Journal of clinical and diagnostic research

Paramolar with a Parapremolar: A Rare Occurrence

Pankaj Prasad, Shikha Ahirwal, Vikas Kumar, Mohit Singh Chauhan, Priyanka Rathor

A supernumerary tooth is an extra tooth to the normal series which can either be deciduous or permanent, single or multiple, unilateral or bilateral in any quadrant of the jaw. Identification and management of supernumerary teeth should be well understood. This case report deals with the discussion of the causes and theories related to the formation of paramolar and parapremolar and their further identification, with management of complications.

An Uncommon Aetiology of a Common Disease: Leptospiral Infective Endocarditis

Shikha Ranjan, Rama Krishnan T C Ramalingam, Chinnasamy Balasubramanian

Leptospirosis is a neglected global disease caused by pathogenic spirochetes, 10% cases of which present as severe disease resulting in multi-system disorders. Cardiac involvement in leptospirosis is not very uncommon, but mainly manifests as electrocardiographic changes and conduction defects. However, leptospiral endocarditis is an extremely rarely reported entity. We hereby present a case of infective endocarditis caused by Leptospira in 15-year-old boy. To our knowledge, this is only the sixth case of leptospiral infective endocarditis, highlighting the fact that clinicians need to be aware of the possibility of leptospirosis, even if the illness presents with unusual features like endocarditis.

Langerhans Cell Sarcoma of Thyroid: A Rare Differential for a Thyroid Swelling

SuhasK Rajappa, Dharma Ram, Makhan L Lohiya, SunilPasricha, Ajay K Dewan

Langerhans Cell Sarcoma (LCS) is a rare disease arising from antigen-presenting cells. The literature on LCS is largely limited to case series and only 67 such cases have been reported till date. We report a case of 27-year-old female presenting as a thyroid swelling. Computerized tomography (CT) scan showed diffuse enlargement of thyroid and patient underwent total thyroidectomy. Final diagnosis on histopathology and Immunohistochemistry (IHC) was langerhans cell sarcoma of the thyroid. Patient was advised adjuvant chemotherapy, however she defaulted and later presented to us with a disseminated disease. This is the 18th case of head and neck LCS to be reported and the first case of primary thyroid origin in the world literature. The diagnosis of LCS is by combination of histopathology and IHC and multi- modality treatment offers the best chance of cure.

Posterior Right Sectoral Duct Downstream of the Cystic Ductal Opening: A Rare Variant

The anatomical variants of the posterior right sectoral duct of the biliary tract are frequent. They have a surgical importance involvement. We report a case of 63-year-old female patient operated by laparoscopy for acute cholecystitis with an intraoperative cholangiography discovery of an insertion of the posterior right sectoral duct on the bile duct below the cystic duct. The insertion of the posterior segmental canal on the bile duct could represent type A6 of the Huang classification. This biliary variation should be known to avoid posterior segmental canal injury, during cholecystectomy

Myroides Species in a Paediatric Burn Patient

Sevda Soydan, Seyda Ignak, Ozlem Unay Demirel, Gulkan Karadag, Zeynep Ocak

Members of the genus Myroides are non-motile, Gram negative bacteria that are mostly found in environmental sources such as soil and water. They are not a part of human flora. For a long time they were evaluated as low grade opportunistic pathogens causing infections in immunocompromised patients whereas a few life-threatening infections were reported in immunocompetent individuals due to Myroides species. The child having a 64% of total body surface area burn was admitted to the burn unit. Myroides spp. was isolated first in urine culture then in blood culture. This is the first time Myroides spp. is reported in a paediatric patient with serious burn.

Delayed Hypersensitivity with Ferric Carboxymaltose

Surabhi Sridhara, Rajesh Vilakkathala, Ravindra Prabhu, Karan Saraf

Ferric Carboxymaltose (FCM) is widely used in the treatment of anaemia of Chronic Kidney Disease (CKD). The clinicians must be alert of the rare adverse events such as hypersensitivity with subsequent doses of FCM. Here, we report a case of a 59-year-old male a known case of CKD, with anaemia and thrombocytopenia. FCM was the treatment of choice. This case report indicates the onset of adverse reaction with FCM with the second dose even though the first dose was well tolerated.

Nasopharyngeal Pleomorphic Adenoma: A Difficult Surgical Proposition

Champion Venkateshalu Srinivas, A. Mahesh, Swati Nair

Salivary gland tumours of the nasopharynx are rare and when present, tend to be malignant. Here, we report an unusual case of benign pleomorphic adenoma of the minor salivary gland arising from the nasopharynx in a 21-year-old female who presented with unilateral nasal obstruction. The radiological features of non-invasion of surrounding structures gave the first clue of benignity of the lesion as well as the location, size and anatomical relations of the tumour with the surrounding structures. This information was useful in planning the surgical approach and predicting the prognosis. Local and adequate excision appeared to be adequate.

A Case of Janumet Poisoning

Arun Bahulikar, Vihita Kulkarni, Deepak Phalgune

Janumet, an anti-diabetic drug is being increasingly used. Each tablet contains 50 mg of sitagliptin + 500/1000 mg of metformin. Metformin works by decreasing glucose production in the liver and decreasing absorption of glucose by the intestines. Sitagliptin works by regulating the levels of insulin the body produces after eating (sugar dependant insulin release). A previously healthy 17-year-old female was found to be unconscious and had an alleged history of consumption of eight to nine tablets of Janumet. Patient had seizures on admission and evidence of hypoglycaemia. Patient remained drowsy for two days. Gradually her clinical condition improved and she was diagnosed with an adjustment disorder with disturbance of emotion and conduct. She was discharged from the hospital on the seventh day with normal clinical parameters.

Congenital Adrenal Hyperplasia– A Rare Cause of Central Precocious Puberty–A Case Report

The term ‘Precocious puberty’ refers to the appearance of pubertal signs at an earlier age than established standard. Precocious puberty may be central or peripheral. Central precocious puberty is caused by early maturation of hypothalamic-pituitary-gonadal axis. Peripheral precocious puberty is due to inappropriate secretion of sex steroid hormones from adrenal gland or gonad or from exogenous source and does not involve hypothalamo-pituitary-gonadal axis. We report a rare case where inspite of clinical and hormonal evidence of central precocious puberty ultimately an adrenal pathology was established in a six-year-old boy.

An Additional Visceral Impression on Spleen – A Rare Anatomical Scenario

Shweta Kumari, Prabhat Goel, Shikha Singh, Vandana Mehta, Rajesh Kumar Suri

An accessory spleen is a small mass of splenic tissue, found apart from main body. An unexpectedly rare location of accessory spleen in phrenicocolic ligament was encountered during the course of preclinical cadaveric dissection programme. The accessory spleen also created an oval impression measuring 2.5x2 cm on the visceral surface of the spleen. Precise knowledge of such anatomical variants is relevant to Radiologists and Surgeons in their clinical practice.

Retroperitoneal Fibromatosis Involving Iliac Vessel: A Rare Case Report

Anil Kumar, Sanjeev Kumar, Prashant Kumar Singh, Subhash kumar, Nishant Sahay

Retroperitoneal fibromatosis (RPF) is extremely rare. It usually occurs after previous abdominal surgery or trauma. The diagnosis and treatment modality for retroperitoneal fibromatosisis is a challenging issue because of its rarity and late presentation. It occurs in close relationship with vital structures like vessel, ureter and other structures in the retroperitoneum space. We report a case of RPF presenting as a mass in left iliac fossa, encasing the left common iliac vessel with symptoms of arterial occlusion, in a young girl with no significant medical, surgical or trauma history. Excision with aortofemoral bypass is the best way to treat such patient.

Go-kart Accident - Induced Isolated Sternal Body Fracture

Onur Kaplan, Ozgur Sogut, Mehmet Yigit, Mustafa Ozturk, Muhamed Furkan Ozden

Sternal fractures can occur in isolation or with concomitant injuries, such as deceleration injuries and blunt anterior chest trauma. They are seen in 3%-8% of cases of blunt chest trauma, the most common cause of which is motor vehicle accidents. These cases account for 60%-90% of sternal fractures. With the mandatory use of seatbelts, the incidence of sternal fracture has increased. A go-kart (or go-cart) is an open-wheeled car that comes in all shapes and forms, from motorless models to high-powered racing machines. Here, we report on the case of a patient who was involved in a go-kart accident that resulted in an isolated sternal body fracture, with no evidence of concomitant injury on portable anteroposterior and lateral chest radiographs. The patient was treated conservatively with a sternum external fixation corset.

Entrapment of Suprascapular Artery between Split Parts of Right Inferior Belly of Omohyoid Muscle - A Rare Case Report

Naina Santosh Wakode, Manisha R Gaikwad, Santosh Laxman Wakode, E Tripati Patro

Introduction: Family history of hypertension in medical students is an important, non-modifiable risk factor for hypertension in future. Aim: To determine the prevalence of sustained hypertension in young asymptomatic medical students with a parental history of hypertension. Materials and Methods: A cross-sectional study was conducted in a medical college of Dehradun. A total of 104 medical students with parental history of hypertension (Group A) and 100 medical students without a parental history of hypertension (Group B) were included. Electronically blood pressures were recorded on two separate occasions at an interval of 15 days. Comparison was done using Chi-square test/Likelihood ratio, Un-paired t-test and ANCOVA. Results: Overall, Group A had significantly higher percentage of prehypertensive (56.7%) and hypertensive (17.3%) students as compared to Group B which were 19% and 1%, respectively. Group A students had significantly higher Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) as compared to Group B, even after controlling for the differences in Body Mass Index (BMI) and gender (p<0.001). Conclusion: Hypertension was significantly higher in asymptomatic, healthy medical students with parental history of hypertension as compared to those with normotensive parents. We need to orient medical students to improve their knowledge, attitude and lifestyle practices early in life to prevent, treat hypertension and prevent its subsequent morbidity and mortality.

Nonfunctional Cystic Hepatic Paraganglioma Mimicking Hydatid Cyst

Preeti Balkisanji Agrawal, Gaurav Wadhawan, Kailashchandra Vyas, Sashi Sujanani

An extra-adrenal pheochromocytoma is also known as a paraganglioma. We are reporting the case of a 68-year-old female patient with an extremely rare primary nonfunctioning hepatic paraganglioma without any clinical signs and symptoms. A CECT scan of whole abdomen was done which showed a huge well defined peripherally enhancing fluid density cystic lesion measuring 14 cm × 14 cm × 12 cm with internal enhancing septations and few foci of calcification involving V to VIII segments of right lobe of liver which was compressing and displacing portal vein, its right branch, common bile duct, gall bladder. Mass was also compressing and displacing right kidney inferiorly. Laparotomy was done and sample of cyst wall sent for histopathology. After immunohistochemistry a diagnosis of paraganglioma was confirmed.

Massive Squamous Cell Carcinoma of the Orbit: A Rare Case Report

Smriti Nagpal Gupta, Sushil Kumar, Ruchi Goel, Charu Sagar, Okram Birbala

Squamous Cell Carcinoma (SCC) is the second most common eyelid malignancy worldwide. SCC is an aggressive tumour, with the ability to cause significant morbidity, mortality and the risk of rapid spread. Hence, urgent diagnosis and management is essential. SCC may mimic other benign and malignant lesions. Its definite diagnosis is generally done by biopsy and immunohistochemistry. Orbital invasion warrants treatment by orbital exenteration. There are chances of incomplete tumour clearance and recurrence, with a five year survival Rate of about 60%. Herein, we describe a young male patient with a massive tumour engulfing the entire orbit, and spilling over to the surface and periocular skin. There was a fungating, multilobulated mass of about 10 X 10 cm in size, with areas of necrosis and secondary infection. The tumour had invaded and destroyed all the orbital structures. However, the nasal cavity and maxillary sinus was free of tumour and there was no evidence of metastasis. The patient underwent surgical debulking of the tumour via orbital exenteration, followed by adjuvant radiotherapy. Histopathology revealed, well differentiated SCC. On follow up, the patient was systemically well, with no evidence of metastasis and the surgical site appeared healthy.

Pyeloduodenal Fistula Complicating Emphysematous Pyelonephritis: Successful Management with Minimally Invasive Approach

Priyank Yadav, Rajanikant R Yadav, Sandeep Nunia, Neelam Soni, Hiralal

Pyeloduodenal fistulae are rare and usually occur between the right renal pelvis and the duodenum due to their anatomical proximity. Pyeloduodenal fistula occurring due to local extension of emphysematous pyelonephritis has been described as a rare entity. Conservative management is preferred for management of emphysematous pyelonephritis and pyeloduodenal fistulae if renal function is adequate. We describe a case of emphysematous pyelonephritis of the right kidney complicated by a spontaneous pyeloduodenal fistula and perinephric air and urine containing collections managed conservatively with percutaneous nephrostomy and percutaneous drainage of perinephric collections.

Laparoscopic Vesico-Psoas Boari Flap and Ureteroneocystostomy: A Case Report

JS Rajkumar, Deepa Ganesh, Anirudh Rajkumar, Akbar Syed, Kalicharan Visvanathan

Ureteric injury, a devastating complication of laparoscopic gynaecological surgery, is often managed by endoscopic stent placement. Failure of endoscopic correction will require laparoscopic or open surgical correction to establish uretero-vesicular continuity. We here with present this case report of a Laparoscopic hysterectomy with right ureteric necrosis due to clip/cautery injury, which was managed with a totally laparoscopic ureteric reimplantation, using Boari flap, a psoas hitch, and an uretero-vesical stented anastomosis.

Imaging Diagnosis of Metastases to Breast: A Rare Presentation of Carcinoma Gallbladder

Breast metastases are extremely rare with a reported incidence of only 0.5-6.6% of all breast malignancies. We report a case of bilateral breast metastases in a 45-year-old lady who presented with an ulcero-proliferative epigastric mass. Imaging features suggested a diagnosis of carcinoma gallbladder as the primary aetiology. The diagnosis was proven by biopsy from the epigastric mass lesion. It is extremely rare to find breast metastases from carcinoma gall bladder and very few similar cases have been reported in the literature.

A Rare Case of LMCA Stenosis Treated by Percutaneous Coronary Intervention (PCI) in Setting of Patent Ductus Arteriosus with Dilated Pulmonary Trunk

Extrinsic compression of the Left Main Coronary Artery (LMCA) by a dilated pulmonary artery is a rare but a treatable cause of angina in patients with Pulmonary Artery Hypertension (PAH). In majority of these patients, angina is attributed to right ventricular or left ventricular demand ischemia and in the absence of cardiovascular risk factors for atherosclerosis, they rarely undergo a coronary angiogram. So this rare diagnosis may be missed in such patients and optimal management delayed. In this case report we describe a patient of PAH secondary to Patent Ductus Arteriosus (PDA), presenting with heart failure and complaining of persistent angina, due to extrinsic compression of the ostial LMCA by the dilated pulmonary artery, treated successfully by Percutaneous Coronary Intervention (PCI). This case reminds us that in all patients of pulmonary hypertension presenting with angina and left ventricular dysfunction, this rare but treatable cause should be identified by coronary angiography and treated with PCI.

A Rare Case of Heterotaxy Syndrome Associated with Hepatolithiasis and Pre-duodenal Portal Vein

Varna Shetty, Samir Mustaffa Paruthikunnan, Sachin Gullappa Shatagar

Polysplenia syndrome is characterised by spectrum of abnormalities which are rarely diagnosed in adults as an incidental finding. The anomalies include multiple spleens, midline liver, gall bladder and biliary tract anomalies, short pancreas, agenesis of pancreas, right-sided stomach, intestinal malrotation, inferior vena cava interruption with azygous or hemiazygous continuation, and a Pre-Duodenal Portal Vein (PDPV). These anomalies may occur isolated or in combination. Since most of the minor anomalies do not cause clinical symptoms, polysplenia syndrome is mostly detected incidentally in the adults because of multi-detector computed tomography which is being used in diagnosis of associated disease process. Therefore, radiologists should become familiar with these rare and peculiar anomalies associated with polysplenia syndrome. In the present report, we describe the case of a 50-year-old male patient with heterotaxy syndrome with polysplenia incidentally diagnosed during an imaging evaluation of an unrelated pathological condition – Cholelithiasis.

Retained Foetal Bones with Recurrent Vaginal Discharge: A Case Report

Termination of pregnancy or abortion is rarely known to result in retained foetal bones. The presentation of a patient with retained foetal bones may be in the form of secondary infertility, chronic pelvic pain, dysmenorrhoea, menorrhagia, etc is common. It is a rare occurrence to have retained foetal bones presenting in the form of recurrent vaginal discharge. The following is a case report of a female who presented with vaginal discharge and was later diagnosed to have retained foetal bones.

Successful Completion of Pregnancy on Maintenance Haemodialysis: Experience from a Resource-Short Model

Data pertaining to pregnancy completion on haemodialysis in Chronic Kidney Disease (CKD) patients from the developing world are scarce. We report three successfully completed pregnancies on Maintenance Haemodialysis (MHD) between January 2012 and June 2015 from two tertiary care hospitals in South India. A total of 58 women of child bearing age underwent MHD during the period of 42 months. Calculated conception rate per year was 1.47% for the period. Conception occurred in two patients while already on haemodialysis. The mean weekly duration of dialysis treatment was 18.75, 23.8 and 21 hours. Pregnancies were completed at 32, 34 and 33 weeks, with delivery of low birth weight infants 1.44, 1.27 and 2.3 Kilograms. All three patients were socioeconomically disadvantaged but could undergo enhanced dialysis with the support of locally generated funding in two cases and an insurance scheme for low income employees in the third.

Management of Inflammatory Bowel Disease and Pregnancy using Prophylactic Low Dose Low Molecular Weight Heparin and Corticosteroids

The circulating nonspecific immune complexes, complement system peptides and auto-antibodies may induce inflammatory/thrombotic events at the placenta and impairment of endometrial receptivity as well as disturbed fetal perfusion in Inflammatory Bowel Disease (IBD) cases. The aim of the case series was to assess the effect of “Low Molecular Weight Heparin” (LMWH) and Low Dose Corticosteroids (LDC) against possible thromboembolic and inflammatory processes happening at the maternal fetal interface and to assess their efficiency in pregnancy outcomes. Nine cases of IBD, referred during the first trimester of their pregnancies, were retrospectively evaluated {Ulcerative Colitis (UC) (n=7) and Crohn’s Disease (CD) (n=2)}. Patients were under aminosalicylate treatment (eight cases mesalamine and one case sulfasalazine) during their admittance to the program and were all in remission. Aminosalicylate treatment was stopped between 8th and 12th gestational weeks and then continued until the appearance of early signs of uterine contractions and/or fetal “discomfort/distress”. Following tests for thrombophilia, patients presenting risk factors were included to the study group and were given low dose LMWH (Enoxaparine 1x2000 Anti-XA IU/0.2 ml/day), prophylaxis plus LDC (Methylprednisolone 4 mg/day). The mean age of the patients was 28.2±4.05 (20-35). No patient had a flare up during their pregnancy. One UC patient with homozygotic Methylenetetrahydrofolate Reductase (MTHFR) 677 polymorphism experienced preterm premature rupture of membranes (PPROM) at the 31th gestational week and was delivered at 32nd gestational week by caesarean section. The other eight cases also delivered between 36-39th gestational weeks by caesarean section due to obstetrical reasons and/or fetal distress. All neonates were discharged from hospital without any complications. Mean gestational age at birth was 258 days (36 weeks 6 days) and mean birthweight was 2772.2±619.3 grams (1530-3670). In this small case series we were able to obtain successful pregnancy outcomes with the current protocol. Both UC and CD have potential risks of affecting “endothelial/trophoblastic/epithelial” tissues of placenta, impairing endometrial receptivity or fetal perfusion. Control of autoimmune inflammatory processes and thrombotic events by combination of low dose LMWH and LDC may maintain better pregnancy outcome without exacerbation of the IBD.

Clinical Spectrum of Autoimmune Encephalitis: Case Series from Western Rajasthan

Pratibha Prasad, Amita Bhargava, Shubhakaran Khichar, Vikas Kumar Gupta

Autoimmune Encephalitis (AE) is a challenging diagnosis due to the similarities in the clinical, imaging and laboratory findings among many forms of infectious encephalitis. Patients generally have impaired memory and cognition and neuropsychiatric manifestations over a period of days or weeks. However, a careful history and examination may show early clues to particular autoimmune causes, such as seizures, dystonia, abnormal movements, psychosis, or the presence of particular tumours. Appropriate autoantibody testing can confirm specific diagnoses. When infectious etiology is excluded, AE must be considered which is potentially reversible with immunomodulation therapy. Here, we describe five patients with AE: four auto-antibody positive, one auto-antibody negative, treated during last 20 months, presenting with different syndromes and first ever reported from western Rajasthan. Hence, this case series highlights the importance of early diagnosis and appropriate treatment leading to significant reduction of mortality and morbidity.

