilli), Streptcoccus mutans (S. mutans) and Staphlococcus aureus (Staph. aureus). AVG showed anti-bacterial property at 100% and 50% concentration (‘t’ value = 7.504, p-value <0.001). At lower concentration there was no effect against the bacteria. At 100% AVG concentration, zone of inhibition measured was 6.9mm in A. actinomycetemcomitans, 6.3mm in C. bacilli, 6.8mm in S. mutans and 6.6mm in Staph. aureus. The standard drugs were also used to compare anti-bacterial property of AVG. Result showed that higher concentration (100%, 50%) of AVG has comparable zone of inhibition with Ofloxacin (5mcg) and Ciprofloxacin (30mcg). Conclusion: AVG at higher concentration showed anti-bacterial property and can be used as a promising adjunct for oral health care.

Infectious Granulomatous Dermatitis at a Tertiary Care Centre in North Maharashtra: A Histopathological Study

Introduction: Infectious granulomatous dermatitis is a distinctive entity of chronic inflammation. Recognizing the aetiology of granulomatous lesion is challenging to the dermatopathologist. Present study aims at classifying the infectious granulomatous diseases based on aetiology and morphology of granulomas, and to highlight the significance of clinical correlation for making an accurate diagnosis. The definitive diagnosis of the granulomatous lesions of skin with identification of aetiological agent is very essential for specific treatment and an appropriate desirable outcome. Aim: To study the histomorphology of various granulomatous lesions of skin and classify them, accordingly into different categories. Materials and Methods: A retrospective study of skin biopsies received to the Department of Pathology over a period of five years (June 2009-June 2014) was objectively reviewed. The skin biopsies diagnosed histopathologically as granulomatous dermatitis on H and E stained sections were selected. Complete clinical and relevant history were recorded. Special stains were employed whenever required. Results: A total of 137 cases exhibited granulomatous reaction pattern. Among the granulomatous lesions of skin, tuberculoid granulomas were seen in 109 cases (79.56%), foreign body type in 12 cases (8.75%), suppurative and necrobiotic granulomas each in 7 cases (5.1%) and histiocytic and mixed inflammatory type each in one case (0.7%). Leprosy was the most common granulomatous lesion in 66.4% of the cases (91/137). Conclusion: Leprosy was the most common granulomatous lesion with Borderline Tuberculoid Leprosy (BTL) as common sub type followed by tuberculoid leprosy. Hence the combination of clinical data and histomorphological findings are essential for establishing an accurate diagnosis of granulomatous lesion of skin.

Practices of Health Care Personnel Regarding Occupational Exposure

Manisha Jain, Ekadashi Rajni Sabharwal, Dhirendra Srivastava

Introduction: With advancing health care sciences, the prevalence of Accidental Exposure to Patient’s Blood (AEBP) amongst Health Care Personnel (HCP) is bound to increase. The only means of preventing such accidental exposure is safe working practices. It is the responsibility of the teachers to inculcate these practices amongst their students. Aim: To evaluate the knowledge, practice and attitude regarding Post Exposure Prophylaxis (PEP) and Hepatitis-B Virus (HBV) immunization amongst faculty and undergraduate students and to assess the frequency of these occupational exposure with the objective of inculcating safe working practices in the teaching curriculum. Materials and Methods: The present study is a descriptive analytical cross-sectional study done from May 2012 to August 2012 in a newly established ESIC dental college at Rohini, Delhi. A 36-item survey questionnaire was distributed to 50 faculty and 115 dental undergraduate students. The survey included questions on demographic details of the respondents, the prevalence of AEBP, the knowledge regarding PEP and HBV immunization and the status of the respondents. The data was analysed using SPSS 12.0 software using various statistical tests such as frequency analysis, Chi-square test and others. Results: The mean age of the study group was 23.3±6.3 years. The prevalence of such accidental exposure was high being 49.7% in our study group. More than half of these respondents did not report the injury. The knowledge regarding the transmissibility of blood borne pathogens and the post exposure prophylaxis was suboptimal amongst the students and even teachers. Almost 20% of the study group was not immunized for HBV. Conclusion: Managing AEBP in HCP is a challenging issue. They are highly prevalent, largely underreported and poorly managed because of the unawareness regarding the hospital’s protocols for reporting and PEP as is seen in the present study. Besides the administrative measures, orientation and reinforcement training of all the staff including faculty is desirable to maintain high level of knowledge and effectively handle such occupational exposure.

Role of Saccharomyces boulardii in Reduction of Neonatal Hyperbilirubinemia

V. Suganthi, A. Gokul Das

Introduction: Probiotics are known to reduce the severity of hyperbilirubinemia. Aim: This study was done to evaluate the effect of probiotic on neonatal hyperbilirubinemia in term neonates. Materials and Methods: A total of 181 healthy term neonates after birth were divided into a control group (n=95) and a treatment group (n=86) randomly and treated with placebo and probiotic (Saccharomyces boulardii) respectively. A total of two doses were given orally in the first two consecutive days. The serum bilirubin levels were detected on day three of life. Babies were exclusively breastfed, clinical outcome was recorded. Comparison between groups was made by the non-parametric Mann-Whitney test. Analysis of Variance (ANOVA) was used to assess the quantitative variables. A p-value of <0.05 using a two-tailed test was taken as being of significance for all statistical tests. Results: On day 3, mean total serum bilirubin in control group among patient who has not developed clinical jaundice is 6.5mg% and in the treatment group is 5mg%. In patient with clinical jaundice, it is 13.6mg% in control group and 10.7mg% in the treatment group. The p-value was found to be <0.05 which is statistically significant. No obvious adverse reactions noted in either group. Conclusion: Probiotics lowered the serum bilirubin level of healthy neonate with jaundice safely and significantly without any adverse reaction.

The Effect of Cognitive Behavioural Therapy on Anxiety, Depression and Stress in Women with Preeclampsia

Elahe Asghari, Mahbobeh Faramarzi, Arsalan Khan Mohammmadi

Introduction: Stress induced by preeclampsia in pregnancy may have a detrimental effect on both the mother and child. Risk of anxiety, depression and stress during pregnancy is, therefore, commonly associated with preeclampsia. Aim: To determine the effect of Cognitive Behavioural Therapy (CBT) on anxiety, depression and stress in pregnant women with preeclampsia. Materials and Methods: In a clinical trial, 60 women with preeclampsia were selected by the convenience sampling method from the Imam-Ali Hospital of Amol city (North of Iran). The subjects were randomly divided into two groups; the study group (n=30) and the control (n=30). All participants completed the Hospital Anxiety and Depression Scale (HADS) and a Pregnancy Distress Questionnaire (PDQ) at the beginning and end of the study. The intervention group received 12 CBT sessions lasting for 90 minutes over 4 weeks (3 sessions in a week) and the control group received no treatment. Results: A MANCOVA test showed that CBT significantly reduced the mean scores of anxiety (5.5 ± 3.2 vs. 9.7 ± 3.8) and depression (6.4±2.6 vs 9.3±4.0) in preeclamptic women (F: 19.933, p-value <0.01). In addition, ANCOVA also revealed that CBT significantly improved the mean scores of specific-stress pregnancy (15.9 ± 6.3 vs 22.2 ± 6.8) in women with preeclampsia (F: 10.214, p-value <0.01). Conclusion: Psychotherapy was effective in reducing anxiety, depression and specific-stress pregnancy in pregnant women with preeclampsia.

Technique, Efficiency and Safety of Different Nerve Blocks for Analgesia in Laser Ablation and Sclerotherapy for Lower Limb Superficial Venous Insufficiency – A Multicentre Experience

Introduction: Laser ablation and sclerotherapy, as minimally invasive alternatives to surgery for varicose veins, have good efficacy, safety and cosmetic result. Some form of anaesthesia is generally used for pain control. Aim: To describe the technique and evaluate the efficacy and safety of femoral, saphenous and sciatic nerve blocks in isolation or in combination for analgesia during laser ablation and sclerotherapy for lower limb varicose veins. Materials and Methods: In this prospective observational study, over a period of 33 months, in 856 limbs of 681 patients with varicose veins, ultrasound guided femoral, saphenous and sciatic nerve blocks for analgesia were performed in 769, 808 and 52 instances respectively; following which, endovenous laser ablation, sclerotherapy or combination of both were carried out using standard practice. After completion of the procedure, Visual Analogue Pain Scale (VAS) was used for pain assessment, and muscle weakness was assessed clinically. Results: Nerve blocks could be successfully performed in all patients. Observed pain scores were 0 or 1 in 591 (69%), 2 or 3 in 214 (25%) and 4 in 51 (9%) legs with no score more than 4. Higher grades of pain were noted in femoral blocks during early stages of our learning curve. Mild to moderate muscle weakness was observed in 163 (2%) and 7 (13%) patients who underwent femoral and sciatic block respectively, which persisted for an average of two and a half hours and none beyond four and a half hours; saphenous nerve being a pure sensory nerve, did not cause motor weakness. Conclusion: For analgesia during laser ablation and/or sclerotherapy of varicose veins, ultrasound guided nerve blocks can be easily and quickly performed. They provide excellent pain relief and comfort to the patient and to the operator; and they do not cause any additional complication.

Effect of CPAP Therapy in Improving Daytime Sleepiness in Indian Patients with Moderate and Severe OSA

Introduction: Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1st month of CPAP use. Aim: To observe both, short-term (one month) and long-term (Three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. Materials and Methods: The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) =15 were categorised as having moderate to severe forms of OSA (moderate OSA with AHI=15-30 and severe OSA with AHI >30), and were scheduled for an initial trial of CPAP therapy. Forty-seven patients reported good tolerance to CPAP therapy after a trial period of 2 weeks and comprised the final study group. ESS scores in these patients were recorded at the baseline, and after 1st and 3rd month of CPAP therapy, and statistically analysed for significance. Results: Mean ESS score at the baseline among moderate and severe OSA patients were 13.67±2.29 and 16.56 ±1.87, respectively. ESS score in both these subgroups improved significantly to 11.63±3.79, p=0.022, CI (0.3293-4.0106)} and 14.13 ±3.74, p < 0.001, CI (1.2991-4.5408), respectively after one month of CPAP therapy. Likewise, mean ESS scores among moderate and severe OSA patients improved significantly to 9.84 ±2.97, p = 0.022, CI (0.3293-4.0106) and 12.29 ±3.97, p <0.001, CI (2.9414-6.1385), respectively after three months of CPAP therapy. Conclusion: The result of the present study shows that CPAP therapy is significantly effective in improving ESS scores in Indian patients having moderate to severe OSA. Benefits in daytime sleepiness were observed after short-term as well as long-term use of CPAP therapy.

A Pilot Study on the Effect of Angiotensin Receptor Blockers on Platelet Aggregation in Hypertensive Patients- A Prospective Observational Study

Introduction: Thrombosis is an invariable component contributing to cardiovascular events in patients with hypertension. One of the risk factors of cardiovascular disease is increased platelet activity. One among the widely used antihypertensive agents are Angiotensin II type 1 Receptor Blockers (ARBs). Even though there are many studies involving antihypertensive agents, their antithrombotic properties remain elusive and not fully characterized. Aim: To evaluate the anti-aggregatory effect of ARBs on platelets in-vivo. Materials and Methods: A total of 60 subjects were included in this observational pilot study conducted in the medicine out patient department of JJM Hospital, Davanagere, Karnataka, India. Among them, 30 patients with essential hypertension attending Medicine OPD of a tertiary care hospital, who were on ARB for at least one month, were enrolled into study group. The control group consisted of 30 normotensive subjects who were not on any drug affecting platelet function. The Bleeding Time (BT) was evaluated for both the groups using Duke method of BT estimation. Data was analysed using SPSS software version 20. The test group was compared with control group using student’s unpaired t-test. Results: The mean BT of study group was 2.488 minutes ± 0.0361 Standard Error of Mean (SEM) and that of control group was 1.998 minutes ± 0.0362 SEM. The result was statistically significant (p<0.001). The average duration of treatment was 2.933 years. Conclusion: ARB have antiplatelet activity. Increase in BT in ARB group when compared with that of control group is a reflection of antiplatelet activity.

To Study the Correlation of Thompson Scoring in Predicting Early Neonatal Outcome in Post Asphyxiated Term Neonates

Dalip kumar Bhagwani, Manisha Sharma, Stanzin Dolker, Sharada Kothapalli

Introduction: Throughout the world each year, an estimated 23% of the 4 million neonatal deaths and 8% of all deaths in <5 years of age are associated with signs of asphyxia at birth. Aim: To study the role of cord arterial blood gas analysis at birth and serial Thompson score in predicting the early neonatal outcome in post asphyxiated term neonates. Materials and Methods: The study was conducted in Department of Paediatrics, in Neonatal Intensive Care Unit (NICU), Hindu Rao Hospital, New Delhi from May 2014 to February. 2015. This study was a prospective cross-sectional study. During this period, a total of 145 post asphyxiated term neonates born in labour room/obstetric operation theatre were recruited. An informed consent was taken from all the parents. The protocol was approved by the institutional ethical committee. Inclusion criteria were full-term babies with low-Apgar score i.e., 1 min score of = 7 National Neonatal Perinatal Database 2010 (NNPD 2010). Statistical Analysis: SPSS 17.0 Software has been used for data analysis. The data were expressed in terms of Means, Standard Deviation and Proportion, followed by comparison between groups through chi-square test or Fisher’s-exact test. A p-value of less than 0.05 was considered as statistically significant. Results: The present study was carried out on 145 post asphyxiated full-term babies with low-Apgar score i.e., 1min score of =7mild Thompson score on day I,2,3 were 96 (66.2%), 119 (82.06%), 125 (86.20%), moderate Thompson score on day 1,3, 7 were 13 (8.9%), 6 (4.13%), 2 (1.37%) and severe Thompson score on day 1, 3, 7 were 36 (24.8%), 13 (8.96%), 7 (4.82%) respectively. Total 11 patients died out of 145 post asphyxiated full-term babies within 7 days, among 11 patients, 7 died within 3 days. There was clinical improvement among HIE patients as indicated by serial Thompson score done on day 1, 3 and 7. Among 145 patients 62(42.8%) had seizure and 83(57.2%) did not have seizure. Most common type of seizure was subtle seizure in 25 (40.3%) followed by multifocal in 21 (33.9%) and tonic in 16(25.8%). Conclusion: There is statistically significant correlation between morbidity and day 1 Thompson score (p-value 0.024). There is statistically significant correlation between mortality and day 1 Thompson score (p-value 0.001). Thompson score allows a very precise description of infants by assigning a numeric score rather than ‘mild’, ‘moderate’ or ‘severe’. Inter-rater reliability is very good with a kappa co-efficient of 0.87.

Caspofungin MIC Distribution amongst Commonly Isolated Candida Species in a Tertiary Care Centre - An Indian Experience

Shashir Wanjare, Rajarshi Gupta, Preeti Mehta

Introduction: Emergence of Candida species resistant to Amphotericin B and triazole has led to use of echinocandins, mostly caspofungin in the management of invasive candidiasis. There are some published reports of caspofungin resistance in Candida species yet no studies on caspofungin susceptibility pattern of Candida species exist in Indian setup. Aim: To carry out the antifungal susceptibility of Candida isolates against caspofungin. Materials and Methods: In a retrospective study at a tertiary care teaching hospital, 60 preserved Candida isolates from inpatients of invasive candidiasis obtained over a period of 6 months from January 2015 to June 2015 were subjected to antifungal susceptibility to caspofungin and the Minimum Inhibitory Concentrations (MICs) of Candida species to caspofungin were determined by Epsilometer test (E-test). Results: Thirty Candida albicans and 30 Non albicans Candida mainly Candida glabrata, Candida parapsilosis and Candida tropicalis were tested for caspofungin susceptibitity by E-test. Caspofungin resistance was detected in 6.67% Candida albicans isolates. Caspofungin resistance was not observed in Candida parapsilosis, Candida glabrata and Candida tropicalis. This shows that caspofungin resistance is still rare. Further elaborate studies with clinical correlation data are needed to detect prevalence of caspofungin resistance. Conclusion: Emergence of resistance in our study warrants need of elaborate studies with clinical correlation data to detect prevalence of resistance to caspofungin. E-test method proved to be an easy and simple technique for testing susceptibility of Candida to caspofungin.

Patch Test as a Diagnostic Tool in Hand Eczema

Natarajan Vigneshkarthik, Satyaki Ganguly, Sheela Kuruvila

Introduction: Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country. Aim: To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing. Materials and Methods: This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher’s-exact test. Results: Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate. Conclusion: Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Role of HRCT Chest in Post Stem Cell Transplant Recipients Suspected of Pulmonary Complications

Abhishek Dwivedi, R Ravi Kumar, Ajay Sharma, S K Pannu

Introduction: Stem cell transplantation is today’s procedure of choice for management of various hematopoietic malignant and severe immunogenic disorders. High Resolution Computed Tomography (HRCT) is a common technique for the diagnosis of pulmonary complications in stem cell transplant recipients. There are a large number of complications which can complicate the post-transplant period. Aim: To study the role of HRCT chest in stem cell transplant patients developing pulmonary complications, detect any evidence of infection, detect clinical signs of lung infections, Graft versus Host Disease (GvHD) or other regimen related toxicities outlined earlier, detect any evidence of GvHD and correlate these clinical signs with radiological changes in the lungs. Materials and Methods: The study was a prospective study of 52 participants with indication of stem cell transplantation. The study included recipients of HSCT transplant and the exclusion criteria was patients who failed for engraftment and having an associated history of pulmonary embolism. Patients were screened for pre-transplant chemotherapy, clinical examination, laboratory investigations including blood and biochemical examinations, imaging by ultrasound, chest radiography, baseline HRCT and a follow-up for post-transplant infections and complications with 16 slice Siemens CT scan. Statistical analysis was done using Pearson's chi-squared test. Results: Four patients among the total 56 were excluded due to non-engraftment. The most common associated findings in decreasing order are (these patients died): consolidation, pancytopenia and gastrointestinal tract symptoms with VOD (Veno-Occlusive Disease). These findings were seen on HRCT as consolidation, cavities, ground glass opacities, fibrotic changes, bronchiectatic changes and tree in bud appearance. Conclusion: The study highlights the significant positive findings on the HRCT which were missed on routine chest radiograph and can be used for early diagnoses. Thus, HRCT helped in decreasing the mortality. The abnormal vitals and TLC counts showed a significant relation between the numbers of death in the study.

Femoral and Tibial Tunnel Widening following Anterior Cruciate Ligament Reconstruction using Various Modalities of Fixation: A Prospective Observational Study

Introduction: Bone tunnel enlargement after Anterior Cruciate Ligament Reconstruction (ACL-R) is a well-accepted phenomenon but there are very few published data comparing the extent of tunnel widening by various methods of fixation after ACL-R. Aim: To compare the femoral and tibial tunnel widening following ACL-R with different methods of fixation using CT scan. Materials and Methods: This one year prospective study included all patients with chronic Anterior Cruciate Ligament (ACL) injury who underwent primary arthroscopic ACL-R using tripled hamstring tendon autograft. The graft was fixed to the tibial tunnel by Interference Screw (IFS) or Suture Disc (SD) and to the femoral tunnel by IFS, SD, Cross-Pin (CP) or Endo-button CL (Smith & Nephew). The widening of the tibial and femoral tunnels in different methods of fixation was assessed by Computed Tomography (CT) at 12 months follow-up; and was compared using paired sample test. Results: A total of 63 patients were included in the study of which 58 (92%) were males and 5 (8%) were females, with a mean age of 29.1 ± 5.9 years. The tibial tunnel widening at one year follow-up was 1.680 ± 1.08794 (19.37%) and 1.517 ± 0.94834 mm (17.39%) by IFS and SD methods respectively. Femoral tunnel widening at one year follow-up was 1.294 ± 0.231, 1.809 ± 0.912, 1.320 ± 0.238, 1.779 ± 0.889 mm by IFS, SD, EB, and CP methods respectively. Femoral tunnel widening following suture disc method of fixation was very highly significant (p<0.001) in comparison with other methods. Conclusion: Femoral tunnel and tibial tunnel widening varies with different methods of fixation and was maximum with suture disc method compared to others at one year follow-up after ACL-R

Assessing Difficulties Encountered by Dental Students Studying Oral Pathology and Addressing Their Concerns

Introduction: The present scenario of Oral Pathology and Oral Histology as a subject is alarming. In spite of so many advancements in terms of books, internet and conferences there are still lacunae between the understanding and interest for the subjects in the students. It can be partly due to the fact that the students perceive it as a non-clinical subject having a lesser scope for practice. Aim: The present study was aimed at evaluating the students approach towards oral pathology department and the subject. The purpose of the study was to analyze practical hurdles encountered by students and to find out solutions to overcome them. Materials and Methods: The cross-sectional questionnaire based study was done with BDS students of People’s Dental Academy, Bhopal, India, to gauge the understanding of their knowledge in the subject of Oral Pathology and Oral Histology. Questionnaire comprised of 28 multiple choice questions under five parameters. The data recorded was subjected to statistical analysis using chi-square test. Results: We found that study samples were efficient enough in terms of following instructions related to their day to day training. Although they were content with light microscope, they thought that some more interactive sessions could be beneficial for them in Oral Pathology. Conclusion: Through our study we found out that the students are well oriented on the whole about Oral Pathology. They certainly encounter difficulties which are easy to handle if proper measures are taken. We through our study would like the readers to be aware of the changing trends in teaching and to incorporate them routinely.

