Journal of clinical and diagnostic research

Toxic Trauma: A Basic Clinical Guide, Second Edition

Amin Talebi

LMP1-Positive Composite Tumour of Larynx: A Diagnostic Quandary

Malignant spindle cell tumours of the larynx are rare, of which the most common are Spindle Cell Squamous Carcinomas (SCSCs). Sarcomas are extremely infrequent in the larynx. Composite tumours, further, are quite unheard of, except for rare case reports. This case report describes a spindle cell malignancy of the larynx in an elderly male, which posed a diagnostic difficulty due to its unique morphological and immunohistochemical features. The tumour was superficial, polypoidal with the proliferation of malignant spindle cells and abundant mitoses under an ulcerated epithelium. Occasional squamous cell rests with keratin pearls were present. Spindle cells were strongly immunoreactive for vimentin, smooth muscle actin and squamoid cells were p63 positive. Desmin was negative. The dilemma in diagnosis was of a SCSC with smooth muscle differentiation against a composite tumour. The tumour also turned out to be positive for Epstein Barr Virus Latent Membrane Protein-1 (EBV-LMP1), establishing a noteworthy association.

Bilateral Psammomatoid Ossifying Fibroma of Maxilla

Ossifying-Fibroma (OF) is a benign neoplasm histopathologically composed of fibrocellularstroma and variable amount of mineralized material. Generally, these tumours in jaw bones are found as solitary lesions. Occurrence of these tumours as Multiple Ossifying Fibromas (MOF) in jaw bones is very rare. The studies reported till now have found an association between MOF and Hyperparathyroid Jaw Tumour Syndrome (HPT-JT). HPT-JT is always associated with the genetic mutation in tumour suppressor gene HRPT2 which encodes protein parafibromin. The simultaneous presentation of ossifying fibroma and other features of HPT-JT may or may not be present. Thus, the expression of parafibromin needs to be evaluated in MOF to rule out it’s association with HPT-JT. The present case of 24 years old female patient, showed bilateral maxillary Psammomatoid Juvenile Ossifying Fibroma (PsJOF). The patient was further investigated for association with HPT-JT. Other finding such as blood serum calcium and parathyroid assay were normal. A negative expression of parafibromin in the tumour tissue suggested an association with HPT-JT. Thus, evaluation of parafibromin can help in accurate diagnosis and treatment of MOF of jaws.

Floating Canine in Maxillary Sinus – Case Report and Overview of Pathogenetic Literature

Ajay M Bhandarkar, Shubhika Jain, Adarsh Kudva, Kailesh Pujary

The eruption of tooth other than the alveolar arch is called Ectopic Tooth. It is frequently encountered in the maxillary sinus. Facial pain is the most common presentation which is commonly misdiagnosed as chronic sinusitis. We present a case of a 47-year-old lady who was incidentally diagnosed to have an ectopic free lying canine in the maxillary sinus and discuss the various theories mentioned in literature predisposing to this condition.

Cisplatin Induced SIADH in Patients Receiving Concurrent Chemoradiation Therapy: A Rare Clinical Observation

The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) can be attributed to various causes such as CNS disorders like head trauma, stroke, pulmonary lesions like TB, bacterial pneumonia, as paraneoplastic syndromes in malignancies, drugs like antidepressants, antineoplastics like cyclophosphamide, vincristine, vinblastine, bortezomib, carboplatin and others. Cisplatin induced SIADH is very uncommon and hence, scarcely reported in literature. Here, we report two cases of dilutional hyponatremia secondary to SIADH that developed in two patients receiving radiotherapy with concomitant cisplatin.

Prosthetic Rehabilitation of a Large Frontal Cranial Defect-A Case Report

With an increased incidence of automobile accidents, head injuries in road traffic accident victims are common. In order to salvage the vital intra-cranial structures from the effects of trauma, emergency attention is necessary. Retrieval of crushed bone fragments or drainage of haematomas to relieve intracranial pressure leaves the patient with continuity defects and unprotected brain tissue. Due to the complex field of expertise involved, rehabilitation of such defects is challenging and requires interdisciplinary attention. This article reports a case of a large frontal cranial defect rehabilitated using a heat polymerised polymethyl methacrylate acrylic resin prosthesis.

Inadvertent Diversion of Superior Vena Cava to the Left Atrium- A Diagnosis Made by Bubble Contrast Echocardiography

Mahendra Tilkar, Agam Bansal

Sinus venosus Atrial Septal Defect (ASD) is the abnormal drainage of pulmonary veins to right atrium, which can present with symptoms of pulmonary hypertension. Sinus venosus ASD presents a diagnostic challenge considering low detection rates using transthoracic echocardiography. We report a case of a 36-year-old female in whom the sinus venosus ASD was wrongly diagnosed as primary pulmonary hypertension. Also, the role of transoesophageal and bubble contrast saline echocardiography in detecting an adequate closure of sinus venosus ASD after the surgical repair was presented. Based on transthoracic echocardiography and ECG findings, the patient was diagnosed with primary pulmonary hypertension. Because of the persistent symptoms and failure to improve with Bosentan, Sildenafil and diuretics, the patient was advised Transoesophageal Echocardiography (TEE), which revealed superior venacava sinus venosus ASD. The patient had surgical closure of the defect but she developed cyanosis and hypoxemia after the surgery. The bubble contrast saline echocardiography was performed for detecting adequate closure of the defect. The bubble contrast echocardiography showed simultaneous opacification of all the four chambers of heart. Thereby, a repeat surgery was done and patient experienced improvement in her symptoms. The present case concludes that bubble contrast saline echocardiography can be used to detect the presence of intra and extra-cardiac shunt.

Bilateral Radicular Dens Invaginatus in Mandibular First Premolars-Report of Two Rare Cases

YM Karuna, Shailaja Datta, BS Suprabha, Arathi Rao, Ravikiran Ongole

Dens invaginatus is a developmental dental anomaly which is clinically seen as a furrow on the palatal aspect of the tooth either limiting to the coronal pulp or extending to the radicular apex. It occurs most commonly in females affecting crowns of the maxillary lateral incisors. This case report presents two bilateral cases of Type II radicular dens invaginatus in mandibular first premolars. It was an incidental diagnosis on an intraoral periapical radiograph when a 12-year-old male patient and a 12-year-old female patient reported with their respective chief complaints. Conservative management in the form of strict follow up of the cases was planned.

Femoral Mononeuropathy: A Rare Manifestation of Complicated Leptospirosis

Arjun Nidambur Ballal, Manjunatha Hande

Neurological manifestations associated with leptospirosis are uncommon with only a few cases reported so far. The present case is of a 65-year-old man with a severe form of leptospirosis, complicated by acute renal failure, jaundice and femoral mononeuropathy. During the course of his hospitalisation, he developed a weakness of his left leg and sensory deficit over his left thigh along the femoral nerve distribution. A nerve conduction velocity study confirmed femoral neuropathy. No other cause for neuropathy could be elicited. His neurological deficits significantly improved with treatment of leptospirosis.

Resolution of Fluid and Normalised Hearing Sensitivity in Otitis Media with Effusion by Ayurveda Management

K Sivabalaji, Sundararaman, BN Ashwini

The current treatment modality for otitis media with effusion is surgical intervention but recurrence is common. This case report discusses the Ayurvedic treatment of a case diagnosed as otitis media with effusion, which was posted for myringotomy with grommet insertion. A five-year-old boy on antihistamines and antibiotics for 3 months presented with constant hearing loss and difficulty with speech discrimination. The features suggestive of otitis media with effusion were diagnosed by pure tone audiometry and tympanogram. Ayurveda medication was started and surgery was deferred because the patient responded positively. The 45 dB and 30 dB conductive hearing loss detected by audiometry improved to 15 dB and 11.6 dB, which is within normal limits. The patient became asymptomatic and recovered his sense of hearing. Till date, there has been no recurrence. Non-surgical intervention of otitis media with effusion demonstrated normalised hearing sensitivity and relief from symptoms. Validation should be further conducted using larger studies.

Mucoepidermoid Carcinoma of Lung Presenting as a Peripheral Cavitary Lesion

KO Rohit, Jacob Baby, K Praveen Valsalan, Elizabeth Sunila, Mitchelle Lolly

Mucoepidermoid Carcinoma (MEC) is a salivary gland neoplasm which originates from minor salivary glands in proximal bronchi. They are usually central in location adjacent to large airways. Here, we report a case of MEC which presented as a peripheral lesion with central cavitation. Patient underwent left upper lobectomy and histopathology was positive for p63, p40, CK5/6, CK7 and negative for TTF-1, Napsin A, with overall features in favour of high grade MEC. Post procedure he was stable and was later advised for chemotherapy.

Paraganglioma of the Urinary Bladder – A Diagnostic Dilemma

Bhaskar Smitha, Koppalkar Kiran Rachana, Pai Muktha Ramesh

Paraganglioma of the urinary bladder is a unique neuroendocrine tumour originating from chromaffin tissue of the sympathetic nervous system. Clinically, patients may be asymptomatic or may present with hypertension or haematuria. Imaging features may suggest urothelial carcinoma. An uncommon case of a silent paraganglioma of the urinary bladder in an elderly female is documented here, who presented with a single episode of haematuria. Transurethral resection biopsy was performed with suspicion of malignancy. Histopathological evaluation revealed paraganglioma of the urinary bladder, which was confirmed by immunohistochemistry. These tumours require complete surgical excision and should be included in the differential diagnosis of any solitary bladder mass.