Adenomatoid Tumours: A Short Series with Literature Review

Athira Sasidharan, Geetha Vasudevavan, Manna Valiathan

Adenomatoid tumours are hormone independent tumours of mesothelial origin. These are distinctive benign neoplasms usually localised in the epididymis in males and myometrium in females. They are uncommon and account for less than 5% of tumours in males and approximately 1% in females. Due to their rarity and distinct histomorphology, we present a case series of six adenomatoid tumours of which three were males and three were females, obtained over a period of five years at a tertiary hospital in South India. The diagnosis of this tumour in all the three women and in one of the male patients was incidental, and they underwent surgical procedure for other coexisting lesions. In two male patients swelling of the testis was present; however, the clinical diagnosis of both these patients was more sinister than a benign entity like adenomatoid tumour. The present series describe the histomorphological features of this entity and establish the unique histopathological findings of this tumour which is clinically subtle and is seldom recognised.

Single Tooth Torquing Auxiliary

Benoy Mathew, Sunil Sunny, Denny Joseph, George Jose Cherackal , KP Anvar

This paper demonstrates the biomechanics used in orthodontics for the labial movement of a lingually blocked out tooth. Alignment of a lingually blocked out tooth with proper expression of labial root torque is often challenging as creation of a moment to force ratio of higher than 10:1 is difficult in the oral environment. This high moment to force ratio is needed to move the root of the tooth ahead of the crown. Here, we demonstrate a very simple spring that can torque the root ahead of crown and align the teeth to the remaining dentition by maintaining the moment to force ratio in a more than 10:1 value. This will move the root ahead of crown into the medullary area and the crown follows the root into a good alignment.

Successful Pregnancy Outcome in a Case of Muscular Dystrophy

Ganeswar Barik, Gowri Dorairajan, S Murali

Mechanical and Adhesive Retention for Bilateral Ear Prosthesis

Laser Assisted Excision of a Sizable Mucous Extravasation Cyst

Lohith Mandadi, Shreya Lingamaneni, Vinay Ram Kaipa, Nishanth Palakurthi

Anxiety and Depression in Persons with Primary Adult Onset Glaucoma in Southern India

Parthasarathi Sathyan, Padma Sathyan

Application of C-Arm for Intra Operative Radiographic Support in Oral and Maxillofacial Surgical Procedures Under General Anaesthesia

Surej Kumar L K, Mathew Tharakan, Johna Peranthodi, Deepa S Divakaran

Value of r2 in Statistical Analysis by Pearson Correlation Coefficient

Shaikat Mondal, Himel Mondal

A Pilot Study on Optimization of Equipment Utilization in a Tertiary Care Hospital in India

Spectrum of Sinonasal Lesions with Expression of p16 and Ki-67 in Premalignant Lesions and Squamous Cell Carcinomas

Madhumita Paul, Suchandra Ray, Moumita Sengupta, Arunabha Sengupta

Introduction: Sinonasal masses are heterogeneous group of non-neoplastic and neoplastic lesions originating from epithelial, mesenchymal, haematolymphoid and neuroendocrine cells. Exact categorization and aetiological evaluation by histopathological and additional immunohistochemical examination are essential for individualized treatment. Aim: To evaluate the clinico-epidemiological variables of sinonasal lesions and to determine the role of Human Papilloma Virus (HPV) infection along with its correlation with Ki-67 level in squamous cell carcinomas and precursor lesions. Materials and Methods: An observational and cross-sectional study was performed in a tertiary care hospital, in the Department of Pathology in collaboration with the Department of Otorhinolaryngology over 18 months from January 2015 to June 2016 including 87 patients. Haematoxylin and Eosin (H&E) stained sections were examined and reported according to WHO category. During immunohistochemical study with Ki-67 and p16, squamous lesions were categorized as Inflammatory Polyp (IfP), Inverted Papilloma (IvP), Exophytic Papilloma (EP), Squamous Cell Carcinoma arising in pre-existing Inverted Papilloma (IvP with SCC), Squamous Cell Carcinoma (SCC) and Sinonasal Undifferentiated Carcinoma (SNUC). Results: Among 87 cases, 39(44.83%) non-neoplastic lesions, 21(24.14%) benign neoplastic lesions and 27(31.03%) malignant neoplastic lesions were found. Ki-67 Labelling Index gradually increased from IfP (3.82%) to SNUC (85%). Expression of p16 was highest (50%) in IvP with SCC group and SNUC group than 33.3% in IvP group and SCC group. Conclusion: Simultaneous evaluation of p16 expression and cell cycle proliferation marker (Ki-67) revealed significant difference. Thus, HPV plays a pivotal role in oncogenesis and malignant transformation in squamous sinonasal lesions.

A Comparative Evaluation of Ramipril as Monotherapy and Combination of Ramipril with Torsemide in Hypertension

Introduction: A Fixed-Dose Combination (FDC) of antihypertensive agents of different groups might offer advantages of efficacy, tolerability and compliance over monotherapy. Aim: To compare efficacy and tolerability of ramipril/torsemide FDC with ramipril monotherapy. Materials and Methods: This prospective open labeled randomized comparative study was conducted on newly diagnosed 100 patients, suffering from primary hypertension. They were divided in two groups viz., Group A (Ramipril 5 mg/day) and Group B (Ramipril 5 mg with Torsemide 5 mg/day). The study drugs were prescribed for a period of 12 weeks. To find comparative efficacy, the primary goal BP was set at less than 140 mmHg systolic and 90 mmHg diastolic blood pressure. Haematological and biochemical assessments were embedded in the methods at baseline and at the end of study. All the participants were evaluated for dyselectrolytemia, Blood urea, Serum Creatinine, and lipid profile during the study period at baseline and three follow ups at 4th, 8th and 12th weeks along with recording of adverse drug reactions. To assess tolerability of both regimens, the participants were interviewed followed by physical examination and laboratory investigation. Results: The participants on FDC therapy (ramipril and torsemide) had shown significant reduction in ambulatory and office-measure BP compared to the participants on monotherapy (ramipril) with Stage I and Stage II hypertension. The goal BP was achieved with combination therapy in 4 weeks compared to monotherapy that was achieved in eight weeks. In the safety profiles, mild adverse drug reactions were reported with both the therapies. Conclusion: FDC treatment showed significant fall in systolic BP after 4 weeks and diastolic BP after 12 weeks compared to the monotherapy while both the regimens were well tolerated.

Fasting Lipid Profile and Disease Severity in Sepsis Patients

P Sunayana, B Renymol, NR Ambili

Introduction: Sepsis is a systemic inflammatory response syndrome that has a proven or suspected microbial aetiology. Sepsis carries significant morbidity and mortality. During sepsis many changes occur in plasma lipids and lipoproteins. These changes help in fighting inflammation and contribute to host defence. Studies have shown that there is are relationship between low cholesterol and sepsis and the levels of total cholesterol and HDL decline during sepsis. Aim: To assess lipid profile abnormalities in patients with sepsis and to study the relation between fasting lipid profile and disease severity and mortality in patients with sepsis. Materials and Methods: This descriptive study was done at Government TD Medical College, Alappuzha, Kerala. The duration of study was one year. A total of 70 patients who were admitted to the medical intensive care unit who satisfied the American College of Chest Physicians/ Society of Critical Care Medicine (ACCP/SCCM) criteria for the diagnosis of sepsis were included in the study. Depending on the severity of sepsis, these patients were grouped into three groups-sepsis, severe sepsis and septic shock group. Results: Significantly lower values of HDL cholesterol and LDL cholesterol were observed in patients with severe sepsis and septic shock compared to patients with sepsis. Total cholesterol also showed lower values in patients with septic shock but this observation was statistically not significant. Triglycerides showed an inverse pattern with higher values in septic shock group. Conclusion: It is observed that low LDL cholesterol and high Triglycerides were associated with a significantly higher mortality in patients with sepsis.

Current Clinical Spectrum and Management of Stricture Disease of Urethra: A Prospective Study

Introduction: Stricture disease of urethra is widely prevalent throughout the world. However aetiology and management varies among different regions. Study of recent trend would help in better understanding of the disease. Aim: To highlight the current clinical scenario and compare outcome of various treatment modalities for urethral stricture. Materials and Methods: Prospective observational study included adult male patients of urethral stricture, admitted during March 2012 to September 2014. After history and examination, patients underwent uroflowmetry and post-void residual measurement, retrograde urethrogram and endoscopic evaluation. Treatment choice and outcomes were recorded. Patients were followed for a minimum of one year. Results: Finally 110 patients were studied. Mean age was 38±15 years. Tobacco chewing and smoking was seen in 43.6% and 20.9% of cases respectively. Two-third of cases had obstructive urinary symptoms, while rests were brought in emergency with acute urinary retention or trauma, 18 cases had recurrent disease. Trauma was the most frequent cause(35.4%), followed by lichen sclerosis (23.6%). Most common site was bulbar region (36.4%), followed by external meatus (27.3%). For distal and pan-anterior strictures, substitution urethroplasty had higher success rate (100%) than urethral dilatation with steroids (60-70%). Anastomotic urethroplasty had durable outcome for bulbar strictures (88%), in comparison to internal urethrotomy (66%). Conclusion: Young and middle aged patients were particular vulnerable for the stricture. Trauma, lichen sclerosis and infections were the leading causes. Bulbar region was the commonest affected site, with a rise in pan-anterior strictures. Open urethroplasty with or without graft had a clear edge over endourological procedures.

Treatment of Fistula-in-Ano with Tight (Cutting) Seton: Analysis of Outcomes and Efficacy Assessment

Tawfiq JM. Al-Marzooq, Qays A. Hassan, Mumtaz KH. Alnaser, Mohammed S. Al-edani

Introduction: Management of fistula-in-ano is a surgical challenge. Various methods for the treatment of anal fistulas have a range of success rates and use of the cutting seton is still questionable. Aim: The aim of this study was to assess the effectiveness and suitability of the tight (cutting) seton as a surgical treatment of anal fistula. Materials and Methods: This was a prospective study of 68 patients (59 males and 9 females) with an anal fistula, mainly of high variety were treated with cutting seton over a 3 year period. Follow up for at least 12 months to record the duration of complete wound healing, fistula recurrence and incontinence was done. Statistical analysis was performed using SPSS version 18.00. A p<0.05 was considered statistically significant. Results: Complete healing was achieved in 55 patients within 3 months (success rate =80.9%). The treatment was failed in 13 (19.1%) patients. 9 (13.2%) patients have presented minor incontinence 6 (8.8%) with gas incontinence and 3 (4.4%) with liquid stool incontinence and there were no cases of solid stool incontinence. The recurrent fistula was noted in 2 (2.9%) patients during the follow up period. Conclusion: Cutting seton yields fairly good results in regard to the cure of fistula with good continence in the majority, but the risk of failure or persistence fistula was relatively high so we not recommend the routine use of cutting seton for all anal fistulas.

Factors Affecting Learning Among Undergraduate Nursing Students: Cross-Sectional Survey

Linu Sara George, Alma Juliet Lakra, Asha Kamath

Introduction: Nursing education expects the students to be competent enough to render quality care for their patients in hospital as well as community setting. To reach the level of expected competency, the students must undergo vigorous training during their undergraduate education. The learning experience of the students is influenced by many factors. Aim: To identify the factors, affecting learning as perceived by the students. Materials and Methods: This descriptive survey was conducted among 414 undergraduate nursing students enrolled in selected Nursing Colleges. Background information was collected using Demographic Proforma and the factors affecting learning were identified using Likert Scale. Factors were identified by exploratory factor analysis using extraction method of principal component analysis with varimax rotation. Results: Majority (73.7%) of the samples were between 22-25 years of age, 93.2% were females, most (38.9%) were studying in the fourth year of nursing, 50% of the students enrolled in the study had chosen nursing as a career due to job security in future, 58.7% students did not spent time every day for their studies and majority (89.1%) had English as their medium of instruction in Pre-university college. Factor analysis identified five factors (Learning environment, Supportive services, Teacher characteristics, Learner challenges and Personal factors) that affect the student learning. Conclusion: From the present study it can be concluded that perception of students do have an influence on factors affecting learning. The study findings will help the faculty members to bring in changes for the best learning outcome.

Significance of Serum Lactate Dehydrogenase in Childhood Acute Lymphoblastic Leukaemia

Introduction: Acute Lymphoblastic Leukaemia (ALL) is the most common childhood malignancy accounting for approximately 30% of childhood malignancies. The incidence rate of leukaemia in various parts of India varies from 0.3-1.2%. Lactate Dehydrogenase (LDH) is a pyridine-linked enzyme which is involved in metabolism of glucose in normal tissue. In leukaemic cells, there is loss of coordination of glycolytic sequence and tricarboxylic acid cycle, which leads to increased utilization of glucose. As there is high cell turnover, this leads to increased cell burden and high levels of serum LDH in ALL and the increase is much more than other haematological malignancies barring Burkitt’s lymphoma. Aim: To study the level of LDH in ALL cases at the time of diagnosis in comparison with Non-ALL cases. Materials and Methods: Fifty five cases of ALL and 23 cases of Non-ALL haematological malignancies as control were evaluated based on clinical manifestations, haematological parameters, peripheral blood picture and bone marrow findings. Serum LDH was estimated at the time of presentation by Cobas 6000, a photometrically automated system. Statistical analysis was done using SPSS version 20. Results: In our study, high serum LDH levels were seen in 89.1% (49) cases and normal levels in 10.9% (6) cases. High blast percentage i.e., >20% on peripheral smear (65.5%) was associated with high serum LDH level. On correlation of serum LDH with peripheral smear blast percentage, a p-value of <0.05 was obtained which shows a significant correlation. Conclusion: Serum LDH level can be considered as a simple cost-effective tool in the presumptive evaluation of childhood Acute Lymphoblastic Leukaemia. LDH in combination with Uric acid helps in detecting tumour lysis syndrome at an early stage thereby aiding in early management.

Evaluation of Semen Oxidative Stress and Sperm DNA Damage in Cases of Unexplained Foetal Congenital Anomalies- A Pilot Study

Introduction: Birth defects lead to significant neonatal morbidity and mortality. Although maternal factors have been widely studied, paternal factors have not received much attention. Inherent integrity of the sperm DNA is vital to normal embryo development, as it contributes one half of the genetic material to the embryo. One of the mechanisms of sperm DNA damage is oxidative stress. Aim: This pilot study was conducted to assess the role of sperm factors in unexplained fetal congenital anomalies. Materials and Methods: 25 couples with antenatally detected fetal anomalies were recruited at a tertiary level hospital. Semen samples from the male partners were evaluated for semen Reactive Oxidative Species (ROS) and sperm DNA Fragmentation Index (DFI) using Luminol-chemiluminescence method and Sperm Chromatin Structure Assay, respectively. Median values were compared for Total Sperm Count and Semen ROS, using non parametric test i.e., Mann Whitney test. Bivariate correlation analysis was used for assessing significant correlation. Results: The median (Inter Quartile Range) of semen ROS levels was 10.70 (86) RLU/sec/million sperm. Ten cases (40%) had elevated semen ROS levels (Reference level: 22RLU/sec/million sperm). The Median (IQR) value of sperm DFI was 31.84 % (13%). Seventeen cases had sperm DFI higher than reference value of 27%. Sperm DFI did not show significant correlation with semen oxidative stress (r = -0.033, p=0.88) Conclusion: Semen reactive oxidative species and Sperm DNA fragmentation levels were not found to correlate with unexplained fetal malformations, although a trend towards higher levels was recognized in this pilot study. Thus, in couples having children with no identifiable cause of congenital malformation, implication of sperm molecular factors warrants further studies.

Serum sE-selectin Levels in Newly Diagnosed Psoriasis Patients and Correlation with Psoriasis Area and Severity Index Score

Shveta, Kiran Agarwal, Ranchander, Shilpi Agarwal

Introduction: Psoriasis is a chronic skin disorder with unknown aetiology affecting 125 million people worldwide. It is an inflammatory T-cell mediated disease. Few studies have reported increased expression of numerous adhesion molecules (ICAM-1, ICAM-3, sE-selectin) in the psoriatic skin. But whether they can be used as a marker of severity of the disease and immunotherapy targets is still questionable. Aim: To study the levels of sE-selectin in patients with psoriasis and correlate the sE-selectin level with disease severity. Secondly, to see the effect of six months of topical therapy i.e coal tar, salicylic acid and dithranol on sE-selectin levels. Materials and Methods: A descriptive cross-sectional hospital based study was conducted in the Department of Pathology in collaboration with the Department of Dermatology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. A total of 52 newly diagnosed cases of psoriasis, attending the Dermatology OPD of Smt Sucheta Kriplani Hospital were included in the study group and severity score was calculated. Venous blood sample was taken from 52 patients and 30 age and sex matched controls comprising of healthy, non psoriatic volunteers with no family history of psoriasis. Blood sample was analysed for sE-selectin levels by ELISA (DIACLONE, France). Cases were followed at six months interval to study changes in sE-selectin levels after topical therapy. Statistical analysis was done using SPSS version 19.0. Paired t-test, ANOVA and pearson’s correlation coefficient was used for statistical analysis. Results: The levels of sE-selectin were significantly raised in the cases as compared to controls, correlated with disease severity and showed a reduction in the patients in which follow up was available. After six months of coal tar, salicylic acid and dithranol treatment, there was decrease in mean Psoriasis Area and Severity Index (PASI) and serum sE-selectin but not enough to reach a statistical significance. Conclusion: The sE-selectin levels are raised in patients of psoriasis and show reduction following therapy. They may be attractive targets for newer therapies in the future.

Exploring Social Factors of Mental Illness Stigmatization in Adolescents with Mental Disorders

Introduction: Labelling children and adolescents having mental disorders as “mentally ill” leads to their isolation from the society. Little information is available about the impact of this stigma on such individuals in Iran. Aim:The purpose of the current study is to explore social factors of mental illness stigma in adolescents diagnosed with mental diseases. Materials and Methods: This descriptive-analytic study was done using purposive convenience sampling. Data was collected using the questions of ‘stigma dimension’ of Experience of Care giving Inventory (ECI). A total of 113 adolescents having mental disorders with/without a history of psychiatric hospitalization answered the questions. Results: The results showed that the stigma of mental illness has a significant relationship with schizophrenia, affective disorder, substance-induced psychosis and Obsessive–Compulsive Disorder (OCD) (p=0.001), but it does not have such a relationship with depression, anxiety and hyperactivity. It was revealed that if a teenager with mental disorder has a friend while undergoing treatment; it will be much easier to overcome the stress of stigma. Moreover, there was a significant relationship between the worry of adolescents concerning the attributing of stigmatization to their families and schizophrenia, affective disorder, substance-induced psychosis and depression (p=0.001). The relationship between the stigma of mental illness and the type of treatment (outpatient, inpatient at least once, history of more than one hospitalization) was significant in psychotic patients (p=0.001) but not so in the case of adolescents with depression, anxiety, OCD and hyperactivity. Conclusion: Factors such as the low awareness level of Iranians with respect to the symptoms of mental diseases and the familys fear of this stigma result in further widening the gap between early signs of a mental disorder and its treatment, so that families are ashamed of having a mentally ill person at home. The labeling of mental illness can be threatening to teenagers by leading them to associate with small heterogeneous social groups which often include people with a history of misbehaviour; hence there is rise of crime rates in this group of patients.