Distribution of Streptococcus mutans and Streptococcus sobrinus in Dental Plaque of Indian Pre-School Children Using PCR and SB-20M Agar Medium

Divya Singla, Arun Sharma, Vinod Sachdev, Radhika Chopra

Introduction: Dental caries is one of the most common infectious diseases affecting the oral cavity. Among the oral bacteria, mutans streptococci have been implicated as major cariogenic bacteria as they can produce high levels of dental caries causing substances such as lactic acid and extracellular polysaccharides. Aim: The aim of the study was to detect the presence of Streptococcus mutans and Streptococcus sobrinus in dental plaque by using Polymerase Chain Reaction (PCR) method, quantification of these micro-organisms using Modified Sucrose-Bacitracin (SB-20M) agar medium and to correlate their presence in Caries Active (CA) and Caries Free (CF) pre-school children. Materials and Methods: Sixty-eight pre-school children, in the age group of 3-5 years were divided equally into 34 CA and 34 CF children. Dental plaque samples were obtained for detection of these microorganisms by PCR method and quantification was done using SB-20M culture medium. The data was analyzed using statistical software SPSS version 16. For statistical analysis, the frequencies and means of Colony Forming Units (CFU) were used with CI = 95%. For bivariate analysis, Fisher exact test was used at 5% level of significance. The comparison of mean of number of CFU of S. mutans and S. sobrinus was made by Mann Whitney U test and Spearman’s Rho test at 1% level of significance was used for correlation between dmft and CFU in CA group. Results: The results showed that S. sobrinus was significantly higher in CA group as compared to CF group whereas S. mutans showed no significant difference. On quantification of these micro-organisms, S. sobrinus was present in significantly higher numbers in CA group as compared to CF group. On correlating the CFU/ml of the micro-organisms with the dmft index, both the micro-organisms showed a positive correlation. Conclusion: We conclude that S. mutans and S. sobrinus were detected in higher numbers in CA children as compared to CF children. PCR is a sensitive, specific, rapid and an effective method for the detection of oral microorganisms.

Shear Bond Strength of Ceramic Brackets with Different Base Designs: Comparative In-vitro Study

Introduction: Knowledge about the Shear Bond Strength (SBS) of ceramic brackets with different base design is essential as it affects bond strength to enamel. Aim: The aim of the present study was to evaluate and compare the effect of base designs of different ceramic brackets on SBS, and to determine the fracture site after debonding. Materials and Methods: Four groups of ceramic brackets and one group of metal brackets with different base designs were used. Adhesive precoated base of Clarity Advanced (APC Flash-free) (Unitek/3M, Monrovia, California), microcrystalline base of Clarity Advanced (Unitek/3M, Monrovia, California), polymer mesh base of InVu (TP Orthodontics, Inc., La Porte, IN, United States), patented bead ball base of Inspire Ice (Ormco, Glendora, California), and a mechanical mesh base of Gemini Metal bracket (Unitek/3M, Monrovia, California). Ten brackets of each type were bonded to 50 maxillary premolars with Transbond XT (Unitek/3M). Samples were stored in distilled water at room temperature for 24 hours and subsequently tested in shear mode on a universal testing machine (Model 3382; Instron Corp., Canton, Massachusetts, USA) at a cross head speed of 1mm/minute with the help of a chisel. The debonded interface was recorded and analyzed to determine the predominant bond failure site under an optical microscope (Stereomicroscope) at 10X magnification. One way analysis of variance (ANOVA) was used to compare SBS. Tukey’s significant differences tests were used for post-hoc comparisons. The Adhesive Remnant Index (ARI) scores were compared by chi-square test. Results: Mean SBS of microcrystalline base (27.26±1.73), was the highest followed by bead ball base (23.45±5.09), adhesive precoated base (20.13±5.20), polymer mesh base (17.54±1.91), and mechanical mesh base (17.50±2.41) the least. Comparing the frequency (%) of ARI Score among the groups, chi-square test showed significantly different ARI scores among the groups (?2 = 34.07, p<0.001). Conclusion: Different base designs of metal and ceramic brackets influence SBS to enamel and all were clinically acceptable.

Factors Affecting Tooth Retention among Adult Population of Dharwad District, India

Salma H Mulla, Nurul Ameen Inamdar, K V V Prasad

Introduction: Oral health in relation to general health is influen-ced by the retention of teeth. Understanding factors affecting tooth retention will help health and social policy-makers to translate the knowledge on tooth retention into action programs for improving oral health of the people and hence enhance tooth retention. Aim: The aim of the present study was to determine the factors affecting tooth retention among adult population of Dharwad district, India. Materials and Methods: A cross-sectional survey of 1100 subjects (616 urban and 484 rural) residing in Dharwad district, Karnataka, India, was conducted. Self-designed questionnaire was prepared and data were collected on socio-demographic factors, oral hygiene practices, diet practices, adverse oral habits and frequency of dental visits by the interview method and clinical examination. Statistical analysis was carried out by applying one way analysis of variance (ANOVA), unpaired t-test and backward stepwise multiple regression. Karl Pearson’s correlation coefficient was used to test the correlation between the two quantitative variables. Results: A total of 66.72% subjects retained all 28 teeth and mean number of teeth retained by the study subjects were 25.33 (90.46%). There was gradual reduction in tooth retention with increase in age. Males (95.8%) compared to females (94.07%), unmarried (98.8%) than married subjects (93.3%) and subjects with intermediate or post high school diploma (97.5%) than those who were illiterate (89.5%) and other low educational level study subjects retained more teeth. Further mean values of tooth retention for other socio demographic factors i.e., occupation, income and family size were not statistically significant (p=0.05). In addition, subjects using tooth brush (96.6%) and tooth paste (96.6%) for cleaning the teeth, subjects practicing mixed diet (96.6%) and subjects who never visited the dentist (96.5%) in their lifetime showed statistically significant greater tooth retention than study subjects who visited the dentist infrequently (92.7%) (p=0.05) (p=significance level). Conclusion: Males compared to females, lower age, profess-ionals compared to illiterates, unmarried and mixed diet population, tooth brush and tooth paste users and population who never visited dentist showed more tooth retention.

Correlation of Beta Angle with Antero-Posterior Dysplasia Indicators and FMA: An Institution Based Cephalometric Study

Introduction: Beta angle utilizes three skeletal landmarks – point A, point B, and point C (the apparent axis of the condyle). It is formed between A-B line and point A perpendicular to C-B line. Further this angle indicates the severity and the type of skeletal dysplasia in the sagittal dimension and it changes with the growth pattern of the patient. Hence, it is important to study the dependence of beta angle on the growth pattern. Aim: The present study was designed to evaluate the correlation of Beta angle with point A–Nasion–point B (ANB) angle, points A and B to palatal plane (App-Bpp), Wit’s appraisal and Maxillary-Mandibular plane angle Bisector (MMB) and Frankfort-Mandibular plane Angle (FMA) in Skeletal Class I, Class II and Class III malocclusion groups. Materials and Methods: Pre-treatment lateral head cephalo-grams of 120 subjects in age group of 15-25 years were obtained. Three skeletal Class I, Class II and Class III malocclusion groups (40 each) were assorted on the basis of ANB, MMB, App-Bpp, Wit’s appraisal and FMA. Analysis of variance (ANOVA) and mean differences were calculated to compare the study groups. Bivariate correlations among different parameters of these groups were obtained. Results: Normal values of beta angle in skeletal Class I group, skeletal Class II group and skeletal Class III group was 31.33±3.25, 25.28±4.28 and 40.93±4.55 respectively. Overall beta angle showed a strong correlation with all parameters of anterio-posterior dysplasia indicators except FMA. Conclusion: Beta angle shows weak correlation with FMA and is not affected by growth pattern/jaw rotation. The normal values are in same range irrespective of the differences in craniofacial morphology.

Redo Mitral Valve Replacement for Prosthetic Valve Thrombosis: Single Center Experience

Introduction: Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided. Aim: To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT. Materials and Methods: Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured. Results: There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months. Conclusion: PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.

A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India

Introduction: The increasing incidences of violence against doctors in their workplaces are an important reason for stress among these healthcare workers. Many incidences of workplace violence against doctors have been reported in the past and are also being continuously reported from different parts of the country as well as the world. Aim: To determine the prevalence of workplace violence among doctors and to study the associated risk factors in a tertiary care hospital of Delhi, India. Material and Methods: A cross-sectional study was conducted using a self-administered semi-structured questionnaire. The contents were: data related to the workplace, incidences at work, violence prevention policy of the institution, reporting of incidences and follow-up, education and training for violence management. A total of 151 doctors participated in the study. Results: Total participants in the study were 151. The mean age of study participants was 26.73+4.24 years. Almost half (47.02%; 44.56% of males and 50.84% of females) of the doctors reported having an experience of violence during work hours in past 12 months. Among the cases, 39.4% were reported from Department of Obstetrics and Gynaecology while Surgery, Medicine and other departments reported 29.6%, 26.8% and 4.2% respectively. Patients or their relatives were perpetrators in most of the cases. Maximum (87.3%) of the reported cases were of verbal violence while 8.6% of the cases were of physical violence. Younger doctors with less work experience were more prone to physical violence. Regarding the time of violence, 35.1% of such cases occurred during afternoon while 30.1% of them took place at night. Conclusion: A large number of doctors had experienced violence in past 12 months in a tertiary care hospital of South Delhi, India. Verbal violence came out to be most common form of violence experienced by the doctors. Afternoon or night hours were the timings when majority of such cases were reported.

Inventory Analysis in a Private Dental Hospital in Bangalore, India

Nitin Gupta, Pushpanjali Krishnappa

Introduction: There are various approaches for inventory management. Of all the inventory control systems, ABC (Always, Better, Control) and VED (Vital, Essential, Desirable) matrix is most suitable for dental stores. We could not find any literature pertaining to inventory analysis in a private dental hospital. So, we conducted a study in a private dental hospital in Bangalore, Karnataka, India. Aim: The present study aimed at evolving an inventory control plan for a private dental institution by categorizing the materials utilizing an ABC-VED coupling matrix. Materials and Methods: The study analysed the annual consumption, the expenditure incurred for the dental consumables and developed a matrix based on ABC and VED analysis to narrow down the group of consumables for managerial monitoring. Results: Of the 215 consumables used 13.5% (A category) consumed 70% of total annual expenditure. About 21% of the consumables (Category B) consumed 20% and 65.5% (C category) accounted for 10% of the annual expenditure. The VED analysis found 47% consumables as vital, 37.6% as essential and 15.4% as desirable category. ABC-VED matrix analysis categorized 51.6%, 33.5% and 14.8% of consumables as category I, II and III, respectively. Conclusion: Categorization by the ABC-VED coupling matrix model helps to narrow down on fewer consumables. The management of Category I consumables was monitored by top management resulting in better control on the annual expenses and at the same time making available the vital consumables. Category II was monitored by middle and Category III at lower managerial level.

Efficacy of Modified Constraint Induced Movement Therapy in the Treatment of Hemiparetic Upper Limb in Stroke Patients: A Randomized Controlled Trial

Raj Kumar Yadav, Rajendra Sharma, Diganta Borah, S Y Kothari

Introduction: Paretic upper limb in stroke patients has a significant impact on the quality of life. Modified Constraint Induced Movement Therapy (mCIMT) is one of the treatment options used for the improvement of the function of the paretic limb. Aim: To investigate the efficacy of four week duration mCIMT in the management of upper extremity weakness in hemiparetic patients due to stroke. Materials and Methods: Prospective single blind, parallel randomized controlled trial in which 30 patients received conventional rehabilitation programme (control group) and 30 patients participated in a mCIMT programme in addition to the conventional rehabilitation programme (study group). The mCIMT included three hours therapy sessions emphasizing the affected arm use in general functional tasks, three times a week for four weeks. Their normal arm was also constrained for five hours per day over five days per week. All the patients were assessed at baseline, one month and three months after completion of therapy using Fugl-Meyer Assessment (FMA) score for upper extremity and Motor Activity Log (MAL) scale comprising of Amount of Use (AOU) score and Quality of Use (QOU) score. Results: All the 3 scores improved significantly in both the groups at each follow-up. Post-hoc analysis revealed that compared to conventional rehabilitation group, mCIMT group showed significantly better scores at 1 month {FMA1 (p-value <0.0001, es0.2870), AOU1 (p-value 0.0007, es0.1830), QOU1 (p-value 0.0015, es0.1640)} and 3 months {FMA3 (p-value <.0001, es0.4240), AOU3 (p-value 0.0003, es 0.2030), QOU3 (p-value 0.0008, es 0.1790)}. Conclusion: Four weeks duration for mCIMT is effective in improving the motor function in paretic upper limb of stroke patients.

Evaluation of Biochemical Markers Serum Amylase and Serum Lipase for the Assessment of Pancreatic Exocrine Function in Diabetes Mellitus

Introduction: Diabetes mellitus (DM), a metabolic disorder characterized by hyperglycaemia, associated with deficiency or resistance to insulin indicates endocrinal abnormality of the pancreas. Amylase and lipase are enzymes secreted by the exocrine portion of the pancreas. Endocrinal derangement observed in diabetes may interfere with the exocrine function of the pancreas. Aim: To estimate the levels of fasting blood sugar, serum lipase, serum amylase in patients of type 1 and type 2 DM. Than comparing them with healthy controls and to study the effect of type 1 and type 2 DM on pancreatic exocrine function using serum levels of amylase and lipase as biochemical marker. Materials and Methods: This study was conducted at GMERS Medical College and Hospital from Dec 2015 to July 2016. Thirty patients of type 1 DM and 30 patients of type 2 DM, who were already diagnosed and taking treatment, were included in this study. A total number of 30 apparently healthy individuals were recruited as the control group in our study. Fasting venous blood samples were collected from the cases as well as the controls and they were analysed by using semi auto analyser for blood glucose, serum amylase and serum lipase. The results were analysed statistically by using SPSS software. Values were expressed as means ± SD. Results: We found statistically significant (p<0.01) low values for serum amylase and serum lipase in patients with type 1 and type 2 DM as compared to healthy controls. Fasting blood sugar was significantly higher in cases as compared to controls. We found negative correlation of fasting blood sugar level with serum amylase and serum lipase and positive correlation of serum amylase with serum lipase in both type 1 and type 2 DM. Conclusion: Our study clearly demonstrated that in type 1 and type 2 DM, there was increase in fasting blood sugar with decrease in serum amylase and serum lipase which signifies the derangement of endocrine-exocrine axis of the pancreas. Serum amylase and serum lipase can be used as biochemical markers for assessment of pancreatic exocrine function.

The Oro–Facial Investment Scale (OFIS) – A Novel Outcomes and Evaluation Measure for Self–Appraised Oro–Facial Behavioural and Aesthetic Constructs among Professional Healthcare Students of Belagavi : A Cross–Sectional Study

Vaibhav Kumar, Anil V Ankola, Sagar G Jalihal

Introduction: Several studies have shown that self perceived dental appearance is an important determinant in the decision to seek treatment. Aim: The aim of the present study was to assess the self-perceived oral health knowledge, attitude, practice, behaviour and perception among 18-20 year old students of professional healthcare institutions in Belagavi city, Karnataka. Materials and Methods: The novel 21 itemed Oro-Facial Investment Scale (OFIS) formulated for this study was distributed to 600 students of professional healthcare institutions (200 each from Medical, Physiotherapy and Ayurveda specialties respectively). Psychometric properties of the questionnaire were assessed. Descriptive statistics and chi-square test were applied. Results: Total 98.17% practiced the use of facial and oral care products on a regular basis. All 600 participants disagreed that they hate their facial appearance and the way their teeth looked. Out of 200, Ayurveda students 37 were unsatisfied with the appearance of their teeth. Also, majority of the respondents agreed that they take prompt care of oral wounds or lesions. While majority of the subjects did not feel conscious when a dentist checks their teeth, a robust 153 respondents expressed their reservations for their dental examination to be performed. Conclusion: The OFIS seamlessly amalgamates the dental unit with the immediate facial components; hence, bringing together, in harmony, a multifaceted dimension in self assessment of the overall facial and dental behavioural practices.

The Association between Prolonged Jaundice and UGT1A1 Gene Polymorphism (G71R) in Gilbert's Syndrome

Introduction: Jaundice is a common condition during the neonatal period. Prolonged jaundice occurs in a large number of breastfed infants. Considering the impact of genetic factors on the incidence of jaundice present study was conducted. Aim: The aim of this study was to determine the association between prolonged jaundice and G71R polymorphism in Gilbert's syndrome. Materials and Methods: This case-control study was conducted at Taleghani Children’s Hospital of Gorgan, Iran. The study group consisted of 87 icteric patients (aged more than 2 weeks) with an indirect bilirubin level higher than 10mg/dL. The control group consisted of 81 newborns without jaundice. The two groups were matched in terms of age and gender. DNA extraction was performed by “phenol-chloroform” method. Polymerase Chain Reaction with Confronting Two-Pair Primers (PCR-CTPP) was applied to amplify G71R polymorphism. Results: Overall, 84% and 64% of subjects in the study and control groups were male, respectively. The distribution of Gilbert genotype was not significantly different between the two groups (p=0.772). There was a correlation between prolonged jaundice in males and UGT1A1 G71R polymorphism (p =0.03). In the study group, 5(5.7%) subjects were homozygous (for A/A), 73 (83.9%) were heterozygous (for A/G), and 9(10.3%) were normal (for G/G). In the control group, 3(3.7%) participants were homozygous (A/A), 68(84%) were heterozygous (A/G) and 10 (12.3%) were normal (G/G). Conclusion: There was no association between prolonged jaundice and G71R polymorphism, even though a relationship was revealed between male gender and the mentioned polymorphism.

An Atypical Presentation of Multiple Central Osteomas Mimicking Craniofacial Fibrous Dysplasia – A Pictorial Essay

Rashmi Kewal Agarwal, Amit A Mhapuskar, Manjula Hebbale, Meenal Tepan, Ayushee

Osteoma is benign neoplasm with slow growth characterized by deposition of compact lamellar cortical or cancellous bone creating a tumour mass. It is still unclear whether osteomas are benign neoplasms or hamartomas. They have typical clinical presentations and are easily diagnosed with the help of radiographs. We present a rare case of non-syndromic multiple osteomas in the craniofacial region which are typically restricted to the midline and presents radiographically as craniofacial fibrous dysplasia causing a diagnostic dilemma.

Metronomic Chemotherapy: Seems Prowess to Battle against Cancer in Current Scenario

Prema Muthusamy, Krishnan Vengadaragava Chary, GK Nalini

Introduction: Metronomic chemotherapy is an emerging method of chemotherapy. Metronomic ’lowdose’ chemotherapy regimen induces tumour dormancy and reduces cancer resistance against anticancer drugs. It tends to improve overall success rate of cancer chemotherapy than conventional cyclical regimen. Aim: The aim of this systemic review was to provide comprehensive data of metronomic chemotherapy trials, regimens used and it’s outcome in cancer therapeutics. Materials and Methods: Fifty chemotherapy trial data were searched sequentially from web. The main sources were official website of Clinical trial forum, USA and Clinical Trial Registry India (CTRI). Evidence on efficacy and safety of such metronomic chemotherapy trials was gathered from various data published in Medline, New England Journal of Medicine (NEJM), Lancet Oncology and other journals with high credentials. As a result of our search, out of 50 trials including breast -15(30%), colon-, 5(10%) ovarian -5(10%), prostate-5(10%) and others including haematologic, soft tissue and nervous system malignancies -20 (50%). Twenty seven trials showed favourable, 20 trials showed equivocal outcome and 3 trials reported unfavourable outcome. Overall comparison showed definitive statistical significance for using metronomic regimen (p-0.05). Conclusion: It can be concluded that metronomic chemotherapy regimen seems convincing beneficial to induce tumour remission and survival at a higher than conventional regimen. More metanalyses are needed to frame common metronomic chemotherapeutic regimen.