Portal Vein Pseudoaneurysm: A Rare Complication of Post Pancreaticoduodenectomy Haemorrhage

Pancreaticoduodenectomy is a complex procedure which is associated with higher rates of mortality and morbidity. With the improvement of surgical techniques and skills the mortality rates have come down drastically, but morbidity rates have remained constant. Haemorrhage after pancreaticoduodenectomy is a rare complication which is associated with increased mortality and morbidity rates. Gastroduodenal artery is the most common site for haemorrhage. Early haemorrhage is most often due to technical complications while late haemorrhage is due to the pancreatic leak. Surgery and endovascular repairs are the preferred option of treatment. Here, authors present a case of a 60-year-old lady who presented with an upper gastrointestinal bleed following pancreaticoduodenectomy which was diagnosed as a portal vein pseudoaneurysm. She was treated with endovascular repair.

Conservative Approach in a Patient with Cervical Intraepithelial Neoplasia Type-3 in Pregnancy: Impact on Disease Progression and Pregnancy Outcome

Treatment strategy of Cervical Intraepithelial Neoplasia-3 (CIN 3) in background of High Grade Squamous Intraepithelial Lesion (HSIL) is very different amongst the pregnant and non-pregnant women. This case report highlights the approach of diagnosis and management of CIN 3 in pregnancy. A 32-year-old woman, Fourth Gravida one Live issue and previous 2 Abortion (G4P1021), was diagnosed to have cervical intra-epithelial neoplasia (CIN 3) in pregnancy at 20+1 weeks period of gestation. The decision to continue pregnancy was made. She was followed with LBC and colposcopy 12 weekly during the pregnancy. Her pregnancy was uneventful. She delivered vaginally a live born girl, 2.74 kg at 38+4 weeks. In the postpartum period repeat, Liquid Based Cytology (LBC) and colposcopy-directed biopsy were done. The LBC revealed HSIL while biopsy was suggestive of CIN 3. Cone biopsy was done and histopathology report revealed CIN 3 with margins and tips of cone free of tumour. Thus, in this patient neither progression nor regression was noted with conservative approach and definitive management was deferred until the post-partum period. The aim of this article is to highlight the approach of diagnosis and management of CIN 3 in pregnancy

Pseudomyxoma Peritonei Secondary to Rupture of Intraductal Papillary Neoplasm of Pancreas (IPMN)

Saurabh Kumar, Alok Kumar Mittal

Pseudomyxoma peritonei is the intraperitoneal accumulation of a gelatinous ascites secondary to mucinous tumour rupture, more commonly associated with ovarian and appendiceal mucinous tumour. However, pancreatic mucinous tumour, rarely Intraductal Papillary Mucinous Neoplasm (IPMN) is sometimes the aetiological factor. IPMN is either main pancreatic duct, branch duct or mixed duct type and is characterised by abundant extracellular mucin production and mucin retention in the pancreatic duct. This case report highlights the rare occurrence of Pseudomyxoma peritonei secondary to IPMN rupture.

An Unusual Case of Abdominoscrotal Swelling in a Young Patient-Hydrocele En Bissac

Samida A Samad, Suresh Vasant Phatak

An abdominoscrotal hydrocele is a rare clinical entity in which there is a large hydrocele that extends from the scrotum into the abdominal cavity through the inguinal canal in an hourglass fashion. It is a condition usually affecting children and is infrequently seen in adults. Unilateral involvement is more common than bilateral. Authors hereby report an unusual presentation of abdominoscrotal hydrocele at an age of 27 years, presented with gradually progressing abdominal mass and bilateral scrotal swelling.

Optic Disc Melanocytoma Associated with Choroidal Neovascular Membrane: An Unusual Presentation

Gladys Reshma Rodrigues, Teena Mariet Mendonca, Shobha G Pai, KS Amruthavalli

Optic disc melanocytoma is a unilateral benign lesion of the optic nerve head, rarely causing visual disturbances. Vascular changes causing central retinal vein occlusion, compressive or mechanical effects of the mass over the optic nerve head can cause decrease in visual acuity. Here, authors report a case of optic disc melanocytoma associated with Choroidal Neo-Vascular Membrane (CNVM) causing visual impairment which is one of the rare association.

Cough Induced Pneumomediastinum Due to Tracheal Tear

K Devaraja, Dipak Ranjan Nayak, Poonam Ashok Kamath

Spontaneous pneumomediastinum associated with subcutaneous emphysema following a sudden bout of cough is rare. Most of such pneumomediastinum would be associated with pneumothorax and would be a result of the ruptured pulmonary alveolus. Here, authors report a case of a 20-year-old male who developed swelling of neck and chest tightness following a sudden bout of cough. On examination, he was haemodynamically stable but had diffuse subcutaneous emphysema involving the neck and the upper chest. Radiology revealed pneumomediastinum without any pneumothorax. Authors think that the tracheal tear is the probable cause of air leak into soft tissue of the neck and the mediastinum. The patient was managed conservatively by close monitoring and supportive care. In patients with no prior underlying chest disease, and in those with no progressive respiratory distress, conservative treatment with cautious observation can successfully resolve this condition. This is a unique report, which attributes spontaneous pneumomediastinum without pneumothorax to the breach in the trachea.

Amiodarone Induced Fulminant Hepatotoxicity: A Case Report

Saif Alam, Sumit Singla, Sanjay Pandit, Hermanjit Singh Hira

Amiodarone is an iodine-rich Class III antiarrhythmic drug, which acts via membrane ion channels. It is metabolised in the liver to produce the active metabolite desethylamiodarone. It is highly lipophilic with a large volume of distribution and accumulates in many different tissue, especially the liver. It is widely used in supraventricular and ventricular arrhythmias and given as a loading dose, either via the intravenous or oral route, followed by maintenance doses. The common adverse effects of amiodarone are nausea, vomiting, tremor, thyroid dysfunction, peripheral neuropathy, photosensitivity, bradyarrhythmia, worsening of arrhythmia and the less common ones are pneumonitis, optic neuropathy and hepatotoxicity.

Case of Antenatal Splenic Rupture: Managed Conservatively

Shikha Sharma, Anshul Jain, Jafar Husain

Splenic laceration antepartum or postpartum is a rare, frequently misdiagnosed and potentially catastrophic pathology that can lead to high maternal and fetal mortality and morbidity. It is therefore, imperative that a differential diagnosis of spleen related pathology or event as in splenic rupture or splenic artery aneurysm should be kept in mind in any woman presenting with upper abdominal pain or in shock during pregnancy

Disseminated Multifocal Epithelioid Haemangioendothelioma- A Multimodality Approach for Diagnosis

Shibani Mehra, KSV Abhinetri, UC Garga

Epithelioid Haemangioendothelioma (EHE) is an extremely rare vascular tumour that develops in the soft tissues or in viscera such as liver, lung, bone, brain, spleen or even the small intestine. The tumour has an intermediate malignant potential. Hepatic Epithelioid Haemangioendothelioma (HEHE) is often not correctly diagnosed and may be confused with benign hepatic cavernous haemangioma or even with hepatic metastatic deposits. Imaging plays an important role in accurate diagnosis of this unusual entity with Dynamic contrast enhanced CT and MR showing the characteristic diagnostic features of HEHE and assist in differentiating it from other hepatic masses such as cavernous haemangioma, cholangiocarcinoma and metastasis. The differentiation is important for appropriate therapeutic triage as once detected these mesenchymal masses cannot be ignored, albeit need to be managed aggressively. Treatment modalities for this mesenchymal tumour include hepatic resection, orthotropic liver transplantation (even in cases with known metastases), radiotherapy and chemotherapy with Adriamycin, Doxorubicin or Interferon. Present case had an innocuous and beguiling clinical presentation and hepatic, pulmonary as well as unilateral adrenal masses were detected on dynamic CT and MR imaging. Metastases and cavernous haemangioma were ruled out based on the imaging appearance and advised vascular tumour markers to confirm the diagnosis of multifocal HEHE. After this, CD34 and CD31 markers were found positive, patient was referred for hepatic resection. A biopsy was conducted, that demonstrated cords of endothelial and spindle cells with large sinusoids, typical of EHE. Patient subsequently underwent a trisegmental right lobe resection (since right hepatic lesions were more numerous), followed by chemotherapy as well as radiotherapy.

Purple Urine Bag Syndrome: Series of Nine Cases and Review of Literature

Arvind Goyal, Vikas Garg, Jyoti Jindal

Purple coloured urine occurs in the patients, mainly elderly who are on urinary catheters for a long-time and develop Purple Urine Bag Syndrome (PUBS), wherein the urinary bag and the tubing turn in to purple colour. The chain reaction responsible for PUBS begins with tryptophan from the food chain being metabolised by gut bacteria like Enterobacter, Klebsiella, Citrobacter etc., which form sulfatases and phosphatases leading to accumulation of indigo (blue) and indirubin (red) that becomes purple. Data were from both OPD and indoor patients visiting the hospital between June 2015 to July 2017. Herein, we present a series of nine cases from our tertiary care hospital that had developed PUBS which can occur in any patient with Urinary Tract Infection (UTI) on catheter with bacteria possessing these enzymes. Bed-bound patients or population with Alzheimer’s, or dementia are groups of the patients who are at higher risk for UTI. Although, PUBS is a harmless problem, prevention and control of the catheter-associated UTIs is very important in present medical era.