Atrophic Rhinitis with Maggot Infestation- A Demographic Study

Introduction: Atrophic rhinitis is a chronic nasal condition characterised by atrophic changes in the nasal mucosa and the underlying bones. This leads to the formation of abnormally roomy nasal cavities, anosmia, foul smelling greenish crusts, epistaxis and occasionally maggot infestation in the nose. The present work has been undertaken to study the demographic features of atrophic rhinitis with maggot infestation (Myiasis) in a population in North Karnataka. Aim: To study maggot infested atrophic rhinitis cases with respect to age and sex distribution, anaemia association, clinical (unilaterality/bilaterality) presentation and seasonal variation. Materials and Methods: This was a retrospective study. As per the records maintained by OPD of ENT Department, Bidar Institute of Medical Sciences, Bidar., between 2006 and 2015, there were 190 reported cases of atrophic rhinitis. Of these, 33 cases showed maggot infestation and were admitted for treatment. The detailed records of these patients were available and collected. This formed our study group. The patients of atrophic rhinitis without Nasal Myiasis were treated on outpatient basis. Details of age, sex, unilaterality, bilaterality, with /without anaemia, seasons, were tabulated and observations discussed. Results: Prevalence of maggot infested atrophic rhinitis cases were 17.4%. Maximum number of cases were seen in the age groups of 45-64 years and 65 years and above. Female predilection was seen with a female:male ratio of 3.1:1. Rural living conditions and anaemia proved to be playing a role in its higher prevalence. With respect to seasonal variation, more number of maggot infested atrophic rhinitis cases were clustered around the months of October, November and December. Conclusion: Atrophic rhinitis with nasal myiasis is multifactorial disease having a female predilection, association with older age group, poor nutrition and anaemia. Patients from rural area were more prone for nasal myiasis. It also shows a seasonal variation with more incidence in the relatively cooler months of October, November and December.

Clinical and Metabolic Profile of Glutaric Aciduria Type 1 from North India: Tertiary Centre Experience

Ankur Singh, Rajniti Prasad, Seema Kapoor, Om Prakash Mishra

Introduction: Glutaric aciduria type 1 is caused by deficiency of glutaryl-CoA dehydogenase leading to accumulation of glutarylcarnitine in blood and excretion of glutaric acid, 3-hyroxyglutaric acid and glutaconic acid in urine. It can be diagnosed through high risk screening in symptomatic cases. Aim: To know the clinical, biochemical, neuroimaging and outcome profile of Glutaric aciduria type 1 patient diagnosed during testing by Tandem Mass Spectrometry (TMS) and Gas Chromatography and Mass Spectrometry (GCMS). Materials and Methods: It was retrospective record analysis of patients diagnosed with Glutaric aciduria type 1. 2000 patients were screened for various indications like (developmental delay/ regression, unexplained seizures, encephalopathy, dystonia, chorea, large head, unexplained sibling death). Screening strategy involved estimation of lactate, ammonia, TMS and GCMS. Neuroimaging was done where it was required. This study was conducted over a period of three years (January 2014 to December 2016). Results: Study group comprised of 10 males and 3 females. Median age (interquartile range) of presentation in study group was 11 months (10-22.5). Pretesting diagnosis was suspected as inborn error of metabolism in each case based on clinical presentation. Seizure and dystonia were important clinical presentation. Frontotemporal atrophy was important neuroimaging finding. Macrocephaly was present in two of thirteen cases. Glutarylcarnitine level was normal in 5 of 11 patients, suggesting poor sensitivity of TMS in diagnosed cases. There was wide variation in excretion of urinary metabolite from cases to cases, highlighting genetic heterogenousity. Conclusion: Seizures and dystonia were important clinical presentations. Presence of bilateral frontotemporal atrophy in clinical testing was an important clue to diagnosis. Presence of macrocephaly (important sign of disease) was present in only two cases. There was only one death in follow up.

Influence of Malaria Parasitemia of Plasmodium Falciparum on the Prevalence and Severity of Premenstrual Syndrome

Introduction: It remains unknown whether Malaria Parasitemia (MP) of Plasmodium falciparum might influence symptoms in Premenstrual Syndrome (PMS). Symptoms of PMS might be not only hormonal but also haematologically related. However, the link of Plasmodium falciparum infection and clinical manifestations of PMS has not been previously investigated. Aim: To determine the association of MP of Plasmodium falciparum and Packed Cell Volume parameters (PCV) with clinical characteristics of PMS. Materials and Methods: A cross-sectional study was carried out in 2014 among undergraduate students in the University. The study participants completed a two-part questionnaire assessing premenstrual dysphoric disorder and PMS symptoms using the Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) based diagnostic criteria. Peripheral blood sample for MP and PCV estimation were also collected at enrollment. Statistical analysis was performed with SPSS version 20.0 (IBM, Armonk, NY, USA). Categorical variables were summarized by absolute frequencies, percentages, and chi-square tests and continuous variables by means and standard deviation. Values were deemed statistically significant at p<0.05. Results: A total of 150 randomly selected participants aged 16–30 years were enrolled. Of the 150 students, 105 (70.0%) regularly experienced symptoms suggestive of PMS. The commonest symptoms were lower abdominal pain (80.0%), joint and muscle pain (72.0%) and pimples/puffy face (65.3%) while the least frequent symptoms were cramps (33.3%) and vaginal discharge (30.0%). Thirty one (20.7%) out of 150 participants were positive for MP and 6 (4.0%) participants had low PCV (<0.33) and all of which tested positive to MP. Compared with PMS negative, the mean PCV in PMS positive participants was statistically lower (0.30±0.033 vs 0.36±0.038, p=0.007). Conclusion: This is the first study to reveal a potential association of MP and PCV with clinical manifestations of PMS. PMS is a prevalent, yet undertreated, disorder among the participants with malaria parasite infestation worsening the condition leading to low PCV values, which adversely affect their quality of life and academic performance of the participants. The findings warrant further research.

The Effect of Chamomile Flower Essence on Pain Severity after Elective Caesarean Section under Spinal Anaesthesia: A Randomized Clinical Trial

Introduction: Nowadays, herbal essence and aromatherapy are used as a form of complementary medicine and non-pharmacological interventions alongside modern medicine and pharmacological interventions. Aim: To evaluate the effect of chamomile flower essence on pain severity following elective caesarean section under spinal anaesthesia. Materials and Methods: This single-blind randomized clinical trial was conducted on 80 women referred to Besat hospital in Sanandaj, Iran in 2016. In total 80 patients who were candidates for elective caesarean section were selected for this study. Following caesarean section, patients were randomly divided into intervention and control groups. For patients in intervention group inhalation of two drops of chamomile flower essence was used. For patients in control group two drops of normal saline was used as placebo. All patients received a 100 mg sodium diclofenac rectal suppository in the recovery room. In case of pain six hours post caesarean section, intervention was performed. Pain intensity was measured by the Visual Analog Scale. Data were analysed using SPSS statistical software version 20. Independent t-test and chi-square test were also used. Results: Pain intensity in the intervention group was significantly lower than the control group (p <0.001). The need for analgesics was also significantly lower in the intervention group than the control group (p <0.001). Conclusion: The results of this study showed that the use of chamomile flower essence following caesarean section reduced pain and also the need for analgesics. Therefore, the use of aromatherapy alongside drug therapy to reduce pain is recommended.

Comparison of Staining Efficacy between Turmeric and Eosin: A Histological Study

Introduction:Turmeric-Curcuma longa is a natural dye and has been used for various purposes since centuries. The global interest to use biodegradable materials; natural dyes/stains has evoked curiosity to explore its staining efficacy. Limited studies have been performed to determine the efficacy of turmeric as a stain for formalin fixed paraffin embedded sections that are routinely stained with Hematoxylin and Eosin (H&E). This study highlights on the comparison of turmeric extraction methods namely, maceration and soxhlet in relation to its staining efficacy which is first of its kind. Also, the staining of turmeric extracts on pathological tissues has not been tried earlier. Aim: To compare two different extraction methods for turmeric namely the maceration and soxhlet, to compare staining efficacy of turmeric with and without mordant, to compare efficacy of turmeric stain with synthetic eosin in normal and pathological tissues. Materials and Methods: Curcuma longa was dried, powdered and extracted by maceration and soxhlet techniques. Tissue sections were stained with and without the mordant potash alum in normal and pathologic tissues. The staining intensity, efficacy of prepared turmeric stain with that of eosin were compared by appreciating the respective tissue structures stained by both the components. The statistical analysis was carried out by Chi-square test. Results: Statistically significant results were observed in sections stained by maceration technique than that of the soxhlet. The Hematoxylin and Turmeric (H&T) sections in which Mordant was incorporated with Turmeric (TEM) fetched better results. Comparable results were obtained in normal and pathologic tissue sections stained with H&T (TEM) with conventionally employed H&E stain. Conclusion: Turmeric extract can be used as an adjunct stain to eosin, a synthetic stain.

Clinical-epidemiological, Cytological and Histopathological Study of Idiopathic Calcinosis Cutis of the Scrotum

Sainath K Andola, Tanmai Tandon, Anuradha G Patil

Introduction: Idiopathic Scrotal Calcinosis (ISC) is characterized by a solitary or multiple, painless intradermal nodules in the presence of normal levels of calcium and phosphate and in the absence of any systemic metabolic disorder. Aim: To study the clinical, cytological and histopathological aspect of Idiopathic Scrotal Cutis in this geographical region and find a possible correlation between ISC and an increase in calcium compounds in the soil and water due to cement pollution in this region with many cement factories. Materials and Methods: In this study, we report twenty cases of this rare entity diagnosed over a ten year period from 2007 to 2016. A detailed history of all the patients which included age, occupation, serum calcium and phosphorus levels, FNAC and USG reports and histopathological slides was reviewed to confirm the diagnosis and study the possible pathogenesis of ISC. Results: The patient’s age ranged from 19 to 65 years with a mean of 37.2±11.4 years. The duration of swelling varied from two to 24 months, mean of 8.8±5.2 months. The most common occupation in the present study was farmers (7/20). The predominant presentation was that of scrotal swellings (17/20) and most common clinical diagnosis was sebaceous cysts (11/20). A history of white chalky discharge from the swelling was present in four cases. No metabolic disorders were noted in any patients. Solitary nodules were noted in fourteen cases which ranged from 0.5 to 3.5 cm. Histopathological examination of the nodules revealed dermal masses which were calcified and few cases were associated with a prominent foreign body reaction. All twenty cases underwent surgical excision and showed no recurrence in follow up. Conclusion: Increased levels of calcium in water could have a favourable role in the occurrence of this otherwise rare entity, inspite of normal calcium levels in the body.

Prevalence of Coracoclavicular Joint in Northern India: Radiological Evidence

Jyoti Chopra, Anita Rani, Prashant Kumar Bajpai, Punita Manik

Introduction: Coracoclavicular Joint (CCJ), present between conoid tubercle of clavicle and coracoid process of scapula, is a known anomalous synovial joint with 0.55%-21% radiological occurrence in various populations. It can be rarely symptomatic and present with shoulder pain, brachialgia or osteoarthritis of itself or neighboring joints. Very few osteological and radiological studies are done in India to observe the prevalence of this joint. Aim: The present study was undertaken to observe the prevalence of CCJ in North region of India and to observe association of presence of joint with laterality and gender. Materials and Methods: A total of 1040 digital chest X-ray films in Posteroanterior view were observed out of which 629 images were of males and 411 of females. Age of the study population ranged from 8 months to 90 years. Presence of a joint like space between the facet like elevation on conoid tubercle and reciprocal facet on superior surface of coracoid process was considered as evidence of CCJ. Prevalence of the joint was calculated and association of presence of joint with laterality and gender was observed. Results: The CCJ was noted in 3.37% (n=35) individuals. Unilateral occurrence (77.15%, n=27) was significantly more common than bilateral (22.85%, n=8) predominantly on left side (62.96%, n=17). Joint was more frequently observed in males (62.86%, n=22) than females (37.14%, n=13) but the difference was insignificant. It was only observed in individuals who were 21 years old and above. Conclusion: Prevalence of CCJ in Northern India is higher than Europeans, Africans and Americans. Knowledge of presence of CCJ as a cause of shoulder pain is important as it is not a rare entity and will prevent misdiagnosis and hence inappropriate treatment.

Relative Efficacy of Piracetam, Modafinil and Citicoline on Cognitive Function in an Animal Model

Introduction: Nootropic drugs or cognitive enhancers are pharmacological agents that improve cognitive function and memory by various mechanisms. Drugs like piracetam, modafinil and citicoline have been used as nootropic agents. Aim: To compare the relative efficacy of nootropics like piracetam, modafinil and citicoline on learning and memory in rats using the Morris water maze test. Materials and Methods: A total of 30 Wistar rats were used for the study. The animals were divided into five groups (n=6). The groups I to V received gum acacia orally, scopolamine 2 mg/kg intraperitoneally, piracetam (52.5 mg/kg), modafinil (2.5 mg/kg), citicoline (25 mg/kg) respectively orally for twenty days. Learning and memory was evaluated using the Morris water maze test. The animals were trained in the Morris water maze on the last five days of dosing. Scopolamine 2 mg/kg was administered intraperitoneally to the above groups of animals (except Groups I and II) for induction of amnesia, 45 minutes before the behavioural test. Results: Scopolamine induced marked impairment of memory evidenced by significant reduction (p<0.01) in the number of entries and time spent in the target quadrant when compared to the control group. There was significant (p<0.05) increase in the number of entries and time spent in target quadrant of the Morris water maze in the animals who were pretreated with piracetam, modafinil and citicoline, in comparison to the scopolamine treated group. Amongst the three nootropics, modafinil and citicoline showed significant (p<0.05) memory enhancement in comparison to piracetam. Conclusion: Modafinil and citicoline can significantly reverse the memory impairment in scopolamine induced amnesia model in comparison to piracetam. However, further studies are warranted to confirm this result.

Dietary Omega-3 Fatty Acids Supplements for Dry Eye in Psoriasis: Are they Effective?

Rahul Bhargava, Mukesh Rajpoot, Yogesh Arora, Shiv K Sharma, Shalini Sharma

Introduction: Dietary consumption of omega-3 fatty acids has been found to be beneficial in patients with dry eye syndrome. Aim: To evaluate the efficacy of dietary omega-3 fatty acids (O3FAs) for dry eye in patients with psoriasis with and without meibomian gland dysfunction. Materials and Methods: An interventional, non-randomized, controlled, multi-center study was done. Psoriatic patients were recruited when they had either dry eye symptoms and/or Schirmer <6 mm or Tear Film Breakup Time (TBUT) <10s. Based on the presence of Meibomian Gland Dysfunction (MGD), subjects were allocated to MGD and Non-MGD groups, respectively (n=50 each). Age and sex matched subjects with psoriasis with no ophthalmological complaints served as controls (n=50). Subjects as well as controls were dosed with two O3FAs capsules, each containing 180 mg of Eicosapentaenoic Acid (EPA) and 120mg Docosahexaenoic acid (DHA), twice daily for 3 months (720 mg of EPA +480 mg DHA/day). Evaluation was done at baseline, one, two, and three months. Change in subjective symptoms was the primary outcome measure. Change in meibomian gland score (in MGD group), Schirmer score, and Tear Film Breakup Time (TBUT) were the secondary outcome measures. Results: Repeated-measures ANOVA revealed that there was a significant (p<0.001) change in symptoms, TBUT and Schirmer score in MGD (5, 4.6 & 4.6) and non-MGD (5.3, 1 & 5.2) groups at three months, respectively. Post-hoc test revealed that test parameters changed significantly at all points of time in MGD group. In non-MGD group the change was significant only after three months of intervention. These parameters did not change significantly in the control group at three months. Conclusion: Dietary O3FA supplementation for three months improved dry eye symptoms, tear film stability, tear production in psoriasis patients with and without meibomian gland dysfunction.

Usefulness of B-Type Natriuretic Peptide in Predicting the Involvement of Right Ventricle in Acute Inferior Wall Myocardial Infarction

Introduction: Cardiovascular Disease (CVD) is the leading cause of deaths globally as the death rate due to CVD has increased from 26% in 1990 to 29.5% in 2010. The Acute Coronary Syndrome (ACS) includes acute Myocardial Infarction (MI) with ST segment elevation, Non-ST Segment Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA). Isolated infarction of the right ventricle is rare and is commonly associated with Inferior Wall MI (IWMI) or Posterior Wall MI (PWMI). B-type Natriuretic Peptide (BNP) is one of the biomarkers which has been evaluated during acute MI. Aim: In this study, the usefulness of BNP in predicting the involvement of Right Ventricle (RV) in acute ST elevation with IWMI and PWMI was assessed. Materials and Methods: The study was a prospective observational study, done on 64 patients less than 60 years of age. The study was conducted over a period of four months at Rajiv Gandhi General Hospital, Madras Medical College, Chennai., Tamil Nadu, India. The patients with diagnosis of IWMI, IW with RVMI, IW with PWMI, IW and PW with RVMI were included. BNP levels, Left Ventricular Ejection Fraction (LVEF) and troponin I were measured. Killip class was also observed and patients were classified and compared against different levels of BNP. Results: When IWMI is associated with RV, PW or RV with PW involvement, BNP level was increased to more than 900 pg/ml, than in isolated IWMI. This increment was statistically significant. There was severe increase in BNP in those having LVEF =30%, and majority of patients were in the range of 30-50%. All the patients in Killip class III and IV had severe BNP increase as did those patients with cardiac troponin levels between the range of 2-4 ng/ml. Conclusion: All the findings are statistically significant and prove that severe BNP increase in acute IWMI is definitely a predictor of associated RV, PW or RV with PW involvement. LVEF has a significant inverse correlation with BNP levels, as the BNP rises, LVEF shows a steady decline. Killip class also shows a poor prognosis with elevated BNP. Troponin I levels are higher with increase in BNP.

Effect of Oxytetracycline on In vitro Mineralization and Demineralization Reactions in the Absence and Presence of Collagen

Monica Kakkar, Rakesh Kakkar, Raj Kumar Jethi, Surinder Kumar Singla

Introduction: Oxytetracycline and its derivatives routinely used to treat various ailments have also been shown to inhibit embryonic bone formation, mineralization in pregnant female rats and parathyroid hormone induced demineralization of bones. Oxytetracycline has also been routinely used as bone fluorochrome to study bone metabolism. However, despite the above observations, its mechanism of action is not clearly understood. Some studies tend to suggest that it acts by inhibiting collagen biosynthesis while others indicate that it acts without influencing collagen metabolism. Aim: To study the mechanism by which oxytetracycline influences the mineralization and demineralization reactions. Materials and Methods: Homogeneous and Heterogeneous systems of in vitro mineralization under physiological conditions of temperature, pH and ionic strength were used to investigate the effect of oxytetracycline not only on initial mineral phase formation but also on its subsequent growth or demineralization. In the Homogenous system, supersaturated conditions with respect to calcium and phosphate ions were employed to study their precipitation as mineral phase resembling hydroxyapatite in nature. However, in heterogeneous system, collagen isolated from sheep tendons was used to induce identical mineral phases under saturated conditions with respect to calcium and phosphate ions prevailing in the body fluids. Results: The study demonstrated that in the homogeneous reaction system (mineralization in the absence of collagen) oxytetracycline inhibited both the initial mineral phase formation and its subsequent growth without influencing its demineralization. Moreover, in the heterogeneous system, oxytetracycline was found to inhibit not only the initial mineralization but also its subsequent growth or demineralization. Conclusion: Oxytetracycline acted like crystal poisons to inhibit the mineralization and demineralization reactions by tightly associating with the mineral phase.

Rising Incidence of Non-albicans Candida and Changing Susceptibility Pattern of Bloodstream Candida Isolates in Neonates

Ashish Jain, Sumit Kumar Rawat, Amardeep Rai

Introduction: Importance of Candida species in nursery and paediatric Intensive Care Units (ICUs) is increasingly being recognized and nowadays isolates resistant to antifungal therapy are on the rise. They account for 9-13% of all bloodstream infection isolates in neonatal intensive care units and also the spectrum of candidemia has changed with the emergence of Non-Albicans Candida (NAC) species, the incidence of which in neonates in different parts of India is not well known. Aim: To find out the incidence of Non albicans candida among bloodstream infections and to determine susceptibility pattern of Candida blood stream infections in neonates admitted to the NICU of a tertiary care center in a remote part of central India. Materials and Methods: This study presents prospective cross sectional data on species distribution and changing antifungal susceptibility profiles of 109 Candida bloodstream isolates by automated blood culture by Bact /Alert 3D (Biomerieux) and susceptibility determination by VITEK2 (Biomerieux) automed instrument from all 689 admitted clinically suspected cases of neonatal septicaemia in central India over a 3 year period. Results: Candida albicans was the Predominant species with 41(37.6%) isolates, followed by Candida parapsilosis 34 (31.1%), Candida tropicalis 18 (16.5%), Candida krusei 11 (10.1%) and Candida glabrata 5 (4.5%). Overall NAC accounted for 68 (62.4%) of all bloodstream Candida infections. The in vitro susceptibility by VITEK2 automated susceptibility testing showed that all C. albicans, C. tropicalis and C. glabrata isolates were susceptible to amphotericin B. Of 34 isolates of C. parapsilosis tested, only 3 (8.8%) and only 2 (18.1%) of C. krusei isolates exhibited an MIC for amphotericin B of >1 µg/ml. Resistance to fluconazole (MIC=32) was observed in all 11 (100%) isolates of C. krusei, 28 (68.3%) of C. albicans isolates, 2 (40%) of C. glabrata and 8 (23.5%) of C parapsilosis isolates. Resistance to 5-flucytosine (MIC =4 µg/ml) was observed in 6 (14.6%) C. albicans isolates, 6 (33.3%) C. tropicalis isolates, 5 (14.7%) C. parapsilosis isolates, 1 (20%) C. glabrata isolate and all 11 (100%) C. krusei isolates. All the isolates of C. albicans, C. tropicalis, C. parapsilosis, were sensitive to voriconazole except only 1 isolate of C. krusei which was also resistant to fluconazole. Conclusion: In the present study, it was also noted that Candida blood stream infections constitute a large percentage (15.8%) of all neonatal bloodstream infections; our isolation of Candida is higher than some of recent studies. Prevalence of NAC is on rise.