Evaluation of Fluid Absorbency of Retraction Cords after Immersing in Two Retraction Medicaments – An In–vitro Study

Introduction: Dry retraction cords help to displace the gingiva and also to absorb the gingival crevicular fluid and saliva to maintain a dry field. When used along with medicaments whether these medicaments help to improve the absorption of fluid or affect the fluid absorption by decreasing the efficiency of the retraction cord is unknown. Aim: The aim of the study was to know the effect of various medicaments on the fluid absorbency of the retraction cords and also, to know whether the thickness of the retraction cords influences it’s fluid absorbency. Materials and Methods: A total of 90 samples of 5cm length retraction cords were taken. Cords were divided into 30 samples for each cord thickness of 0, 1 and 2. Of these 30 samples, 10 samples were used to measure dry weight (Group I), 10 samples were immersed in 15.5% ferric sulfate (Group II) and remaining 10 samples were immersed in 10% aluminium chloride (Group III) for a period of 20 minutes. The excess medicament was removed by blotting paper. Initial weight was recorded. Following this, five cords from each group were immersed in plasma solution and remaining in artificial saliva for 10 minutes. Then these were taken out and measured. The amount of the fluid absorbed was determined by subtracting the weight before fluid immersion (weight after immersion in test medicament) from the weight after fluid immersion (weight after immersion in plasma or artificial saliva). The study was analyzed through one-way ANOVA and Bonferroni post-hoc comparisons for pair wise differences. Results: When immersed in medicaments, there is a significant difference in absorption of fluids (artificial saliva and plasma) between the untreated dry cord and cord treated with 15.5% ferric sulfate (p<0.05). But, there was no significant difference in fluid absorption between the dry untreated cord and cord treated with 10% aluminum chloride and between cords treated with 15.5% ferric sulfate and 10% aluminum chloride. Conclusion: Ferric sulfate (15.5%) is a better medicament for absorption of fluid.

Evaluation of Low Level Laser Therapy on Pain Perception Following Orthodontic Elastomeric Separation: A Randomized Controlled Trial

Mai M.E. Almallah, Wael H. Almahdi, Mohammad Y Hajeer

Introduction: Periodontal pain caused by elastomeric separators is a very common problem in the commencement of orthodontic treatment. Previous studies have shown good results in reducing this pain by Low Level Laser Therapy (LLLT) and different protocols of application have been suggested in the literature. Aim: This trial aimed to evaluate LLLT on managing orthodontic pain caused by elastomeric separators and to compare single versus double irradiation in possible pain reduction. Materials and Methods: A clinical randomized compound (parallel-group and split-mouth design) trial was conducted on 36 patients between 12 and 26 years of age. Elastomeric separators were placed at the mesial and distal surfaces of the first molars in one jaw (upper or lower) for each patient and in only one side of the mouth (the other side served as the placebo side).The trial had two groups: the first group received single irradiation of LLLT [Gallium Aluminum Arsenide (GaAlAs): 830 nm, 4J/cm2, 100mW] immediately after separators insertion, where as the second group received double irradiation immediately after separators insertion and after 24hours. All patients were instructed to rate the level of pain at 1, 6, 24, 48, 96 hours on a Visual Analog Scale (VAS). The student 't' tests, repeated measures ANOVA and LSD post-hoc tests were employed. Results: LLLT was successful in reducing post-separation pain when the experimental side was compared to the placebo side at all assessment times in each group (p<0.05). There were no statistically significant differences between single and double irradiation groups in terms of pain reduction (p>0.05). Conclusion: GaAlAs LLLT application reduced early orthodontic pain caused by elastomeric separators by single or double irradiation.

Diffuse Parenchymal Lung Diseases with Clinicoradiological Discordance: Role of Transbronchial Lung Biopsy as a Diagnostic Tool - An Observational Study

KP Suraj, Kiran Vishnu Narayan, Jyothi Edakalavan, Neethu Kesava Kumar

Introduction: The diagnosis of Diffuse Parenchymal Lung Disease (DPLD) requires a multidisciplinary approach with reconciliation of clinicoradiological and histopathological data. But when the preliminary clinicoradiological profile fails to suggest a diagnosis, an adequate lung biopsy specimen with meticulous histological examination and a multidisciplinary approach usually yields results. There is also a high chance of sampling error due to patchy and heterogeneous involvement of the disease process and due to the small volume of tissue taken. As seen in our study, Trans-Bronchial Lung Biopsy (TBLB) if performed by an experienced bronchoscopist can be done as an outpatient procedure yielding adequate specimens for diagnosis and guide effective treatment in these patients. Aim: To study the utility and diagnostic yield of TBLB in DPLD patients when there is clinicoradiological discordance. Materials and Methods: The current retrospective observational study was undertaken in the Institute of Chest Diseases, Government Medical College, Kozhikode, Kerala, India, from January 2012 to December 2014. Out of 169 DPLD patients who attended the tertiary care centre, 66 patients without a definite diagnosis by clinicoradiological assessment were included in the study. They underwent TBLB using a fibre-optic video bronchoscope. An open lung biopsy was advised if the TBLB did not yield a definite diagnosis. Results: Among the 66 patients, histopathological confirmation was obtained in 51 patients, 39 of which were by TBLB (59%). Few diagnoses like invasive adenocarcinoma, Pneumocystis jirovecii pneumonia and Aspergillus infection were least expected. Conclusion: TBLB if performed correctly can be an effective intervening modality in establishing the diagnosis of DPLD before going for an invasive surgical biopsy.

Metabolic Derangements in Lichen Planus - A Case Control Study

Bikash Ranjan Kar, Maitreyee Panda, Nibedita Patro

Introduction: An association between psoriasis and metabolic syndrome has been established in previous studies. Lichen Planus (LP) is also a chronic inflammatory disease morphologically related to psoriasis and few studies have shown association of metabolic derangements in LP. Aim: To study the association of metabolic derangements in LP. Materials and Methods: A prospective case control study was undertaken for a period of one year. Age and sex matched patients of LP and other non-inflammatory diseases were taken as cases and controls respectively. Data on height, weight, lipid profile and fasting blood glucose levels were collected for all the patients. Body Mass Index (BMI) was calculated. Results: A total of 80 patients were recruited, 40 cases and 40 controls. The mean values for all the lipid and glucose parameters were high in cases as compared to controls with significant p-values. Conclusion: In the present study metabolic derangements were seen in patients with LP.

Anaerobic Bacteriological Microbiota in Surface and Core of Tonsils in Chronic Tonsillitis

Meera Niranjan Khadilkar, Nitin R.Ankle

Introduction: Tonsillar infection may stem from bacteria within tonsillar crypts or parenchyma rather than from those on the surface. Pathogens isolated from surface culture may be colonizing the tonsil, but not essentially infecting it. Anaerobes though not often studied, are known to cause chronic tonsillitis. Aim: To study the correlation of anaerobic bacterial isolates in surface and core cultures from recurrently infected and inflamed tonsils. Materials and Methods: A cross-sectional study was conducted in Charitable Hospital and Medical Research Centre, Belagavi from January 2014 to December 2014 on 100 patients of chronic tonsillitis who underwent tonsillectomy. Swabs were obtained from tonsil surface and core and analysed for anaerobes as per standard protocol. Chi-square test and Fischer-Exact test were used for statistical analysis. Results: Twenty eight out of 63 (44.4%) patients had anaerobic growth on tonsil surface and 30 out of 62 (48.4%) patients had anaerobic growth in tonsil core. Porphyromonas sp. was the most common anaerobe isolated from the surface as well as from the core. There was no statistical significance between anaerobes isolated in the tonsil surface and core. Conclusion: Anaerobic organisms obtained from tonsil surface and core cultures were similar. A throat swab satisfactorily depicts the core organism and is reliable in recognizing the bacteriology of chronic tonsillitis. Anaerobic organisms known to inhabit the surface as well as the core of tonsils may be treated with suitable antibiotic therapy.

A Comparative Study of the Results of the Anatomic Medial Portal and All Inside Arthroscopic ACL Reconstruction

Introduction: Many techniques of graft placement in Arthroscopic Anterior Cruciate Ligament (ACL) reconstruction is available now-a-days, like trans-tibial, anatomical accessory medial portal and anatomical all-inside technique. Aim: To compare the improvement in clinical status of patients treated by anatomic accessory medial portal and all-inside arthroscopic ACL reconstruction technique pre-operatively post-operatively using International Knee Documentation Comittee (IKDC) Subjective Knee Scores, Lysholm Knee Score, Knee Society Score, Lachman test, Visual Analog Score (VAS) in both the groups. Materials and Methods: After informed consent from patients and clearance from Ethical Committee, we included patients aged 18 to 50 years with ACL injury and clinical laxity admitted in Department of Orthopaedics, King George Medical University, Lucknow. We included 100 patients in the study, which were divided into two groups, Group1 comprised of patients treated by Anatomic accessory medial portal technique and group 2 comprised of patients treated by All-Inside technique. Then the patients were followed up post-operatively at 6 weeks, 12 weeks and 6 months, clinically for functional status using Lysholm Knee Score, IKDC Subjective Knee Score, Knee Society Score and VAS score. Grading of laxity was evaluated by Lachman test at pre-operative stage and 6 months follow-up. After collection of the data, analysis was carried out on SPSS software version 16.0 (Chicago, inc. USA) and the statistical test that was used was 2-Way Analysis of Variance (ANOVA). Results: IKDC Subjective Knee Score, Lysholm Knee Score, Knee Society Score, Lachman Test and VAS Score was better in group 2 treated by All-inside technique as compared to group1 and the difference was significant (p<0.005). Conclusion: All- Inside arthroscopic ACL reconstruction technique (group2) is a better technique than arthroscopic Anatomic accessory medial portal technique (group1).

Use of Lung Ultrasound For Diagnosing Acute Heart Failure in Emergency Department of Southern India

Introduction: Diagnosing heart failure is often a challenge for the healthcare providers due to it's non-specific and usually subtle physical presentations. The outcomes for treatment are strongly related to the stage of the disease. Considering the importance of early and accurate diagnosis, it is important to have an easy, inexpensive, non-invasive, reliable and reproducible method for diagnosis of heart failure. Recent advancement in radiology and cardiology are supporting the emerging technique of lung ultrasound through B-line evaluation for identifying extravascular lung water. Aim: To establish lung ultrasound as an easy, inexpensive, non-invasive, reliable and reproducible method for diagnosing Acute Decompensated Heart Failure (ADHF) in emergency department. Materials and Methods: The study was a cross-sectional, prospective, observational, diagnostic validation study of lung ultrasound for diagnosis of acute heart failure in an emergency department and was performed at Amrita Institute of Medical Science, Kochi, Kerala, India. A total of 42 patients presenting with symptoms suggestive of acute decompensated heart failure were evaluated by plasma B-type Natriuretic Peptide (BNP), Echocardiography (ECHO) and X-ray. Lung ultrasound was done to look for the presence of B-lines. Statistical Analysis: Sensitivity, specificity and predictive value of diagnostic modalities were calculated using Mc Nemar’s Chi-square test for the presence and absence of heart failure. Results: Lung ultrasound showed a sensitivity of 91.9% and a specificity of 100% in diagnosing acute heart failure comparable to plasma BNP which had a sensitivity of 100% and a specificity of 60%. It was also superior to other methods of diagnosing ADHF namely X-ray and ECHO and showed a good association. Conclusion: Lung ultrasound and its use to detect ultrasonographic B-lines is an early, sensitive and an equally accurate predictor of ADHF in the emergency setting as compared to BNP.

Dexmedetomidine in Attenuation of Haemodynamic Response and Dose Sparing Effect on Opioid and Anaesthetic Agents in Patients undergoing Laparoscopic Cholecystectomy- A Randomized Study

Introduction: Perioperative procedures are stressful and lead to haemodynamic instability with potentially devastating consequences. Dexmedetomidine is found to have many of the desired characteristics that are required in perioperative period. Aim: To evaluate the ability of pre and intraoperative dexmedetomidine to attenuate stress induced haemodynamic responses, quantifying the anaesthetic agents sparing as well as its cost-effectiveness in patients undergoing laparoscopic cholecystectomy. Materials and Methods: The present single blind randomized study was conducted with 120 ASA I and II consented patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into 2 groups (i.e., group D and group N). Prior to induction, group D received 1 µg/kg of Dexmedetomidine and group N received Normal saline infusion over 20 minutes. Group D also received maintenance Dexmedetomidine intraoperatively. Bispectral index and minimum alveolar concentration monitoring was done in both the groups. Haemodynamic parameters were noted till 100 minutes post laryngoscopy. Opioid and anaesthetic agent consumptions were also noted and cost analysis was done. Medcalc–Version 12.5.0.0 software was used for statistics and p <0.05 was considered significant. Results: Dexmedetomidine attenuated the stress induced haemodynamics responses and produced stable, relatively non fluctuating haemodynamics throughout. The Minimum Alveolar Concentration (MAC) requirement and the consumptions of Fentanyl and Isoflurane were significantly less in the Dexmedetomidine group (p<0.0001). However, despite anaesthetic dose sparing effect the anaesthetic technique was not cost-effective. Conclusion: Dexmedetomidine is effective in attenuating haemodynamic responses in laparoscopic surgery and having dose sparing effect on Fentanyl, Propofol and Isoflurane. However, overall this technique is not cost-effective.

The Effect of Consanguineous Marriage on Mental Health among the Students of the Shahrekord University of Medical Sciences

Introduction: In Iran, after unintentional accidents, mental health problems are the second leading burden of disease. Consanguineous marriage is very common in Iran and the association between parental consanguinity and mental health is an important issue that has not yet been studied sufficiently in Iran. Aim: To investigate the effect of consanguinity and the degree of relationship on different levels of mental health. Materials and Methods: In this cross-sectional study, conducted in the Shahrekord University of Medical Sciences, two groups of students were enrolled. The first group consisted of 156 students that had consanguineous parent (case group) and the second group was 156 students whose parents had non-blood relationship (control group). The students were evaluated using General Health Questionnaire (GHQ-28). Statistical analysis was conducted by Pearsons correlation coefficient, independent t-test and the one-way analysis of variance. Odd ratio was used to estimate the relative risk. Results: Over 30% of the individuals were suffering from mental health problems. The most and least common mental health problems in both groups were social dysfunction (54.5% in the case group and the control group 50%) and depression (15.4% in the case group and 17.3% in the control group), respectively. No statistically significant difference was observed in the frequency of overall mental health and its subscales between student with non-consanguineous parent (control group) and the students that had consanguineous parent (case group) (p>0.05) and the status of mental health was not significantly different among student with different degree of kinship (p>0.05). Conclusion: The study revealed that social dysfunction was very common among the study students and also there were no relationship between parental consanguineous marriage and mental health. Parental consanguinity and genetic factors may not be the major causes of high prevalence of mental health problems in Iran and the effects of the environmental factors on these problems may be greater than those of the inherited ones.

As the Nasal Spine Goes, So Goes the Septum

Introduction: "As the septum goes, so goes the nose". A well-known phrase by Maurice Cottle forms the pillar of septoplasty. Since the inception of septal surgeries, numerous methods of septoplasty have been described. But, if not performed meticulously, may lead to deformity. For a successful surgery, understanding the anatomy and addressing the anterior nasal spine and maintaining the tip integrity is vital. Aim: To study the outcomes of “ROUND ABOUT technique” to correct deviated nasal septum which focuses on the importance of anterior spine and hence maintain the tip integrity. Materials and Methods: This was a prospective, single-centre outcome study of 35 patients with symptomatic nasal obstruction. Here, we describe a method of elevating the mucoperichondrial and mucoperiosteal flaps bilaterally, without transecting the quadrilateral cartilage of the septum. The Sino Nasal Outcome Test-22 (SNOT-22) Questionnaire was administered pre-operatively and after 3 months following surgery. The post-operative follow-up period ranged from 3 to 6 months (mean= 4.5 months) to evaluate the functional and aesthetic outcomes of the performed procedure. Results: A total of 35 patients underwent surgery by this technique who presented with deviated nasal septum and variable degrees of nasal obstruction. To assess the statistical outcome, Paired t-test was applied. Mean SNOT-22 scores decreased significantly from 40.02 pre-operatively to 18.65 three months after surgery. The results sustained after 6 months (p-value <0.0001), 85% of these patients had improved breathing post-operatively and none of the patients complained any aesthetic criticisms. The patients were content and the requirement of medications post-operatively were minimal. Conclusion: The ROUND ABOUT technique is a very effective and safe method in correcting the septal deviations especially the ones with caudal or dorsal deflections. It also helps in maintaining the tip integrity and addressing the anterior nasal spine. It avoids the complications of conventional septoplasty.

Gender Difference in Aerobic Capacity and the Contribution by Body Composition and Haemoglobin Concentration: A Study in Young Indian National Hockey Players

Hanjabam Barun Sharma, Jyotsna Kailashiya

Introduction: Although gender difference in aerobic capacity is known, the contributing factors have been researched seldom. Aim: To investigate the gender gap and the contribution by percentage Body Fat (BF), Body Mass Index (BMI) and haemoglobin concentration Hb. Materials and Methods: The study was conducted on 30 (17 males, 13 females) training status matched young hockey players. Healthy players who were playing upto national level competition were included. BW (Body Weight), BF, BMI, LBM (Lean Body Mass), rHR (restring Heart Rate), HRR (Heart Rate Recovery), Hb, a/rVO2max (absolute/relative), a/rPWC (Physical Work Capacity) and RMR (Resting Metabolic Rate) were measured and analysed. Results: There was significant gender difference in the measured parameters. Difference in a/rVO2max remained significant even after controlling for BF, BMI and Hb. Multiple regression and correlation analysis revealed gender difference in VO2max/LBM was due to: BMI(31.91%)>BF(27.60%)>Hb(9.91%). BMI also significantly contributed 3.66% of VO2max/LBM variance, independent of that by gender. Difference in RMR was mainly related to LBM, BF and BMI. Conclusion: The study provided an understanding for gender gap in aerobic capacity. Differences in BMI & BF were one of the main reasons.

Prevalence of Irritable Bowel Syndrome (IBS), Migraine and Co-Existing IBS-Migraine in Medical Students

Introduction: Irritable Bowel Syndrome (IBS) and migraine frequently co-exist. Stress is a major contributing factor for both. Our medical students are subjected to stress related to the implicit responsibility of courses. But the prevalence of IBS, migraine and co-existing migraine in medical students is not known. Aim: To estimate the prevalence of migraine, IBS and co-existing IBS and migraine among medical students. A Cross-Sectional Survey. Materials and Methods: Self-reported questionnaire based study, was conducted in which migraine was defined according to International Headache Society (IHS) criteria while IBS by both Asian criteria and Rome III criteria. Both preclinical (n=142) and clinical students (n=151) of four medical colleges (government and private) of Dhaka and Sylhet district participated in the study. Statistical Analysis: Student's t-test and chi-square test were used to compare the distributions of continuous data and categorical data respectively with significance level set at 0.05 or less. Results: Among the 293 students (mean age 21.09 ± 2.24 years) volunteered in the study (Males= 177), 14 (4.8%, 11 males, 3 females, p = 0.175) met the criteria for IBS with comparable prevalence among preclinical and clinical (4.2% vs. 5.3%, p = 0.787) students from both private and government institutions (2.1% vs. 7.2%, p = 0.055). IBS-D was the most prevalent subtype (n = 8, M = 6) and abdominal pain relieved by defecation (n = 11), was the most prevalent symptom. Fifty percent (n = 7) of IBS patients considered their bowel habit as normal. Among the 221 (75.4%) students with headache, only 51 (17.4%, 20 males and 31 females, p = 0.001) were diagnosed of migraine, with comparable prevalence among preclinical and clinical students (16.2% vs. 18.5%, p = 0.645). Only 17 (33%) subjects with migraine had accompanying aura. Common triggers were stress (n = 43), lack of sleep (n = 42), and daily life events. Twelve (23.5%) subjects with migraine had migraine-associated frequent disability. Only two female students with IBS-D (14.3%) had concomitant IBS and migraine. Conclusion: IBS and concomitant migraine - IBS prevalence was found to be low in our medical students, but migraine prevalence corresponds to other countries as well as in medical students.

Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview

Anita Pandey, Sanjiv Ahuja, Molly Madan, Ajay Kumar Asthana

Introduction: Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving. Aim: To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome. Materials and Methods: The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by number of occupied beds. Results: Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in colour coded polythene bags as per the hospital protocol. The different type of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 Kg.), 8686.8 Kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by ‘Synergy’ waste management Pvt. Ltd. Conclusion: The practice of BMW Management was lacking in 30-35% HCP which may lead to mixing of the 15% infectious waste with the remaining non-infectious. Therefore, training courses and awareness programs about BMW management will be carried out every month targeting smaller groups.

Physician Related Delays in the Diagnosis of Lung Cancer in India

Introduction: Lung cancer is associated with a poor prognosis, if detected late in the disease course. Delay in seeking health care, wrong diagnosis and delay in specialist referral can contribute to delay in diagnosis. Aim: This study was done to assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center. Materials and Methods: A total of 96 consecutive patients diagnosed with lung cancer were enrolled in this study. Details of previous physician consultations, their specialization, diagnoses made and treatments given were obtained from records available with the patients. Results: Patients, on an average consulted two physicians before presenting to our center. Less than half of the physicians (45%) suspected lung cancer during their evaluation. Around 18% of physicians made an incorrect diagnosis of tuberculosis, out of whom, 88.6% had prescribed anti-tuberculous therapy. Only 27% of physicians referred the patients to higher medical centres for evaluation. Pulmonology Specialists (PS) were the most likely to diagnose lung cancer (p<0.0001). General Medicine Specialists (GMS) were the most likely to misdiagnose cancer as tuberculosis, followed by General Practioners (GP) when compared to PS (p-value =0.0422). Conclusion: Our study demonstrates that, many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis. It is likely that most patients failed to seek the services of PS directly or through referral either due to a shortage of PS or due to other reasons.

Morphometric Study of Pancreas in Human Fetuses

Abhijeet S. Dhende, Mahendra A. Kathole, Deepak S. Joshi

Introduction: The pancreas arises from the endoderm as a dorsal and a ventral bud which fuse together to form the single organ. It extends transversely across the posterior abdominal wall from the duodenum to the spleen. Functionally, it is endocrine and exocrine. Aim: This study was undertaken to study the morphometry of human pancreas at different gestational age groups of normal, still born fetuses. Materials and Methods: Forty aborted human fetuses (25 male and 15 female) of 12-40 weeks gestational age with no obvious congenital abnormality were obtained. The fetuses were dissected and pancreas was removed. The length and weight of the pancreas as well as height of its head were noted. Results: It was observed that there was increase in body weight and crown rump length with increasing gestational age. The average length of pancreas was 1.80 cm in 12th week and 4.70 cm in 40th week of gestation. The average height of pancreas head was 0.80 cm in the 12th and 2.70 cm in 40th week of gestation. Conclusion: The knowledge of development of pancreas helps in planning new therapeutic interventions in the treatment of various congenital and functional pancreatic anomalies.

Outcomes of Short Segment Posterior Instrumentation in Unstable Thoracolumbar Fractures

Sharvil H Gajjar, Hari J Menon, Nitin Chaudhari, Vipul Chaudhari

Introduction: The spinal traumas are common and leading problem in orthopaedics practice. The individuals are at a risk of high energy trauma in modern era. Unstable thoracolumbar burst fractures are serious injuries of concern, if left untreated may result in marked morbidity and disability to the patient. Thoracolumbar is the second most common segment involved in the spinal cord following spinal injuries followed by cervical segment. The goal of treatment of any spinal injury is restoration of the patient to maximum possible function with disability free life. Aim: To analyse the outcomes of unstable thoracolumbar burst fractures stabilized with short segment posterior instrumentation with transpedicular screws. Materials and Methods: This prospective interventional study consisted of 32 patients with unstable thoracolumbar burst fractures carried out at Department of Orthopaedics, New Civil Hospital, Surat during Jan 2014 to Dec 2015. We stabilized the patients with unstable thoracolumbar spinal fractures with short segment posterior instrumentation by using the intermediate screw option in the fractured vertebra level as a method of augmentation. Patients were evaluated for maintenance of spinal correction and neurological improvement after short segment posterior instrumentation in unstable thoracolumbar burst fractures. Results: The mean age for males was 35.57 ± 11.62 years and for females was 33.56 ± 11.2 years. The most common vertebra involved in the study group was T12 (31.25%). In the study, about 66% patients had a fall from height as the mode of injury, whereas 34% injuries were due to road traffic accident. In the study group, the mean regional angle observed during pre-operative stages was 16.0°±5.1°. There was a statistically significant (p<0.05) difference between pre-op and post-operative regional angles as well as anterior wedge angles. There was a statistically significant difference (p<0.05) in the vertebral height between pre-operative and post-operative stages. Conclusion: Short segment posterior instrumentation is a very stable implant construct in maintenance of deformity correction and fracture reduction along with the added advantage of sparing of the motion segments.

Evaluation of Sinonasal Diseases by Computed Tomography

Rashmi Kandukuri, Suresh Phatak

Introduction: Computed Tomography (CT) plays an important diagnostic role in patients with sinonasal diseases and determines the treatment. The CT images clearly show fine structural architecture of bony anatomy thereby determining various anatomical variation, extent of disease and characterization of various inflammatory, benign and malignant sinonasal diseases. Aim: To evaluate sensitivity and specificity of CT in diagnosis of sinonasal diseases and to characterise the benign and malignant lesions with the help of various CT parameters. Also, to correlate findings of CT with histo-pathological and diagnostic nasal endoscopy/ Functional Endoscopic Sinus Surgery (FESS) findings. Materials and Methods: In this hospital based prospective study 175 patients with symptomatic sinonasal diseases were evaluated by clinical diagnosis and 16 slice Multi Detector Computed Tomography (MDCT). The details of findings of nasal endoscopy, Functional Endoscopic Sinus Surgery (FESS), histopathological examination and fungal culture were collected in all those cases where those investigations were done. All those findings were correlated with CT findings and statistical analysis was done by using Test statistics (sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy), Chi-Square test and Z-test for single proportions. Software used in the analysis was SPSS 17.0 version and graph pad prism 6.0 version and p < 0.05 was considered as statistically significant. Results: CT diagnosis had higher sensitivity, specificity, PPV and NPV in diagnosing various sinonasal diseases in comparison to clinical diagnosis. On correlating CT diagnosis with final diagnosis, congenital conditions have 100% sensitivity and specificity. Chronic sinusitis has 98.3% sensitivity and 97.8% specificity. For fungal sinusitis the sensitivity was 60% and specificity was 99.3%. Polyps have sensitivity of 94.4% and specificity of 98.1%. Benign neoplasms have sensitivity of 90.9% and specificity of 99.2%, malignant neoplasms have sensitivity of 94.1% and specificity of 99.3%. The p-value in all instances was <0.05, i.e. <0.0001 indicating the significance of the findings. Conclusion: CT is the modality of choice in imaging the sinonasal region for evaluating various congenital, inflammatory, benign and malignant pathologies and associated complications thereby planning the further management of the patient. CT is the best modality of choice for evaluating the bone erosion or destruction. The potential pitfalls to differentiate on CT are fungal sinusitis and dense secretions.

Osho Dynamic Meditation's Effect on Serum Cortisol Level

Anuj Bansal, Ashish Mittal, Vikas Seth

Introduction: Dynamic meditation is one of the most popular active meditation, introduced by an Indian mystic Osho in 1970. This one hour meditation consists of five stages: Deep fast chaotic breathing, catharsis, using a mantra "Hoo", silence, and dancing. A previous study observed that Osho dynamic meditation causes decrease in several psychopathological variables such as aggressive behaviour, anxiety and depression. However, it is not objectively established that the dynamic meditation has an anti-stress effect. Aim: To find out the effect of Osho dynamic meditation on the serum cortisol levels (cortisol is an indicator of stress) and therefore to observe whether it has any anti-stress effect. Materials and Methods: An experimental study was planned doing the dynamic meditation empty stomach in morning at 6 to 7 am every day for 21 days from 1st March 2015 to 21st March 2015 at Lucknow. Twenty healthy volunteers between 20 to 50 years (14 males and 6 females) participated in the study. Serum cortisol level was estimated from the blood samples collected in the morning one day prior (baseline) and post-meditation on the 21st day of the study. The difference between mean cortisol levels of the baseline and post-meditation groups were tested for significance by applying the paired t-test. Results: Sixteen volunteers out of the 20 completed the study while four dropped out due to their health and personal reasons. The serum cortisol levels were decreased in all the 16 participants on 21st day as compared to the baseline levels and the decline in the mean cortisol level was highly significant (p<0.001). Conclusion: The results of the study showed a significant reduction in plasma cortisol levels when the participants were tested after 21 days of meditation; it can be concluded that the Osho dynamic meditation produces anti-stress effects. The mechanism of action could primarily be attributed to the release of repressed emotions and psychological inhibitions and traumas. Thus, dynamic meditation could be recommended for the amelioration of stress and stress related physical and mental disorders. More clinical studies should be done on dynamic meditation to prove its efficacy and become an approved therapy in hospitals.

Prosthetic Status, Needs and Oral Health Related Quality of Life (OHRQOL) in the Elderly Population of Aluva, India

Albin Geo Joseph, Chandrashekar Janakiram, Anil Mathew

Introduction: Oral Health Related Quality of Life (OHRQOL), being a patient-centred outcome has profound association with the existing prosthetic status and needs. Aim: To assess the association between the prosthetic status and needs with OHRQOL in the elderly population of Aluva, Kochi, Kerala, India. Materials and Methods: A cross-sectional study was conducted among the elderly residing in the municipal wards of Aluva municipality, Kochi, Kerala, India. A total of 539 subjects whose age was 60 years or above were considered for the study. Proforma utilizing a validated structured questionnaire of two sections; the first section noted with demographic details with WHO assessment of prosthetic needs and details regarding loss of teeth and denture wear and the second section consisted of Oral Health Impact Proflie (OHIP)-14 questions to measure the OHRQOL which was prepared in the local language. Type III oral examination (WHO Basic Oral Health Assessment 2013) was carried out on selected elderly subjects from house hold survey at municipal wards and recordings were done by the trained local health worker. ANOVA was used to find out the association between different domains of the OHIP and prosthetic status and need. Results: The prosthetic status was 18.2% and 14.7% and the prosthetic needs 62.7% and 60.3% of the upper and lower jaws respectively for the population. The prosthetic status was found to have no impact on the OHRQOL. However, the prosthetic need was significantly related to various components of OHRQOL of the study population. Of all the domains in OHRQOL, physical pain was the most affected in this population. Conclusion: There is high unmet prosthetic care for non-institutionalised elderly population in Aluva.

Spectrum of MDCT Findings in Bowel Obstruction in a Tertiary Care Rural Hospital in Northern India

Introduction: Multidetector Computed Tomography (MDCT) provides clinically and surgically important information in bowel obstruction. It can depict the severity, level and cause of obstruction. Aim: To depict the spectrum of MDCT findings in cases of small and large bowel obstruction. Materials and Methods: Contrast enhanced MDCT examination of 50 patients were retrospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Ingenuity CT (128 slice MDCT, Philips Medical Systems). The axial sections were reconstructed in coronal and sagital planes to determine site and cause of bowel obstruction. Results: There were 34 males and 16 females patients in this study with mean age of 28.4 years. The level of obstruction was in small bowel in 39 patients (76.67%) and large bowel in 11 patients (23.33%). Adhesive bands were the cause of Small Bowel Obstruction (SBO) in 17 patients (43.5% of SBO patients). The most common CT signs in adhesive band SBO were beak sign (seen in 70.6% patients) and fat notch sign (52.9% patients). Five cases of SBO were secondary to benign stricture. Matted adhesions were the cause of obstruction in 3 patients. All these patients showed transition zone in pelvis with positive small bowel faeces sign. Two patients with SBO due to adhesive band had evidence of closed loop obstruction with evidence of gangrenous gut on surgery. Large Bowel Obstruction (LBO) was seen in 11 patients. Most common cause of LBO was primary colonic malignancy, accounting for 7 patients (63.6%). In one patient, the cause was direct invasion of hepatic flexure by carcinoma of gall bladder. Other causes of LBO were pelvic adhesions, faecal impaction and ischaemic stricture. Conclusion: SBO is more common than LBO with adhesive bands being the most common cause of SBO. MDCT is very useful for depicting site and cause of obstruction and any associated complications.

Anti-microbial Efficacy of Soursop Leaf Extract (Annona muricata) on Oral Pathogens: An In-vitro Study

BH Mithun Pai, Gururagavendra Rajesh, Ramya Shenoy, Ashwini Rao

Introduction: Annona muricata also called as Soursop is a, flowering evergreen tree native to Mexico, Cuba, Central America and parts of India. The miracle tree as it is widely known as a natural cancer killer that is 10,000 times stronger than chemotherapy. Based on these miraculous claims, the leaves of these plants were used as an extract at varying concentrations as an antibacterial agent against oral pathogens. Aim: The aim of the study was to assess antimicrobial efficacy of Soursop leaf extarct (Annona muricata) on Streptococcus mutans, Streptococcus mitis, Porphyromonas gingivalis, Prevotella intermedia and Candida albicans using disc diffusion method. Materials and Methods: Extracts of Annona muricata leaves of concentrations of 1%, 5%, 10%, 15% and 20% were prepared. The anti-microbial efficacy was evaluated using disc diffusion method against Streptococcus mutans, Streptococcus mitis, Porphyromonas gingivalis, Prevotella intermedia and Candida albicans on agar plates. Results: All concentrations of extracts were effective on the microbiota except for the P. Intermedia. The Soursop extract was highly effective on Candida species, with all concentrations exhibiting bactericidal and fungicidal property. The extracts at different concentration were effective when compared to the gold standard controls and the effect was statistically significant (p<0.05). Data obtained was analysed using one way analysis of variance (ANOVA) and Tukey’s post-hoc test. Conclusion: The Soursop extracts were efficient for all test organisms expect P. intermedia. The present study demonstrated the in-vitro efficacy of Soursop was highest against S. mutans followed by C. albicans and least on P. intermedia. Hence, this study proves to an extent that the Soursop extract when used against oral microbiota has sufficient anti-microbial and fungicidal property.

Headache Disability, Suicidality and Pain Catastrophization - Are They Related

Harshal Rathod, Dushad Ram, Harsha Sundarmurthy, Snehal Rathod, Deepa John

Introduction: Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. Aim: To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. Materials and Methods: Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. Results: In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). Conclusion: Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal behaviour.

Congenital Cystic Adenomatoid Malformation: A Tertiary Care Hospital Experience

Introduction: Congenital Cystic Adenomatoid Malformation (CCAM) is an uncommon developmental deformity affecting the terminal respiratory structures. It is characterized by broncho pulmonary foregut malformations. The reason behind it is an arrest in lung development between 4th and 7th week of fetal life. Aim: The present study was conducted to assess the clinical and radiological profile and also to study the role of surgical intervention in patients with CCAM. Materials and Methods: All patients with clinical suspicion or provisional diagnosis of CCAM were included in the study. A clinical questionnaire was prepared to collect data. Computed Tomography (CT) chest with High Resolution Computed Tomography (HRCT) was done for all the patients. Patients were assessed by paediatric surgeon and eligible patients were operated. The procedure conducted was usually open thoracotomy under general anaesthesia. The affected lobes were removed and specimens were sent for histopathological analysis. All included patients were followed up prospectively to find out about their current level of health. Via telephonic interview they were asked about their overall growth, quality of life, activity, rate of respiratory infections and requirement of hospital admission. Results: Total 15 patients with diagnosis of CCAM were included in the study. Of them, 8 (53.3%) were male. The commonest presentation was cough 13(86%), sucking difficulty 11(73%), fever 9(60%), recurrent pneumonia 4(26%), hypoxia requiring oxygen supplementation 6(40%), others 2(12%). Thirteen patients required surgical intervention and underwent lobectomy. There were 2 cases of type I, one each of type II and III, 3 case of type IV while 5 were intermediate type. There was no procedure related mortality. The median duration of hospital stay and all were successfully discharged with median duration of stay 11 ± 16 days. Conclusion: The study concludes that if recognized early, surgic al removal of affected lung prevents the complications like recurrent pulmonary infections. The surgery is well tolerated without any post-operative mortality or morbidity.

Association of Age at Menarche with Anthropometric Measures in Punjabi Bania Girls

Pratibha Goyal, Zora Singh, Gurmeet Kaur Sethi

Introduction: Menarcheal age is the age at which menstruation begins. Menarcheal age is regarded as a sensitive indicator of physical, biological and psychological environment. Aim: 1) To determine the menarcheal age and to examine the relationship between current age at menarche with anthropometric measures in Punjabi bania girls. 2) To develop maturity standards for Bania girls. Materials and Methods: The present cross-sectional survey was carried out on 200 bania girls at the age of onset of menarche. Menarcheal data was obtained by status quo method by asking about whether menarche has been experienced or not. In the present survey adolescent girls were interviewed with the help of pre-designed questionnaire. Statistical analysis was carried out in SPSS software, version 16.0. The data were analysed using descriptive statistics and one-way ANOVA. Pearson’s correlation coefficient was used for correlation studies. Results: A total of 200 Punjabi bania girls were examined in the study. The median age of onset of menarche in these girls was 12.3 years. Menarcheal age was positively associated with bi-acromial width, bi-iliac width and arm span. Conclusion: The present research has revealed secular trend in the age of onset of menarche as indicated by median age of 12.3 years in Bania girls. The bi-acromial width, bi-iliac width and arm span were also correlated with the age of menarche.

Paediatric Prescription Analysis in a Primary Health Care Institution

Jinish Jose, Denny Devassykutty

Introduction: Paediatric prescription analysis was done by vari-ous studies in tertiary care centers but not much published data, at primary care level. The Medical Council of India introduced new prescription format and also antibiotic stewardship program was launched by Government of Kerala in the year 2015. So in these contexts this study was conducted. Aim: To analyse the patterns of prescriptions and drug dis-pensing in pediatric patients using WHO core drug use indicators and parameters in the prescription format prescribed by Medical Council of India. Materials and Methods: Prospective study was done at a community health center, for a period of four months where parents of children attending the outpatient department were interviewed and the prescriptions and medicines that is with them was examined and analysed for any prescription errors or dispensing errors. For statistical analysis, quantitative variables were expressed in mean and standard deviation and qualitative variables in percentages. Results: The mean age of the patients was 6.1 (SD±3.4) years. The average number of drugs prescribed was 2.29 (SD±35.91), 98.4% drugs were prescribed by generic name. Majority of drugs prescribed were in the form of syrups (62.73%), use of antibiotics was frequent (73.18%), but injection use was very minimal (0.006%). Weight of the patient was recorded in 58.33% of the prescriptions. Only 30 prescriptions (5.43%) were written in capital letters. A 100% of the prescriptions contain the details of the child along with provisional diagnosis and signature of the doctor. A 98.44% of the drugs prescribed were from the essential drug list. Copy of the essential drug list is available at the institution. The availability of key drugs was 100%. 98.73% knew the correct dosages and 100% of the drugs were adequately labeled. Conclusion: The prescription pattern is in accordance with the standard guidelines of WHO. Interventions are needed to rectify over prescription of antibiotics to strengthen antibiotic stewardship program so that emergence of drug resistant strains can be avoided.