Terbinafine in Fixed Cutaneous Sporotrichosis: A Case Series

Sporotrichosis is a chronic granulomatous mycotic infection caused by thermally dimorphic fungus, Sporothrix schenckii. The disease is endemic in tropical and subtropical belts throughout the world. In India, it is commonly seen in the Himalayan belt, frequently encountered in gardeners. Infection generally occurs by traumatic inoculation of soil and plants contaminated with the fungus. In humans, the lesions are usually restricted to the skin, subcutaneous cellular tissue and adjacent lymphatic vessels. Disseminated disease occurs when the fungus spreads throughout the body. Itraconazole is regarded as the treatment of choice for patients with most forms of cutaneous as well as extracutaneous sporotrichosis and amphotericin B as the preferred treatment for patients who are severely ill in disseminated mycotic infections. Terbinafine is a synthetic allylamine used as the drug of choice in tinea infections. This article compiles three cases of fixed cutaneous sporotrichosis, proven histopathologically, who were treated with oral terbinafine due to poor response to itraconazole or because of cost factor, with dosage ranging from 250mg/day to 1g/day, given upto six weeks after clinical resolution. The article also highlights the importance of terbinafine as an effective drug for sporotrichosis where there is poor response to itraconazole or affordability may be an issue.

Large Placenta and Small Foetus at Early Gestation Predicts Foetal Growth Restriction due to Placental Dysmorphology

When placenta appears large on ultrasound, there are certain differential diagnoses to be kept in mind. We present a series of three cases in which large placenta was observed in first trimester scan. All three pregnancies resulted in Foetal Growth Restriction (FGR) associated with placental morphological abnormality.

Ball in Right Atrium Cavity: What is your Diagnosis?

Ansul Kumar, Arpita Rai

Mucosal Tears Following Biopsy in Eosinophilic Oesophagitis

William G Simpson

Correspondence: Home Based Blood Pressure Monitoring in Indian Setting: A Consensus Document

Himel Mondal, Sarika Mondal, Shaikat Mondal

Subtyping of Non-Small Cell Lung Carcinomas in Bronchoscopic Biopsies: A Tertiary Care Centre Experience

Mihir Mohan Vaidya, Sharada R Rane, Shaila C Puranik

Introduction: The advent of promising targeted therapies against specific subtypes of Non-small Cell Lung Carcinoma (NSCLC) has made it mandatory for the pathologists to subclassify NSCLC into its subtypes, along with saving tissue for molecular studies and work closely with the radiologists and the clinicians for effective management of the cases. Aim: To subclassify NSCLC into its subtypes using routine diagnostic techniques, to study the demographic, clinical and radiological features of lung cancer in addition to performing a limited immunohistochemistry panel on bronchoscopic samples. Materials and Methods: Clinically and radiologically suspected cases of lung cancer having non-small cell morphology were subjected to cytological and histopathological examination for subtyping. A limited immunohistochemistry (IHC) panel comprising of TTF-1, Napsin A, P63 and Neural Cell Adhesion Molecule (NCAM) was used in poorly differentiated tumours for further subtyping. Results: There were 52 cases of NSCLC with an incidence rate of 1.78 per 1000 per 1.5 years. Average age of patients was 56.13 years and there was a slight male preponderance. Breathlessness (85%) was the most frequent clinical finding followed by weight loss and cough (81% each). All cases presented with solid nodule or mass lesion. Adenocarcinoma (n=46%) was the most frequent histological type followed by Squamous cell carcinoma (n=34%). Ten poorly differentiated cases were classified on IHC as follows: three cases each of NSCLC favour Adenocarcinoma and NSCLC favour Squamous cell carcinoma, two cases each of Small cell lung carcinoma and NSCLC Not Otherwise Specified (NOS). Conclusion: Using routine diagnostic methods and a limited IHC panel comprising of TTF-1, Napsin A, P63 and NCAM in biopsies, it was possible to classify all 52 cases of NSCLC as per latest classification guidelines while restricting the number of NOS cases to just two.

A Cross-sectional Study to Assess Respiratory, Eye and Ear Health Problems among Traffic Police Personnel in Nashik City

Anirban Bandopadhyay, Shweta Bandopadhyay, Pushkar Lele, Rakesh N Patil

Introduction: Health of a person is largely affected by the environment in which they work, thus making occupation an important determinant of health. More than 80% of the global burden of occupational disease is borne by people in the developing countries. The health hazards get more severe when the duration of exposure increases and it is more important in situations among the personnel engaged in traffic duty. Aim: To assess the prevalence and factors associated with respiratory, eye and ear morbidities among traffic police in Nashik city. Materials and Methods: In this descriptive cross-sectional study, total 196 traffic police of Nashik city between 20-60 years age during February-April 2018 were included. Institutional ethics committee approval, informed consent from participants was taken. A semi-structured interview schedule, clinical examination and clinical tests were used to collect the data. Chi-square test was used for data analysis with the help of SPSS Inc. statistical software for Windows Version 18.0. Results: Most (175; 89.3%) of the traffic police personnel were males and mean age of participants was 40.4 years. Prevalence of respiratory, eye and ear morbidity was 29.6%, 25.0% and 20.4% respectively. Restrictive lung disease (17.9%), was the most common respiratory morbidity. Refractive error (14.8%), was the most common eye morbidity while sensorineural hearing loss (Right ear: 21.6%; Left ear: 4.2%) was the most common ear morbidity. Old age (> 40 years), =10 years service duration and presence of co-morbidities (Diabetes, Hypertension etc.,) were significantly associated with respiratory and ear diseases. Eye disease was not associated with any factor studied. Conclusion: The respiratory health problem was the most common morbidity in traffic police. Age (=40 years) and long service duration were significantly associated with respiratory and ear diseases.

Evaluation of Pain on Probing using Anaesthetic Gel in Chronic Periodontitis Patients with True Pressure Sensitive Probe: A Placebo Controlled Trial

Introduction: Periodontal diagnosis and treatment plan rely on an important aspect which is called as the periodontal probing. However, probing has proven to be a painful procedure especially in untreated chronic periodontitis patients. In an effort to reduce the pain while probing various anaesthetic gels were used and have shown better results. Aim: The aim of the present study was to evaluate the pain elicited during probing pocket depth estimation in a split mouth using anaesthetic gel (Lox 2%) and Placebo. Materials and Methods: The present study was a randomized, placebo-controlled trial, double masked, split mouth study. It was conducted by using a True Pressure Sensitive probe (TPS), wherein probing was done in each quadrant having probing pocket depth >5mm. Randomization was done for application of anaesthetic gel and placebo within the pocket. After 30 seconds of application with the test (Anaesthetic gel Lox 2%, NEON LABORATORIES) and control (placebo) probing was performed. Pain was assessed using visual analogue scale rating from 0 to 10 with ‘0’ as no pain and ‘10’ rating the worst pain. Statistical analysis was done using Mann-Whitney test. Results: The mean VAS score for the test group was 0.621±0.25 and the placebo group was 3.22±1.08. Significant difference in the mean VAS scores was found between the test group and the placebo group. Conclusion: Administration of LOX 2% gel in periodontal pockets prior to probing have shown a significant reduction in pain while probing.

Risk Factors for Peripartum Wound Dehiscence

Introduction: Wound Dehiscence (WD) following Vaginal Delivery (VD) or Cesarean Delivery (CD) causes considerable discomfort to the woman, leading to significant physical, emotional and financial burden. The rate of Perineal Wound Dehiscence (PWD) is relatively low and more common with instrumental delivery. However, there is minimal information on the incidence and risk factors causing WD, especially for PWD. Aim: To assess the incidence and risk factors of peripartum wound dehiscence. Materials and Methods: This retrospective study was conducted in a large tertiary care centre where there were 14759 deliveries. 4671 women had caesarean deliveries and 10,088 women had the vaginal delivery. There were 86 cases (0.8%) of WD in the VD group and 95 (2%) in the CD group. These cases were compared with twice as many controls. Results: Induction of Labour (IOL) and BMI >30 kg/m2 were more common in cases compared to controls in the CD group. However, on multivariate analysis, this association was not seen. IOL, meconium stained liquor (MSAF), instrumental delivery and use of episiotomy was more common among cases than controls in the VD group. IOL did not show up as an independent risk factor on multivariate analysis. Conclusion: An association between IOL, primigravidae, instrumental delivery and MSAF was seen with peripartum WD.