Clinicopathological correlation in Chronic Suppurative Otitis Media

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the main causes for preventable hearing loss and is characterised by permanent perforation of tympanic membrane and ear discharge. Observing histopathological changes in middle ear and mastoid in CSOM can help in planning the surgical procedure and outcome of the disease. Aim: To study the relationship between various clinical features of CSOM and the histopathological findings and to study if this relationship helps in assessing the treatment protocol and surgical planning of the cases. Materials and Methods: The procedures followed were in accordance with the ethical standards of the Institutional Ethical Committee and with the Helsinki Declaration of 1975 that was revised in 2000. After obtaining informed and written consent regarding their willingness to participate in the study, patients of CSOM were taken for the study. CSOM was diagnosed after eliciting proper history, thorough clinical examination and after performing relevant investigations. Mucosa of middle ear was obtained from all such cases and sent for histopathological examination. The surgical patients were followed up every week for three weeks, fortnightly for the next month and monthly for the next six months. The patients were examined for any aural discharge, during their postoperative follow up, the condition of the graft was assessed and PTA for hearing evaluation was done after a month. CSOM patients attending ENT Outpatient Department (OPD) or admitted in ward, with a willingness to participate and on regular followup for six months. Patients not willing to participate in the study, with uncontrolled systemic diseases, and with predisposing factors and who missed the postoperative follow up. Results: Histopathological examination of the cases showed changes corresponding to chronic inflammation with lymphoplasmacytic infiltrations in most of the cases, with few cases showing granulation tissue. Patients with granulation tissue are associated with ossicular necrosis. Conclusion: The present study helps in comprehensive management of CSOM considering the various clinical and pathological features. Amount of hearing loss is correlated with the size of perforation. Granulation tissue is associated with mucopurulent discharge. Ossicular necrosis is seen in 50% of cases with granulation tissue. The study helps in better understanding of clinical and pathological course of CSOM and helps in rationalising the treatment protocol and in surgical planning.

Percutaneous Achilles Tenotomy with a Large Gauge Needle in Ponseti Management of CTEV: A Modified Technique

Ritesh Arvind Pandey, Bobby John

Introduction: Tenotomy of tendo achilles for clubfoot deformity is routinely done percutaneously with a surgical blade. This method though safe and effective, carries risk of complications such as excessive bleeding and injury to nearby neurovascular structures. Alternatively, sectioning of achilles tendon can be done safely by a large gauge needle percutaneously. Aim: To study the safety and effectiveness of the modified technique. Materials and Methods: A total of 37 children with 51 congenital clubfoot were included in this observational study. After successful correction of forefoot adduction and heel varus using the Ponseti technique, tendo achilles was sectioned percutaneously with a 16/18 gauge needle. Any complication occurring during the procedure was noted. Completeness of the tenotomy was checked by Thompson’s test and gain in passive dorsiflexion at ankle. Results: Complete division of tendon was achieved in all 51 feet. No incidence of excessive bleeding, neurovascular injury or formation of pseudoaneurysm was found. However, minor bleeding from the surgical site was noticed in three cases and was managed by applying mild pressure over the involved area. Conclusion: Percutaneous tenotomy of tendo achilles with a wide gauge needle is simple, safe and effective technique. It causes less morbidity and carries lesser risk of complications when compared to a surgical blade.

Activity of Catalase (CAT), ALT and AST in Different Organs of Swiss Albino Mice Treated with Lead Acetate, Vitamin C and Magnesium-L-Threonate

Introduction: Lead is a natural element with toxic properties and is widespread in the environment. Lead toxicity is associated with generation of reactive oxygen and nitrogen species and consumption of antioxidants elements (vitamin E and C, glutathione, thioredoxin and lipoic acid, melatonin, carotenoids and natural flavonoids) in the cell, and unbalancing oxidants-antioxidants levels. Aim: To evaluate the effects of different chemical combinations (lead acetate, Vitamin C and Magnesium-L-threonate) on antioxidant enzyme activity (catalase-CAT) of liver, kidney, spleen, pancreas and brain, and serum transaminases [Serum Alanine Transaminase (ALT) and Serum Aspartate Transaminase (AST)]. Materials and Methods: Experimental animals (49 male Mus musculus-swiss albino mice) were separated into five different groups. The first group was used as a control, hence the other four groups were treated with sub-lethal doses (90 mg/kg) of lead acetate (group 2), lead acetate (90 mg/kg) and Vitamin C dose 40mg/kg (group 3), lead acetate (90 mg/kg) and Magnesium-L-threonate dose 100 mg/kg (group 4) and only with Magnesium-L-threonate dose 100 mg/kg (group 5), during the treatment period (40 days). Blood samples were taken from the facial vein and used for transaminase analysis. Organ tissue was collected after euthanizing anaesthetized animals with neck dislocation technique. Results: The results showed that lead acetate treatment has caused significant elevation in the activity of AST (group 2 and 3) and ALT (group 3). Also, CAT activity was significantly (p<0.05) increased in groups treated with lead acetate (liver, pancreas, kidney and brain but not in spleen). Treatment of lead intoxicated groups with Vitamin C and Magnesium L-threonate increased significantly CAT activity in brain. Conclusion: Lead effects by interacting with different molecular systems and increasing enzyme activity (CAT, ALT and AST). Effects on CAT activity of Magnesium-L-threonate and Vitamin C treatment in lead acetate intoxication case are similar. Detoxifying properties of Vitamin C in the brain compared with other organs were very ineffective, because of Blood Brain Barrier (BBB) metabolic competences.

Complete Response after Neoadjuvant Therapy in Rectal Cancer- Does T0 Mean N0?

Introduction: Rectal resection after neoadjuvant chemoradiotherapy is the standard of care for rectal cancer. Non-operative management of rectal cancer is the new frontier. Selection of these patients is based on the absence of mucosal disease after neoadjuvant therapy. The question that is quintessential is whether absence of mucosal disease means absence of nodal disease. Aim: To see the correlation between absence of mucosal disease and mesorectal disease in rectal resections after neoadjuvant therapy for rectal cancer. Materials and Methods: A retrospective study was done on 479 patients of locally advanced carcinoma rectum from 2008 to 2015. All patients received neoadjuvant therapy which was mainly long course radiation therapy with 5040cGy over duration of 28 days with concurrent chemotherapy. Some patients underwent neoadjuvant chemotherapy. After an interval of approximately 6 weeks they underwent curative surgery. The patients who had complete pathological response were analysed in this study. Results: Out of the 479 patients, 76 patients were found to have no disease in the rectal wall. Only 1 patient (1.3%) had node positive disease without having any rectal disease (T0N1). The rest had no tumour either in the rectum or the mesorectal nodes. Thus, 75 patients had a pathological complete response (15.6%). Conclusion: In patients with rectal cancer undergoing neoadjuvant chemoradiotherapy followed by radical resection, absence of tumour in the rectum correlates well with absence of disease in the mesorectum and absence of nodal disease. Thus, absence of mucosal disease can be taken as marker of complete response to neoadjuvant therapy.

Mental Health and Old Age: A Qualitative Study in Iranian Population

Fariba Tabari, Morteza Khaghanizade, Nahid Dehghan-Nayeri, Soheil Najafi-Mehri

Introduction: Health, which usually declines with age, is one of the determinants of quality of life. Mental health disorder is one of the most common health-threatening problems of older age. Aim: The present qualitative study was conducted with the aim to identify factors that affect the mental health of elderly population. Materials and Methods: This study was a qualitative study with content analysis approach, conducted on the elderly Iranians in Tehran. Purposive sampling method was used to select 15 elderly Iranians. Semi-structured and in-depth interviews were carried out with 15 elderly Iranians in the parks and homes in 2015. To analyze the data, the content of interviews was typed and entered into MAXQDA software. This software was also used to code the data. The interview began with a main question about their experiences of everyday life, and then, exploratory questions to encourage the participants and access to deeper information were required. Results: Two themes of “interaction” and “worthiness”, 5 main categories (communication/relationship, empathy/compassion, entertainment/amusement, support and respect), and 15 sub-categories (interpersonal communication, communication with others, communication with God, talking to people, being consulted, being employed, studying and learning, using the media, going to park, family support, social support, social respect, family respect, respect for personal space, and respect for beliefs) were extracted from the data. Conclusion: The results of this study encourage healthcare providers to identify the factors that influence the sense of worthiness in elderly by keeping continuous contact with them and taking advantage of the unique opportunity they have to interact with them and influence their belief. By designing educational programs, mental disorders can be prevented, that this population may develop.

Effect of Punica granatum Extract Gel on Gingival Crevicular Fluid Levels of Interleukin-1ß, Interleukin-8 and CCL28 Levels: Randomised Controlled Clinical Trial

Introduction: Pomegranate (Punica granatum) fruit extract has anti-inflammatory, anti-bacterial, anti-oxidant and immune-modulatory features. Due to increased bacterial resistance to synthetic agents Pomegranate Extract Gel (PEG) could become a natural remedy for the treatment of periodontal disease. Aim: To compare topically applied PEG, Chlorhexidine (CHX) gel, Ornidazole-Chlorhexidine (ORN-CHX) gel and Placebo Gel (PG) on clinical parameters and on Gingival Crevicular Fluid (GCF) levels of interleukin-1ß (IL-1ß) and IL-8 and Chemokine (C-C motif) ligand 28 (CCL28) levels in a two week human experimental gingivitis model. Materials and Methods: Eighty systemically healthy subjects were randomly assigned to one of the four groups; Group I: PEG, Group II: CHX gel, Group III: ORN-CHX gel, and Group IV: PG. On the selected quadrant the subjects refrained from routine hygiene procedure and solely used the topical gel. The primary outcome measured were IL-1ß, IL-8 and CCL28 levels from GCF at baseline and 14 days. Gingival Index (GI), Plaque Index (PI), Bleeding On Probing (BOP) and Probing Depth (PD) were secondarily assessed at baseline, 14 and 60 days. Paired t-test and one-way ANOVA followed by post-hoc Tukey’s test was used for intra and intergroup comparisons with p-value of 0.05 as significant. Results: The PEG had an inhibitory effect on pro-inflammatory cytokines and chemokine. PEG showed significantly less increase in IL-1ß, IL-8 (p=0.003, 0.002) while CCL28 levels showed no difference from baseline (p=0.15) when compared to other three groups (p<0.001). The BOP and GI among subjects using PEG showed less increase (p=0.01, 0.05) compared to other three gels (p<0.001) after 14 days. PEG and CHX-ORD gel were similar (p=0.96) in exhibiting lowered PI. Conclusion: Pomegranate extract gel was effective in reducing the inflammatory markers and can be used as an adjunct to mechanical therapy for the treatment of gingivitis.

Anatomical Configuration of Roots and Canal Morphology of Primary Mandibular First Molars: A CBCT Study

Introduction: Root and canal morphology plays a vital role in improving the success rate of the endodontic treatment in primary teeth. The morphology of root canals in primary teeth leads to complications during pulp therapy. Studies done for assessing the root canal morphology and variations in primary teeth in Indian population are very scarce. Aim: To evaluate the root and canal morphology of primary mandibular first molar (PMFMs) teeth using cone beam computed tomography (CBCT) in paediatric Indian population. Materials and Methods: A total of 30 complete mandibular arch CBCT images of paediatric patients of the age group five to 10 years used in this study. The database was collected from Department of Oral Medicine and Radiology, Rajarajeswari Dental College and Hospital, Bengaluru. Sixty PMFMs from these 30 CBCT images were assessed for root and canal morphology and variation. Children of five to 10 years only were included in this study because the root completion of primary mandibular molars is around three years of age. This particular age group was chosen in order to ensure the integrity of the original morphology of the root canals of primary mandibular molars and also the amount of root resorption is minimal in this age. The study data was analyzed using SPSS version. 22 [IBM, Corp.,] for windows. Results: Out of the 30 individuals enrolled with 60 PMFM’s majority of the primary mandibular first molars had two roots and three canals (68.3%), 20.0% had two roots and four canals and 11.7% had three roots and three canals. The bilaterally symmetrical incidence of variant 2 in this population was 70.4% variant 3 was – 18.5% and for variant 4 was 11.1%. There was no statistical difference between genders in the variance of root and canal number and morphology. Conclusion: The results of this study indicated the PMFMs showed considerable variation in number and morphology of its root and its root canal. Very few studies have been conducted to find out the root canal morphology and anatomical variations in primary dentition. We as Paedodontists should be critical in evaluating root canal morphology in primary teeth for the overall success of the treatment plan.

Hypertension in Asymptomatic, Young Medical Students with Parental History of Hypertension

The Relation of Serum Arginine Levels with Serum Arginase and Nitric Oxide Synthase Activity in Patients with Breast Cancer

Shelgikar Prachi Jayant, Abhang Subodhini Anant

Introduction: There is a significant disparity between metabolism in normal individuals and cancer patients which have resulted in metabolism based diagnosis. Several types of tumours have abnormalities in arginine and arginine metabolic enzymes. It is now becoming apparent that the two key enzymes of arginine metabolism: arginase and Nitric Oxide Synthase (NOS) in mammals play key roles in regulation of most aspects of arginine metabolism in cancer. Aim: To evaluate arginine levels, arginase and nitric oxide synthase activity from serum of breast cancer patients of different stages and healthy controls and to find out the diagnostic use of these parameters for early breast cancer detection. Materials and Methods: Fifty histopathologically proved cases of breast cancer of any stage (Stage I to Stage IV) in the age group of 35-70 years and 25 age and sex matched healthy controls were recruited for this prospective case control study. Intravenous blood sample was obtained to evaluate study parameters. Serum arginine levels were estimated by Sakaguchi method, serum arginase activity was estimated by Roman and Ray method while serum NOS activity was measured by Cortas and Wakid method. Results: The results of this study showed significant decrease in serum arginine levels and significant increase in the activities of serum arginase and NOS in patients of all stages when compared with controls (p<0.01). Serum arginine levels further decreased (p<0.05) and activity of serum arginase (p<0.01) and of serum nitric oxide synthase (p<0.05) was found to be significantly increased in final stage (Stage III+IV) patients when compared with patients of initial stage (Stage I+II). Conclusion: Complex interrelationship exists between the two important arginine metabolic pathways: arginase and NOS which may profoundly influence tumour growth and biology. The estimation of these parameters can give additional insight regarding disease progression.

Evaluation of Liver Stiffness in Healthy Individuals by Sonoelastography

Veerendra Kumar Sharma, Ankur Malhotra, Tarun Kumar Chauhan

Introduction: Successfully detecting and managing Liver Fibrosis (LF) at an early phase can significantly improve the prognosis of patients in clinical practice; therefore, accurately assessing the degree of fibrosis when the disease is at an early stage is extremely important. However, the normal range of Liver Stiffness (LS) on Point Shear Wave Elastography (PSWE) is not well established. Aim: The present study aimed to quantitatively evaluate and compare sonoelastographic values of liver stiffness in healthy individuals without any clinical complaints. Materials and Methods: A prospective cross-sectional study was done from November 2014 to January 2017 in a tertiary care hospital in Uttarakhand region. The mean kilopascal value of 10 consecutive measurements were used as representative value for each healthy individual. The effects of potential confounding factors (age, gender, hepatic steatosis, and BMI) on liver elasticity were evaluated. Results were evaluated using SPSS© for windows™ Vs 23 (IBM™ Corp NY) and Microsoft excel™ 2007(Microsoft® Inc USA). Student’s t-test was used to check the significance of difference between two parameters. ANOVA followed by Tukey’s HSD test was used to test the significance of difference between more than two parameters in parametric data. Results: A total of 207 healthy individuals out of which 59 had fatty liver (incidentally detected) formed a part of this study. Reference range of liver stiffness in total study population was 4.48±0.78 kPa. Liver stiffness in males was 4.56±0.76 kPa and in females was 4.32±0.80 kPa. Reference range of liver stiffness for fatty liver was 4.59±0.84 kPa and for healthy liver was 4.47±0.75. Conclusion: Normal reference range of liver stiffness in healthy individuals in Uttarakhand region was 4.48±0.78 kPa. Of all the confounding factors only males have significant higher liver elasticity as compared to females. Other confounding factors have no significant effect on liver elasticity.

Assessment of Physical Activity among Adolescents: A Cross-sectional Study

Introduction: Inadequate Physical Activity (PA) is a common feature running through most public health problems across the world. PA declines during the lifespan, especially during adolescence. We studied the current status of PA of children in Anand, Gujarat India. Aim: To study the current status of PA of children in Anand, Gujarat, India in the age group of 10-19 years. Materials and Methods: Cross-sectional study was conducted using a self-reported modified Physical Activity Questionnaire (PAQ-A) which has consistently high validity and moderate reliability. It comprehensively captures the PA in last seven days. Self-reported anthropometric data and socio-demographic data were also recorded. Anthropometric data was not reported in 709 out of 3337 participants. Descriptive statistics {mean (SD), Frequency (%)} were used to depict the characteristics of the study population and PA levels. Using age and sex-specific WHO growth charts for BMI, we determined the prevalence of overweight (z=+2 SD), obesity (z=+3 SD) and undernutrition (z=-2 SD) in our study population. Results: Mean PA level (n=3337) amongst adolescents was 2.62 (SD=0.72). It was significantly higher in males as compared to females {2.66 (0.73 SD) vs 2.56 (0.71 SD), p<0.001}. 2312(69.3%) students fell in low PA group (PA score <3). Correlating their PA with age, in females (n=1410) correlation was -0.204 and in males (n=1927) it was -0.095. PA declines with age but in males it was not statistically significant. Correlating PA with BMI (n=2553), the overall correlation was -0.116 showing insignificant. Correlation of BMI with PA was -0.314 for an affluent school (n=328). Most common physical activity was bicycling {729 (51.7%) in females and 1077 (55.9%) in males)}. Overall (n=2628), 143 (5.4%) were obese {103 (6.7%) males and 40 (3.7%) females} and 556 (21.2%) were overweight {369 (24.0%) males and 187 (17.1%) females}. Overweight and obesity levels were higher among males. Conclusion: Physical activity was found to be inadequate among adolescents. Solutions to improve physical activity in children need to be incorporated for Indian schools.

Cardiac Output in Late Onset Neonatal Sepsis

Sujata Deshpande, Pradeep Suryawanshi, Ninad Chaudhary, Rajesh Maheshwari

2Introduction: Haemodynamics in sepsis is complex. Clinical variables such as heart rate, blood pressure and capillary refill time have been demonstrated to be misleading in their accuracy. Measurements of central blood flow such as cardiac output provide haemodynamic information, which may be different from the assumed underlying physiology. Aim: To evaluate the Right Ventricular Output (RVO) and Left Ventricular Output (LVO) in neonates diagnosed with late onset sepsis, with the help of functional echocardiography (FnECHO). Materials and Methods: This prospective cohort study was conducted at a tertiary care neonatal unit of Western India from March 2015 to November 2015. All infants admitted in the NICU with suspected late onset sepsis underwent FnECHO within 12 hours of onset of clinical signs, before initiation of inotropic support. Right Ventricular Output and LVO were recorded. Infants with positive culture results were included in the final analysis. Infants with early onset or culture negative sepsis, perinatal asphyxia, congenital heart disease, major congenital malformations and genetic syndromes were excluded from the study. Descriptive statistics were used to analyse data. Unpaired t-test was used for comparison of means of two independent groups. Results: Thirty one infants were analysed, of which two-thirds were preterm. Majority of patients (24, 77.4%) in the study group had gram-negative sepsis. Mean (±SD) RVO and LVO of the infants with late onset sepsis were 313 mL/kg/minute (±110.4) and 347 mL/kg/minute (±139.9) respectively, which were higher than normal values. The higher values of RVO and LVO were seen in patients with gram-negative sepsis (338 and 378 mL/kg/minute respectively), while remaining in the normal range in patients with gram-positive sepsis (225 and 240 mL/kg/minute respectively). Conclusion: Neonates with late onset sepsis showed high RVO and LVO as demonstrated by FnECHO. The higher cardiac output values were predominantly seen in patients with gram-negative sepsis as compared to those with gram-positive sepsis.