To Study Brain Stem Auditory Evoked Potential in Patients with Type 2 Diabetes Mellitus- A Cross- Sectional Comparative Study

Mishra Indira Sushil, J.N. Muneshwar, Sayeeda Afroz

Introduction: Neuropathy is one of the commonest complications of Diabetes Mellitus (DM). Apart from having peripheral and autonomic neuropathy patients with type 2 DM may also suffer from sensory neural hearing loss, which is more severe at higher frequencies. However, few studies have done detailed evaluation of sensory pathway in these patients. In this study brain stem auditory evoked potential is used to detect the acoustic and central neuropathy in a group of patients with type 2 DM with controlled and uncontrolled blood sugar. Aim: To study brain stem auditory evoked potential in patients of type 2 DM with controlled and uncontrolled blood sugar and to correlate the various parameters e.g., age (years), weight (kilograms), height (meters), BMI (kg/m2), HbA1c (%) in patients with type 2 DM with controlled and uncontrolled blood sugar. Materials and Methods: Cross-sectional comparative study conducted from January 2014 to January 2015. Total 60 patients with type 2 DM of either sex, between age groups of 35-50 years were enrolled from the Diabetic Clinic of Medicine department, of a tertiary care hospital. Based on the value of HbA1c, patients were divided in two groups with controlled and uncontrolled blood sugar and with each group comprising of 30 patients. BERA (Brainstem Evoked Response Audiometry) was done in both the groups on RMS ALERON 201/401. Recordings were taken at 70dB, 80dB and 90dB at 2KHz frequency. Absolute latency of wave I, III, V and interpeak latencies I–III, III-V and I-V were recorded. Results: Mean±SD of the absolute latency of BERA waves I, III, V and interpeak latencies I–III, III-V and I-V at 2 KHz and at varying intensity of 70dB, 80dB and 90dB in uncontrolled group of DM were delayed and were significant as compared to controlled group of DM. Conclusion: If BERA is done in diabetic patients, central neuropathy can be

Health Related Quality of Life in Family Caregivers of Patients Suffering from Mental Disorders

Introduction: In the light of the advances in treatment measures and early discharge of patients with mental disorders from psychiatric hospitals, families play important role in caring for such patients. Aim: The aim of this study is to determine the Quality of Life (QoL) of the family caregivers of patients with mental disorders. Materials and Methods: This cross-sectional study was conducted in teaching health care centers affiliated with medical universities in Tehran, Iran. Sampling was conducted by convenience random technique. Participants were 238 family caregivers of mental disorder patients and the Short-Form Health Survey Questionnaire was used to gather data. The data were analyzed by Spearman’s correlation, t-test and ANOVA in SPSS 18.0. Results: The women’s mean QoL was lower than the men’s. Regarding family relationship with the patients, the lowest QoL was observed among the mothers. There was a significant relationship between the caregivers QoL and economic status, the caregivers gender, family relationship with the patients and the patients’ gender (p<0.05). Conclusion: The caregivers of mental disorder patients have lower QoL compared with general population. Appropriately developed plans should be implemented to improve QoL among the family caregivers of these patients.

Effects of Storytelling-Based Education in the Prevention of Drug Abuse among Adolescents in Iran Based on a Readiness to Addiction Index

Introduction: One of the most effective strategies in the prevention of addiction is increasing awareness among young people, towards the tendency for taking drugs their physical, mental and social side effects. Storytelling is effective for increasing characteristics of happiness and resilience. This study uses storytelling, a common and popular method to increase awareness among adolescents. Aim: To examine the effect of storytelling-based education on the prevention of drug abuse, based on a readiness to addiction index. Materials and Methods: This quasi-experimental study was conducted on 136 high school students (grade one), selected by a cluster sampling procedure from May 2014 to February 2015 in Zabol, Iran. The instrument for gathering data was a readiness to addiction questionnaire. This questionnaire included 41 items for which the scoring of each item followed the Likerts format. The data gathered was analysed using SPSS version 21 with descriptive statistics and inferential statistics. Results: The results revealed that the mean of the readiness to addiction index in the case group fell from 75.66 ±19.99 to 69.57 ±21.83 (paired t-test; p =0.02); in the control group the same index changed from 103.01 ±21.88 to 93.98 ±27.70 (paired t-test, p = 0.775). That is, the index decreased for both groups, but the reduction was statistically significant only for the case group (p =0.02). Conclusion: This suggests that the narrative method is effective in reducing adolescents readiness to addiction. Storytelling is an effective way to raise awareness among young people about addiction and its detrimental impacts on health. Therefore, such a technique can be taken into consideration in teaching principles of prevention.

Morphometric Analysis of the Occipital Condyle and Its Surgical Importance

Sandeep Saluja, Sushant Swaroop Das, Neelam Vasudeva

Introduction: The Occipital Condyle (OC) is an integral component of craniovertebral region which is predisposed to a wide array of traumatic, degenerative and neoplastic diseases. Frequent surgical interventions of OC are required for successful management of these conditions. Hence a meticulous anatomical knowledge of the OC is vital but variability in morphometric dimensions exist amongst different races and hinder the standardization of measurements. Aim: The aim of this study was to present a morphometric reference database for OC of the Indian population and enable comparisons with other populations. Materials and Methods: The study was performed on 228 OC of 114 adult human skulls. Linear measurements of the OC were taken with the help of digital Verniers calliper and angular measurements were determined with software Image J. Statistical Analysis: Mean and standard deviation of the morphometric parameters taken into account were analysed. The comparison of morphometric dimensions of the right and left sides was carried out using Student’s t-test and p-value was calculated. Results: The morphometric analysis of the OC established that mean width was larger (12.97 mm) in Indians population when compared to other races. The anterior and posterior intercondylar distances as well as the distances between the tips of OC and opisthion and basion were observed to be shorter in Indians. We found a significant difference (p=0.01) among the distance between Posterior tip of Occipital Condyle (POC) and basion of the right and left sides. The sagittal condylar angle and sagittal intercondylar angle were found to be greater in our study when compared to other researchers. There existed a highly significant difference (p=0.001) between the sagittal condylar angles of the right and left sides. Conclusion: The present morphometric study would be valuable for the successful instrumentation of the OC as wider and ventrally oriented OC as well as smaller intercondylar distances may pose challenge to the surgeons during condylectomy. The data of present study offer anatomical reference to the surgeons and would be helpful in designing implants for the OC.

Computed Tomography Evaluation of Canal Transportation and Volumetric Changes in Root Canal Dentin of Curved Canals Using Mtwo, ProTaper and ProTaper Next Rotary System-An In-vitro Study

Introduction: Complete cleaning and shaping of root canal system is of paramount importance to achieve a successful root canal treatment. There are various rotary Ni-Ti systems available in the market to achieve mechanical goal of root canal preparation. But aggressive preparation of root canal with such systems would result in canal transportation and excess root dentin removal that would be one of the major reasons to decide the prognosis of root canal treated tooth. Aim: The present study was conducted to compare the root canal preparation in terms of canal transportation and volumetric changes in the root canal dentin among three Ni-Ti file systems, namely Mtwo, ProTaper (PT) and ProTaper Next (PTN) file system, using Computed Tomography (CT). Materials and Methods: A total of 45 mesiobuccal root canals of extracted first molar teeth with completely formed root apices and angle of curvature ranging between 10°– 35° were selected. These teeth were randomly divided into three experimental groups containing 15 teeth each, based on rotary system used. Group-I: Mtwo files, Group-II: PT files and Group-III: PTN files. Pre-instrumentation CT images were obtained at three cross- sectional planes – 3mm, 7mm and 11mm from apical end of the root. Similarly, post-instrumentation images were obtained. Shortest distance from the edge of the canal to the periphery of the root was analyzed by using Analysis of Variance. Results: All three file systems tested in the present study presented similar behaviour with respect to the root canal transportation. Lesser canal transportation was recorded in Mtwo. But no statistically significant difference was seen in terms of canal transportation and volume of dentin removed between all three rotary systems (p>0.05). Conclusion: Mtwo, PT and PTN rotary systems have similar behaviour with respect to canal transportation and volume of dentin removed.

The Insight for Initiation and Maintenance of Areca nut chewing Habit and its Effects on Oral Health Status among School Age Population in Western Rajasthan, India

Introduction: Areca nut is highly carcinogenic according to International Agency for Research on Cancer (IARC). Its usage is continuously increasing in children and adolescents in India. Aim: The aim of the study was to understand the reasons for the development of the areca nut chewing habit at early age. Materials and Methods: A total of 2846 subjects were surveyed from rural government schools between ages of 4 to18 years in Western Rajasthan, India. A structured questionnaire was designed to record the factors associated with initiation and continuation of areca nut chewing habits. A systemic oral examination was done to access current oral health status in these users. Students were divided into two groups viz. Group 1 and 2, comprising of students from 4 to 10 years and 11 to18 years respectively. Results: Total 34.5% children in Group 1 and 72.8% in Group 2, were indulged with the habit of chewing areca nut. Study revealed that social environment and secondarily stimulating effect of areca nut have association with initiation and maintenance of habits. A total of 55 subjects were diagnosed at various clinical stages of Oral Submucous Fibrosis (OSMF). Conclusion: Areca nut cessation programs should be initiated on the primary education level for the prevention of this habit in Western Rajasthan, India.

Comparison of Efficacy and Safety of Intramuscular Piroxicam and Tramadol for Post-operative Pain in Patients Undergoing Caesarean Delivery

Introduction: Post-caesarean section pain can be both stressful and unfavourable. Effective and rapid reduction of pain facilitates early ambulation and care of the new born. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are used for pain relief but they are associated with adverse effects both in the mother and the child. Aim: To evaluate efficacy and safety of piroxicam and tramadol in post-caesarean section pain. Materials and Methods: Primigravidae who underwent elective caesarean section received either piroxicam 20mg or tramadol 100mg intra-muscularly, following recovery from anaesthesia. Severity of pain was assessed using Visual Analogue Scale (VAS) and side-effects to study drugs were noted. Rescue analgesic butorphanol 2mg was administered if VAS score was more than four. Patient’s satisfaction score was assessed at 12 hours post-operatively. Results: Mean age in piroxicam and tramadol groups were 23.32±3.43 and 22.03±2.0 years respectively. Significant reduction in pain was observed at 2, 4, 8, 12 and 24 hours in both groups (p<0.001). Pain relief was significant at 2, 4 and 8 hours in piroxicam group compared to tramadol. Twenty-one and 12 patients in tramadol and piroxicam groups received rescue analgesic respectively. Sedation and nausea was significantly higher in tramadol group (p<0.001), 46.66% of patients graded their satisfaction score as good and 15% as excellent in piroxicam group. Conclusion: Intra-muscular piroxicam was effective in reducing post-caesarean section pain for 24 hours with minimal side-effects compared to tramadol.

IV Ferric Carboxymaltose Vs Oral Iron in the Treatment of Post-partum Iron Deficiency Anaemia

Sree Chandana Damineni, Suchitra Thunga

Introduction: Iron deficiency is the most common cause of Post-partum anaemia, reported as 50-60% in India. It is primarily due to inadequate iron intake and due to peripartum blood loss. It has been associated with significant post-partum complications. Therefore, Post-partum iron deficiency warrants greater attention and higher quality care. Oral iron treatment has been considered the standard of care. However, parenteral iron treatment is expected to be advantageous in cases where oral iron therapy is not possible. As a result, there is increased interest in parenteral iron therapy. Recently, a new parenteral iron preparation, Ferric Carboxy Maltose (FCM), was developed to facilitate effective treatment of Iron Deficiency Anaemia (IDA). This study was carried out in women with Post-partum IDA who were expected to benefit from the short treatment period permitted by the larger doses given parenterally. Aim: To evaluate the efficacy, safety and tolerability of intra venous FCM compared to oral iron in treating Post-partum IDA patients. Materials and Methods: This was a hospital based prospective comparative study. Women with Haemoglobin (Hb) between 7-10 g/dl and peripheral smear showing microcytic hypochromic anaemia on the first Post-partum day were included in the study. These women were randomised to receive either IV FCM (single dose 1000 mg) or oral ferrous ascorbate (100 mg twice daily for 6 weeks). Statistical analysis was done by student’s paired and unpaired t-test and by chi- square test and fischer-exact t-test. Results: Ninety patients (45 in each group) were followed at one week and six weeks from the start of treatment and their Hb were estimated. Significant rise in Hb was observed in subjects treated with FCM compared to oral iron. FCM treated subjects were more likely to achieve an Hb rise greater than or equal to 3.0 g/dL. FCM was better tolerated with complete adherence to treatment as compared to oral ferrous ascorbate. Conclusion: FCM showed robust evidence of efficacy, tolerability and safety in comparison to oral iron. Collectively, these data support the clinical utility of FCM in treating Post-partum IDA patients.

Prevalence of Anaemia and Its Associated Risk Factors Among Adolescent Girls of Central Kerala

P.M. Siva, A. Sobha, V.D. Manjula

Introduction: Adolescent age group is the window of opportunity to correct nutritional status of children. If we intervene correctly during this period we can prevent future consequences of nutritional deficiencies. Very few studies have been conducted in kerala regarding adolescent anaemia. Aim: To estimate prevalence of anaemia and its associated factors among adolescent girls of central Kerala, India. Materials and Methods: A cross-sectional study was conducted among 257 adolescent girls of ettumanoor panchayat, the field practice area of Government Medical College, Kottayam. A pre-designed and pre-tested proforma was used to obtain data regarding socio-demographic details and factors associated with anaemia. Relevant clinical examination of participants were done. Blood samples were analysed using an auto-analyser and stool examination for ova or cyst was done under microscopy. Diagnosis of anaemia was established when haemoglobin was less than 12gm/dl. Data analysis was done using SPSS 16.0. Association between Categorical variables were Results: The prevalence of anaemia was 21%. Risk factors associated with anaemia in the univariate analysis were presence of ova or cyst in stool (p = 0.003, OR = 2.94) and number of pads per day during menstruation (p = 0.004). Protective factors were hand washing after toileting (p = 0.021, OR = 0.311), hand washing before food intake (p = 0.026, OR = 0.5), foot wear usage (p = 0.022, OR = 0.25) and jaggery consumption (0.042). The factors which were significant in logistic regression were worm infestation, number of pads per day, washing hands before food intake and foot wear usage. Conclusion: Worm infestation and number of pads per day during menstruation were found to be risk factors for anaemia. Personal hygiene practices like hand washing and foot wear usage were found to be protective factors.

Prevalence of Trichomonas vaginalis and Candida albicans among Brazilian Women of Reproductive Age

Introduction: There are no studies assessing the simultaneous occurrence of Candida albicans (C. albicans) and Trichomonas vaginalis (T. vaginalis) in the primary health care in Brazil. Despite different conditions to establishment of each one, the co-detection of both has been reported by some authors in previous studies from other regions. Aim: To compare the prevalence of T. vaginalis and C. albicans in correlation with associated variables. Materials and Methods: A cross-sectional study conducted in a family health clinic in the Federal District of Brazil, between November 2014 and March 2015. Vaginal swabs were collected from 201 women of the reproductive age selected from women registered at the family health clinic. Minors and pregnant women were excluded. The rates of T. vaginalis and Candida albicans prevalence were evaluated with vaginal pH, the whiff test, sexual practices and other social and demographic variables. Difference between proportions was assessed by Z-Test. Results: C. albicans was present in 20% of the women, while 16% of them had T. vaginalis. The simultaneous occurrence of the agents was found in 1.5%. Significant differences were found between prevalence rates for the variables race/skin colour, practice of anilingus and lifetime number of sexual partners. Conclusion: The prevalence of T. vaginalis exceeds C.albicans among women with higher numbers of sexual partners. The prevalence of C. albicans was higher than T. vaginalis among white women and those who practice active and receptive anilingus. The simultaneous occurrence of the two microorganisms was uncommon.

Yoga Practice for Reducing the Male Obesity and Weight Related Psychological Difficulties-A Randomized Controlled Trial

P.B. Rshikesan, Pailoor Subramanya, Ram Nidhi

Introduction: Obesity is a health disorder and increasing all over the world. It is also a cause for many non-communicable diseases. Yoga practice reduces the stress level which may improve the eating habits and help in weight reduction. Aim: To assess the final outcome of the effects after 3 months of the 14 weeks yoga training on obesity of adult male in an urban setting. Materials and Methods: This was a randomized controlled trial with parallel groups (Yoga and Control groups) on male obese. Total 80 subjects with Body Mass Index (BMI) between 25 to 35 kg/cm2 were enrolled and randomized into two equal groups in which 72 subjects (yoga n = 37 and control n=35) completed the trial. Yoga group mean age ± SD was 40.03±8.74 and Control group mean age±SD was 42.20±12.06. A 14 weeks special IAYT (Integrated Approach of Yoga Therapy) yoga training was given to the Yoga group and no specific activity was given to Control group. The interim results of this study at 14 weeks were covered in another article which is under process. After the 14 weeks of yoga training the Yoga group was asked to continue the yoga practice for the next 3 months and the Control group was not given any physical activity. The final outcome is covered in this paper. The assessments were anthropometric parameters of body weight (Wt), BMI (Body Mass Index), MAC (Mid-upper Arm Circumferences of left and right arm), WC (Waist Circumference), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF (Skin Fold Thickness) of biceps, triceps, sub scapular, suprailiac and cumulative skin fold thickness value), Percentage body fat based on SKF and Psychological questionnaires of PSS (Perceived Stress Scale) and AAQW (Acceptance and Action Questionnaire for Weight related difficulty). Assessments were taken after 3 months of yoga training, for both Yoga and Control groups. Within group, between group and correlation analyses were carried out using SPSS 21. Results: Improvement in anthropometric and psychological parameters such as Wt, Percentage body fat, PSS were observed in the final outcome. Also, some of the improvements such as AAQW score were lost in the final outcome, compared to interim results. Conclusion: The yoga practice is effective for obesity control for adult male in an urban setting.

Radiological Study of Maxillary Sinus using CBCT: Relationship between Mucosal Thickening and Common Anatomic Variants in Chronic Rhinosinusitis

Marco Capelli, Patrizia Gatti

Introduction: Inflammatory diseases of the maxillary sinus favour the thickening of the sinus mucosa. Therefore, it might be possible to establish a radiological, pathological threshold of mucosal thickening. Furthermore, there is an association between common anatomic variants of the nose and maxillary mucosal thickening. Aim: To define the pathological thickening of maxillary sinus mucosa and its association with the presence of common anatomic variants (concha bullosa, Haller’s cell and accessory maxillary ostium). Materials and Methods: From March 2014 to February 2016, Two hundred patients underwent Cone Beam Computed Tomography (CBCT) of the paranasal sinus. We conducted this retrospective study of total 70 patients, 34 patients i.e., a total of 68 meatus-maxillary units (study group - those affected by Chronic Rhinosinusitis (CRS) and another 36 patients i.e., a total of 72 meatus maxillary units (control group - without symptoms of CRS). We assessed the degree of thickening of the sinus mucosa distinguishing between = 2mm or = 2mm, than we analysed the behaviour of the thickness in the study group and in the control group. Chi-Square test was used to compare mucosal thickening between study and control group and the presence of some common anatomic variants or closure of maxillary ostium. Results: In the study group we observed a clear association between maxillary mucosal thickening = 2mm and CRS (p<0.01). We however, observed no association between the presence of common anatomic variations and thickening of the maxillary mucosa and between the presence of common anatomic variations and the study group. Instead, using a binary logistic regression, we observed a significant association (p<0.01) between closure of natural ostium of the maxillary sinus and mucosal thickening or between closure of natural ostium and study group. Conclusion: We believe that a thickening of the maxillary mucosa = 2mm and closure of natural maxillary ostium are statistically associated with CRS. The common anatomical variants do not seem to be associated with this condition.

Comparison of Dexmedetomidine-Propofol versus Fentanyl-Propofol on Insertion Conditions of Proseal Laryngeal Mask Airway

Shalaka Sandeep Nellore, Abhijeet Dattatray Waychal, Preeti Sachin Rustagi

Introduction: Proseal Laryngeal Mask Airway (PLMA) is a newer supraglottic airway device that requires adequate depth of anaesthesia and suppression of upper airway reflexes thereby providing optimal insertion conditions. Aim: To compare dexmedetomidine and fentanyl for co-induction with propofol with respect to PLMA insertion conditions, haemodynamic variation and the total dose requirement of propofol. Materials and Methods: This was a prospective randomized double-blinded study conducted in 60 cases of American Society of Anaesthesiologists (ASA) class I/II undergoing elective surgery under general anaesthesia. They were randomly divided into two equal groups, D and F, each receiving 1µg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of PLMA insertion was Young’s Criteria and Modified scheme of Lund and Stovener. The haemodynamic parameters (mean heart rate, mean arterial pressure, Respiratory rate, SPO2) were monitored at: Baseline, Pre-medication, Pre PLMA, Post LMA (at insertion), 1, 3, 5, 10, 15 and 20 minutes. Results: PLMA insertion conditions and haemodynamics were comparable between the dexmedetomidine-propofol and fentanyl-propofol groups according to the Young’s criteria and Modified scheme of Lund and Stovener. Total induction dose of propofol and its increments were significantly reduced in the dexmedetomidine group. Conclusion: Dexmedetomidine and fentanyl when both used individually for co-induction with propofol for PLMA insertion give excellent overall insertion conditions with haemodynamic stability. Dexmedetomidine also significantly reduces the requirements of induction dose propofol for PLMA insertion.