Neonatal Nosocomial Infections: A Kashmir Experience

Javid Maqbool, Mohd Ashraf, Basit Aslam, Shafat Ahmed Tak

Introduction: Nosocomial Infection (NI) is associated with substantial morbidity and mortality in neonates admitted to Neonatal Intensive Care Units (NICUs). These infections are growing globally and are associated with future life post-infection morbidity, increased length of stay in the hospital, and healthcare costs. Aim: To determine the frequency of neonatal NI and most common sites of infections in our NICU. Materials and Methods: The study was conducted at NICU of Department of Pediatrics, GB Pant Hospital, an associated hospital of Govt Medical College, Srinagar, from April 2017 to September 2017. Neonates admitted for more than 48 hours in the NICU, who developed infections as evidenced by the clinical and/or laboratory parameters were included in the study. A p-value of <0.05 was considered statistically significant. Results: Of the 300 neonates studied, 160 were males and 140 were females, among whom 12 were extreme premature (<28 weeks of gestation), and 30 were very low birth weight (<1500 grams). The incidence of NI rate in our NICU was 37.33% with prematurity and low birth weight as major risk factors (p<0.05). Sites of infection were primary blood stream infections in 70(62.52%), pneumonia in 20(17.85%), meningitis in 10(8.92%), and others 12(10.71%). Among the studied neonates we found, Klebsiella in 45(40%), Staphylococcus aureus in 34(30%), E. Coli in 11(9.8%), Acitinobacter in 7(6.25%), Pseudomonas in 3(2.67%) and others 12(10.71%). Conclusion: This study emphasizes the high incidence rate, sites and types of microorganisms causing NI at NICU so that appropriate antibiotics can be judiciously used. This study highlights the need for the development of robust measures to reduce the incidence rate of NI.

Mosaicism in 22q11.2 Microdeletion Syndrome

Ashutosh Halder, Manish Jain, Amanpreet Kaur Kalsi

Introduction: Microdeletion syndrome is characterized by sub-microscopic chromosomal deletion smaller than 5 Million bp (5Mb) and frequently associated with multiple congenital anomalies. Fluorescent In Situ Hybridization (FISH), Multiplex Ligation-Dependent Probe Amplification (MLPA), Quantitative Fluorescence Polymerase Chain Reaction (QFPCR), array Comparative Genomic Hybridization (aCGH), Single Nucleotide Polymorphism (SNP) microarray and Next-Generation Sequencing (NGS) techniques are commonly used for precise genetic diagnosis of microdeletion syndrome. Aim: To study the role of mosaicism for the causation of phenotypic heterogeneity in 22q11.2 microdeletion syndrome. Materials and Methods: In this study, for over the period of 10 years, we worked on detection of 22q11.2 microdeletion and observed mosaicism frequently. FISH analysis was used to assess level of mosaicism in metaphase and interphase cells derived from peripheral blood culture (lymphocytes) and interphase cells of various tissues like blood nucleated cells (mesodermal origin), buccal cells (ectodermal origin) and urinary exfoliated cells (endodermal origin). We have also used SNP microarray and QF PCR for further characterization. Results: Among 257 cases of clinically suspected 22q11.2 microdeletion syndrome, presence of 22q11.2 microdeletion was confirmed in 39 cases (15.2%) by FISH. Eleven of 22q11.2 microdeletion cases (28.2%) were found to have mosaicism. We report high (28.2%) prevalence of mosaicism in 22q11.2 microdeletion syndrome and often (about 36% cases) low grade mosaicism (<35% deleted cells). Outsourced SNP microarray failed to detect low grade mosaicism. We also observed wide variations in deleted cell concentration amongst various tissues (blood, buccal and urinary cells). Conclusion: We conclude that mosaicism in 22q11.2 microdeletion is common (28.2%) and interphase FISH should be the choice of test for detecting mosaicism.

Infection Control Prevention Practices on Pulmonary TB Transmission among Health Care Personnel of Selected Hospital in India

Karishma Khaund, Christopher Sudhakar, Charlet Jasmine Vaz

Introduction: Fundamental infection control practices in India revolve around biomedical waste management and disposal of sharps; while Airborne Infection Control (AIC) measures are mostly absent from the protocol of health care facilities. Aim: To assess infection control practices that a health care personnel follows to prevent transmission of Tuberculosis (TB) and to evaluate the resources and facilities available in the area and also to identify the factors which helps to improve the practices. Materials and Methods: A mixed methodological study was carried out to assess the infection control practices for prevention of pulmonary TB. This study was conducted among 82 health care personnel between 2nd January 2017 and 4th February 2017. Health care personnel (20-35 years) and people who worked in TB units were recruited from a multi-specialty tertiary care hospital. An observation checklist on infection control practices was developed to assess the preventive practices followed by acknowledge questionnaire. Complete enumerated sampling was used for observing the practices. A focus group discussion was conducted after analysing the Survey findings among health care personnel by purposive sampling. Thematic analysis was used to analyse and identify the emerging themes. Results: The mean age of the participants was 25.76±5.968 years. Non-compliance was found in infection control practices among health care personnel in preventing TB transmission. A 58.5% of the participants have good knowledge, 74.1% had answered correctly in the area of personal protective equipment. Intermittent interruption of supply (e.g., N95 masks), lack of knowledge, lack of adherence to infection control practices and lack of awareness by the patients were found to be the factors for non-compliance. Conclusion: This study emphasizes the challenges faced in infection control preventive practices in a resource limited countries and how collective efforts may change and strengthen the practices using available resources.

Early Diagnostic Markers in Diabetic Nephropathy Patients

Abdulrahman Hefdhallah Amer, N Haridas

Introduction: Diabetes Mellitus is one of the most important causes of chronic complications of kidney diseases. Cystatin C could serve as an ideal marker of the glomerular filtration status. The ability to assess renal function in diabetic patients rapidly and early is of major importance for the possibility of preventing the development of nephropathy. Therefore, it is important to add a more sensitive or specific indicator for detecting early renal impairment in diabetic patients, so that corrective measure could be adopted to prevent the progression of kidney function impairment towards frank nephropathy. Aim:To evaluate the clinical advantage of serum cystatin C and creatinine level in predicting renal impairment in patients with Type 2 diabetes in Gujarat, India. Materials and Methods: A cross-sectional study was conducted from September 2015 to April 2017 in Pramukhswami Medical College (PSMC) and Shri Krishna Hospital, Karamsad, Anand-Gujarat. This study included a total of 170 participants classified into two groups; 85 patients with diabetic nephropathy and 85 patients without diabetic nephropathy. Serum samples were collected to measure cystatin C using immunoturbidimetric assay (On TURBODYNE TM SC). Glucose, Urea, Creatinine, HbA1c, Cholesterol, Triglycerides, and HDL-Cholesterol were estimated by using Automated Analyser (Siemens Dimensions RxL/Xpand). The data were computer analysed using SPSS 20. USA. Results: The results revealed that the mean cystatin C level was higher in diabetic nephropathy patients (1.87±0.51 mg/L) than diabetics without nephropathy (1.025±0.30 mg/L), and the difference was significant with p-value <0.001. The results showed a significant correlation between Cystatin C with age(r=0.214; p=0.005), Creatinine (r=0.55; p<0.001), Urea (r=0.66; p<0.001) and HbA1c (r=0.164; p=0.033). But no significant correlation with gender (r=0.075; p=0.33). The results also showed that the level of serum cystatin C was higher in some patients (28 out of 85 cases) with a normal level of creatinine. But the level of serum cystatin C was higher in all the patients who had an abnormally high serum creatinine level. This was significant with p=0.001. Conclusion: Cystatin C is a useful marker for early detection of diabetic nephropathy. The results of this study suggest that cystatin C measurement in serum is useful for the early detection of renal impairment in a way better than S. creatinine in the patients with diabetes.

Prediction of Peak Aerobic Power among Costa Rican Older Adults

Introduction: The peak oxygen uptake (VO2peak) is considered a valid indicator of the cardiovascular system function, and when measured on a metabolic cart it is considered the gold standard for cardiorespiratory fitness. Prediction equations have been developed to indirectly determine VO2 peak; however, there are no equations specific to Costa Rican older adults. Aim: To develop a VO2peak prediction equation for Costa Rican adults over 60 years using the distance achieved on the Six minutes Walking Test (6MWT) and anthropometrical measures. Materials and Methods: Seventy-nine adults (Mean age=68.8±4.79 yr.) read and signed the informed consent, then scanned on DXA for body composition, then measured the HR before and after the 6MWT. Following a 10-minutes recovery period from the 6MWT, they performed a VO2peak treadmill test with breath-to-breath calorimetry gas analysis. The prediction model included body weight, height, Body Mass Index (BMI), body fat mass index, distance on the 6MWT, and change in Heart Rate (HR) following the 6MWT. Results: The prediction equation was VO2peak=17.59+0.028 {6MWT(m)}–0.256{BMI (kg/m2)}–2.567 (gender: 0 male, 1 female)±3.25 ml•kg-1•min-1 (R2=0.48). A strong correlation (r=0.70, p<0.01) between predicted and measured calorimetry VO2peak values was obtained; yet, a poor concordance based on Lin’s coefficient (r=0.61). Conclusion: A VO2peak prediction equation with high accuracy and highly correlated to directly-measured VO2peak was developed for urban Costa Rican older adults. Non-specific population equations are not valid to predict VO2 peak in urban Costa Rican older adults.