Fetomaternal Outcome in Medically Indicated Induction of Labour at Term Gestation

Nivetha Sarvanan, Nivedita Jha, Sneha Badwe Dhodapkar, Ravichandran Kandasamy

Introduction: The medical induction of labour at term gestation has always been controversial and is based on conflicting evidences. Aim: To determine the fetomaternal outcome of medical induction of labour at term gestation. Materials and Methods: It was a retrospective observational study and manual and electronic data were retrieved from a tertiary care centre of Southern India. All women after 37th week of gestation with single live fetus in cephalic presentation with a Bishop score <6 and a reactive non-stress test having medical indications were induced with medical method. The primary outcome measures included number of women who went into spontaneous labour, incidence of failed induction, induction delivery interval and modes of delivery. Results: A total of 602 patients were included in this study. The mean age, gravida and parity were 25.24±4, 1.4±0.6 and 1.45±0.84 respectively. Oligohydramnios was the commonest indication 174(28.9%) for labour induction, followed by diabetes 119(19.8%) and Premature Rupture Of Membrane (PROM) at term 77(12. 8%). Normal vaginal delivery was achieved in 406 (67.4%) of women. LSCS (lower segment caesarean section) was performed in 140(23.3%) of patients, while 56(9.3%) patient required instrumentation. The incidence of LSCS in oligohydramnios, gestational hypertension and diabetes was 40(23%), 16(23.1%) and 26 (21.8%) respectively. Furthermore, the fetomaternal outcomes were similar irrespective of gravidity and gestational age. Conclusion: Medical methods of induction are safe and reliable and also do not increase the risk of foetal and maternal complications. Induction of labour for medical indication in term pregnancy does not increase the risk of caesarean delivery and adverse foetal and neonatal outcomes.

Hair, Nails and Oral Mucosal Disorders among People Living with Human Immunodeficiency Virus and AIDS in Osogbo and Diagnostic Performance on Low CD4 Cells Count

Adeolu Oladayo Akinboro, Edward Olugbenga Ayodele, Olaniyi Emmanuel Onayemi

Introduction: The epidemic of HIV/AIDS continues amidst reduce funding in most low and middle-income countries. The need to find low-cost clinical equivalents of the laboratory markers of immunosuppression, therefore become imperative. Aim: To document hair, nails and oral mucosal disorders among People Living with HIV/AIDS (PLWHA) and determine their performance in predicting low CD4 count. Materials and Methods: This cross-sectional study included 315 patients recently diagnosed PLWHA at the HIV clinic of LAUTECH Teaching Hospital, Osogbo, Nigeria. Participants were examined for hair, nails, and oral mucosal disorders and CD4+ cell count was estimated. Sensitivity, specificity, positive and negative likelihood ratio were calculated using online MedCalcR. Results: Mean age of participants was 36.68±10.03 years, and 227 (72.1%) were female. The CD4+cell count below 200 was significantly associated with lower weight, BMI and male gender. The prevalence of integument and oral lesions include blue-black nail pigmentation 17.8%, oral candidiasis 17.5%, fluffy hair 14.9%, lighter colour hair 13.8%, diffuse alopecia 9.2%, oral hyperpigmentation 7.3%, and onychomycosis 5.4%. Disorders significantly associated with median CD4 count <200 cells/mm3 include: blue-black nail pigmentation (p <0.001), fluffy hair (p<0.001), lighter colour hair (p=0.002), oral candidiasis (p=0.004) and aphthous ulcers (p=0.004). Performance of hair, nails and oral disorder in detecting CD4+ cell count <200: Blue nails: sensitivity 92.9%, specificity 64.1%, positive likelihood ratio 2.6, and negative likelihood ratio 0.1; onychomycosis: sensitivity 70.6%, specificity 55.4%, positive likelihood ratio 1.6, and negative likelihood ratio 0.5; fluffy hair: sensitivity 70.2%, specificity 58.2%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; lighter colour hair: sensitivity 74.1%, specificity 56.6%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; Oral candidiasis: sensitivity 78.2%, specificity 60.8%, positive likelihood ratio 2.0, and negative likelihood ratio 0.4. The combinations in twos and threes increased the sensitivity (88.9-100.0%) and negative predictive values (85.7-100%), but specificities are reduced below 50%. Conclusion: Although blue-black nail pigmentation, fluffy hair, lighter colour hair, oral candidiasis are associated with low CD4 count, their presence is not a good diagnostic test to detect CD4 count <200 cells/mm3, hence cannot replace the CD4 count machine but their absence make the presence of CD4+cells count <200 cells mm3 reliably unlikely.

Chronic Effects of Maternal Malnutrition during Lactation: Severe Influences on Cortical Bone Mass of Wistar Rats Femur

Introduction: Malnutrition is a world health problem and has high incidences in developing countries. It is known that the nutritional status of the mother during gestation and lactation affects the growth and development of its child. Maternal malnutrition during breastfeeding has been shown to cause alterations of thyroid function and bone tissue. Aim: The present study aimed to evaluate the chronic effects in bone tissue of energy-protein restriction in rats during lactation period through a histological and morphometric analysis of the cortical mass of the femur. Materials and Methods: At parturition, Wistar rat dams were divided in three groups: (1) Control group - which received 23% protein diet without restrictions; (2) Protein-Energy restriction group - which received 8% protein diet; (3) Energy restriction group - which received 23% protein diet in limited amounts, according to the ingestion of the second group. Each group had 12 pups. After weaning, all pups were separated from its dams and received free access to 23% protein diet until 180 days and then euthanized. Afterwards, the femur of these specimens were excised and fixed in 4% formaldehyde solution and decalcified by EDTA. 10 µm thick transverse sections on the middle third of the femur diaphysis were performed. Then, the tissue was stained with Haematoxylin/Eosin and analysed under a microscope. Results: The cortical area of the control, energy restriction and protein-energy restriction groups were, respectively: 6.54±0.23 µm, 5.51±0.29 µm and 6.18±0.19 µm, while the medullary cavity showed the following results: 3.65±0.16 µm, 4.1±0.20 µm and 3.53±0.12 µm. Reduction of the cortical area and an increase of medullary zone were observed on the protein-energy restriction group. Conclusion: Maternal malnutrition during lactation has negative effects on femur growth even after normalization of the diet in adult aged Wistar rats.

Treatment of Three-and Four-Part Proximal Humerus Fractures by MultiLoc Nailing Technique- A Prospective Study

Introduction: Proximal humerus fractures are third most common fractures with lack of proper consensus for treatment, especially in three-and four-part fractures. With the advent of Multiloc technique, the advantages of nailing can be successfully applied to the proximal humerus fractures. Aim: To assess the functional and radiological outcome in three-and four-part fractures treated with Multiloc nailing. Materials and Methods: A prospective study patients over a period of two years between December 2013 and February 2015 was conducted on 21 patients with proximal humerus fracture treated with Multiloc nailing system. Patients with three-and four-part fractures above 60 years were included in the study and regular follow-ups were done till the end of two years. Results: The most common mechanism of injury was fall comprising of 15 (71.4%) cases followed by Road Traffic Accident (RTA) with six (28.6%) cases. As per Neer’s classification, 13 (61.9%) cases had three-part and eight (38.1%) cases had four-part fracture respectively. Mean operative time was 112±8.6 minutes. The average duration of hospital stay was 4.6±1.3 days. Radiological union was seen at 13±2.6 weeks. There was one (4.7%) case with varus collapse. Two (9.5%) cases had shoulder impingement in the present study. The mean Constant shoulder score was 61±12.4. The final outcome was measured using the Constant scoring system. There were 8 (38.2%) excellent, 9 (42.9%) good, 2(9.5%) satisfactory, 1 (4.7%) fair and 1 (4.7%) poor case respectively. Conclusion: MultiLoc nailing is a good angular stable device which gives a secure fixation in communited three-and four-part fractures especially in osteoporotic bones.

Pomegranate Seed Oil Shows Inhibitory Effect on Invasion of Human Breast Cancer Cell Lines

Introduction: The pomegranate seeds are a good source of compounds such as conjugated linoleic acid and punicic acid that can have anticancer effects. Aim: To assess the potential inhibitory effects of Pomegranate Seed Oil (PSO) on human breast cancer cell lines metastasis. Materials and Methods: This research was an in vitro study on human breast cancer cell lines MCF-7 and MDA-MB-468. Pomegranate was collected from Fars Province of Iran and the seed oil was extracted. Cells were treated with different concentrations of the oil and their viability was determined using MTT assay. The morphology, colony formation, invasion, migration, wound healing and cell adhesion of cancer cell lines were evaluated. Half maximal inhibitory concentration (IC50) was obtained after 24, 48 and 72hrs. of treatment of cell lines. The statistical analysis of results were done by SPSS 19.0 software using One-way ANOVA followed by Post-hoc Tukey test and the level of significance was set at p<0.05. Results: The colony formation for MCF-7 and MDA-MB-468 cell lines were reduced compared to the control. At doses of 800 µg/mL and 1000 µg/mL for MCF-7 and MDA-MB-468, morphological changes have been observed. The MCF-7 cells migration was dropped in a dose equivalent to 1150 µg/mL and for MDA-MB-468 cells at a dose equivalent to 842 µg/mL. In MDA-MB-468 cells, the cellular invasion was dropped in a dose equivalent to 842 µg/mL. Attachment assay showed that cell binding at a dose equivalent to IC50 for both cell lines dramatically was reduced. Wound healing test results indicated that PSO prevents MCF-7 and MDA-MB-468 cell lines migration toward the split. Conclusion: The results indicate that PSO may inhibit the migration and invasion of MDA-MB-468 cell line.

Serosurveillance of Dengue, Chikungunya and Zika in Jammu, a Sub-Himalayan Region of India

Introduction: Dengue and chikungunya are Aedes mosquito-borne viral diseases of major public health concern in India. Recently, there is a gradual rise in number of dengue and chikungunya positive cases in various states of Northern India and a similar emergence and increase of dengue positive cases has been observed in Jammu since 2011. Among the mosquito-borne diseases dengue has become a regular seasonal disease while chikungunya has recently emerged in 2016 and Zika the third aedes borne viral infection is needed to be under surveillance under national guidelines. Aim: To report the emergence of chikungunya and analyse the status and pattern of dengue over a period of one year along with serosurveillance of Zika which was done under Central Government guidelines. Materials and Methods: A total of eight hundred eight (808) samples from patients suspected of dengue infection over a period of one year from January 2016 to December 2016 from all the districts of Jammu Province, were tested serologically at our tertiary care centre for dengue NS1 antigen and IgM anti - dengue antibodies. Besides three clinical suspects of chikungunya, 167 dengue (7 positive and 160 negative) sera were tested by National Institute of Virology (NIV) CHIK IgM Capture ELISA, as there is an overlap of clinical symptoms. For Zika testing, the stored negative samples of dengue and Chikungunya (215) were sent to NIV Pune. Results: Recurring dengue infection with periodic upsurge since last few years and emergence of chikungunya was reported in Jammu region. Of the 808 sera tested for dengue and 170 tested for chikungunya, 17.82% and 18.2% were positive respectively. The results for Zika testing were negative. The association of dengue on the basis of sex was found to be highly significant (p=0.009276). Conclusion: In the absence of specific treatment and vaccine for dengue and chikungunya fever, early diagnosis is important in the management of these infections. This also demands continuous seroepidemiological surveillance of the locally prevalent and emerging arthropod borne infections for timely formulation and implementation of effective arboviral control programme.

Effect of Chronic Obstructive Pulmonary Disease on Interleukin-8 Level in Sputum and Peripheral Blood Neutrophils: A Case Control Study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by partially reversible airflow obstruction and chronic inflammation in the pulmonary as well as in systemic compartment. Interleukin 8 (IL-8) is one of the most potent inflammatory mediators and it is involved in the migration and activation of neutrophils. Previous studies demonstrated the increased levels of IL-8 in plasma and sputum of COPD, but peripheral blood neutrophils mediated IL-8 level including their relationship to smoking pack years and spirometric parameters is still unknown. Aim: To assess the levels of IL-8 in sputum and peripheral blood neutrophils of COPD patients and to compare them with healthy controls. Materials and Methods: This case control study was done from March 2014 to November 2016 in the department of respiratory medicine KGMU. A total of 81 COPD patients and 81 healthy controls were recruited in this study. Peripheral blood neutrophils were isolated from COPD patients and healthy controls and stimulated with Lipopolysaccharide (LPS). The neutrophils cell culture supernatant was assessed for IL-8 level using ELISA techniques, whilst IL-8 mRNA expression was measured using real-time polymerase chain reaction. Induced sputum was obtained from all participants and processed. The sputum supernatant was also assayed for IL-8 level. Results: COPD patients had significantly higher protein level of IL-8 in peripheral blood neutrophils (p=0.018) and sputum supernatant (p=0.011) compared to healthy controls. Gene expression of IL-8 was also significantly higher in peripheral blood neutrophils of COPD patients (p=0.001). In the patients with COPD, the smoke pack year was significantly correlated with the level of IL-8 in peripheral blood neutrophils (r=0.42; p=0.009) and sputum (r=0.48; p=0.002). The smoke pack years was found negatively correlated with FEV1 % predicted (r=-0.37; p=0.044) and FEV1 /FVC (r=-0.47; p=0.007) in the COPD patients. Conclusion: The increased level of IL-8 in peripheral blood neutrophils and sputum support the hypothesis that COPD is a multicomponent disease. IL-8 level may be helpful in predicting development of COPD in smokers.

Long-Term Effect of Intravenous Iron on Overall Survival and Hospitalization in Patients with Heart Failure with Reduced Ejection Fraction, Iron Deficiency and Mild Renal Impairment: An Open-Label 5-Year Follow Up Observation

Jorge Eduardo Toblli, Federico Pablo Di Gennaro

Introduction: Iron Deficiency (ID) is associated with increased mortality rates in patients with Heart Failure with reduced Ejection Fraction (HFrEF), as well as a general increase in morbidity compared with patients with normal iron levels. Aim: To determine 5-year overall survival rates among HFrEF patients with ID anaemia and reduction in renal function treated with intravenous (IV) iron in a pilot study. Materials and Methods: In this randomized controlled pilot study with a 5 years follow up, 40 patients from the general population that spontaneously consulted the outpatient’s office of the cardiology section at the Hospital Alemán Buenos Aires with HFrEF, renal impairment, anaemia, and ID were enrolled into two groups (n= 20/group). For 5 weeks, one group received isotonic saline solution and the other received IV iron sucrose, 200mg weekly. Over a 5-year follow-up period, overall survival and the number of hospitalizations were recorded, as well as variables associated with iron status, anaemia, HFrEF severity and cardiac function, renal function and level of inflammation. Results: Among patients treated with IV iron sucrose, survival was 80% after 5 years, which was significantly greater than survival in the control group (45%, p<0.05 versus treated group). Throughout the study, there were fewer hospitalizations among patients treated with IV iron sucrose compared with those in the control group. After 5 years, 85% of patients in the control group had been hospitalized, more than four times than among iron-treated patients (p<0.01). Iron treatment also improved iron status, New York Heart Association class and renal function. Conclusion: IV iron treatment increased survival in patients with HFrEF, renal impairment and ID anaemia, as well as reducing the number of patients requiring hospitalization over 5 years.

Knowledge and Attitude of Personnel, Key Factors in Implementation of Neonatal Pain Management in NICU: A Qualitative Study

Nasrin Mehrnoush, Tahereh Ashktorab, Mohammad Heidarzadeh, Sirous Momenzadeh

Introduction: Pain management is important, especially for neonates who are not able to verbally express their pain. Therefore, stress reduction and pain management are essential components of neonatal care. Aim: The aim of this study was to explore the key factors in implementation of neonatal pain management in Neonatal Intensive Care Unit (NICU). Materials and Methods: A qualitative study using conventional content analysis method was conducted with participation of nurses, physicians and nurse managers working in Alavi Educational Medical Center in Ardabil, Iran during July 2016 to October 2016. Twenty-five nurses took part in focus group discussions, five paediatrician and five nurse managers attended private interviews. Four focus group discussions and ten interviews were performed until data saturation was ensured. Results: Data analysis indicated two effective categories on implementation of infant’s pain management which included “knowledge of the personnel” and “attitude and commitment of the personnel”. The first category consisted of six subcategories “symptoms of pain”, “outcomes of pain”, “pain interventions”, “side-effects of drugs”, “parent’s role”, and “education of personnel.” The second category consisted of three subcategories including “personnel’s conscience”, “personnel’s emotions”, and “personnel’s belief.” Conclusion: According to the main findings of this study, there is a need for empowerment of the personnel about pain management and assessment.

Implementation and Evaluation of NICU Registry in IRAN

Kayvan Mirnia, Taha Samad-Soltani, Peyman Rezaei-hachesu

Introduction: Specialized registry in the NICU (neonatal intensive care unit) is necessary to gather process and report data in an accurate and timely manner. An electronic registry could enable the mother and infant to be monitored and traced through complete and comprehensive data. Aim: Registry has been developed on the basis of a literature study and view point of participants about effectiveness and efficiency was evaluated. Materials and Methods: A situational analysis was performed to achieve a clear view from current status of NICU data collecting and reporting, then a customized three tier architecture was proposed to design and implement a specialized registry. User satisfaction was evaluated by system usability scale among 30 participants to assess user’s attitude about system. Results: A comprehensive data model with seven categories was defined by 65 entities, which actually retains part of the infants information. System usability scale was in a high range about 70%. The highest agreement is on reduced registration error. The advantages of system were perceived by users and they had positive attitude about it. Conclusion: The use of a suitable architecture and standard templates lead to enhanced acceptability, effectiveness, performance and functionality. Quality of data and health promotion has a direct relationship with system usability. These systems have a great potential to increase safety of patients by providing fast and easy access to information, monitoring and decision support operations.

Paraoxonase 1 Gene Polymorphism (rs662) and Increased Risk of Idiopathic Foetal Growth Restriction

Introduction: Idiopathic Foetal Growth Restriction (IFGR) is a major health challenge. One of the proposed mechanisms for IFGR is oxidative stress. Paraoxonase (PON) enzyme protects Low Density Lipoprotein (LDL) from oxidation. Paraoxonase 1 (PON1) gene polymorphism causes a decrease in PON activity. Aim: The present study aimed at exploring possible association of PON1 gene Q192R (rs662) polymorphism and expression with development of IFGR. Materials and Methods: A cross-sectional, case-control study was conducted from December 2011 to March 2013. Seventy five unrelated IFGR neonates and their mothers were recruited as cases with controls. PON1 polymorphism was detected by Polymerase Chain Reaction-Restriction Fragment length Polymorphisn (PCR-RFLP). PON1 expression and activity were assessed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and spectrophotometrically, respectively. The genotypes were compared using one-way ANOVA. True Fold Change (FC) was used to assess change in gene expression. Chi-square test and t-test were used for the comparison of biochemical data in the different groups. Results: The QR and RR genotype of rs662 in mothers and neonates were found to be associated with increased incidence of IFGR. Decreased PON1 expression and activity was observed in affected mothers. Conclusion: Incidence of IFGR is higher in foetus and mothers with unfavourable PON1 rs662 polymorphism and may be used to identify pregnancies at greater risk for Foetal Growth Restriction (FGR).

Paracervical Block and Paracetamol for Pain Reduction During IUD Insertion: A Randomized Controlled Study

Selen Dogan, Bulent Simsek

Introduction: Unintended pregnancies and its consequences are considerable public health problem. Intrauterine Devices (IUD) are reversible, safe and effective contraceptive method for most women. Aim: The aim of this study was to compare the effects of paracervical block and paracetamol on pain reduction during IUD insertion. Materials and Methods: A total of 118 patients were enrolled in to this prospective randomized study. Paracervical block was performed in 42 patients (Group 1), 30 patients received paracetamol (Group 2) and 46 patients did not receive any analgesic method (Group 3). The primary end point was to determine the pain levels using Visual Analogue Scale (VAS) during (VAS1) and after (VAS2) insertion of intrauterine device. Results: Mean VAS1 and VAS2 scores of groups were 3.69±1.6 and 3.02±0.1 for Group 1; 3.73±0.8 and 3.0±0.7 for Group 2; 4.37±1.4 and 3.83±1.2 for Group 3 respectively. There were no significant difference between VAS 1 among the groups. However VAS2 scores were significantly different between Group 3 and both Group 1 (p<0.001) and Group 2 (p<0.001). Neither VAS1 scores (p 0.9) nor VAS2 scores (p 0.5) were different between Group 1 and 2. Conclusion: Paracetamol and paracervical block are both effective methods for pain relief after IUD insertion and there is no difference between these two methods with respect to pain relief.