Effectiveness of Self Instructional Module on Coping Strategies of Tri–Dimensional Problems of Premenopausal Women – A Community Based Study

Prasanta Kumar Bhattacharya, Enu Boro, Md Jamil, Aakash Roy

Introduction: Pre-menopause in women presents with diverse symptoms, encompassing the tri-dimensional spheres of physical, social and psychological domains, which requires development of appropriate coping strategies to overcome these problems. Aim: To assess level of knowledge about tri-dimensional problems in pre-menopausal women and evaluate effectiveness of self instruction module on coping strategies of these problems by pre-test and post-test analysis. Materials and Methods: In a cross-sectional, community based study, in pre-menopausal women aged 40-49years baseline knowledge of tridimensional problems was assessed in 300 pre-menopausal women, selected by convenient sampling after satisfying selection criteria, by a pre-formed questionnaire. This was followed by administration of a pre-tested, Self-Instructional Module (SIM). The SIM dealt with imparting knowledge about coping strategies regarding pre-menopausal problems and the participants were required to read and retain the SIM. Post-test was conducted using same questionnaire after seven days. Statistical Analysis: Chi-square test/ Paired t-test was used for comparing ratios. A ‘p-value’ <0.05 was considered statistically significant. Results: Baseline knowledge of tridimensional problems was adequate in 10%, moderate in 73% and inadequate in 17% women with a pre-test mean knowledge score of 8.66±2.45. The post-test mean knowledge score was higher (19.11±3.38) compared to the pre-test score. The post-test mean knowledge difference from pre-test was -10.45 with a highly significant paired t-value of -47.45 indicating that the self-instructional module was effective in increasing the knowledge score of pre- menopausal women under study. Conclusion: Administration of self instructional module was shown to significantly increase the knowledge scores in all areas of pre-menopausal tri-dimensional problems. Such self-instructional module can be used as an effective educational tool in increasing the knowledge of tri-dimensional problems in premenopausal women.

Serological Diagnosis of Acute Scrub Typhus in Southern India: Evaluation of InBios Scrub Typhus Detect IgM Rapid Test and Comparison with other Serological Tests

Introduction: Scrub Typhus (ST) is being reported from different parts of India in the recent past. However, the diagnosis and confirmation of ST cases require specific serological and molecular diagnostic tests. Both rapid and conventional ELISA tests need to be properly evaluated. Aim: Evaluation of a new ST IgM Immunochromatography (ICT) test kit (InBios Scrub Typhus Detect IgM Rapid Test) and compare it with another rapid kit, conventional ELISA kit and Weil-Felix (WF) test. Materials and Methods: This prospective study was carried out in Mahatma Gandhi Medical College and Research Institute, Puducherry, during November 2015 to June 2016. Clinically suspected 220 ST patients were examined by a new kit, InBios Scrub Typhus Detect IgM Rapid Test, taking the conventional InBios Scrub Typhus Detect IgM ELISA as reference. Additional comparison was made with ImmuneMed Scrub Typhus Rapid, and WF test (single OXK titers =1:320). Statistical analysis was performed (Chi-square, Spearman’s correlation and Kappa) using IBM SPSS Statistics 17 for Windows (SPSS Inc; Chicago, USA). Results: Percentage Sensitivity, Specificity, Positive Predictive and Negative Predictive Values for InBios, ImmuneMed and WF were 99.25, 93.02, 95.68, 98.77; 94.87, 94.19, 96.21, 92.05 and 50.38, 95.51, 94.29, 56.67 respectively. A total of 134 patients were positive in reference standard InBios IgM ELISA. Conclusion: This new rapid ST IgM kit validated for the first time in India, showed good sensitivity and specificity. As a Point-of-Care (PoC) test, the kit would be helpful in both urban and remote rural parts of India.

A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India

Disha Arora, Ketan Garg, Ankit Kaushik, Richa Sharma, Ds Rawat, Ak Mandal

Introduction: With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today. Aim: To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure. Materials and Methods: Records of single donor apheresis were retrospectively analysed from 1st January 2010 to 31st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included – age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure. Results: Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure. Conclusion: We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/µl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors.

Comparing Assay Performance of ELISA and Chemiluminescence Immunoassay in Detecting Antibodies to Hepatitis B Surface Antigen

Introduction : Antibodies to Hepatitis B surface Antigen (Anti-HBs) levels are measured as markers for immune response to vaccination and in decision making for post-exposure prophylaxis against Hepatitis-B. Several immunoassay formats are used to measure Anti-HBs, thus carrying the possibility of variation in measured levels between different assays. This study compares the performance of Chemiluminescence Immunoassay (CLIA) against Enzyme-linked Immunosorbent Assay (ELISA) in measuring Anti-HBs titer by looking into concordance between the two test reports. Aim: To compare the agreement between ELISA and CLIA in measurement of Anti–HBs antibody titers. Materials and Methods: This prospective comparative study conducted at Kasturba Medical College, Manipal measured consecutive serum samples (69) sent for anti-HBs levels during May-June 2016 using both CLIA (Abbott Architect) and ELISA (Bio-Rad). Anti-HBs values of =10mIU/ml was considered as non-protective and >10mIU/ml as protective. The agreement between the tests in classifying the antibody titers as non-protective or protective was computed using Kappa coefficient, and the difference in individual titer values between the tests compared using Bland-Altman plot on SPSS (v.15). Results: Out of the 69 samples analysed, 18 samples (26.1%) were of health-care personnel and remaining of patients. Agreement between ELISA and CLIA in identifying the antibody titers as protective and non-protective were 96.5% and 90.9% respectively, resulting in an agreement of 0.84. The coefficient-of-variation of ELISA and CLIA were 74.5% and 113.1%, respectively. Three value based discordant results were noted; two samples deemed protective by ELISA were reported as non-protective by CLIA. One non-protective titer by ELISA was reported as protective by CLIA. Conclusion: Analytical agreement is good between the two immunoassays. However there are some discrepancies in quantitative measurement. This may have been due the variation in the standard calibrators used in each assay. Though CLIA showed more variation in the values, it has the advantage of being automated test with low turn around time. Therefore, both the test methodologies can be reliably used in place of each other for detection of Anti- HBs titer.

The Effect of Folic Acid Supplementation on Hyperhomocysteinemia and Pulmonary Function Parameters in Chronic Obstructive Pulmonary Disease: A Pilot Study

Introduction: Preliminary studies have established the elevated plasma total Homocysteine (tHcy) levels as a risk factor for Chronic Obstructive Pulmonary Disease (COPD). However, studies describing plasma tHcy levels and their relationship to folic acid supplementation and Forced Expiratory Volume in 1 Second (FEV1) status in COPD patients are still lacking. Aim: We investigated the role of hyperhomocysteinemia in COPD and then prospectively examined the relationship between plasma tHcy concentration and effect of folic acid supplementation on FEV1 status in COPD patients. Materials and Methods: This was a prospective case-control study with 50 clinically stable patients of COPD attending the chest clinic of the hospital and 30 healthy controls. The study was done at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India, from August 2011 to February 2013. Plasma levels of Hcy were measured by Enzyme Linked Immuno-Sorbent Assay (ELISA) method. All the subjects were given folic acid therapy (5mg daily) for six weeks duration and were followed up. Repeat plasma Hcy and FEV1 were measured after six weeks. Results: COPD patients had higher baseline plasma tHcy concentration than controls (Mean: 27.42±23.89µmol/L, versus 15.21±15.71µmol/L, p<0.001) and COPD was associated with higher tHcy concentrations also after adjusting for smoking, and age. The mean BMI of the patients was 21.36±4.26kg/m2. The mean Hcy values decreased from 27.42±23.89µmol/L to 15.2±15.71µmol/L (p-value=0.001) after six weeks of folic acid supplementation. However, no significant change was observed in FEV1 upon folic acid supplementation (FEV1=1.14±0.60 and 1.08±0.56 respectively; p-value=0.654). A significant correlation was observed between BMI and Hcy and also between plasma Hcy levels at the baseline and after six weeks of folic acid supplementation (r=0.283, p=0.04 and r=0.340, p=0.02, respectively) and (r=0.840, p=0.001). Conclusion: COPD patients seem to have a poor folic acid status and as a consequence high tHcy. Also, folic acid supplementation has shown decreased plasma tHcy concentrations, but not necessarily significant change in FEV1

Spectrum of Abdominal Aortic Disease in a Tertiary Health Care Setup: MDCT Based Observational Study

DG Santosh Kumar, Venkatraman Bhat, Karthik Gadabanahalli, Arjun Kalyanpur

Introduction: Abdominal aortic disease is an important cause of clinical disability that requires early detection by imaging methods for prompt and effective management. Understanding regional disease pattern and prevalence has a bearing on healthcare management and resource planning. Non-invasive, conclusive imaging strategy plays an important role in the detection of disease. Multi-Detector Computed Tomography (MDCT) with its technological developments provides affordable, accurate and comprehensive imaging solution. Aim: To evaluate regional demography of abdominal aortic disease spectrum detected using MDCT imaging data in a tertiary hospital. Materials and Methods: A descriptive study was conducted based on MDCT imaging data of patients who were investigated with clinical diagnosis of abdominal aortic disease, from March 2008-2010, over a period of 24 months. Patients were examined with the contrast-enhanced MDCT examination. Morphological diagnosis of the aortic disease was based on changes in relative aortic caliber, luminal irregularity, presence of wall calcification, dissection or thrombus and evidence of major branch occlusion. Patients were categorized into four groups based on imaging findings. MDCT information and associated clinical parameters were examined and correlated to management of patient. Descriptive statistical data, namely mean, standard deviation and frequency of disease were evaluated. Results: A total of 90 out of 210 patients (43%) were detected with the abdominal aortic abnormality defined by imaging criteria. Group I, comprising of patients with atherosclerosis –including those with complications, constituted 65.5% of the patients. Group II represented patients with aneurysms (45.5%). Group III, consisting of 32.2% of the patients, contained those with dissections. The rest of the patients, including patients with aorto-arteritis, were classified as group IV. Eight patients with aneurysm and one patient with aorto-arteritis were considered for surgical treatment. Ten patients with dissection underwent endovascular procedure. Rest of the patients was managed conservatively. Conclusion: Aortic disease was observed in 43% of investigated patients. Atherosclerosis with and without aortic aneurysm constituted the largest group. MDCT provided comprehensive information about the lesion and associated complications. In view of the wider availability and desired imaging qualities, MDCT provided optimal information for diagnosis and management of aortic pathology. Majority of our patients (90%) were treated conservatively.

An Osteologic Study of Cranial Opening of Optic Canal in Gujarat Region

Binita Jigneshkumar Purohit, Praveen R Singh

Introduction: Optic canal is a bony canal situated in between the roots of lesser wings of sphenoid, lateral to body of sphenoid. It transmits optic nerve and ophthalmic artery, surrounded by meninges. Various authors have studied variations in skull foramina and correlated clinically, as variants in the body structures have been found to be associated with many inherited or acquired diseases. Aim: The present study aimed to examine morphologic and morphometric variations in cranial openings of optic canals. Materials and Methods: The study was undertaken in total 150 dry adult human skulls. The variations in size, shape, presence or absence and duplication or multiplication if any, in optic canal were observed bilaterally. Unusual features such as recess, fissure and notch were also observed bilaterally. Student's t-test was applied to compare size of cranial openings of optic canal on both sides. Similarly, morphologic features related with the canal were studied by calculating frequency and proportions of various parameters. Results: Optic canal was present in all 150 skulls studied bilaterally. The mean maximum dimension of the canal at cranial opening was 5.03±0.72 mm on right side and 5.02±0.76 mm on left side. The shape of the canal was ovoid at cranial opening in all the skulls studied. Duplication of optic canal was present in one skull on left side. Recess was found in 105(35%) sides of total skulls observed. Fissure was found in 20(6.67%) sides and notch was observed in 30(10%) sides of total skulls. Conclusion: The optic canal showed variability in various parameters. Knowledge regarding variations in size, shape and unusual features on cranial opening of optic canal can be helpful to clinicians while approaching optic canal for various invasive procedures such as optic nerve decompression.

A Comparative Evaluation of the Linear Dimensional Changes of Two Different Commercially Available Heat Cure Acrylic Resins during Three Different Cooling Regimens

Abhishek Savirmath, VaVandita Mishra

Introduction: Close mucosal adaptation of denture base to the underlying mucosa is of prime importance for denture stability. This however can be affected by various temperature changes which the denture base undergoes during processing and also to its material properties. Aim: The aim of the present study was to compare linear dimensional change of heat cure acrylic resin with three different cooling regimens on two different commercially available acrylic denture base resins. Materials and Methods: Six groups of acrylic specimens with 10 samples each were prepared using either PYRAX or DPI acrylicresin, with a standard processing technique. Three different cooling methods were used for both the commercially available heat cure acrylic denture base resins. Linear dimensional changes were measured between three pre-determined points on the specimens of all the groups using a travelling microscope after removing the sample from the flask. One way ANOVA and unpaired t-test was used for statistical analysis. Results: Linear dimensional change was more in quenching followed by air and water bath method of cooling respectively. Amongst the materials, linear dimensional changes were more in PYRAX than in DPI acrylic. Conclusion: Slow cooling by methods described should be advocated for better mucosal adaptation of the denture base.

Female College Students Knowledge, Attitude and Future Intention towards Breastfeeding: Implications for Advocacy

Ramya Padmanabhan, Mahalakshmy Thulasingam, Palnivel Chinnakalai

Introduction: Breastfeeding is important for promoting child’s health. Since, breastfeeding decisions are made before pregnancy and are strongly influenced by women’s knowledge and attitude, it is important to identify knowledge gaps in youth girls. Aim: To assess the knowledge, attitude and future intention regarding infant feeding among female college students in Puducherry, India. Materials and Methods: This descriptive study was done among 307 college going female students. Their knowledge, attitude and future intention was assessed using structured questions and Likert’s scale. Data were summarized as percentages with 95% confidence interval. Responses to Likert’s scale were analyzed using consensus index. Results: Around 98% (95% CI: 96.5%, 99.6%) and 86.3% (95% CI: 82.5%, 90.2%) knew that breast milk and colostrum respectively is good for the child. However, students had poor knowledge about exclusive breastfeeding, the age of starting supplementation, recommended duration of breastfeeding. Noteworthy, 15% and 38% of them thought that breastfeeding spoils the mother’s beauty and interferes with mother’s employment respectively. Around 98% (95% CI: 97.0%, 100.0%) wanted to breastfeed their child in future. A high proportion of students, 20.5% (95% CI: 16.0%, 25.0%) wanted to give formula feed before 6 months. Knowledge and future intention to breastfeed was better among ‘arts and science’ students than engineering students. Conclusion: The knowledge and attitude of female college students on breastfeeding is good. Almost all students wanted to breastfeed their children in future. However, the study has identified knowledge gaps and misconceptions which need to be stressed during the health education activity to promote optimal breastfeeding practices.

Evaluation of Baseline CD4+ T Cell Counts and ART Requirement in Newly Diagnosed HIV Seropositive Individuals in a Tertiary Care Hospital of Northern India

Sonali Bhattar, Bhanu Mehra, Preena Bhalla, Deepti Rawat

Introduction: Antiretroviral Therapy (ART) has changed the outlook of Human Immune deficiency Virus (HIV)/ Acquired Immuno Deficiency Syndrome (AIDS) patients worldwide. Aim: To analyse the trends in baseline CD4+ T cell counts and ART requirements in newly diagnosed HIV seropositive individuals in a Tertiary care hospital of Northern India. Materials and Methods: Out of 1263 HIV seropositive clients identified from January 2012 to June 2014, the baseline CD4+ T cell counts of only those 470 clients were analysed, who registered at the linked ART centre. Results: The mean baseline CD4+ count of the study group was 249.77±216.0 cells/mm3 and that of male and female were 300.31±240.47 cells/mm3 and 232.38±204.25 cells/mm3 respectively. A total of 259 of 334 (77.54%) HIV reactive males, 83 of 130 (63.85%) HIV reactive females and overall 348 of 470 (74.04%) required antiretroviral treatment on enrolment. Conclusion: In the present study, about three-fourth of newly diagnosed HIV positive Indian patients required initiation of ART at registration. The relatively low baseline CD4+ T cell counts in this population highlights the need for timely baseline CD4+ T counts testing of HIV positive patients and the urgency of initiating treatment in HIV reactive individuals in Indian health care settings.

Evaluation of Clinical Outcomes of Management of Paediatric Bone Forearm Fractures using Titanium Elastic Nailing System: A Prospective Study of 50 Cases

Rajesh Kapila, Rakesh Sharma, Ankush Chugh, Mahesh Goyal

Introduction: Forearm fractures are common injuries in children. In older children, there management is difficult due to increased chances of re-displacement after closed reduction. Aim: The aim of this prospective study was to evaluate the clinical outcome of managing paediatric forearm fractures using Titanium Elastic Nailing System (TENS). Materials and Methods: A total of 50 patients in the age group 6 to 14 years with fractures in both bones of forearm were managed by internal fixation using TENS and prospective follow-up were done for six months. Results: On final evaluation in terms of symptoms and range of motion of adjacent joints using Price CT et al., criteria for results, we had excellent outcomes in 92% patients and good in 8%. There were no significant complications except for superficial pin tract infections at entry site of nail in only 6% of patients. Conclusion: We conclude that TENS is an effective and minimally invasive method of fixation of forearm fractures with excellent results in terms of bony union and functional outcomes with minimal complications and without jeopardizing the integrity of the physis.

Variation of Cost among Anti-cancer Drugs Available in Indian Market

Introduction: Although cancer remains a major health problem all over the world, its treatment is limited by affordability of patients in a developing country like India. Information generated from cost analysis studies will be helpful for both the doctors in choosing the correct medicine for their patients and also for policy makers in successfully utilizing the meager resources that are available. Aim: The aim of the present observational study was to analyse the price variations of anti-cancer drugs available in India. Materials and Methods: The cost of a particular anti-cancer drug being manufactured by different companies, in the same dose and dosage form, was obtained from latest issue of ‘‘Current Index of Medical Specialties’’ (CIMS) January–April, 2016. The difference between the maximum and minimum prices of various brands of the same drug was analysed and percentage variation in the prices was calculated. The results of the study were expressed as absolute numbers and percentages. Results: Overall, the price of a total of 23 drugs belonging to 6 different categories available in 52 different formulations were analysed. Among alkylating agents, oxaliplatin (50mg; injection) showed the maximum price variation of 125.02%. In anti-metabolites, methotrexate (2.5mg; tablet) showed the maximum price variation of 75.30%. The maximum price variation among natural products was seen with paclitaxel (260 mg; injection) of 146.98%, among hormonal drugs, was seen with flutamide (250mg; tablet) of 714.24%, among targeted drugs was seen with imatinib mesylate (100mg; film coated tablet) of 5.56% and among supportive drugs, granisetron (1mg; tablet) showed the maximum price variation of 388.68%. Conclusion: The average percentage variations of different brands of the same anti-cancer drug in same dose and dosage form manufactured in India is very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-cancer drugs and minimizing the economic burden on the patients.

Androgen Receptor Expression in Breast Carcinoma of Egyptian Patients

Rehab Monir Samaka, Sheren Fouad Younes

Introduction: Breast carcinoma (BC) is a heterogeneous disease, with distinctive molecular sub-types, influencing BC patients prognosis and therapeutic options. Androgen Receptor (AR) is a steroid nuclear receptor involved in complex signaling pathways, that are thought to play a role in cell proliferation. AR expression in relation to different molecular sub-types of BC is not clearly understood. Aim: The aim of this study was to evaluate the expression of AR in BC from Egyptian patients and correlate it with the standard clinico-pathologic variables, molecular sub-type of BC and the Overall Survival (OS). Materials and Methods: This retrospective study was conducted on 81 cases of BC from egyptian patients, stained immunohistochemically with AR. Chi-Square and Kaplan- Meier tests were applied to study the correlation between AR expression and clinicopathologic variables and the OS of BC patients respectively. Results: Among studied BC cases, 37.04% were immunoreactive to AR. AR immunoreactivity was significantly corrrelated with older age (p=0.03), post-menopausal status (p=0.001), lower grade (p=0.003), the presence of in-situ component (p= 0.014), early stage of presentation (p=0.03) and good-moderate NPI (0.009). It was also correlated with Positive ER, negative HER-2/neu, low Ki-67 proliferation index and luminal A subtype. AR expression didn’t correlate with the OS in the studied cases. Conclusion: AR was found to be related to favourable prognostic factors in BC but not to OS. It was particularly expressed in luminal A group and in significant proportion in Triple Negative Breast Carcinoma (TNBC), providing an opportunity for AR targeted therapy.