Closing the Gap Between Phenotypic and Genotypic Detection of Carbapenem Resistant Enterobacteriaceae by New Modified Carbapenem Inactivation Method

Introduction: Carbapenems have become one of the last resort of antimicrobials. But in last few years, Carbapenem Resistant Enterobacteriaceae (CRE) have been reported worldwide. Various phenotypic tests have been proposed for detection of carbapenemase activity including the newer modified Carbapenem Inactivation Method (mCIM) as advised by Clinical Laboratory Standard Institute (CLSI) 2017 guidelines. Aim: Detection of CRE from clinical specimens with new mCIM method and its comparative evaluation with phenotypic and genotypic methods. Materials and Methods: Study was conducted between January 2017 and December 2017 at KIMS, Karad. Total 66 CRE, isolated from 1634 clinical specimens and identified by VITEK 2 (Biomerieux, France) were included in the study. Phenotype screening was done by mCIM (CLSI 2017) method and was compared with Modified Hodge test (MHT) and Combined Disc Test (CDT) methods. Klebsiella pneumoniae ATCC BAA-1705 and Klebsiella pneumoniae ATCC BAA-1706 were used as positive and negative controls respectively. Molecular confirmation of these isolates for carbapenemase producing genes blaNDM-1, blaOXA-48, blaKPC was done by multiplex Polymerase Chain Reaction (PCR) study. Results: Klebsiella pneumoniae (n=35) outnumbered the other bacterial species among 66 CRE included in the study. mCIM was positive for 65 (98.48%) out of 66 isolates while MHT and CDT was positive for 50 (75.75%) and 59 (89.39%) of CRE isolates respectively. All the CRE isolates showed presence of at least one carbapenemase producing gene. Conclusion:The mCIM method is simple, less subjective, cost effective, reproducible and most sensitive method and plays important role in detection and prevention of spread of CRE, thereby, reducing morbidity and mortality, especially where there is lack of automation and molecular diagnostic facility.

Gonadotropin Releasing Hormone Agonists versus Antagonists in Women with Polycystic Ovary Disease Undergoing Intracytoplasmic Sperm Injection

Introduction: Polycystic ovary syndrome (PCOS) is one of the most important endocrine disorders that cause infertility in young women. Recent meta-analyses have reported that treatment success with GnRH antagonists and GnRH agonists was similar. But no studies are available to determine which protocol is the best in the PCOS patient group. Aim: To compare the Intracytoplasmic Sperm Injection (ICSI) outcome of Gonadotropin Releasing Hormone Agonists (GnRHa) to antagonists (GnRHant) in women with polycystic ovary disease. Materials and Methods: In this retrospective cohort study; out of 3000 patients, 144 women were enrolled who met the inclusion criteria for polycystic ovary disease, according to the Rotterdam criteria at the In Vitro Fertilization Unit. Cases with GnRHa used for controlled ovarian hyperstimulation (n=95) were compared to cases with GnRHant use (n=49). All analyses were performed using the Statistical Package for Social Sciences software, version 15.0 for Windows. The variables were compared to Pearson Chi-Square and Fisher’s-Exact Tests in 2×2 eyes. Normally distributed (parametric) variables were evaluated between groups, whereas Independent groups were compared using t-test. Results: The mean age, infertility period, FSH level, body mass index and the mean number of embryos transferred were similar in both groups (p>0.05). The average dose of FSH was significantly lower in Group 2 (1765±624 IU) compared to Group 1 (2535±838 IU, p<0.001). The rate of cycle cancellation due to ovarian hyperstimulation risk was 6.4% in group 2, which was similar to the 15.2% in group 1 (p=0.13). The cleavage rate (Group 2; 49.1±22.2%, Group 1; 64.2±24.4%, p=0.001), fertilization rate (Group 2; 48.7±21.5%, Group 1; 63.2±21.5%, p=0.001) and the mean number of good quality embryos transferred (Group 2; 2.5±0.2, Group 1; 2.9±0.8, p=0.02) was significantly lower in group 2 compared to group 1. The clinical pregnancy rate was 30% in group 2 compared to 34.1% in group 1 (p=0.6). The live birth rate was 22.5% in group 2 and 25% in group 1 (p=0.7). Conclusion: Similar clinical pregnancy outcomes can be achieved in GnRH antagonist cycles using lower gonadotropin doses compared to GnRH agonist cycles.

Association of Tissue Transglutaminase with Nerve Growth Factor, Prolidase Activity and Oxidative Stress in Celiac Patients

Introduction: Celiac Disease (CD) is an autoimmune gastrointestinal disorder; it is characterised by chronic inflammation and elevation of tissue Transglutaminase Immunoglobulin-A (tTG-IgA). Nerve Growth Factor (NGF) and prolidase enzyme are elevated in different autoimmune and chronic inflammatory diseases; however, the status of NGF and prolidase enzyme remains unexplored in celiac patients till date. Aim: To evaluate the correlation of tTG-IgA to NGF, Serum Prolidase Activity (SPA) and oxidative stress in the CD patients. Materials and Methods: The study was conducted on a total of 92 subjects, 46 patients with CD and remaining 46 healthy controls. The tTG-IgA and NGF were measured with the use of ELISA kit. SPA and oxidative stress were measured spectrophotometrically. Results: The tTG-IgA, NGF, SPA, Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) were significantly elevated in the serum of patients as compared to controls (all p<0.001); however, Total Antioxidant Status (TAS) was significantly decreased (p<0.001). The tTG-IgA showed a positive correlation with NGF, SPA, TOS and OSI in the patients (all p<0.001); while it was negatively correlated to TAS (p<0.001). Conclusion: The present study concluded that elevated NGF, prolidase enzyme, tTG and oxidative stress might be associated with the pathogenesis of celiac disease.

A Comparative Study of Supraclavicular Brachial Plexus Block with Clonidine as Adjuvant in Two Different Doses in Upper Limb Surgery

Shreya Das Adhikari, Manoj Kumar Panwar, Shweta Mahajan

Introduction: Supraclavicular route of brachial plexus block is considered as ‘The Spinal of Arm’, in which local anaesthetic agent is delivered at a point where the three trunks are compactly arranged and carry entire sensory, motor and sympathetic innervations of the upper extremity. Aim: To compare the efficacy of two moderate doses of clonidine as an adjuvant to lignocaine and bupivacaine in combination in supraclavicular brachial plexus block by using USG guided method. Materials and Methods: After approval by the research Ethics Committee and written informed consent, the randomised controlled study was carried out in 90 ASA I and II patients, who were posted for unilateral upper limb surgery. Supraclavicular brachial plexus block was performed using an ultrasound-guided technique with a total volume of 30.6 mL of drugs. Group N received 15 mL of 2% lignocaine with adrenaline (1 in 200000) and 15 mL of 0.5% bupivacaine with 0.6 mL of normal. Group C1 received 45 µg of clonidine and Group C2 received 90 µg of clonidine along with the local anaesthetics. The time taken for onset and the duration of sensory and motor blocks were noted until 24 hours postoperatively. Vitals were noted before, during and after anaesthesia. The time required for rescue analgesia was noted along with VAS scores and sedation scores. The results were tabulated and correlations were obtained using ANOVA and Student’s t-test. Results: The mean duration (in minutes) of onset of motor block was 14.6±3.024 in Group N, 7.567±1.0726 in Group C1, 6.033±1.756 in Group C2. The mean duration (in hours) of motor block was 3.8±0.6967 in Group N, 5.65±1.1533 in Group C1, 8.05±0.9035 in Group C2. The mean onset of time (in minutes) of sensory block is 14.9±3.1442 in Group N, 6.8±1.0635 in Group C1 and 5.4±2.4403 in Group C2. The mean duration (in hours) of sensory block was 4.233±0.6915 in Group N, 5.833±1.0367 in Group C1 and 8.417±0.8914 in Group C2. The differences were highly statistically significant (p<0.001). Rescue analgesia was required much earlier in Group N (4.43±0.774 hours) than in Group C1 (6.87±0.9 hours) and C2 (10.43±2.339 hours). Conclusion: Ninety microgram clonidine is an attractive alternative as an adjuvant in the ultrasound-guided supraclavicular block for upper limb surgical procedures especially in those that need quite long time with minimal side effects and excellent quality of postoperative analgesia.

Measurement of Menopausal Symptoms using Greene Climacteric Scale in a Tertiary Care Centre in Uttarakhand, India

Rajlaxmi Mundhra, Niharika Dhiman, Jaya Chaturvedi, Sandipan Chowdhuri

Introduction: Menopause represents an important phase in a woman. Increase in life expectancy has resulted in prolongation of this phase. Aim: To identify the age of onset of natural menopause, associated symptoms of menopausal women attending the outpatient department of AIIMS Rishikesh, Uttarakhand, India. Materials and Methods: A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of AIIMS Rishikesh, Uttarakhand, India. A total of 100 women having natural menopause over a period of five months were interviewed using Greene Climacteric Scale (GCS)questionnaire. The analysis was based on GCS and its various sub scores. Data analysis was carried out by SPSS version 17.0. Chi-square test, unpaired t-test, Pearson coefficient of correlation were used for statistical analysis. A p=0.05 was considered as significant association. Results: The mean age at menopause was 47.2±4.62 years. Six percent of women had primary ovarian insufficiency. Urinary complaints (49 cases), backaches and lower abdominal pain (31 cases), hot flushes (24 cases), pruritus vulvae (15 cases) and musculoskeletal pain (15 cases) were most frequently self-reported menopausal symptoms in the present study. The most frequently reported symptoms as per GCS score were muscle and joint pain (87%), loss of libido (80%), insomnia (60%), hot flushes (54%) and feeling tired (30%). The mean number of symptoms reported by a single lady was 5.69±2.97 (ranged from 0-14). Regular physical activity or doing regular yoga was associated with lower total GCS score (9.50±6.1 vs. 11.18±5.6). Conclusion: Women in this region viewed menopause negatively. As observed in this study, symptoms were common and disturbing and hence cannot be ignored. Attempt should be made to treat menopausal symptoms starting from lifestyle management perspective in the form of yoga/exercise/calcium supplementation.