NT-proBNP: A Biochemical Marker of Maternal Complications in Pre-eclampsia

Supriya Kumari, Mamta Gupta, Harsh Vardhan, Vandana Saini, S.K. Gupta

Introduction: Elevated serum levels of NT-proBNP (N terminal pro-Brain Natriuretic Peptide) are associated with Pre-Eclampsia (PE) and its complications. Aim: To evaluate NT-proBNP in women with PE and correlate its levels with maternal outcome. Materials and Methods: A total 90 out of which 45 women with PE (Group A) and 45 normotensive healthy pregnant women with singleton pregnancy (Group B) were enrolled. NT-proBNP was estimated at term or just before induction of labour or in early labour. These women were followed till 48 hours postpartum. Maternal outcome was recorded and analysed using statistical tests like Student t-test, Mann-whitney, ANOVA, Kruskal Wallis, Pearson and Spearman correlation. Results: Significant elevated serum levels of NT-proBNP were seen in PE women than controls (mean 439.47±431.99 and 99.40±37.89 respectively) (p-value <0.001). Severity and early onset of PE was associated with further increased serum NT-proBNP levels. In Group B none of the women developed any complication whereas, in Group A 19/45 (42.22%) women had a total of 31 complications. Forty percent of these PE women had maternal complications and elevated NT-proBNP levels above 500 pg/mL. Cardiovascular complications were observed in 4/45 women with NT-proBNP levels of 770 pg/mL and above. The positive predictive value for NT-proBNP for detecting complications was 83.33% at a cut-off level of 500 pg/mL. The negative predictive value was 92.85% at a cut-off level of 100 pg/mL. Women in Group A with early onset PE, who did not develop maternal complications, had low serum NT-proBNP. Women without severe features of PE (n=12) in Group A who developed complications, had elevated NT-proBNP (mean 434±307.219 pg/mL) than those who had no complication (mean NT-proBNP 80.66±37.54 pg/mL). Conclusion: NT-proBNP is a useful marker for predicting maternal complications and risk stratification for optimum maternal outcome in a PE women.

Evaluation of Efficacy of Intravenous Iron Sucrose in Management of Adolescent Iron Deficiency Anaemia

Saubhagya Kumar Jena, Arati Mallick, Sushree Sangeeta Rout

Introduction: Worldwide, most common nutritional deficiency anaemia is iron deficiency anaemia. Anaemia in adolescent girls is defined as blood haemoglobin (Hb) level <12g/dL. The highest prevalence seen in ages of 14-19 years, more than 50% girls of this age are anaemic. It affects both physical endurance and cognitive performance in adolescent. Adolescent anaemia if not corrected at proper time, will attribute to the high maternal mortality rate, higher incidence of low birth weight babies and high perinatal mortality rates. Aim: To establish the efficacy and safety of intravenous iron sucrose and to compare with oral iron ascorbate in management of iron deficiency anaemia in adolescent girls. Materials and Methods: It is a prospective, interventional, hospital based clinical study carried out in over 61 adolescent girls (10-19) years, having haemoglobin 8-<12 g/dL. Thirty girls were given intravenous iron sucrose and 31 girls were given oral ferrous sulphate. In intravenous group, 200-800 mg intravenous iron sucrose has been given in divided doses, 200 mg (per dose) diluted in 200 ml of normal saline on alternate day whereas in oral group, 200 mg ferrous sulphate tablet given orally, twice daily for three weeks. Data was collected after four week for haemoglobin and Packed Cell Volume (PCV) estimation. Results: A significant improvement of haemoglobin was observed with intravenous iron sucrose. The mean haemoglobin was increased from 9.9±0.94 gm/dL to 11.54±0.80 gm/dL after four weeks. Within a short span of four weeks, intravenous iron sucrose leads to a significant increase (p<0.001) in haemoglobin concentration of 1.6±0.83 g/dL compared to 0.89±0.48 g/dL increase in concentration of haemoglobin in oral iron sulphate group. Iron sucrose was very well tolerated. Only one out of 30 patients experienced headache and burning sensation at injection site. 20 (64.5%) girls in oral group complained of gastrointestinal side effects like nausea, dyspepsia and constipation compared to none in intravenous group. Conclusion: Overall, intravenous iron sucrose therapy compared to oral iron ascorbate found to be very effective in treating mild to moderate anaemia in adolescent girls with negligible side effects and good safety profile.

IL-8 mRNA and Serum Levels in Vitiligo Patients: A Case Control Study

Introduction: Many theories are suggested to explain aetiology of vitiligo, such as autoimmune, genetic and biochemical. Interleukin-8 (IL-8) is a pro-inflammatory chemokine which is evaluated in the pathogenesis of some skin diseases, like psoriasis, however, in vitiligo, few studies were reported regarding this issue. Aim: The aim of the present study was to investigate serum level of IL-8 and IL-8 mRNA in patients with different types of vitiligo to validate its role in aetiopathogenesis of vitiligo. Materials and Methods: This case-control study was conducted on 39 vitiligo patients and 15 age and gender matched healthy controls. The participants were selected from Dermatology Outpatient Clinic, Menoufia University Hospitals from October 2014 to October 2015. They were subjected to clinical history, examination and full general examination. Detailed dermatological examination including VASI score was applied. IL-8 serum level was measured by ELISA and IL-8 mRNA was quantitated by Real Time-PCR. The statistical analysis was done using SPSS, version 20.0. Mann Whitney U test was used to compare two quantitative not normally distributed. Chi-square test (?2) was used to study association between two qualitative variables. Spearman correlation test was applied to assess correlation between two continuous quantitative variables. A p=0.05 was considered significant. Results: IL-8 serum level and mRNA concentration mean values were significantly elevated in vitiligo patients (26.25±43.28 pg/mL and 8.48±11.92 ng/mL) than controls (0.57±0.50 pg/mL and 0.60±0.32 ng/mL) (p=0.002, for both), and they showed significant positive correlation with each other (r=0.622; p=0.001). Moreover, both of them revealed significant high values in localised vitiligo (62.20±74.39 pg/mL and 12.42±13.85 ng/mL) than generalised (18.39±29.49 pg/mL and 7.61±11.52 ng/mL) (p=0.000 and p=0.004), respectively. Conclusion: Serum IL-8 chemokine and its mRNA increased significantly in vitiligo patients indicating that it may have a dynamic role in vitiligo development and participate in its pathogenesis.

The Relationship between Social Support and Food Insecurity in Pregnant Women: A Cross-sectional Study

Introduction: Household food insecurity has increasingly been recognized as a serious public health problem which is associated with higher rates of self-reported poor or chronic health conditions and also adverse impact on the mother and foetus. Aim: The present study was aimed at identifying the relationship between social support and food insecurity in pregnant women. Materials and Methods: This cross-sectional study was carried out on 734 pregnant women using Stratified cluster sampling in Ilam province in 2016. Some urban health centers were selected from each city and the samples that had the inclusion criteria were enrolled in the study in their 24-28 gestational weeks. Data collection tools were four questionnaires; women’s demographic and obstetric characteristics, socio-economic status, food security status and social support questionnaires. Data were analysed using descriptive statistics and Chi-square test and logistic regression through SPSS version 19.0. The statistical tests were performed at 95% confidence interval. Results: Food security was observed in 64.9% of participants while 35.1% suffered from insecurity. The results of assessing social support status indicated that 15.4%, 50.4% and 34.2% of the pregnant women had low, moderate and high social support, respectively. The chi-square test showed that there was significant association between social support and food security (p<0.001). The results of the logistic regression analysis revealed that social support was a protective factor against food insecurity as the probability of household food insecurity was lower for women with a higher level of social support compared to those with lower social support (OR: 0.187, CI: 0.116-0.303). Conclusion: There was significant association between perceived social support and food insecurity. This highlighted the necessity of providing educational programs for spouses and families of pregnant women in order to support and alleviate food insecurity.

Effect of Visual Cue Training on Balance and Walking in Elderly: A Single Blind Randomized Controlled Trial

Sumam Sunny, Suchetha PS Bhat

Introduction: Balance disorders emblematize as a sprouting area of public health concern, due to its conjunction with falls amidst the elderly dwellers in the community. As age increases there is a marked reduction in functioning of visual system and gaze behaviour which adversely affects balance and gait in elderly. Balance and gait training methods aided by visual cues are technology based so the study was initiated to find about a visual cue training method which is feasible and can be used in rural settings easily amongst the elderly veterans of the community. Aim: To determine the effect of visual cue training on balance and walking in elderly population. Materials and Methods: The study was a single blind randomized controlled trial carried out in Abhaya Ashraya old age home, Assaigoli, Mangalore. A total of 55 patients were screened out of which 40 patients who met the inclusion criteria were enrolled in the study. All participants receive balance training for 30 minutes. In addition, the experimental group received visual cues along with balance training. Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) scores were taken pre and post-treatment in both the groups. Paired and independent t-test was used for comparing within and between group difference respectively of the experimental and control group of BBS and DGI scores. Results: There was a significant improvement in the Berg balance and Dynamic gait index scores before and after the intervention within the groups and between the groups with a p-value<0.001 in both experimental and control group but more marked improvement was found in experimental group with mean difference of 4.9 and 2.2 for BBS and DGI respectively. Conclusion: The present study concludes that visual cue training can be utilized as a simple and effective tool for training in clinical settings to address sprouting public health issue of balance and gait disorders which is cohesively coupled with catastrophe of falls admist elderly residents in the community.

Effect of Upper Limb Neural Mobilization on Vibration Threshold and Hand Grip Strength in Asymptomatic Individuals: A Randomized Controlled Trial

Introduction: Neural Tissue Mobilization (NTM) is a common technique used in clinical presentation with increased neural mechanosensitivity and was found to improve signs and symptoms. However, there is dearth in the literature indicating the physiological effects of NTM on asymptomatic subjects with reduced neural extensibility. Aim: To determine the immediate and short-term effect of upper limb neural tissue mobilization on hand grip strength, vibration threshold (VT) and neural extensibility in asymptomatic individuals. Materials and Methods: A prospective, parallel group, single-blinded randomized controlled trial was conducted on 40 participants. The subjects in the experimental group were administered five sessions (on alternate days) of median and ulnar nerve mobilization techniques, whereas the subjects in the control group received no intervention. Outcomes were assessed at three time-points i.e., at baseline, immediately after the first session and two days following the fifth session. Means for outcomes were compared. Results: Statistically significant improvement was observed in VT in the experimental group. Both groups demonstrated an improvement in neural extensibility measured as Elbow Extension Range of Motion (EEROM) while performing neural provocative testing. No within group or between group significance was noted in grip strength. Conclusion: There is no immediate or short-term effect of neural mobilization on grip strength in asymptomatic subjects but, it is seen to improve neural tissue extensibility and VT.

Role of a Surveillance System in the Management of an Outbreak of Dengue in the Mid Hills of Himachal Pradesh, India

Introduction: Surveillance systems are instrumental in not only eliciting the impending outbreaks but also for initiation of public health action. Integrated Disease Surveillance Programme (IDSP) of India guides in the clinical and laboratory diagnosis of vector borne diseases such as Dengue and its management. Aim: To assess any impending outbreak of Dengue in the region, by using IDSP surveillance data and to assess the need based mitigation measures. Materials and Methods: The routine IDSP surveillance of June 2015 highlighted an impending outbreak of Dengue in Solan district of Himachal Pradesh, India. Spot map was prepared for epidemiological linkage of the sporadic cases being reported. Moreover the retrospective epidemiologic IDSP surveillance data was analysed for finding out any cases of Dengue reported in the past. Clinical case definition of Dengue, formulated by IDSP was adopted. Diagnostic facility was set up. Entomological surveillance was used to calculate House Index, Container Index, Breteau Index. Aedes ageypti mosquito was identified by laboratory techniques. Mitigation activities like sanitation and cleanliness drive, fogging, inter-sectoral meetings and coordination were initiated. Daily surveillance was initiated and data was analysed in Microsoft Office Excel 2010 and Epi Info software version 7.2.0.1. The value of p<0.05 was considered as significant. Results: Based upon data analysis, outbreak of Dengue was declared on 7th September, 2015. A total of 686 probable cases were positive by rapid diagnostic/card tests whereas 57 and 109 patients were positive by NS1Ag and IgM tests. The relation of Dengue with respect to age and sex of the patients was found statistically non-significant with p-values of 2.01 and 3.20 respectively. House Index was higher (37.5%) in the industry dominated Nalagarh region. Genus Aedes was identified in three out of 12 mosquito specimens with the help of available mosquito key. Other specimens were beyond recognition since these were deformed either during collection or in the process of rearing and thus could not be identified. A 7.5% of total houses screened were covered under sanitation drive. Pyrethrum fogging was done in 1397 houses. Conclusion: The study shows the utility of IDSP system feedback in management of Dengue by formulated clinical case definitions and setting up of diagnostic facility for prompt identification of cases and early curtailment of outbreak.

Pattern of Risk Factors and Correlates of Pruritus among Patients with Chronic Kidney Disease in Sokoto, Nigeria

Introduction: Chronic Kidney Disease (CKD) has become a major public health challenge globally. A cause for concern is the increasing burden of its risk factors, the complications of the disease, and their effects on the well-being of the increasing proportion of populations with end stage renal disease worldwide. Aim: To determine the pattern of risk factors and the correlates of pruritus among patients with CKD. Materials and Methods: A cross-sectional study was conducted among 124 consecutively diagnosed CKD patients at the nephrology unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between December 2014 and May 2015. A proforma was used to collect data on study subjects’ socio-demographic and clinical parameters. Data analysis was done using International Business Machines (IBM) SPSS Version 20.0 statistical computer software package with all levels of significance set at p<0.05. Results: The mean age of the study subjects was 46.7±14.9 years; out of 124, 103 (82.3%) were aged 21 – 60 years, and most of them were males (79.0%). The most prevalent risk factors of CKD were hypertension (47.6%), chronic glomerulonephritis (22.6%) and obstructive uropathy (13.7%). A larger proportion (54.8%) of the study subjects were haemodialysed. About one-fifth 20 (16.1%) had pruritus and the correlates of pruritus identified were sleep deprivation 55 (44.4%) and suicidal ideation 17 (13.7%). Conclusion: Hypertension and chronic glomerulonephritis were the major risk factors of CKD identified in this study. Although only a few had pruritus, the correlates of pruritus identified were sleep deprivation and suicidal ideation. In addition to initiating or scaling up interventions, targeting the risk factors of the disease, policymakers and healthcare providers should make routine screening for pruritus and its correlates an essential component of CKD patients’ care.

Magnetic Resonance Imaging Evaluation of Central Nervous System Manifestations in Patients Infected with Human Immunodeficiency Virus

Introduction: Involvement of Central Nervous System (CNS) occurs early in Human Immunodeficiency Virus (HIV) infection resulting in significant morbidity and mortality. In these patients, neuroimaging is the modality of choice and Magnetic Resonance Imaging (MRI) is the preferred imaging modality for brain as it helps in the diagnosis, deciding appropriate therapy and follow up. Aim: To evaluate features of brain parenchymal involvement on MRI in HIV patients. Materials and Methods: The study was a retrospective study conducted over a period of two years from February 2014 to September 2016 at a tertiary care hospital in Delhi, India. A total of 400 new cases of HIV/AIDS were registered in the immunodeficiency center during this period. Out of these cases, 107 patients presented with predominantly CNS symptoms and underwent MRI of the brain. Imaging was performed on GE Wipro Sigma 1.5 Tesla machine using standard sequences with pre-contrast and post-contrast acquisition. The patients with positive findings (n=75) were followed up. Laboratory and HPE correlation were carried out. Results: MRI Brain was performed in 107 cases, out of which 75 cases had radiological findings. The study finally included 75 patients who had positive findings on MRI brain. There were 61 (81.3%) males and 14 (18.7%) females with mean age of 38.3 years range (4–60 years). Twenty-seven had Tuberculosis (TB), 26 HIV encephalitis (15 HIV encephalitis, 11 in addition had other brain pathology), 12 toxoplasmosis, four cryptococcal meningitis, three Primary CNS Lymphoma (PCNSL), nine Progressive Multifocal Leukoencephalopathy (PML) and one HIV vasculitis. Conclusion Classic CNS infections in the setting of Acquired Immunodeficiency Syndrome (AIDS) include toxoplasmosis, CNS TB, cryptococcosis, PML, cytomegalovirus encephalitis, and neurosyphilis. In our study, we included neuroimaging in our institutional protocol and it was a crucial component of the diagnostic work-up in our study population. MRI proved to be the preferred imaging modalities for brain and spine in confirming the diagnosis due to its multiplanar capability and excellent soft tissue resolution. Findings of TB, HIV encephalopathy and toxoplasma were the most common on evaluating HIV patients with CNS symptoms.

High Resolution Computed Tomography Assessment of Interstitial Lung Diseases and its Correlation with Spirometry Indices

Manoj Mathur, Saryu Gupta, Rajiv Bhalla, Aditi Mathur

Introduction: Interstitial lung diseases are characterized by varying degrees of inflammation and fibrosis of the lung interstitium. Lung biopsy, though the sine qua non for diagnosis is not feasible at routine health facilities due to its invasive nature. High Resolution Computed Tomography (HRCT) is now a valuable tool for the evaluation of patients with Interstitial Lung Diseases (ILD). But even HRCT is not widely available in India. Spirometry, a non-invasive modality, can be used in detecting the severity of the ILD. Spirometry carries no harmful effects of radiation, is much more easily available compared to HRCT and is also cheaper. Aim: The present study aims at an in-depth HRCT based evaluation of interstitial lung diseases with relevant spirometric correlation. Qualitative as well as semi quantitative features of interstitial lung diseases were assessed on the HRCT scan. Materials and Methods: A total of 60 patients were included in this study conducted at Government Medical College, Patiala. HRCT chest was done on Siemens-Somatom Emotion 6 slice third generation spiral CT scanner using standard protocol in supine position. Lung parenchymal abnormalities were categorized for specific diagnosis. Spirometry was performed using Medisoft Spiro Air dry rolling seal spirometer. Results: Usual Interstitial Pneumonia (UIP) was the most common ILD (55%) found in our study followed by Nonspecific Interstitial Pneumonia (NSIP) (15%) and sarcoidosis (8.33%). HRCT severity had strong and significant negative correlation with spirometry indices, especially Forced Vital Capacity (FVC), followed by Vital Capacity (VC) and least with forced expiratory volume in first second (FEV1). Conclusion: HRCT and spirometry are two simple and reliable noninvasive modalities for the diagnosis. Each ILD presents with its typical HRCT features. HRCT, with relevant clinical and laboratory information, gives a reliable diagnosis of various ILDs. Spirometry with its merits of non-invasiveness, easy availability and low cost is a reliable means for assessing the severity of disease.

Assessment of Panoramic Radiomorphometric Indices of Mandible in Diabetes Mellitus Patients and Non Diabetic Individuals

Introduction: Bone health is a crucial concern in diabetes. There are evidences for relating diabetes mellitus as a risk factor for osteoporotic fractures. Because of the large number of patients with diabetes, this condition cannot be neglected in the daily routine of dental clinics. Previous studies revealed that the thickness of the inferior cortex of the mandible can be used to predict occurrence of osteoporosis in patients. Apart from this, literature also supports the fact that panoramic radiomorphometric indices are significantly correlated with mandibular bone mineral density. Aim: To measure radiomorphometric indices of mandible on panoramic radiographs of diabetics and non diabetic individuals so that diabetes induced mandibular bony changes could be assessed. Materials and Methods: This cross-sectional study was done on 100 people who were divided in to 4 groups of 25 subjects each. Group 1 consisted of healthy controls; Group 2 consisted of type 2 diabetes mellitus subjects; Group 3 consisted of type 2 diabetics on calcium supplements and Group 4 had subjects with type 1 diabetes. A panoramic radiograph was taken for all sample population. Images were saved and viewed in DICOM format. After taking DICOM printout, all indices were manually drawn and measurements were taken. Kruskal wallis test was used to compare panoramic indices between groups. Since it was significant, dunn bonferroni test was applied. Results: MI (Mental Index), AI (Antegonial Index) and GI (Gonial Index) showed statistically significant difference between diabetics and healthy controls. PMI (Panoramic Mandibular Index) had no appreciable variation between diabetics and non diabetics. Conclusion: There was a significant reduction of bone mineral density in type 1 as well as type 2 diabetics. Thus MI, AI and GI can be considered as a primary screening tool for better appreciation of diabetic bone mineral density.