Review of the Management of Peroral Extrusion of Ventriculoperitoneal Shunt Catheter

Rajendra Kumar Ghritlaharey

Introduction: Peroral extrusion of peritoneal part of Ventriculoperitoneal Shunt (VPS) catheter is an extremely rare complication following VPS implantation. Aim: To review the options available for the management of peroral extrusion of VPS catheter. Materials and Methods: PubMed, Medline, PMC (PubMed Central), Embase, Google scholar databases search was performed to retrieve the published/available data relating to the peroral extrusion of VPS catheter. The keywords employed were “peroral extrusion of ventriculoperitoneal shunt catheter”, “transoral extrusion of ventriculoperitoneal shunt catheter”, and “oral extrusion of ventriculoperitoneal shunt catheter”. The maiden description of peroral extrusion of VPS catheter was reported in the year 1987, and the data relating to peroral extrusion of VPS were retrieved from that period to June 30, 2016, and those were available in English literature. Results: Twenty-two published manuscripts (n) were available on the topic relating to peroral extrusion of VPS catheter. All were cases and were included for the review. This review included n=10; 45.45% male and n=12; 54.54% female. All of them were reported in children below 12-year of the age, except two case reports in adult that occurred at the age of 27-year and 47-year, respectively. Overall, the mean age at the time of peroral extrusion of VPS catheter was 6.94 ± 10.87 years. The interval from VPS insertion or last shunt revision to the occurrence of peroral extrusion of VPS catheter ranged from 10-days to 10-year, with a mean of 20.31 ± 28.37 months. More than two-third (n=15; 68.18%) of the case occurred within one-year of VPS insertion/last shunt revision. Clinical diagnosis was obvious in all the cases due to peroral extrusion of VPS catheter. The site of perforation by the VPS catheter was stomach in 15, jejunum in 1, diaphragm/trachea in 1, while the site of bowel perforation was not mentioned in 5 cases. Surgical procedures opted by authors in order of frequency were: (a) removal of entire VPS catheter n=5; (b) removal of entire VPS catheter, and delayed re-VPS n=5; (c) removal of peritoneal catheter with or without External Ventricular Drainage (EVD), and revision of peritoneal catheter n=3; (d) removal of peritoneal catheter, with or without EVD, and VA shunt n=3; (e) removal of peritoneal catheter, EVD and delayed re-VPS n=2; (f) removal of entire VPS catheter, EVD and delayed re-VPS n=2; (g) removal of peritoneal catheter, EVD and others n=2. Two deaths are also reported during the management of peroral extrusion of VPS catheter. Conclusion: Peroral extrusion of peritoneal part of VPS catheter is an extremely rare complication following VPS insertion, and most frequently observed in children, although also reported in adults. In more than two-third of the cases it occurred within one-year of the VPS placement or last shunts revision, so a close follow-up is a must during this period following VPS placement. Management of such a case depends upon many factors such as presence or absence of shunt tract infection, peritonitis, meningitis, and cerebro spinal fluid infection.

Sleep Disorder, Gastrointestinal Problems and Behaviour Problems Seen in Autism Spectrum Disorder Children and Yoga as Therapy: A Descriptive Review

Kumar Narasingharao, Balaram Pradhan, Janardhana Navaneetham

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with deficiencies in many developmental milestones during the infantile childhood. Recent researches have shown that apart from behaviour problems, the ASD children also suffer from physiological conditions such as disturbed sleep and gastrointestinal problems that could be the contributing factors to their daytime behaviour problems. Lots of parents have expressed that, lack of sleep among the children have resulted in high levels of stress among the family members particularly among the immediate caretakers which are in most cases the mother of the child. Early behaviour intervention is a norm for ASD children which mainly affect the psychological level. Through this paper, an effort has been made to study the contributions made by yoga in order to mitigate such problems. Yoga is a non-invasive and alternative therapy that brings change in both physiological and psychological level of an individual. High levels of stress among the caretakers of these children could make them susceptible to non-communicable diseases such as hypertension, diabetes, arthritis etc. Parental based yoga intervention can be more effective for both children and parents and subsequently to the entire family.

Oral Health and Oral Contraceptive - Is it a Shadow behind Broad Day Light? A Systematic Review

Introduction: Oral contraceptives are one of the risk factors for gingival disease. Oral contraceptives can affect the proliferation of cell, growth and differentiation of tissues in the periodontium. Nowadays recent research has suggested that the newer generation oral contraceptives have less influence on gingival diseases. Aim: The purpose of this study was to systematically review the effect of oral contraceptives on periodontium. Materials and Methods: A literature review was performed; PubMed, PubMed Central and Cochrane Library, Embase, Google Scholar were searched from 1970 up to December 2015 to identify appropriate studies. Results: Out of the total 94 titles appeared 13 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched and one article which was through e-mail was also included. The hormones progesterone and estrogen have direct impact on immune system of the body and thus, affect the pattern and rate of collagen production in the gingiva. Furthermore, the review also shows that longer duration usage of oral contraceptive could lead to poorer oral hygiene status, gingival inflammation and increased susceptibility to periodontal disease. Conclusion: There are relatively few studies evaluating the effect of oral contraceptives on periodontium. It was found that oral contraceptives have a marked effect on periodontium. The gingival changes after use of oral contraceptives are pronounced in the first few months and with the passage of time these changes get enhanced.

Haemovigilance: A Current Update in Indian Perspective

Somnath Mukherjee, Rituparna Maiti

Haemovigilance is an organised scheme of monitoring, identifying, reporting, investigating and analysing adverse events and reactions pertinent to transfusion and manufacturing blood products. This system is also an elemental part of quality control in a blood system, bringing about corrective and preventive measures, and for the perpetual advancement of the quality and safety of blood products and the transfusion process. Nowadays haemovigilance setups have been enforced throughout the globe in most developed countries, to monitor the adverse reactions and episodes associated with blood donations and transfusions. Indian Pharmacopoeia Commission has started a Haemovigilance Program of India (HvPI) in 2012 under its Pharmacovigilance Program of India (PvPI) in collaboration with National Institute of Biologicals, Noida, Uttar Pradesh, under Ministry of Health and Family welfare, Government of India with a primary objective to track adverse reactions/events and incidences associated with blood transfusion and blood product administration and to identify trends, recommend best practices and interventions required to improve patient care and safety. This review article is a detail update of current scenario of haemovigilance in India.

Epigenetics and Periodontitis: A Contemporary Review

Geetha Ari, Sandhya Cherukuri, Ambalavanan namasivayam

Periodontitis is characterized by infection and inflammation of the tooth supporting structures. Few signs of susceptibility and recurrence after treatment are seen due to the outgrowth of various pathogenic microorganisms. Many studies have been done to understand the genetic basis of periodontal disease. An increased risk for periodontitis has been shown with the variations in genes related to the inflammatory response. Interestingly, some of the genes regulated by epigenetic modifications are modified in response to environmental stimuli. Conditions such as cancer, autoimmune or inflammatory diseases have been dispensed by epigenetic mechanisms. The understanding of these molecular mechanisms and the early detection of susceptibility may guide in future periodontal disease treatment and prevention.

Protocol Writing in Clinical Research

Azzam Al Jundi, Salah Sakka

Writing a research proposal is probably one of the most challenging and difficult task as research is a new area for the majority of postgraduates and new researchers. The purpose of this article is to summarize the most important steps and necessary guidelines for producing a standard research protocol. Academic and administrative success of any project is usually determined by acquiring a grant for the related field of research. Hence, the quality of a protocol is primarily required to achieve success in this scientific competition.

Natural Alternatives for Chemicals Used in Histopathology Lab- A Literature Review

Histopathology lab is the place where the specimen gets processed and stained to view under microscope for interpretation. Exposure to the chemicals used in these processes cause various health hazards to the laboratory technicians, pathologists, and scientists working in the laboratory. Hence, there is a dire need to introduce healthy and bio-friendly alternatives in the field. This literature review explores the natural products and their efficiency to be used as alternatives for chemicals in the histopathology lab.

Faculty Perception Towards a “Hybrid” Problem Based Learning Methodology

Nitin Joseph, Animesh Jain, Shashidhar M Kotian

This sequential quantitative and qualitative study was done to assess the perception of faculties towards a hybrid Problem Based Learning (PBL) methodology. To begin with, all faculty members of the department featured in a round of PBL facilitation. Later in phase I, their perception was assessed using a validated self-administered questionnaire. In phase II, personalized interview was conducted with each faculty. Finally phase (III) involved a focus group discussion on issues identified in previous phases. Among the 10 faculties, 9 had good and 1 had average perception about PBL. The various issues brought out by faculty in phase (II) and (III) were; need of formalized training in PBL for facilitators, need of integrated PBL sessions, need of variety of PBL exercises and need of student’s assessment for every session.

Rotation Flap Closure of Moderate Size Scalp Defects – Technique and Outcome

Philip Umman, Vinod G. Pillai, Pradip M. Abraham, Roshan G. Varkey

Many patients present to general surgeons with scalp lesions which require wide local excision with margin, following which the defect is too large to be closed primarily. These lesions can be benign or malignant. Skin grafting of these defects gives poor cosmetic outcome. Knowledge of basic flaps will enable the general surgeon to close these defects to heal by primary intention. Also, the margin of excision will not be compromised because of anticipated difficulty in closing the wound. We present a series of three cases who underwent excision of scalp lesions resulting in moderate size scalp defects. These defects were closed with rotation flap with good cosmetic outcome.

De Garengeot´s Hernia – A Diagnostic and Therapeutic Challenge

Arun Prasath Sinraj, Nagaraja Anekal, Surag Kajoor Rathnakar

De Garengeot’s hernia is an eponym for femoral hernia containing vermiform appendix as its content and is named after Rene-Jacques croissant De Garengeot after he first described the condition in 1731. We present a case of a 38-year-old woman who presented with right inguinal swelling for 15 years associated with pain and vomiting for 2 days. Clinical examination revealed an irreducible femoral hernia. Emergency surgery was done and inflamed appendix was found as content of the sac. Appendectomy followed by mesh repair was done. Standard treatment protocol does not exist owing to its rarity and the outcome depends on the time of diagnosis and treatment given. A low inguinal approach is reasonable and use of polypropylene mesh warrants further study. This article is being presented because of its rarity and intends to briefly discuss the surgical pitfalls and considerations through an up-to-date literature review.

A Rare Case of an Adult with Untreated Bladder Exstrophy Presenting with Signet-Ring Cell Adenocarcinoma of Urinary Bladder

Abhishek J. Savalia, Vikash Kumar, Gaurav Kasat, Ajit Sawant

Untreated bladder exstrophy in an adult is rare, as the defect is obvious and primary reconstruction is usually done in infancy. There are less than 90 reported cases of primary adenocarcinoma in an untreated bladder exstrophy in literature and only two such case reports from India. Of these, only one case was of signet-ring cell type of mucinous adenocarcinoma. Here we report the second case of signet-ring cell adenocarcinoma in a 63 year old male with untreated bladder exstrophy (oldest patient in literature), to highlight the extreme rarity, yet distinct possibility and challenges faced in surgical management of such cases.

Lizard Bite Masquerading as Scorpion Sting Envenomation

Lizard bite is very infrequent in children. Lizards tend to avoid confrontation. Bites are only inflicted when they are manipulated or when they are cornered and feel threatened. Lizard bites may be frightening but most do not cause serious health problems. The wall lizard or gecko, found in most homes, is not poisonous at all. It only checks insect population. A two-year-old boy was brought with history of lizard bite over right hand when he was trying to capture it. The child had experienced excessive sweating and irritability within two hours of bite. He was treated with supportive care. Prazosin hydrochloride was administered in the dose of 30µ/kg as his symptoms mimicked the autonomic storm which is typically seen with scorpion sting envenomation. To the best of our knowledge autonomic storm following lizard bite has not been reported in the Indian literature so far.

Spectrum of Changes in RBC Indices and Histograms in Blood from Subjects with Cold Antibodies

Chidambharam Choccalingam, Aarthi Kannan

Cold antibodies are mostly immunoglobulin M, which interact with red cell antigens at lower temperatures (<37°C). The analysis of samples from subjects with cold antibodies in automated haematology analysers may show abnormal Red Blood Corpuscles (RBC) indices and changes in histogram. High Mean Corpuscular Haemoglobin (MCH) and Mean Haemoglobin Concentration (MCHC) along with plateau effect beyond 110fl at Upper Discriminator (RU) end of RBC histogram are good indicators of presence of cold antibodies in plasma. Cold antibodies in plasma must be considered while reporting the peripheral smear in presence of plateau effect beyond 110fl at RU end of RBC histogram.

Intestinal Type Adenocarcinoma From Inverted Papilloma: A Rare Recurrence

Garima Singh, Meeta Singh, Mansi Chandana, Sompal Singh, Namrata Nargotra

Inverted Papilloma (IP) is an uncommon and locally aggressive benign tumour of sinonasal region, which tends to recur after surgical resection. Most tumours are confined to the lateral nasal wall and sinuses, with maxillary sinus being most commonly affected and a male preponderance. It has a known association with in situ and invasive carcinomas with a <10% rate of malignant transformation. Most common association has been seen with squamous cell carcinoma and extremely rare association with adenocarcinoma and small cell carcinoma. A 36-year-old male presented with a left sided polypoidal nasal mass and underwent a polypectomy. Pathology results showed IP with mild dysplasia. The polypoidal growth reappeared on the same side after a period of 10 months and on histopathological examination, the growth revealed features of intestinal type adenocarcinoma. IP recurring as adenocarcinoma is rare and even after exhaustive literature search only few cases could be found. Two studies have described recurrence of adenocarcinoma in existing IP previously. We report an unusual case of inverted papilloma showing malignant transformation into an intestinal type adenocarcinoma in a 36-year-old male patient within 10 months of previous surgery.

Unusual Visceral Sarcomas: Report of 2 Cases with Review of Literature

Navneet Jain, Nadia Shirazi, Neena Chauhan, Meenu Gupta

Sarcomas account for only 1% of adult solid tumours. Visceral sarcomas except Gastrointestinal Stromal Tumours (GIST) are rare and therefore little is known about the natural history and prognosis of these tumours. They tend to occur in older adults with no sex predilection and are characterized by an aggressive behaviour. Proper evaluation of these tumours is necessary because these are uncommon tumours which often present with advanced disease in an anatomically complex location. Since there are very few published studies on visceral sarcomas, the data is insufficient to suggest prognosis and optimum treatment strategies. We present two cases of such unusual malignancies in spleen and urinary bladder.

Inflammatory Myofibroblastic Tumor of the Kidney: A Rare Renal Tumor

Inflammatory Myofibroblastic Tumour (IMT) or ‘pseudotumour ‘of the kidney is a rare benign tumour of unknown aetiology affecting mostly young adults. A subset of IMT is neoplastic and harbours translocations of activin receptor-like kinase-1 (ALK-1) gene and can recur or rarely metastasize. Presentation varies from an incidentaloma to gross haematuria. Clinical examination and radiological investigations are usually inconclusive. Often, biopsy is inconclusive necessitating a management similar to that of Renal Cell Cancer (RCC). Diagnosis is based on immunohistochemistry. We are reporting a case of IMT in a 50-year-old male patient who presented with left flank mass which on evaluation was suggestive of left renal cell carcinoma. Excision of the tumour, histopathological examination and Immunohistochemistry proved the tumour to be IMT.

Safety and Efficacy of Itolizumab in the Treatment of Psoriasis: A Case Series of 20 Patients

Anchala Parthasaradhi

Psoriasis is a common, chronic, relapsing/remitting, immune-mediated skin disease that causes itchy skin with silvery scales. It is characterized by thickened red erythematous plaques covered with silvery scales. Biological therapies have been recently introduced for patients with psoriasis in India. The biological therapies contain protein biomolecules which can be employed to target specific immune or genetic mediator of a pathophysiological process. Here, we share our clinical experience of managing 20 patients with moderate to severe psoriasis by itolizumab a humanized IgG1 monoclonal antibody. Eighteen patients achieved Psoriasis Area and Severity Index (PASI) 75 response after receiving 10 infusion of itolizumab (at the completion of treatment). Out of 18 patients 4 patients had achieved PASI 95 response and 10 patients had achieved PASI 90 response. There was no adverse event reported during the treatment period. Itolizumab was found effective and safe in the treatment of moderate to severe psoriasis patients.

Pleural Mesothelioma with No Asbestos Exposure: A Case Report

Salmaait Batahar, Othmane ouradi, Safae ELIdrissi, Lamyaeamro

Malignant Pleural Mesothelioma (MPM) is the primary malignant tumour of the pleura. It is highly aggressive and linked to the exposure to asbestos fibers. The prognosis of this cancer is bad with a median of survival around 12 months. The diagnosis of pleural mesothelioma is often done at an advanced stage of the disease because of the lack of specific clinical and radiological signs differentiating it from any malignant pleural effusion. The absence of an explicit asbestos exposure is another diagnosis problem. We report the case of a 60-year-old patient without any prior exposure to asbestos who presented for pleural effusion and a nodular thickening of the pleura on the CT scan. The diagnosis of MPM was confirmed after pathology study of the biopsies obtained by video assisted thoracoscopy.

Pulmonary Hamartoma Mimicking Malignancy: A Cytopathological Diagnosis

Manjari Kishore, Prajwala Gupta, Preeti, Desh Deepak

Pulmonary Hamartomas (PH) are benign tumour-like lesions of lung with an uncommon occurrence and pose a diagnostic challenge on chest radiograph. Fine Needle Aspiration Cytology (FNAC) can lead to a definitive diagnosis as well as distinguishes these from malignant lung mass. Most of the patients are asymptomatic and incidentally detected on routine chest radiographs. We report a case of pulmonary hamartoma where the patient was symptomatic and a possibility of malignant neoplasm was considered until the FNAC concluded the diagnosis.

Primary Pulmonary Primitive Neuro-Ectodermal Tumour (PNET) in an Eight-Year-Old Girl - A Rare Case

Radhika Narayan, J Sreedevi, Farah Rana, Minakshi Mishra, Rajesh Mohanty

Primitive Neuro-Ectodermal-Tumours (PNET) and Ewing’s sarcoma are part of the spectrum of Ewing’s Family of Tumours (EFT) and show varying degrees of neuroectodermal differentiation. Both these tumours share similar histological and genetic features. PNETs arising primarily in the lungs without pleural or chest wall involvement are extremely rare. We report a case of pulmonary PNET in an eight-year-old girl. To the best of our knowledge, this is the youngest case of primary pulmonary PNET to be reported in paediatric age group in the Indian literature.

Revitalization of an Immature Permanent Mandibular Molar with a Necrotic Pulp Using Platelet-Rich Fibrin: A Case Report

Dayalan Subash, krishnamma Shoba, Shibu Aman, Srinivasan Kumar Indu Bharkavi

Any insult to the pulp during its development causes cessation of dentin formation and root growth. Pulpal status and degree of root development are the decisive factors in the treatment approach. Various treatment options have been tried like surgery with root-end sealing, calcium hydroxide–apexification, placement of apical plug and regenerative endodontic procedures to induce apexogenesis. An ideal scenario for a necrosed tooth with immature root would be continued root development coupled with regeneration of pulp tissue. We report a case, where revitalization was done using Platelet-Rich Fibrin (PRF) as a scaffold in immature mandibular molar tooth.

Abdominal Necrotising Fascitis Mimicking Peritonitis in a Gatka Playing Indian Male: A Case Report

Sonika Jha, Devinder Pal Singh

The present case report is of abdominal Necrotising Fascitis in a young Gatka player. The patient was clinically diagnosed to have peritonitis with plan for laparotomy but since ultrasound abdomen showed no free intra-abdominal fluid and any other pathology a Contrast Enhanced Computed tomography (CECT) abdomen was done. CECT showed fluid collections in rectus sheath and superficial fascia. Patient was thus, diagnosed as having abdominal myofascitis and treated accordingly. A review of literature showed that such a clinical presentation of this disease is quite rare and can lead to unnecessary laparotomy and delay in diagnosis leading to morbidity.

Conservative Management of Isolated Superior Mesenteric Artery and Celiac Trunk Dissection: A Case Report and Literature Review

Mohamed Hedfi, Yosra Messaoudi, Adnen Chouchene

Isolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.

A Rare Case of Ovarian Hyperstimulation Syndrome in a Preterm Infant

Ovarian hyperstimulation syndrome is a rare disease among preterm infants. This syndrome was first described in 1985 in four infants with a gestational age of <30 weeks. Several explanations for this syndrome have been suggested namely the immaturity of Hypothalamic-Pituitary-Gonadal (HPG) axis, lack of negative feedback, increased sensitivity of Follicle Stimulating Hormone (FSH) receptors due to mutation and high level of estradiol. In this report, a case of hyperstimulation syndrome in a newborn with gestational age of 30 weeks is presented and the probable mechanisms in the literature are discussed.