Overweight/Obesity: An Emerging Epidemic in India

Mohd Shannawaz, P Arokiasamy

Introduction: The nutrition, demographic, and epidemiological transition process are at a pace in most of the states of India since the 1990s. In India, the recent National Family Health Survey 4 (NFHS 2015-16) data shows commendable rise in the prevalence of overweight/obesity. Aim: To determine the levels, trends, differentials and determinants of overweight/obesity in the states of India. Materials and Methods: Data from rounds of the National Family Health Survey (NFHS) that is NFHS-4 (2015-16), NFHS-3 (2005-06) and NFHS-2 (1998-99) were used in the analysis of this study. To examine the effect of predictors of overweight/obesity, the multivariate logistic regression model was used in the analysis using NFHS-3 data. Results: Results indicated that overweight and obesity have become substantial problems among different socio economic spectrum of women and men in India, particularly in older ages, people living in urban areas, well-educated and among households of highest wealth quintile and simultaneously among people living in poorer wealth quintile, uneducated and people belonging to socioeconomically less developed states. Analysis reveals that overweight and obesity prevalence in India increased swiftly in last two decades. An alarming trend is that overweight/obese women as well as men population has been more than doubled in 2015-16 since last one and a half decade. There was a significant rise in the prevalence of overweight and obesity from 1998-99 to 2015-16 in both urban and rural areas in all the states of India. An emerging concern is that there was rise in overweight/obesity prevalence up to critical level among the states, where it was not severe earlier. It was also found that food habits did not conclude any definite effect on the prevalence of overweight and obesity. One reason may be the complex and non-uniform dietary habits across the states, and other may the availability of nutritious and balanced food. Conclusion: The steep emergence of overweight/obesity poses great challenge to healthcare providers and policymakers. Effective implementation of programmes is required before overweight/obesity becomes a more widespread epidemic.

Epidemiology of Orthopaedic Morbidities in Pilgrims of Shri Amarnath Yatra

Amit Kumar Salaria, Vishal Kumar, Prasoon Kumar, Ekta Dogra

Introduction: In a religiously diverse country like India, visits to holy shrines situated at geographically diverse topographical spots are a common norm. “Shri Amarnath shrine” is one of the most sought after and difficult pilgrimage in the country and because of the suboptimal terrain, people who flock to take this trip have to face major medical issues, every year, moreover in absence of streamlined adequate medical facility. Aim: To describe the Epidemiology of Orthopaedic morbidities at high altitude pilgrimage sites and formulate an advisory for the public and the authorities alike of the critical steps required to minimise the same. Materials and Methods: All the individuals with isolated orthopaedic morbidities who presented to our base camp hospital at Baltal from July 11th to 26th 2017 were enrolled in the study. Patients with head injuries, Blunt trauma chest and Blunt trauma abdomen were excluded. Patients with aggravation of preexisting orthopaedic morbidities (low back ache, knee pain) were included in the study. Also persons who either used helicopter or small litters as a mode of travel were also excluded. Results: Out of the 253 patients presented to us 54.7% were males and 45.3% were females. About 60% of the patients were from the northern and eastern part of India. Patients between the age group of 21-40 years were most frequently injured. About 60 percent of the patients sustained injury while travelling on foot and the mode of injury was fall. Aggravation of the preexisting low back ache was the most common (33%) orthopaedic morbidity. Most common fracture encountered was that of the distal end of radius. Most common reason for immediate referral was open fractures. Conclusion: Adequate exploration and addressal of the trauma victims during pilgrimage is the need of the hour. Results of this study may be used for planning preventive measures and strategies for strengthening the medical infrastructure at the base camp hospitals so as to decrease the orthopaedic morbidity.

Immunohistochemical Expression of HER2/neu Receptors in Iraqi Patients with Endometrioid Carcinoma

Zinah Hussein Abd Ali, Farah Falah Hassan, Alaa Qasim Yahya

Introduction: With the advent of era of targeted cancer therapy, the serious side effects of chemoradiotherapy have been minimised. Considering the success story of anti-HER2/neu drugs in breast cancer oncology, the present study was conducted. The study evaluates the immunohistochemical expression of HER2/neu in endometrioid cancer among Iraqi patients. Aim: To assess the immunohistochemical expression of HER2/neu in endometrioid carcinoma of uterus and to find the relationship of this expression with FIGO stage and grade and with patient age. Materials and Methods: In this cross sectional study, formalin-fixed, paraffin-embedded tissue blocks of 62 hysterectomy specimens that were diagnosed as endometrioid carcinoma in the teaching laboratories in the Medical City complex, Baghdad were retrieved and assessed by three pathologists using the same scoring system for HER2/neu as in breast cancer with positivity regarded as +2 or +3. Statistical correlation using Chi-square test analysis was done. Results: Out of 62 cases of endometrioid carcinoma, 30 (48.38%) were positive for HER2/neu and a significant statistical relationship between expression of this marker with histological grade and patient age was seen. The cases which were immunohistochemically positive for HER2/neu were closely associated with high grade morphology and patients younger than 40-year-old. Conclusion: Endometrioid carcinoma is a type of endometrial adenocarcinoma commonly having a well differentiated morphology (Grade I) and low stage at presentation. The study concludes that young patients with a high grade endometrioid carcinoma would hopefully benefit from the application of targeted anti-HER2/neu therapy in future.

Association between Sedentary Behaviour and Depression, Stress and Anxiety among Medical School Students in Chennai, India

Vinoth Gnana Chellaiyan, Fasna Liaquath Ali, Jasmine Maruthappapandian

Introduction: Physical inactivity has been found to be a major contributing factor for occurrence of non-communicable diseases like cardio vascular diseases, type 2 diabetes, dyslipidemia and also certain mental illnesses. With the higher prevalence of sedentary behaviour among medical students in India, the researches on sedentary behaviour related to mental illness (depression, anxiety, self-esteem, psychological stress, and quality of life) have become the focus considering the medical students role in future physicians and public health intervention programme. The prevalence and association of sedentary behaviour and certain mental illnesses has been explored in this study. Aim: To find the prevalence of physical inactivity among medical school students and its association with anxiety, stress and depression. Materials and Methods: A cross-sectional study was conducted among medical students of Tagore Medical College, Chennai, Tamilnadu. Total 507 medical school students who were >18 years of age from all academic years (First year MBBS to Fourth year MBBS) students were included. A pretested, structured study tool was used which comprised of five sections-Socio-demographic profile, International physical activity questionnaire, Perceived Stress Scale, Generalised Anxiety Disorder-7 and Beck Depression Inventory. Data was analysed with SPSS–IBM software version 21. Prevalence of physical inactivity was measured in proportions. Chi-square test and Mann Whitney test was applied. A p-value of <0.05 was considered significant. Results: Among the study participants, 73% and 53.5% had moderate and severe intense activity, respectively. Out of 507 study participants, 21.5% were sedentary. Significant association was found between depression and sedentary behaviour. (p-value-0.049). There was a significant mean difference in depression scores among participants with sedentary and non-sedentary behaviour. (p-value-0.046). Conclusion: The study was able to find significant association between sedentary behaviour and depression. Promotion of physical activity could help in improvement of negative emotional effects.

Visual Outcome and Complications of Manual Sutureless Small Incision Cataract Surgery with Foldable IOL-A Teaching Hospital Based Study

Introduction: Manual Small Incision Cataract Surgery (SICS) is an effective alternative to phacoemulsification surgery. SICS with single piece foldable Intraocular Lens (IOL) implantation ensures compulsory in the bag placement of IOL due to Continuous Curvilinear Capsulorrhexis (CCC). It is also associated with less chances of complications like after cataract because of the foldable lens implanted, giving it an upper edge over the SICS with rigid IOL implantation. Aim: To assess best spectacle corrected visual acuity at one month postoperative in cases who underwent SICS with foldable IOL and also to evaluate their complications. Materials and Methods: Prospective study conducted on 30 patients in Department of Ophthalmology, Bharati Medical College Deemed to be University and Hospital, Sangli for one month from August 2017 to September 2017. Preoperative examination of patients consisted of autokeratorefractometry, visual acuity, detailed slit lamp examination to rule out any significant anterior segment pathologies, type of cataract on the basis of morphology on slit lamp and applanation tonometry. A-scan was done by contact method and Fundus examination was done to rule out any posterior segment pathologies. At all follow-up visits i.e., at one week and one month patients underwent autorefractometry, visual acuity with corrected refractive correction, anterior and posterior segment evaluation on slit lamp to rule out any postoperative complications. The statistical analysis by Z-test was performed comparing the unaided visual acuity of patients preoperatively and postoperatively at one month. Results: The number of patients at post-operative one month were significantly less than preoperative for the visual acuity of (6/60-6/36). The Z-Score was 2.3355. The p-value was 0.01928. The result was significant at p<0.05. Conclusion: This study showed that manual SICS patients can have good visual outcome at the end of one month and when combined with the benefits of acrylic IOL it can be a long term solution to affordability issues related to the cataract surgery. Thus, the use of this combination technique can be a good tool in eliminating cataract from the developing world.