Molecular Identification of Mutations Associated with Pyrazinamide-Resistance in Multidrug-Resistant Tuberculosis in Eight Provinces of Iran

Introduction: Multidrug-Resistant Tuberculosis (MDR-TB) is a growing concern which has always played a role in controlling infectious diseases. Pyrazinamide (PZA) is one of the four front line cures of tuberculosis during the first two months of the treatment course. Diagnosis of PZA resistance is imperative in order to optimize the efficacy of new treatment regimens and minimize the risk of developing resistance to new drugs. In addition, high prevalence of PZA resistance, especially among those afflicted with MDR-TB, points to the need for developing those medicinal regimens that can be used in patients with PZA resistant MDR-TB. Aim: The aim of this study was to determine anti-tuberculosis drug resistance rate and identify the correlation between MDR-TB and of mutations in pncA gene among Mycobacterium tuberculosis isolates and frequency of mutations associated with PZA resistance in all the isolates. Materials and Methods: This is a cross-sectional descriptive study conducted from April 2014 to June 2015. A total of 118 Mycobacterium tuberculosis (M. tuberculosis) clinical strains were isolates from patients referred to TB reference laboratory of Kermanshah from 8 provinces including: Kermanshah, Lorestan, Hamadan, Ilam, Kurdistan, Ardabil, Uromia and Tabriz. Antimicrobial susceptibility testing was performed using the proportional method and Minimum Inhibitory Concentration (MIC) and mutations in pncA for the PZA resistant isolates were studied using monoplex- Polymerase Chain Reaction (PCR) and then PCR products were sent for sequencing. Results: Among the 118 clinical samples of M. tuberculosis investigated in various parts of Iran, 10 isolates (8.5%) were resistant to Isoniazid, 10 isolates (8.5%) were resistant to Rifampin, 7 isolates (6%) were MDR, and 23 isolates (19.5%) were resistant to PZA. Only did one MDR-TB isolate resistant (14.3%) to PZA show inactive mutation at Glu-122 codon that was found in pncA gene. According to our results, a significant correlation was found between MDR strains and of mutations in pncA gene (pv=0.049). pncA gene was not isolated from any of the PZA resistant isolates. Conclusion: Our findings indicated that only one MDR-TB isolate resistant to PZA showed a mutation in the pncA gene (14.3%) and mutations were not observed in the other PZA-resistance isolates. The reason for resistance to PZA in the other PZA-resistance strains might be related to mutations in other genes or to some other factors. Thus, these reasons need to be further investigated in our study population.

Study of Thalassemia and Haemoglobinopathies in Pokhara, Nepal

Ganesh Bastola, Rishikeshav Acharya, Niraj Dhakal, Umesh Prasad Gupta

Introduction: Presence of thalassemias and haemogl-obinopathies are described in some communities especially from Terai belt. However, there are no any population based studies done till date, including other parts of Nepal. So, this study may indicate the presence of haemoglobin disorder in other parts of Nepal as well. Aim: This study was done to know the presence of Haemoglobin disorder in this part of Nepal. In addition, this study also focuses on the application of electrophoresis and densitometric quantification for easy and accurate determination of Haemoglobin disorder. Materials and Methods: In this cross-sectional study, a total of 45 blood samples of all age groups with mean corpuscular volume and mean corpuscular Haemoglobin less than 80 femtoliter (fL) and 27 picogram (pg) respectively, were analysed for Haemoglobin pattern and their quantification. The Haemoglobin electrophoresis and quantification of haemoglobin was performed by using automated Haemoglobin electrophoresis system (Genio S, Italy) in an alkaline medium. Results: Out of total 45 subjects, 42 subjects (93%) showed normal Haemoglobin patterns. Two subjects were suspected to have beta thalassaemia trait based on the Haemoglobin A2 (HbA2) level. One subject showed the heterozygote Haemoglobin E. In addition, automated haemoglobin electrophoresis and direct densitometric quantification is easy and accurate method for determining haemoglobin pattern rather than manual process. Conclusion: Haemoglobin disorders are also present in other parts of Nepal, like Pokhara. In addition, this quantitative method could be of great diagnostic value rather than classical comparative method.

Assessment of Orthodontically Induced Apical Root Resorption during Anterior Retraction: A Computed Tomographic Study

Introduction: External Apical Root Resorption (EARR) is characterized by loss of the superficial layer of cells that protect the tooth root. Although many studies have estimated EARR, very few studies have examined permanent teeth from central incisor to first molar with adequate radiographic techniques like Computed Tomographs (CT) as used in the present study. Aim: To investigate the prevalence and degree of orthodontically induced EARR with fixed appliances from central incisor to first molar in permanent teeth after en-masse retraction using Dentascan. Materials and Methods: All patients had Class I malocclusion with dentoalveolar protrusion and minimum crowding (<3 mm). Total 10 patients of either sex with a mean age 18.4±3.13 years were included in the study. After first premolar extraction, en-masse retraction was carried out arch using T-Loop in maxillary and NiTi closed coil spring in the mandibular arch. Root resorption in maxillary and mandibular arch was evaluated and comparison was drawn between both the arches from central incisor to first molar using Dentascan. The t–test was used for statistical analysis. Results: The results indicated that EARR occurred in almost all the teeth from incisors to first molar but the maxillary arch was more affected compared to the mandibular arch. Lateral incisors in both the arches showed maximum root resorption (maxillary arch- 1.79±0.71 mm, mandibular arch- 1.51±0.85 mm) followed by central incisors (maxillary arch- 1.57±0.88 mm, mandibular arch- 1.49±0.85 mm) and molars (maxillary- mesiobuccal root- 0.49±0.49 mm, distobuccal root- 0.81±0.53 mm, palatal root- 1.25±0.96 mm, mandibular- mesial root- 0.42±0.25 mm, distal root- 0.42±0.20 mm) whereas minimum root resorption was seen in premolars in both the arches (maxillary arch-0.38±0.22 mm, mandibular arch-0.38±0.20 mm). Conclusion: Root resorption was seen in all the teeth to some extent. Lateral incisors showed more resorption compared to central incisor whereas premolars showed least resorption in both the arches.

Comparative Evaluation of the Antibacterial Efficacy of two different Formulations of Calcium hydroxide as Intracanal Medicaments against Enterococcus faecalis: An In vitro study

Priya Sapra, Anand C Patil, Kishore Bhat, Amritpal S Kullar

Introduction: Complete disinfection of the root canal system is necessary to ensure the success of the root canal treatment. Calcium hydroxide alone has shown to be ineffective against persistent intracanal infections. Studies have shown that addition of newer antimicrobial agents to calcium hydroxide has a synergistic effect on its antibacterial properties. Aim: To evaluate the disinfection of dentinal tubules using calcium hydroxide with imipenem and calcium hydroxide with octenidine Hydrochloride (OCT) as compared to calcium hydroxide alone against Enterococcus faecalis (E.faecalis). Materials and Methods: The antimicrobial efficacy of the medicaments against E. faecalis was assessed in vitro, using a dentinal tubule model at a depth of 400 µm in extracted single rooted permanent human mandibular premolar teeth. The dentin blocks (n=125) were contaminated with E. faecalis for 21 days. At the end of 21 days, five blocks were selected randomly and depth of penetration of microorganisms was checked using Scanning Electron Microscopy (SEM). The blocks (n=120) were irrigated using saline and randomly divided in three groups (n=40) depending on the medicament placed in the canals Group I (control)- Calcium Hydroxide {Ca(OH)2} +Saline, Group II-Ca(OH)2+imipenem, Group III- Ca(OH)2+OCT. Twenty blocks were taken from each group on 2nd and 7th day respectively. Medicament was removed. Dentin debris were harvested at a depth of 400 µm and at the end of 24 hours, optical density was evaluated using ELISA reader at 620 nm. Statistical analysis was carried out using Analysis of variance (ANOVA) and Tukey’s multiple post hoc test. Results: All the three experimental groups of medicaments exhibited antibacterial efficacy against E. faecalis on day 2 and day 7. However, when mean optical density was compared, the antibacterial efficacy of Group II on 7th day was significantly higher than Group I on 2nd day and 7th day and Group III on 2nd day. Conclusion: All the tested medicaments in this study exhibited antibacterial activity against E. faecalis on day 2 and day 7 but the most potent medicament against E. faecalis was the combination of Ca(OH)2 mixed with imipenem for 7 days.

Histological Evaluation of Epithelial Thickness, Microvasculature and Number of Mast Cells in the Gingiva of Smokers and Non-smokers with Chronic Periodontitis

Introduction: Smoking influences the clinical parameters and disease progression in many ways. Increase in the gingival epithelial thickness and alteration in the microvasculature can be associated with decreased clinical sings of inflammation and bleeding on probing. Aim: To histologically compare the epithelial thickness, vascular density, lumen area and the number of mast cells in the gingiva of smokers and non-smokers with chronic periodontitis. Materials and Methods: Gingival biopsies were obtained from 30 chronic periodontitis patients (15 smokers and 15 non-smokers) undergoing due to poor periodontal prognosis. Two sections were obtained and were stained with Haematoxylin & Eosin (H&E) and toluidine blue. The epithelial thickness, vascular density, lumen area of blood vessels and number of mast cells were assessed using histomorphometric image analysis. Results: Results of this study showed that the mean epithelial thickness among smokers was significantly increased when compared to non-smokers. The vascular density (p-value 0.790), area of lumen (p-value 0.790) of blood vessels were more in smokers than in non-smokers but did not show any significant difference. The number of mast cells were increased in smokers with significant difference when compared with non-smokers. Conclusion: Based on the present histomorphometric study, it can be concluded that smokers have increased epithelial thickness which could be attributed to the reduced clinical signs of inflammation, but vascular density and lumen area were comparable to non-smokers. The mast cell density was higher in smokers which could be attributed to the increased disease severity.

The Ameliorating Effect of Beta Vulgaris Extract on Memory and Learning Impairment Induced by Lesions of the Nucleus Basalis of Meynert in Rat

Shiva Mokhtari, Zahra Rabiei, Mehrdad Shahrani, Mahmoud Rafieian-Kopaei

Introduction: Alzheimer's Disease (AD) affects a large number of aged populations. The current therapeutic approach to treat cognitive loss associated with AD is cholinergic enhancement strategy using muscarinic or nicotinic receptor ligands and Aacetylcholinesterase (AChE) inhibitors. The Beta Vulgaris Leaves (BVL) extract has AChE inhibitory and antioxidant activities and may have beneficial effects in AD patients. Aim: To investigate the effects of BVL extract on memory impairments induced by lesions on Nucleus Basalis of Meynert (NBM) using the passive avoidance and the Morris water maze tasks in rat. Materials and Methods: Total of 49 male Wistar rats were divided into seven groups including: Group 1- control, without surgery, received saline, Group 2-NBM lesion, Group 3 and Group 4 -NBM+BVL extract 100 and 200 mg/kg b.w. per day for 15 days, respectively. A Group 5- Sham group (with surgery, but no drug), Group 6 and Group 7- intact groups which received BVL extract, 100 and 200 mg/kg b.w. per day for 15 days, respectively. The step through latency was measured by shuttle box test. The preference probe test was done using water maze apparatus. Results: In shuttle box test, the step through latency increased significantly in NBM+100 BVL (Group 3), NBM+200 BVL (Group 4), Intact+100 BVL (Group 6), Intact+200 BVL (Group 7) groups in comparison to AD group (p<0.05). In the probe test all experimental groups demonstrated a significant preference for the quadrant in which the platform was located on the preceding day. Conclusion: Our results suggested that BVL extract has repairing effects on memory and behavioural disorders in rats and may have beneficial effects on treatment of AD patients.

A Comparative Study of Single Versus Multiple Cysts of Neurocysticercosis Based on their Clinico-Serological Profile

Ishwar Agrawal, Manish Mittal, Garima Mittal

Introduction: Neurocysticercosis (NCC) is a common disease in developing countries. Its diagnosis is based on clinical, epidemiological, imaging findings and laboratory tests. Aim: To study and compare the clinical profile and diagnostic utility of NCC IgG ELISA in patients with single and multiple neurocysticercosis. Materials and Methods: This cross-sectional study was conducted in the Department of General Medicine, Himalayan Institute of Medical Science (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months from August 2014 to July 2015. Patients were grouped into those with single NCC and multiple NCC based on their radio imaging findings. A total number of 60 patients, 30 in each group were taken in the study and their clinical profiles were studied. Serum Immunoglobulin G(IgG) Enzyme-Linked Immunosorbent Assay (ELISA) test was applied on both the groups and serological profile was thus compared. Results: Most commonly affected age group was 18 to 35 years of age (60%). Most common symptom at presentation was seizure (53%). Out of 60 patients, 39 suffered from generalized tonic-clonic seizures. Status epilepticus was found exclusively in patients with multiple NCC (26.6%). Sensitivity of serum IgG ELISA was 53.3% amongst single NCC and 76.7% amongst multiple NCC. Conclusion: NCC may present with varied clinical features. No sign or symptom is pathognomic of the disease entity. Diagnostic tests are the only method to clinch the diagnosis. Detection of specific antibodies in patients with NCC is a useful tool for diagnosis, especially when radio imaging facilities are not available or inconclusive. Serological tests are useful if they are positive. Negative tests, however, do not exclude the diagnosis of NCC.

Knowledge, Utilization and Benefits of a Child Health Care Scheme

Sheetal Sriraman, Shantharam Baliga, Bhaskaran Unnikrishnan, Nutan Kamath

Introduction: Child health plays an essential role in shaping the future of a community. For this reason, governments worldwide have made child health care a priority. Studying the trends of utilization and benefits of child health care schemes is therefore, imperative to assess its impact on the community. Aim: This study was undertaken to assess the knowledge, utilization and benefits of a child health care scheme Bal Sanjeevani Program (BSP) in a Government District Hospital. Materials and Methods: Hundred children belonging to Below Poverty Line (BPL) families, between 0 to 6 years of age admitted for tertiary care were divided equally into cases and controls. The children who availed the BSP were enlisted as the case, whereas those who did not avail the benefits of the BSP were enrolled as the control. The study was conducted in March and April 2016. A semi-structured questionnaire was used for data collection, after approval of the Institutional Ethics Committee. Data analysis was done using SPSS 16.0. Descriptive statistics as well as the Chi-square test were used for analysis. Results: Of the respondents, 61(61%) had heard of the BSP, of which 11(22%) chose not to register for the scheme. Of those not availing the scheme, 39(78%) stated lack of awareness as the main reason for non-utilization. The mean expenditure of those not utilizing the scheme was 12.87 times more than that of the mean expenditure of those utilizing the scheme. Conclusion: This program significantly alleviates the financial burden on families with children admitted in tertiary care centers. Increasing the awareness regarding the BSP and identifying eligible children at the Primary Health Care (PHC) level would enhance optimum utilization of this scheme.

Association of Lin-28A rs3811464 Variant with Susceptibility to Type 2 Diabetes

Mona Khodabandeh, Hamid Ghaedi, Behnam Alipoor, Taghi Golmohammadi

Introduction: It has been suggested that Lin-28A and the let-7 microRNA family (Lin-28/let-7 axis) play a critical role in the control of glucose metabolism, insulin sensitivity and resistance to diabetes. Aim: This case-control study aimed at evaluating the association between Lin-28 rs3811464 polymorphism and the susceptibility to Type 2 Diabetes (T2D) in a sample of Iranian population. Materials and Methods: This study involved 172 T2D patients and 160 non-diabetic age and gender-matched controls. Lin 28A rs3811464 genotypes were determined by Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP) technique. Results: The results showed that the frequency of the AA genotype was significantly higher in control subjects than in diabetic patients (13.12% vs. 4.65%). In addition, binary logistic regression analysis revealed that rs3811464-AA genotype was significantly associated to T2D after adjustment for BMI, age and lipid profiles. Indeed, subjects with AA genotype were less likely to develop T2D than GG and AG subjects (OR of 0.26, 95% CI 0.10-0.66, p=0.005). Conclusion: The findings of our study suggest that the Lin 28A rs3811464 is associated with type 2 diabetes susceptibility and subjects with AA genotypes were less likely to develop T2D diabetes.

Clinical Evaluation of Effect of Instrument Size and Type on the Accuracy of Electronic Apex Locator on Upper Premolars

Introduction: Root canal treatment is a standard procedure for pulpal diseases and dental injuries. Working length determination is significantly important for successful outcome of root canal treatment. Aim: The aim of this in vivo study was to evaluate the effect of instrument Size and Type on the accuracy of Electronic Apex Locator (EAL) on upper premolars. Materials and Methods: One hundred and twenty root canals from 98 patients scheduled for endodontic treatment were included in this study and informed consent was obtained. Electronic measurements were made using Root ZX apex locator with stainless steel ISO k-file #8, #10, #15 and Nickel Titanium (NiTi) ISO k-file #8, #10, #15 in sequence and also radiographic length was measured. Statistical analysis was analysed with One-way ANOVA and Post-Hoc Tukey HSD tests. Results: It was found that a highly significant difference was found between Ingle’s method and apex locator measured with stainless steel and NiTi #8 files and significant difference with Ingle’s method and apex locator measured with NiTi#10. There was no significant difference found between Ingle’s method and apex locator measured with stainless steel and NiTi #15 files and stainless steel #10 file. Conclusion: Stainless steel files showed more accurate results compared to their corresponding NiTi files. This study has concluded that the use of steel instruments whose size corresponds to master apical file brings the best results.

The Influence of Vitamin D on the Temporomandibular Joint and the Activities of Daily Living

Sunali Sundeep Khanna, Nikhil R Parulekar, Prita Abhay Dhaimade

Introduction: A significant correlation has been established between the pain and/or discomfort of Temporomandibular Joint (TMJ) and the various Activities of Daily Living (ADL). TMJ pain and/or discomfort have a significant negative impact on the daily activities and life of an individual. Although complex interplay of multifactorial causes accounts for temporomandibular disorders, bone markers like serum vitamin D are a reliable qualitative and quantitative tool to asses bone metabolism and health. Aim: To investigate the association between TMJ pain and discomfort in the ADL and to ascertain the relationship between serum vitamin D 25(OH)D levels and pain and discomfort with respect to TMJ during the ADL amongst controls and vitamin D deficiency patients in an Indian hospital based population in Mumbai, Maharashtra, India. Materials and Methods: The study included 100 adult patients reporting to the department of oral medicine and radiology on outpatient basis, who were divided into two groups (samples and controls) based on their serum 25(OH)D levels, the cut-off being 30 nmol/L. The effect of vitamin D levels on the activities of daily living were assessed using the scale by List and Helkimo. Variables were evaluated for statistical differences between male and female groups with Anova ova test. Significance of correlation was tested using Spearman rank correlation coefficient. A level of significance of 0.05 was considered to be significant. Results: In the study it was found that the serum vitamin D levels in female participants was lower than the male participants. The experience of TMJ pain and discomfort significantly impacts the activities of daily living in both sexes based on the rating scale elaborated in medical and behavioral science and modified by List and Helkimo. The study also shows that the pain/discomfort associated with TMJ has a significant negative influence on the social life, daily activities and also the psychological status of the individual. Conclusion: Vitamin D deficiency is significantly associated with tempormandibular pain, which can have adverse effects on the comfort and ADL of the patient.