A Rare Case of An Atypical Solitary Fibrous Tumour of Orbit

Solitary fibrous tumours are of mesenchymal origin and comprise of uncommon spindle cell neoplasias. Most commonly the lesions arise from pleura but other rarer sites include lungs, peritoneum, pericardium, nasal cavities, thyroid, parotid gland and orbit. We report the case of a 41-year-old male patient who presented to us with a painless, progressive growth of a mass in the superior part of left orbit with proptosis and inferotemporal displacement of the left eye. Computed Tomography (CT) scan revealed homogeneous enhancing lesion in the superior compartment of left orbit in the extraconal region, extending intraconally and distorting the globe. Upon imaging, the differential diagnosis were lacrimal gland tumour, atypical cavernous haemangioma and nerve sheath tumour. Surgical treatment included complete excision of the mass with the intraoperative finding of mass extending upto the superior oblique tendon, a part of which was excised. Histopathological examination revealed CD34 positive, Bcl-2 and MIC-2 positive tumour with the diagnosis of a solitary fibrous tumour with atypical features but no malignant features. After a follow-up of 18 months, no recurrence was detected.

A Case Report on Unilateral Accessory Humeral Head of Pronator Teres

Suman Verma, Sulochana Sakthivel

The presence of an accessory muscle in the forearm is likely to compress on the neurovascular structures and has clinical implications. We encountered an accessory humeral head of pronator teres during routine dissection of left upper limb in a male cadaver. The accessory head had fleshy origin from medial supracondylar line, medial intermuscular septum and brachialis fascia. It coursed downwards in the cubital region covering brachial artery and median nerve. Further, it narrowed becoming mostly tendinous and joined with the humeral head of pronator teres. Awareness of accessory head is essential to explain multiple sites of nerve compression. High proximal origin of pronator teres and its course superficial to median nerve makes it more susceptible for distal entrapment neuropathy. Accessory muscles affect surgical field and can be confused with soft tissue pathologies.

Pharmacokinetic Potentiation of Mixed Organophosphate and Pyrethroid Poison Leading to Prolonged Delayed Neuropathy

Organophosphate (OP) and mixed pesticide poisoning remains an important cause of hospital admission. Therefore, physician must be aware of atypical presentations of delayed neurological complications of poisoning by taking proper patient history. We report a case of a 23-year-old female who presented with high stepping gait and muscle wasting in hands. Patient history revealed consumption of approximately 4ml of mixed pesticide, consisting of 50% chlorpyrifos with synthetic pyrethroid, 5% cypermethrin. The prolonged and severe nature of delayed peripheral neuropathy, persisting at two years of follow-up, suggests that even small quantities of OP taken in combination with a pyrethroid can result in significant morbidity and is irreversible.

Asymptomatic Traumatic Hepatothorax, Symptomatic Gall Stone Disease – A Rare Coincidence

Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management. We report a case of acute cholecystitis which revealed a rare association of traumatic right diaphragmatic hernia and hepatothorax.

Primary Extracranial Meningioma as a very Rare Cause of Nasal Mass and Epistaxis in an Elderly

Raman Wadhera, Sharad Hernot, Madhuri Kaintura, Sandeep Bhukar, S Dheeraj

Meningioma is known to be an intracranial pathology, but it can also present extracranially. We report a case of a 55-year-old female who presented to the Ear, Nose and Throat (ENT) emergency with a complaint of epistaxis for 1 day. There was a 7-8years history of self-resolving intermittent epistaxis. Nasal examination revealed a mass from which biopsy was taken. The specimen showed meningioma on histopathological examination. The mass was excised by ENT surgeons through lateral rhinotomy incision. It was confirmed to be a meningioma by final histopathological examination. The patient was discharged on 10th post-operative day after suture removal under stable condition and was symptom free on regular follow-ups. Worldwide there have been very less number of cases of primary extracranial meningioma causing symptoms of epistaxis, nasal obstruction and a large sinonasal mass in an elderly.

Choriocarcinoma in Ongoing Pregnancy Presenting with Intracranial Metastasis

Sujata Siwatch, Vanita Suri, Pooja Sikka, Neelam Aggarwal, Seema Chopra

Choriocarcinoma presents usually as persistent trophoblastic disease, with prognosis worsening with duration from antecedent pregnancy. We present a unique case of a woman with choriocarcinoma who presented in the third trimester of pregnancy with eclampsia. She was managed with magnesium sulphate and underwent a caesarean section. However, she developed seizures in the post-partum period that were further investigated and attributed to intracranial metastatic lesions of Gestational Trophoblastic Neoplasia (GTN). We discussed the diagnostic challenge in this rare case of GTN and the grave potential it can have in such a presentation, as in our patient.

Retroperitoneal Haematoma in a Patient with Dengue Haemorrhagic Fever: A Rare Case Report

Jasminder Singh, Harpreet Singh, Gagandeep Sukhija, Ruchi Jagota, Saroj Bala

Dengue Haemorrhagic Fever (DHF) has diverse manifestations ranging from asymptomatic petechial skin haemorrhages to life threatening cerebral, pulmonary, gastrointestinal and genitourinary haemorrhages. However, the association of spontaneous retroperitoneal haematomas with DHF is not well documented in literature. We report a rare case of spontaneous retroperitoneal haematoma complicating DHF.

Endodontic Management of a Mandibular First Molar with Radix Entomolaris and Conservative Post-endodontic Restoration with CAD/CAM Onlay: A Novel Clinical Technique

This case report describes a novel technique of restoring endodontically treated teeth. Hidden caries causing irreversible pulpitis in a mandibular molar with Radix Entomolaris (RE) was evident. The intact occlusal surface anatomy was duplicated before preparing an access cavity to replicate the original occlusal surface in the post endodontic restoration using (Computer-Aided Design and Computer-Aided Manufacturing) CAD/CAM technique. This report highlights uniquely designed onlay utilizing the benefits of contemporary materials and advanced technology.

Mucinous Cystadenocarcinoma in a Horse Shoe Kidney Masquerading as Giant Hydronephrosis – A Case Report: Diagnostic Challenges, Lessons Learnt and Review of Literature

Primary epithelial tumour of the renal pelvis is a rare entity. So far, very few cases are reported in literature. Of these, mucin secreting adenocarcinomas are distinctly rare. However, mucinous cystadenocarcinoma, that too arising in a horse shoe kidney is extremely rare to be reported. Mucinous cystadenomas and carcinomas arising from the renal pelvis are regarded to be secondary to a metaplastic change in the urothelium. Here, we present a case of a 51-year-old male, who complained of abdominal pain, palpable abdominal mass, haematuria along with passage of mucoid material in the urine, with a very poorly functioning kidney. A pre-operative diagnosis of horse shoe kidney with pelvi ureteric junction obstruction and a poorly functioning kidney was made. Intraoperative findings and frozen section biopsy were suggestive of mucin secreting cystic mass and a right heminephrectomy was done. The final histopathology was suggestive of mucinous cystadenocarcinoma of the renal pelvis of the right moiety. This case is presented for its rarity, diagnostic challenges faced and the lessons learnt, stressing on the need for having a high index of clinical suspicion in making such diagnosis.

Symptomatic Granuloma Secondary to Embolic Agent: A Case Report

Onyx is a liquid embolic agent presently gaining wide acceptance for embolisation of multiple vascular cranial pathologies like Arteriovenous Malformation (AVM) and Arteriovenous Fistula (AVF). Onyx stays in the nidus of vascular pathology and initiates inflammatory response leading to thrombosis and subsequently resulting in occlusion of vascular nidus. However, if onyx spills into the surrounding brain tissue, reaction occurs in the form of foreign body inflammatory reaction. This is one of the very few cases in literature whereby embolisation of AVM with onyx lead to granuloma formation which needed surgical excision. It presented with limb weakness and seizure episodes.

Severe Left Ventricular Endomyocardial Fibrosis Presenting as Biventricular Failure in a Young Adult: A Case Report

Endomyocardial Fibrosis (EMF) is a form of progressive restrictive cardiomyopathy of unclear aetiology prevalent in areas within 150 of equator including coastal areas of Kerala a few decades back. It inflicts young adults and carries a poor prognosis due to limited options for treatment. Fortunately, the incidence of cases is now declining due to improvement in health and hygiene standards. Here, we review the aetiology and pathogenesis of EMF and report a case of a young male from Mumbai (non-endemic area) presenting with progressively worsening breathlessness and signs of heart failure unresponsive to conventional medical treatment. To delineate the extent of the disease transthoracic echocardiography and cardiac Magnetic Resonance Imaging (MRI) was done which revealed infiltrative lesions in left ventricular apex with grade 2/3 mitral regurgitation. Due to progressive and severe nature of the disease the patient was managed conservatively. Through this report we would like to rekindle the interest of reader in a forgotten tropical disease which is considered rare in this geographical area but should not be missed as a cause heart failure considering its significant mortality.

Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report

Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality.

Unusually Large Peripheral Osteoma of the Mandible – A Rare Case Report

Pulkit Khandelwal, Vikas Dhupar, Francis Akkara

Osteoma is a benign tumor which is composed of mature compact or cancellous bone. Osteoma may be periosteal (arising from surface of the bone) or endosteal (develop in the medullary bone) or combination of both. Here, we present a case of unusually large osteoma present on the lingual surface of the mandible in a 40-year-old female patient. The lesion had grown slowly for 15 years and caused intra-oral swelling leading to difficulty in mastication, speech and tongue movements. Under general anesthesia, local complete surgical excision was performed.

Cardiofaciocutaneous Syndrome: Case Report of a Rare Disorder

Soutrik Seth, Tanmoy Biswas, Biswajit Biswas, Atanu Roy, Asok Kumar Datta

Cardiofaciocutaneous syndrome or CFC syndrome is a rare genetic disorder first described in 1986. It is one of the RASopathies involving multiple organs particularly the heart, skin and face affecting males and females equally. The phenotypic features overlap with 2 other conditions, the Noonan and Costello syndrome. We report on a 22-month-old boy with CFC syndrome presenting with typical craniofacial appearance, heart defects, ectodermal abnormalities, growth failure and developmental delay. Estimated population of affected individuals worldwide is a few hundreds.

Congenital Acute Myeloid Leukaemia with Pseudo-Chediak-Higashi Like Granules: A Case Report

Vandana Puri, Sandip Barman, Pooja Sharma, Meera Sikka

Congenital leukaemia is a very rare entity comprising 0.8% of all childhood leukaemias. Pseudo-Chediak-Higashi Anomaly (PCHA) in acute leukaemia is a rarely described entity. However, co-existence of congenital myeloid leukaemia with PCHA is a very rare entity and to the best of our knowledge has not been described in literature till date. A full term new-born presented on the 27th day of life with severe gastroenteritis. Complete blood counts and peripheral smear examination revealed leucocytosis with presence of 76% blast cells. Approximately 15% of these blast cells showed presence of pseudo-Chediak-Higashi like granules. The diagnosis of acute myeloid leukaemia was confirmed by flow cytometry. The case report is presented due to its rarity and to highlight the differential diagnosis and clinical implications of this entity.

Juvenile Xanthogranuloma in Vulva of a 10-Year-Old Child

Barkha Gupta, Surekha Yadav, Nita Khurana, Manish Sharma

A 10-year-old child presented with asymptomatic, well-circumscribed nodule in the vulva. Excision biopsy showed features of classic Juvenile Xanthogranuloma (JX) which is a rare benign disorder of non-langerhans’ cell group of histiocytic proliferative diseases. The presentation of this lesion as vulval nodule is extremely rare and the extensive literature search revealed only handful of cases of vulval xanthogranuloma that too in an adult age group. The lesion is however prognostically favourable and should be kept in mind as one of the differential diagnosis of the vulval nodule.

Renal Cell Carcinoma with Unusual Skeletal Metastasis to Tibia and Ankle: A Case Report and Review of Literature

Renal Cell Carcinoma (RCC) accounts for 5% of the epithelial malignancies worldwide with clear cell carcinoma accounting for 85% of these malignancies. One third of these patients experience synchronous metastatic disease and 20-30% of the remaining patients experience metachronous metastatic RCC. Bony metastasis accounts for 20% of metastatic RCC. They most commonly affect the axial skeleton and rarely the long bones or the small bones of the hands and feet. Bone metastases from RCC are predominantly osteolytic in nature, leading to significant patient morbidity due to the associated Skeletal Related Events (SRE). SREs may significantly decrease patient quality of life. Bone pain is most common SRE and radiotherapy is most common form of treatment. Only 2% of the patients require surgery. Here we present a case of advanced RCC with tibial and ankle metastasis who presented to us after one year of radical nephrectomy with severe pain and inability to walk and underwent above knee amputation.

Multiple Cerebrovascular Complications due to Sphenoid Sinusitis

Sphenoiditis is of particular interest because the sphenoid sinus has thin wall and its special anatomical location facilitate dissemination of infection to many intracranial structures including vascular structures. The main objective of this report is to gain insight into patterns of presentation and imaging findings in cerebrovascular complications of sphenoid sinusitis and to emphasize the need of reviewing Brain Computed Tomography Scan in all windows. This is a report of 32-year-old young female presented with fever and headache who was diagnosed to have sphenoid sinusitis after radiological examination. Sphenoid sinusitis may involve several intracranial structures, with potentially severe or even fatal complications. Prompt diagnosis and antibiotic/antifungal therapy is essential to minimize mortality and morbidity.

Alobar Holoprosencephaly Associated with Meningomyelocoele and Omphalocoele: An Unusual Coexistence

Holoprosencephaly is a rare congenital disorder which results from failure of cleavage or incomplete differentiation of the forebrain structures at various levels or to various degrees. Depending on the degree of involvement, it is classified into 4 types: Alobar, Semilobar, Lobar and Middle interhemispheric fusion variant. A male child was born to 28-year-old female at 34 weeks of gestation. The mother on antenatal follow-up was detected to have a fetus with multiple congenital anomalies on Ultrasonography (USG) done at 34weeks of gestation. The baby died after 12 hours of birth. A complete autopsy was performed. On external examination, multiple congenital anomalies were seen including cleft lip and palate, absent nasal bridge, proptosis of right eye, micropenis, left undescended testis, bilateral rocker bottom feet, omphalocele and sacral meningomyelocele. Internal examination of the brain revealed hydrocephalus and features of alobar holoprosencephaly. This case is presented for its rarity. In addition, it is unusual for a fetus with alobar holoprosencephaly to survive till term as this is the most severe type. Though facial malformations are usually present in a case of holoprosencephaly, its association with sacral meningomyelocele and omphalocele has rarely been described in literature.

An Unusual Case of Septic Arthritis of the Hip

Ujjwayini Ray, Soma Dutta, Arpita Sutradhar

Non-typhoidal Salmonella, particularly Salmonella enterica serovar typhimurium is food borne pathogen causing mild self-limiting diarrhoea in healthy adults. It can occasionally cause extraintestinal focal infection in susceptible patients. Salmonella, as the aetiological agent of osteomyelitis and septic arthritis is rare and has been mostly reported in patients with sickle cell disease or thalassaemia. We report a case of septic arthritis by Salmonella typhimurium in an immunocompromised patient who was successfully treated following timely isolation and identification of the aetiological agent.

Decision Making in Bowel Obstruction: A Review

Aswini Kumar Pujahari

Over the last century there have not been significant changes in the anatomical location of obstruction. The age of presentation has increased along with age related co-morbidity. Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management. A selective review of the literature pertaining to common age related aetiologies, diagnosis methods leading to standard decision making and treatment of acute intestinal obstruction was done. The same is obtained from randomized controlled studies, meta-analysis and other related evidence based publications. Predicting the conservative or operative management of Bowel Obstruction (BO) is difficult. BO in young age, in unscarred abdomen and Large Bowel Obstruction (LBO) needs early surgery. Decision on surgery should be taken in paediatric patient by second day and preferably between 3-5 days of admission in adults. Higher American Society of Anaesthesiologists (ASA) grade correlates well with the mortalities. In this article, the timing of surgery, methods to avoid bowel resection and type of surgery in various causes are stressfully analysed and discussed.

Current Development of Anti-Cancer Drug S-1

S-1 is a novel oral fluoropyrimidine derivative, widely used for treating gastric, pancreatic, lung, head, neck and breast carcinomas. It is designed to enhance the clinical utility of an oral fluoropyrimidine and is associated with low gastrointestinal toxicity. S-1 consists of three pharmacological agents (at a molar ratio of 1:0.4:1)-Tegafur (FT), a prodrug of 5-Fluorouracil (5-FU), 5-Chloro-2-4-Dihydroxypyridine (CDHP), which inhibits the activity of Dihydropyrimidine Dehydrogenase (DPD) and Oxonic Acid (Oxo), which reduces Gastrointestinal (GI) toxicity of 5-FU. The present article reviews the current development of clinical study of S-1.

The Impact of CYP1A2 and CYP2E1 Genes Polymorphism on Theophylline Response

Em Sutrisna

Theophylline is a medicine with narrow therapeutic index. This implies that a small change in dosage would cause side effects. Theophylline is metabolized by CYP1A2 and CYP2E1. The aim of this review is to know the impact of CYP1A2 and CYP2E1 genes polymorphism on theophylline response. The review was done by searching literature in Pubmed and Science Direct databases with keywords ‘polymorphism’, ‘pharmacogenetic’, ‘CYP1A2’, ‘CYP2E1’ and ‘theophylline’. There were 5 research articles from Pubmed and 65 articles (21 research articles, 23 review articles and 21 book chapters) from Science Direct. The exclusion criteria were - articles discussing about polymorphism but not CYP1A2 or CYP2E1, the ones with a mention of theophylline but not about its metabolism, articles on CYP1A2 and/or 2E1 polymorphism but not on the effect on theophylline. Thus, 33 articles were reviewed due to their suitability. The review discusses the influence of polymorphism of CYP1A2 and CYP2E1 genes on theophylline response.

Lupus Vulgaris Involving Both Inguinal Regions: A Case of Autoinoculation

Non-Surgical Management of Teeth with Wide Open Apices and Large Periapical Lesions: A Conservative Reality

Sarang Sharma, Shibani Grover, Pooja Dudeja, Vivek Sharma, Deepak Passi

Management of Oehlers Type II Dens in Dente with Open Apex and Alveolar Bone Defect

Oral Pulse Granuloma: A Veiled Entity

Post–caesarean Haematomas, Septic Collections and Wound Disruptions– Re–Laparotomy Based on Abdominal Imaging

Peritoneal Recesses of Human Duodenum

P.A. Nandagopapalan, Cessy Job, M.B. Prasanna

Malignant Ascites due to Prostatic Adenocarcinoma: An Extremely Rare Manifestation of a Common Disease

A Simple Sustained Traction Method for Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Removal

Shantajit Nameirakpam, Sharatkumar Singh Naorem, Salinitadevi Naorem

CAPA Analysis of Haemolysed Red Cell Unit Detected During Component Preparation: Importance of Quality Check on Cold Chain Maintenance

Babita Raghuwanshi, N.K. Pehlajani

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

Anirban Mandal, Amitabh Singh, Puneet Kaur Sahi, Bhavika Rishi

Gigantic Hand: A Rare Case of Macrodystrophia Lipomatosa

Kamal Kant Sahu, Gitesh Upender Sawatkar, Deba Prasad Dhibar, Tarun Narang

Interference of Vaccine Derived Polio Viruses with Diagnosis of Enteroviral Diseases in Neonatal Period

Mohammad Saeed Sasan, Alireza Ataei Nakhaei, Abdolvahab Alborzi, Mazyar Ziyaeyan

Introduction: Enteroviruses (EV) are a common cause of neonatal sepsis especially at the junction of summer and fall. Aim: This study was planned to find the frequency of Enteroviral (EV) sepsis among neonates with clinical sepsis. Materials and Methods: This is a prospective descriptive study. Rectal and pharyngeal swab samples were taken from all neonates with clinical sepsis and a control group of neonates with simple jaundice. EV was confirmed by both cell culture and RT-PCR. Anti polio antiserum was used to differentiate Polioviruses from Non Polio EVs (NPEV). Results: We had 67 neonates with clinical sepsis and 31 cases of simple jaundice during 105 days. NPEVs were isolated from 2 cases (2.9%) of the sepsis arm and one neonate (3.2%) of the jaundice group. Polio virus was isolated from 16.2% and 15.3% of OPV recipients in the sepsis and jaundice group respectively. Conclusion: Enteroviruses were not a common cause for neonatal sepsis in Nemazi hospital at the time of this study. OPV vaccinated neonates commonly pass the vaccine virus in their pharynx and stool which can be mistaken with NPEV.