Comparative Study of Active Release Technique and Myofascial Release Technique in Treatment of Patients with Upper Trapezius Spasm

Daxa Mishra, R Harihara Prakash, Jigar Mehta, Ankita Dhaduk

Introduction: Trapezius muscle pain and spasm is most common musculoskeletal disorder occurring in individuals who works with an awkward position of neck for a prolonged period of time, with repetitive movements. Active Release Therapy (ART) and Myofascial Release (MFR) are soft tissue manipulation techniques practiced by physiotherapists for reducing muscle spasm and pain. Aim: To compare the effect of ART and MFR on the upper trapezius muscle spasm on pain and cervical range of motion. Materials and Methods:The study was done on 60 patients of both genders between the age group of 20 to 55 years with upper trapezius spasm. They were divided into two groups by computerised randomisation. Each group received treatment in the form of either ART or MFR for seven days. Cervical Range of motion (ROM), Neck Disability Index scale (NDI) and Visual Analog Scale (VAS) were used as outcome measures. Results: Paired Sample t-test was used to compare the outcome differences within each group, while Independent t-test was used to compare the differences between the two groups for the same outcome measures. Improvement was found in both the groups on seventh day following intervention, but the group which received ART showed significant improvements in neck ROM (p<0.001), NDI (p<0.0001) and in VAS (p<0.0001) as compared to group which received MFR. Conclusion: Although both techniques are effective in alleviation of symptoms and associated disability in upper trapezius muscle spasm, ART gave better results as compared to MFR.

Is Obesity a Concern in Breast Cancer?

Patricia Sebastian, Rajesh Balakrishnan, Subhashini John

Introduction: Breast cancer is one of the commonest cancers in women in India. The risk factors also include modifiable ones such as obesity. Obesity has been shown to increase the risk of developing breast cancer and is also associated with advanced stage of disease at presentation. There is not enough evidence to show that obesity increases the recurrence rate of breast cancer in Indian patients. Aim: To see if obesity influenced the outcome of breast cancer patients in terms of Disease Free Survival (DFS). Materials and Methods: A series of 341 patients treated for invasive breast cancer during the period of July 2010 and July 2015 were analysed retrospectively for their DFS. Body Mass Index (BMI) was used to identify obese, overweight, normal and underweight women. DFS rates were estimated using the Kaplan-Meier method. The Fisher-Exact test was used for various clinical variables to determine if BMI influenced them. Unadjusted Cox proportional hazard models were used. Results: Obesity was seen in 15.5% (n=53), overweight in 39.6% (n=135), normal weight in 40.2% (n=137) and underweight in 4.7% (n=16). Mean duration of follow-up was 34.06 months with a median of 37 months (3-82). Five-year estimation of DFS was 70.7% (95%, CI 0.64-0.76) for the total population in the cohort. Disease recurrence or progression was seen in 24% of the cohort and 51.2% of them in whom recurrence occured had BMI =25. In the univariate analysis, overweight and obesity were not found to be significant factors influencing DFS. Conclusion: Obesity and overweight were not found as statistically significant factors influencing DFS in this study. Though overweight and obesity were more common than normal BMI in the breast cancer patients, WHO Class II obesity was rare. The postmenopausal women, Oestrogen Receptor (ER) positive patients and locally advanced disease patients had the majority of BMI =25 than normal BMI. Further randomised prospective controlled studies in Indian population are needed to further validate this finding.

Appraisal of Oral Hygiene Status amongst Subjects with Suicidal Leanings-A Pilot Study

Introduction: Suicide is an alarming social problem affecting the society at large causing a high mortality rate especially in the younger generation. Suicide is one of the top three causes of death among youth worldwide. Aim: The aim of the study was to draw a correlation between an alteration in one’s oral hygiene regimen and an innate suicidal tendency in an individual. Materials and Methods: This double blind cross-sectional study was conducted in a suicide prevention centre, a Non-Governmental Organisation (NGO) at Chennai. A total of 78 subjects (age 22-50 years) participated in the study. They were divided into two groups-Group A and Group B. Participants in Group A had attempted suicide at least once in the past one year. Participants in Group B had only threatened to commit suicide. Both Group A and B participants were attending counseling sessions at the centre. In addition to this, the Group A participants were also undergoing psychiatric therapy and taking anti-psychotic medications. Oral examination was done using a mouth mirror, probe and explorer. A printed questionnaire was also circulated to collect patient’s information like tooth brushing habits, smoking and their employment status. The statistical analysis was done using chi-square tests. Results: The participants in Group A had poorer oral hygiene index scores and clinical attachment loss scores than those in Group B. There was also a statistically significant association between the frequency of changing a tooth brush in Group A and Group B. The socioeconomic status of participants in Group A and Group B also showed a statistical significance. Based on the above findings it was found in this pilot study that there was a correlation in oral hygiene status and suicidal tendencies. Conclusion: The oral hygiene levels in the participants who had attempted suicide were poorer than that of the participants who had not actually attempted suicide.

Evaluation of the Epigenetic Biomarker Bone Morphogenic Protein 3 for Colorectal Cancer Diagnosis

Introduction: Colorectal Cancer (CRC) is a common type of cancer with a rising prevalence worldwide. Morbidity and mortality of CRC can be reduced by screening programs and early diagnosis. Currently used screening tests include fecal-based methods are non-invasive and inexpensive, however the sensitivity and specificity of these tests are not high enough. Aim: To evaluat hypermethylation of Bone Morphogenic Protein 3 (BMP3) as a biomarker in early diagnosis of CRC. Materials and Methods: A total of 96 individuals were enrolled in the present case-control study (59 CRC patients versus 37 healthy controls) and Methylation-Specific Polymerase Chain Reaction (PCR) was used to evaluate methylation status of the BMP3 gene in plasma samples and colonoscopy tissue biopsies. Results: In plasma samples, 75% of CRC patients showed hypermethylation in the BMP3 gene versus only 30% of the controls. In colonoscopy tissue biopsies, BMP3 showed hypermethylation in 81.6% of CRC patients. Specificity and sensitivity of this gene in CRC diagnosis were found to be 76% and 66% respectively. Conclusion: The results of the present study showed that BMP3 in combination with other genes could be used as a non-invasive and promising biomarker in screening and diagnosis of CRC.

Magnetic Resonance Spectroscopy of Giant Cell Tumour of Bone

Chetana Ramesh Ratnaparkhi, Kushal Ashok Tayade, Kajal Ramendranath Mitra

Introduction: Usefulness of proton Magnetic Resonance Spectroscopy (MRS) in evaluating and differentiating benign from malignant bone tumours is well known and has been reported in literature. Role of magnetic resonance spectroscopy in Giant Cell Tumour (GCT) of bone is still not well established. Aim: To evaluate the magnetic resonance spectroscopy features of GCT and to assess whether choline is a frequent occurrence in these tumours and whether magnetic resonance spectroscopy appearance can be correlated with clinical, radiological and histopathological findings. Materials and Methods: Ten patients with suspected GCT of bone based on clinical history and radiograph were subjected to Magnetic Resonance Imaging (MRI) and multivoxel magnetic resonance spectroscopy on 1.5T MR machine. On the basis of magnetic resonance spectroscopy findings, patients were grouped into two categories, one with demonstrable choline peak and another without choline peak. Clinical and radiological findings viz., are Campanacci grading and magnetic resonance imaging features were compared in these two groups. Preoperative histopathology was done in all patients. All underwent operative procedures and postoperative histopathology was also done. Results: All 10 patients in present study belonged to Campanacci Grade III i.e., showing aggressive radiographic appearance. Out of these 10 patients, only four showed elevated choline level (40%). Soft tissue component was seen in one patient and cystic component was seen in three patients showing choline peak. Fluid-fluid levels were seen in only one patient with demonstrable choline peak. On histopathology all of them turned out to be benign. Conclusion: This study indicates that even if GCT of bone showed elevated choline level on magnetic resonance spectroscopy, it is not a predictor of malignant transformation. There is no linear correlation between aggressive radiological features and occurrence of choline peak.

Efficacy of Episodic Use of Montelukast in Preschool Children with Intermittent Wheezing

Introduction: Acute intermittent wheezing illnesses are frequent occurrences in preschool children and need better management strategies. Montelukast, a leukotriene receptor antagonist has potent anti-inflammatory property with rapid onset of action and may be effective in reduction of asthma symptoms. Aim: To examine the effectiveness of episodic use of montelukast in modifying the severity of an acute wheeze episode in preschoolers. Materials and Methods: Children aged 1-5 years with acute wheezing were included in an observational prospective case control study. Montelukast, 4mg orally, was started on admission and continued until symptom resolution, maximum upto 14 days. Primary outcomes were duration of respiratory symptoms, severity of respiratory illness by Paediatric Respiratory Assessment Measure (PRAM) score and duration of hospital stay. Secondary outcomes were need for number of doses of bronchodilator, inhaled or systemic steroid or other medication (MgSO4 and/or Aminophylline). Chi-Square test, unpaired, two sided student t-test and Mann-Whitney U test were applied wherever applicable. Results: Total 107 patients were enrolled, out of which 53 patients were given montelukast and 54 patients served as control. Montelukast resulted in early reduction in symptom of breathlessness (p=0.0226), sleep disturbance (p=0.0214), feeding difficulty (p=0.011), significant improvement in PRAM score at 24 hour (p=0.046) and significant reduction in hospital stay (p=0.0448) compared to control group. There was significant increase in number of doses of systemic steroid (p < 0.00001) and need for other medication (p=0.027) in control group as compared to cases. There was no significant difference in proportion of patients requiring systemic steroid between two groups. Conclusion: Episodic use of short course montelukast is effective in reduction of symptoms, hospital duration and systemic steroid use.