A Comparative Study of Surgical Outcomes Following Onlay and Underlay Repairs for Ventral Hernias

Joseph Mathew, V Shashikala, N Arun Kumar

Introduction: Today, a variety of procedures are available for ventral hernia repair. Prosthetic reinforcement is necessary in all but the smallest of hernias to reduce recurrence rates. However, the ideal site of mesh placement for better outcomes in open repair has not been established in literature. Aim: To compare onlay and underlay (either retrorectal or preperitoneal) techniques in adults, with respect to operative parameters and treatment outcomes, and to determine the associated prognostic factors. Materials and Methods: This prospective, observational study was conducted from January 2012 to January 2015 at Bangalore Medical College and Research Institute; 199 patients with midline ventral hernias (primary or following first recurrence) with defect size less than 10cm and scheduled to undergo mesh repair were selected. Demographic data, relevant comorbidities, body mass indices and hernia characteristics were noted preoperatively. Type of repair was decided by the attending surgeon based on clinical judgement. Operating time, post-operative pain, wound-related complications and duration of hospitalization were recorded. Patients were followed-up for two years to detect recurrence. Statistical analysis was performed using one way-ANOVA to compare means and Chi-square test, to determine association between categorical variables. p-value <0.05 was considered statistically significant. Results: Mean age at presentation was 44.3±12.90years. Females comprised 77.9% of cases. Primary hernias constituted 66.3%. Mean follow-up period was 15.9±8.39months. Onlay repair was performed in 56.3% whereas retrorectal and preperitoneal in 22.6% and 21.1% cases, respectively. Significantly shorter operating time (in minutes) was noted with onlay (48.8±8.63) compared to retrorectal (59.0±15.47) and preperitoneal (64.5±16.00) repairs (p<0.001). Differences in pain scores were not statistically significant. Incidence of surgical site occurrences (SSO) and length of hospitalization were significantly higher with onlay repair (p-values 0.005 and <0.001, respectively). Statistical significance was not evident when comparing recurrence rates at 1year follow-up. Obesity, diabetes and previous surgery were associated with significantly higher SSO rates, pain scores and duration of hospital stay. Conclusion: Compared to onlay, underlay repairs have significantly lower wound-related complications and may be considered the procedure of choice over other open techniques for small, uncomplicated ventral hernias. Obesity, diabetes and prior surgery are important risk factors adversely affecting surgical outcomes.

Health Needs Assessment among Female Adolescents: A Case Study from Iran

Introduction: Identification of health needs of female adolescents is a necessity due to their double roles in the health status of current and future generations. Aim: To assess various types of health needs in physical, mental-emotional, social, spiritual, and educational aspects among Iranian female adolescents. Materials and Methods: A total of 400 girls studying in high schools of Khorramabad city of Iran, were selected using the stratified sampling and multistage cluster sampling. The tool used for data collection was Female Adolescents Health Needs questionnaire. SPSS Version 20 Software was used to analyse the obtained data via Pearson correlation coefficient, ANOVA, and t-test. Results:The mean score and the Standard Deviation (SD) of the girls health needs were 89.79±11.47. The highest and lowest health needs were spiritual and educational needs with the average scores of 94.79±11.70 and 87.37±14.13, respectively. The correlation coefficient test indicated that there is a strong and significant correlation between different dimensions of female adolescents health needs. Social (75%) and spiritual (65%) dimensions had the highest and the lowest correlations with other dimensions, respectively. Conclusion: The study results show that the girls had varied health needs. To be prioritized are spiritual health, physical health, social health, mental-emotional health, and educational health, as found in this study.

The Expanding Spectrum of Zika Virus Transmission: A Systematic Review

Denise Araujo, Silvia Vilas Boas, Uyi Faluyi, Srinivas Medavarapu

Introduction: Large numbers of confirmed Zika Virus (ZIKV) infections have been reported as a result of vector-borne and non-vector-borne transmission. With a recent ZIKV outbreak, several methods of transmission have been identified during this pandemic. Knowledge of transmission methods is essential to prevent further spread. Aim: To conduct a literature review on ZIKV and its methods of transmission, to improve the understanding of how the virus may spread. Materials and Methods: Systematic literature review was performed on methods of ZIKV transmission including: vector-borne, sexual, mother to foetus, blood transfusion, and breast milk. Results: A total of 18 articles were reviewed involving 2573 cases. Vector-borne transmission was most prevalent in ZIKV cases, followed by mother to foetus vertical transmission and sexual transmission. ZIKV has been detected in blood, urine, semen, saliva, amniotic fluid and breast milk. However, ZIKV is not present in all bodily fluids at one time. Blood and semen have proved to be infectious and a contributory to the spread of ZIKV. It is unknown whether breast milk is infectious to neonates. Conclusion: Our systematic review demonstrates the influence of different methods of ZIKV transmission possess with the spread of ZIKV. It provides significant implications on testing, prevention and control of ZIKV. Finally, it provides a guide for further research opportunities.

A Review of Knowledge and Attitudes Towards Dementia Among College and University Students

Introduction: Dementia is pressing problem for family and society. Next generation health care providers which are current healthcare program students are important part of professional caregiving system in future. Particularly, having good knowledge and attitudes towards dementia will be key elements in providing best care for people with dementia. Aim: The aim of this paper is to review the literature of the knowledge and attitudes towards dementia among college and university students. Materials and Methods: Academic Search Complete, Psychology and Behavioural Sciences Collection, Medline Complete, SocINDEX with full text, Education Research Complete and ERIC databases from January 2010 to March 2017 were used to identify relevant papers for this review. Key words used in the search were "knowledge," or "attitude," or "perception," or "opinion," or "belief," and Dementia," or "Alzheimer's," and "students." The inclusion criteria were peer-reviewed academic journals, English language, focussed on knowledge, attitude, perception, opinion or beliefs towards Dementia or Alzheimer's Disease (AD) and studies that include college and university students as study sample. Meanwhile, the exclusion criteria were papers published before January 2010, non-English language papers, topics not related to knowledge and attitude towards Dementia and the study sample does not represent college and university students. Results: A total of eighteen studies on knowledge and attitudes towards dementia among college and university students were found and reviewed. Ten of the studies (55.56%) were experimental intervention programmes while seven (38.89%) were questionnaire surveys. However, one paper did not report the study design. The intervention programmes which included clinical hands-on experience with dementia patients consistently improved students knowledge and attitudes towards people living with dementia. Current evidence shows that there is room for improvement in the curricular, particularly for courses related to clinical healthcare services. Conclusion: This review provides basis for future planning to improve the current curricular by addressing the gaps in knowledge, incorporating hands-on clinical experience as well as integrating interprofessional approaches into the teaching or training module.

IL-21: The Future of Medicine

Interleukin-21 (IL-21), a T- cell-derived cytokine, is a signaling molecule secreted by a subpopulation of T cells called follicular T helper (Tfh) cells. Studies have proved that IL-21 co-stimulates T cell proliferation by mediating enhanced T cell viability. This is done when IL-21 binds to its receptor, activating the phosphatidylinositol-3 kinase (PI-3K) signaling pathway and inducing B-cell Lymphoma-2 (Bcl-2) expression. Besides the B and T cells, IL-21 also regulates several Natural Killer (NK) cell functions. Due to its multi-faceted effects on different receptors, IL-21 has been used in multiple diseases. However, it was recently found that IL-21 had potent effect on various viruses including Lymphocytic Choriomeningitis Virus (LCMV), influenza virus and Vesicular Stomatitis Virus (VSV). The study proved that both B and CD4+ T cells need IL-21 signaling for generating long-term humoural immunity by generating long-lived plasma cells, thus, highlighting the importance of IL-21 in humoural immunity to viruses. These findings highlight how IL-21 could be important in the development of antiviral vaccines and vaccines for other potential life-threatening diseases leading scientists to design future vaccines to incorporate IL-21 directly or to use the ability to stimulate IL-21 as a gauge of vaccine activity. It is the need of the hour to go for larger studies which will be needed to better elucidate the cause and effect relationship and to demonstrate the effect size. It may possibly yield appreciable results in the future for untreatable diseases like HIV/AIDS.

Oral Habits Associated with an Increased Risk of Oral Cancer in Vietnam

While tobacco and alcohol related oral cancer is showing a decreasing trend in most of the developed countries, this is not the case with South Asian and South-East Asian countries including Vietnam, where the incidence of oral cancer is increasing. The usage of tobacco, alcohol and betel nut products, all well established oral cancer risk factors, is prevalent in Vietnam; however, there is a lack of information in literature regarding the incidence of oral cancer in Vietnam and the associated types and forms of associated risk factors. In this paper, we provide an overview of oral cancer and precancer incidence with description of oral cancer related habits practiced in the Vietnamese population. We also describe the cultural aspects of these habits as well as the implementation of new tobacco regulations by Vietnam government.

Clinical Significance of Presence of Extensor Indicis Brevis Manus – A Case Report

N Esakkiammal, Renu Chauhan, Rakhee Sharma

Anatomical variations of additional muscles and tendons are commonly encountered in extensor aspect of the forearm and hand during surgeries and dissections. There are reports on different kinds of variations like, extra tendons, additional bellies, and abnormal attachments of the muscle. Surgeons should have the knowledge about these variations for muscle or tendon grafting and also to plan surgeries. While dissecting the extensor compartment of the forearm and dorsum of hand of an elderly female cadaver, an anomalous muscle belly was noticed on dorsum of hand bilaterally alongwith the main tendon of extensor indicis muscle. This additional belly of extensor indicis muscle was called Extensor Indicis Brevis Manus (EIBM). This muscle originated from the dorsal carpal ligament and joins the main tendon of extensor indicis muscle in both the hands. Awareness of existence of this kind of variation is important for clinicians and surgeons for a correct diagnosis and eventual surgery in patients presenting with a cyst on the dorsum of hand, to avoid accidental mishaps.

Primary Xanthoma of Ulnar Bone in a Normolipemic Patient

Xanthoma of bone is an exceedingly rare primary bone lesion. It is generally known that bone xanthomas are associated with hyperlipidemia. Non-hyperlipidemic xanthomas are very rare. Radiologically it presents as well-defined osteolytic lesion thus mimicking benign bone tumours. Definitive diagnosis is based mainly on histopathology. Histologically, presence of sheets of foamy macrophages with multinucleated giant cells and cholesterol clefts at places confirms the diagnosis of xanthoma. Surgical curettage followed by bone grafting is curative. We report a case of skeletal xanthoma in ulnar bone of a non-hyperlipidemic patient.

Urinoma Secondary to Posterior Urethral Valve Presenting with Features of Intestinal Obstruction in a Neonate: A Case Report

Arijit Bhowmik, Dona Banerjee, Rajasree Sinha, Sandeep Lahiry

Urinoma (or perirenal uriniferous pseudo cyst) occurs due to extravasation of urine in the perirenal space. Common causes include traumatic renal injury or an obstruction in the outflow tract as in a posterior urethral valve. Though rare, such diagnosis should be considered in neonates presenting with expanding cystic masses in the abdomen. Here, we present a case of a four-day-old neonate, who presented to us with abdominal distension and bilious vomiting. The initial radiographic studies showed a cystic mass surrounding the right kidney. Urine was aspirated from the mass and Micturating Cysto-Urethrogram (MCU) showed the presence of a Posterior Urethral Valve (PUV). A diagnosis of urinoma secondary to PUV was confirmed. After relieving the obstruction by vesicostomy, symptoms of intestinal obstruction resolved. On later follow up, size of urinoma also gradually decreased. This proves that not every case of a distended abdomen and bilious vomiting in a neonate, necessarily points towards Necrotising Enterocolitis (NEC) or intestinal obstruction.

Sinonasal Neuroendocrine Carcinoma in a Young Female – A Case Report

Divya Radhakrishnan, Nilambur Kovilakam Supriya, K Rajasree Varma

Sinonasal Neuroendocrine Carcinoma (SNEC) is a very rare malignancy which is difficult to differentiate from other nasopharyngeal malignancies due to similar morphological characteristics and small biopsy specimen. We report the case of a 35-year-old female who presented with nasal obstruction and recurrent epistaxis. Histopathological examination along with immunohistochemistry for neuroendocrine markers is required for accurate diagnosis.

Melena Secondary to Duodenal Dieulafoy’s Lesion: A Rare Case Report

Melena is one of the presenting feature of Upper Gastrointestinal Bleeding (UGIB). Melena due to Dieulafoy’s lesion in the duodenum is one of the obscure causes of Gastrointestinal Bleeding (GIB) and is a rare but life threatening entity. We report a unique case of Dieulafoy’s lesion in a 74-year-old male patient with premorbid condition of diabetes who presented with two episodes of blackish coloured stools, filling up the entire toilet bowl. No other symptoms of either abdominal pain, vomiting of blood, fever or any intake of medications were noted. Upper Gastro-Intestinal (UGI) endoscopy revealed abnormal vessels at D1/D2 of C loop duodenum with normal mucosa consistent with Dieulafoy’s lesion along with active bleeding. Haemoclips were applied to the duodenal Dieulafoy’s lesion and patient recovered well. This case was reported for the first time from Malaysia.

Multidisciplinary Conservative Approach to Restore Mutilated Immature Maxillary Central Incisor with an Unusual Foreign Object in the Root Canal Space - A Rare Case Report

Restoration of mutilated tooth with immature apex in a young patient presents challenge in complete biomechanical preparation, achieving apical seal and post endodontic restoration. The present article describes three years follow up of successfully managed mutilated maxillary central incisor with an immature apex and evidence of foreign object in the root canal space followed by its aesthetic rehabilitation. After retrieval of foreign object from the root canal, root end maturation was accomplished by using combination of deproteinized bovine bone mineral (Bio-Oss) and Enamel Matrix Derivative (EMD). To achieve optimum gingival attachment with alveolar bone support, mutilated tooth was extruded using removable orthodontic appliance and restored functionally using fibre post. Finally both traumatised maxillary incisors were rehabilitated aesthetically with full coverage acrylic crowns. At three years follow up, the patient had no clinical symptoms or any radiographic sign and the healing of periapical lesion and formation of the apex was observed.

Aesthetic Rehabilitation of Class II Malocclusion through Interdisciplinary Approach: A Case Report

Aesthetics has become a respectable concept in dentistry as people are being more concerned of their appearance in today’s world. Malocclusion is one such condition for which patients seek treatment for because of its significant impact on function, aesthetics and psychological condition and we come across increased number of young adults who desire cost effective, non-surgical correction of these malocclusions in shortest possible time in our day-to-day practice. The optimal treatment for these malocclusions may include orthodontic therapy, orthognathic surgery, periodontics and fixed or removable prostheses. If the patients do not accept or undergo optimal dental treatment, other treatment modalities are to be considered. This article describes an aesthetic rehabilitation of class II malocclusion with a conservative interdisciplinary treatment plan tailored to the patient’s specific dental and skeletal problems, as well as considering her needs and desires.

A Case of True Hemaphroditism Presenting with Dysgerminoma

Manika Khare, Manish Kumar Gupta, Ashish Airun, Umesh Babu Sharma, KM Garg

The true hermaphroditism represents only 5% of all disorders of sexual differentiation, thus it is one of the rarest varieties. Diagnosis of true hermaphroditism requires the presence of both ovary and testis either as separate organs or combined to form unilateral or bilateral ovotestis. Dysgerminoma is one of the tumours which are commonly seen in true hermaphrodites. The main treatment modality includes removal of the dysgerminoma followed by chemotherapy if the tumour is Ib-IV stage So, early diagnosis of hermaphrodite and associated tumours can help the patient to lead a better life ahead as enlarged tumours have more aggressive treatment and are associated with poor prognosis. We are presenting this case because true hermaphrodites are themselves rare, and association with germ cell tumours is still rarer. This case is still special as the diagnosis of true hermaphrodite was made during surgery only.

Prosthetic Joint Infection due to Burkholderia cenocepacia: An Opportunistic Pathogen with an Expanding Spectrum of Disease

Sujeesh Sebastian, Rajesh Malhotra, Rojaleen Das, Arti Kapil, Benu Dhawan

Burkholderia cenocepacia is an opportunistic pathogen widespread in moist environments. It has been associated with lung infections, blood, skin and genitourinary tract infections. We report here the first case of Prosthetic Joint Infection (PJI) caused by B. cenocepacia isolated from the periprosthetic tissue samples and prosthesis sonicate fluid identified by Matrix-Assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS). A good clinical outcome was obtained by two-stage exchange arthroplasty and administration of co-trimoxazole and ciprofloxacin. In addition to the expanding spectrum of this opportunistic pathogen, this case also shows the reliability of newer diagnostic tools to rapidly identify the Burkholderia Cepacia Complex (BCC) to the species level.

Thiopentone Induced Paralytic Ileus in Super Refractory Status Epilepticus: Erythromycin to the Rescue

Karen Ruby Lionel, Ajay Prasad Hrishi

Neurocritical care, a unique specialty requiring skill and adeptness presents us with many challenging situations. Management of super refractory status epilepticus warrants the use of intravenous anaesthetic agents and along with it comes its various complications such as paralytic ileus which need to be diagnosed accurately and managed appropriately. We report a case of a patient diagnosed with super refractory status epilepticus who developed paralytic ileus because of thiopentone infusion which was refractory to the conventional prokinetic therapy resulting in the decision to initiate Total Parenteral Nutrition (TPN) but responded dramatically to intravenous erythromycin. Hence, we would like to highlight this as an important tool in the armamentarium in paralytic ileus management.

Aseptic Inflammation and Synovitis of Knee by Splinter Injury in an Adult- A Rare Presentation

Pankaj Kumar Mishra, Anil Kumar Pandey, Aashish Anand Gupta, Tanmay Shah

Synovitis of knee due to an unaware incident of splinter piercing is rare in adults. This is a case report of 30-year-old female with a painful knee in a flexed attitude with a swelling. Her history did not reveal any positive findings, i.e., recent trauma, fever or any such previous episode. Arthrotomy revealed a turbid synovial fluid with inflamed friable synovial thickening. On further inspection, there was a presence of a foreign body in the suprapateller pouch. It was removed and washed. This was ultimately found to be a splinter. Normal inflammatory markers with minimal signs and symptoms of infection may provide weightage to this differential diagnosis. Arthrotomy and antibiotic coverage can give an excellent result.

Tooth Extraction in a Hepatic Cirrhosis Patient Receiving the Novel Oral Thrombopoietin Receptor Agonist Lusutrombopag

Lusutrombopag was administered to a patient with thrombocytopenia due to chronic liver disease before an invasive procedure. Lusutrombopag, the first drug of its kind, was developed to improve platelet count thereby, avoiding the need for platelet transfusion. Lusutrombopag is potentially effective for the management of haemostasis during invasive procedures, such as tooth extraction. Herein, we present a case of tooth extraction surgery in a patient treated with lusutrombopag. The patient was a 63-year-old woman suffering from thrombocytopenia due to liver cirrhosis. Tooth extraction was indicated by the diagnosis of caries and apical periodontitis of the maxillary left second molar. Mild spontaneous bleeding in the surrounding gum tissue and a reduced platelet count (5.1 × 104/µL) were observed. Haemostatic difficulties were predicted to accompany tooth extraction surgery. Consultation with a gastroenterology clinic led us to implement lusutrombopag prior to the procedure. The patient’s platelet count had risen to 10.9 × 104/µL by the day of the surgery. Neither intraoperative nor postoperative bleeding was observed. No adverse events associated with lusutrombopag administration were observed. Lusutrombopag can increase platelet count, suggesting its utility in invasive procedures such as tooth extraction.

Evaluation of Cellular Response to the Indigenously Fabricated Dental Magnet for Application in Prosthodontics- An Animal Study

Introduction: Prosthetic constructions retained by magnets play an important role in the application of dental removable prosthesis and orofacial epithesis. One of the issues during the introduction of these magnets into clinical practice is that they may exert some negative impact on the surrounding tissues. Therefore, the effect of the indigenous dental magnets on the cellular changes needs to be qualitatively evaluated. Aim: To check the effect of indigenously fabricated dental magnets on the cellular changes in the dermis and epidermis of rabbits. Materials and Methods: A total of five New Zealand rabbits were selected from the animal house of SDM Medical College, Dharwad. A small sub cutaneous incision was made on the back region of the rabbit on right and left side with a no. 15 Bard Parker (BP) blade under phenobarbitone anaesthesia. The skin layers were slightly dissected under the incision creating a pouch. Bare magnet without casing (control) was embedded in the pouch on one side and the teflon encased magnet (test) on the other side. Sutures were placed and post-operative care was taken. The obtained tissues were paraffinized and sections were stained with haematoxylin and eosin. The parameters assessed were thickness and keratinization of epidermis and arrangement of fibres and type of infalmatory cells in dermis. Data was subjected to statistical analysis. Mann-Whitney U test was performed. Results: Statistically significant difference was observed in keratinization at 28 days and was still observed after 3 months. There was no difference in dermal fibres arrangement or chronic inflammation at the end of three months between the two groups. Haematoxylin and eosin stained sections from control and test showed mild chronic inflammatory response at 28 days. Inflammation subsided in three months in the test sample, whereas focal aggregates of inflammation were evident in control sections. Persistence of inflammatory cell reaction in control samples indicates mild cell toxicity induced by the magnet. Conclusion: To conclude indigenously fabricated dental magnet did not show host inflammatory reaction in the animal study model over the control magnet.