Pre-hypertension and Hypertension in School Children Aged 8 to 17 Years in Southern India: A Community Based Study

Diksha Rai, K Amita, Vijay S Shankar

Introduction: Pre Hypertension (pre HT) and Hypertension (HT) in childhood have strong association with cardiovascular disease in adult life. There is scarcity of this data in Indian scenario. Aim: To determine the prevalence of HT and pre HT in school children between 8 to 17 years, in a rural set up. An attempt was also made to determine correlation between Blood Pressure (BP) and other risk factors like Body Mass Index (BMI), waist circumference, family history of HT and diabetes mellitus. Materials and Methods: A cross-sectional, community based observational model, comprising of 500 healthy students, between 8 to 17 years of age, was adopted. A semi structured questionnaire was administered to obtain socio-demographic details which were filled by the parents. Mean Systolic Blood Pressure (SBP) and/or Diastolic Blood Pressure (DBP) greater than or equal to the 95 percentile for that particular sex, age, and height was defined as HT. Pre HT was considered when average SBP or DBP levels that were higher than or equal to the 90th percentile, but lower than the 95th percentile. Height, weight, waist circumference and hip circumference and BP were measured using prior validated and standard tools. Results: Prevalence of pre HT was 4.2% and HT was 3.4%. BMI among the students with elevated blood pressure (pre HT and HT) and normotensives was 17.088251±2.88 and 19.796462±3.76 respectively. The Pearson's (r) correlation between SBP and BMI was 0.349 (p<0.0001). The r-value for DBP and BMI was 0.249 (p<0.00001), implying a significant positive correlation between BP and BMI. Similar significant positive correlation was observed for weight, waist circumference and BP. However, no relationship was observed between family history of hypertension, family history of diabetes mellitus and BP. Conclusion: Pre HT and HT is an important public health problem in children and adolescence. Increased BMI is a major risk factor for childhood HT. Early identification and prevention will help reduce long term consequences due to HT.

Morphology: A Keystone in Therapeutic Decision Making of Post Therapy Tumour Regression in Ovarian Tumours

K CHANDRAMOULEESWARI, K Ashwini

Introduction: Ovarian carcinoma is one of the most common malignancies of the female genital tract. Treating ovarian cancer with Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (IDS) is said to reduce surgical morbidity and has equivalent survival times when compared with primary cytoreductive surgery followed by adjuvant chemotherapy. Aim: This study aims to evaluate the histomorphological changes induced by NACT and its influence on the progression free survival of patients with malignant ovarian neoplasms. Materials and Methods: A total of 52 patients who were operated in VS Hospital, Chennai, after administration of four cycles of platinum-based chemotherapy were included in this six year study from January 2011-December 2016. Various histomorphological changes caused by NACT were looked for and five parameters namely fibrosis, necrosis, inflammation, residual tumour and psammoma bodies were graded. Progression free survival was calculated after follow-up of patients for three years. The graded parameters were compared with the survival time and their effect on survival was estimated. Results: The age of the patients ranged from 34 to 80 years with a mean age of 52 years. Out of the 52 cases, 46 were serous cystadenocarcinoma, four were mucinous cystadenocarcinoma, one case each of endometrioid adenocarcinoma and malignant mixed mullerian tumour. On comparing features like presence of fibrosis, necrosis, inflammation, residual tumour and psammoma bodies with progression free survival period, necrosis was found to have statistically significant association with disease free survival. Median progression free survival estimated in this study was about 22 months. Conclusion: This study analysed the various histomorpholgical changes induced by NACT in malignant ovarian neoplasms and their influence on survival of the patients.

Randomised Control Study of Palonosetron Versus Dexamethasone in Preventing Postoperative Nausea and Vomiting Following Ear and Nose Surgeries under General Anesthesia

Introduction: Postoperative Nausea and Vomiting (PONV) is defined as any nausea or vomiting that occurs during the first 48 hours after surgery. It is considered as a distressing event following anaesthesia. The incidences of PONV is 25-30% in all post-surgical patients and the incidence of PONV with middle ear surgeries are 50%-80%. Various pharmacological techniques were used to prevent PONV. Five-HT3 receptor antagonists are most commonly used prophylactic agents. Aim: To compare the efficacy and safety of intravenous Palonosetron 75 mcg, and intravenous Dexamethasone 8 mg in preventing PONV. Materials and Methods: Hundred patients of 18-60 years undergoing ear and nose surgeries under general anaesthesia requiring intubation for more than one hour were randomised into two groups of 50 patients each. Group P received 75mcg of palonosetron and Group D received 8 mg of dexamethasone before induction. The incidence of PONV in the two groups was noted using a four point score until 24 hours postoperatively. Results: The overall incidence of PONV in 0-24 hours were maximum in the dexamethasone group with 50% and 20% in palonosetron group. The four point score was higher in dexamethasone group compared to palonosetron group & with statistically significant difference. The requirement of rescue antiemetic medication was 30% in dexamethasone group and 10% in palonosetron group. Conclusion: Our study has shown that palonosetron is more effective in the prevention of PONV without apparent side effects.

A Study on Microbial Flora on Skin of Health Care Providers in a Tertiary Care Hospital in Southern India

Mathavi Sureshkumar, R Suriyapraba, R Indra Priyadharsini

Introduction: Human skin is constantly covered with microorganisms both commensals and pathogens depending on topography, environmental factors and host factors. Though these organisms are regarded as commensals in immunocompetent individuals, they can become pathogenic in immunocompromised persons especially in hospitalised individuals. In recent years, Staphylococcus epidermidis is regarded as an agent of hospital and community acquired infections. When the health care workers do not wash their hands between patients or do not practice standard infection control measures, they are responsible for transmission of nosocomial infections. Aim: This study was done to know the microbial flora on skin of Health Care Workers (HCWs) and to create awareness on the effective infection control measures. Materials and Methods: This prospective study was done in Vinayaka Mission’s Kirupananda Variyar Medical College, Salem for a period of four months. Two swabs were collected from 130 Health Care Workers (HCWs) (Doctors, Staff nurse, Medical students, Lab technicians and Housekeeping staff) and subjected to bacterial and fungal culture. Blood agar and MacConkey agar was used for bacterial culture and Sabouraud’s dextrose agar for fungal culture. The bacterial isolates were then subjected to antibiotic sensitivity testing. Results: Bacterial growth was observed in all the HCWs (100%) and fungus was isolated from eight HCWs (6.2%). Among the bacterial isolates, Diphtheroids (47) were the predominant isolate accounting for 29% followed by coagulase negative Staphylococcus (39) which was 24% of isolates. The predominant pathogen isolated was Staphylococcus aureus (15%, 25 isolates). 17% (11 isolates) of Staphylococci were resistant to Cefoxitin which indicates both MRSA and MR-CONS. Among gram-negative isolates, most of them were resistant to ampicillin, cotrimoxazole and cephalosporins. Candida (4 out of 8, 50%) was the predominant fungal isolate. Conclusion: Physical contact with HCWs is the most frequent mode of transmission of nosocomial infections. Hence, awareness should be created among HCWs about the significance of handwashing and use of personal protective equipment to prevent cross-infection.

Pharmacoeconomic Evaluation of Pantoprazole and Pantoprazole Plus Domperidone in Treatment of Patients with GERD

Introduction: Gastroesophageal Reflux Disease (GERD) is a common public health problem causing increased economic burden and decreased quality of life. Proton Pump Inhibitor (PPI) and prokinetics are the frequently used medications. The efficacy and safety of combined prokinetic and PPI therapy for GERD remains controversial. Aim: The study was conducted to perform pharmacoeconomic evaluation of Pantoprazole and Pantoprazole plus Domperidone in the management of GERD which helps to provide quality care within limited financial resources. Materials and Methods: This RCT was conducted on 80 patients suffering from GERD. These patients were randomly divided into two groups; Pantoprazole (40 mg once daily) and, Pantoprazole plus Domperidone (40 mg+30 mg once daily), respectively. The clinical outcomes were observed and analysed after two weeks of treatment. Cost-effectiveness ratio for pantoprazole and pantoprazole plus Domperidone was calculated by dividing the cost of treatment by its clinical outcome that is, Frequency Scale for the Symptoms of GERD (FSSG) score. Cost minimization analysis was done in accordance with the cost of both drugs available in market (over the counter) and Hospital pharmacy. All the data was recorded in the entry form and presented as mean±SEM/SD for numerical data, and proportion (%) for the categorical data. In all tests mean values of test groups (A and B) compared with Student's paired t-test. Results: After two weeks of treatment, the total improvement rate was found to be higher in Pantoprazole plus Domperidone group than in Pantoprazole group (improvement score 12.93 vs 11.32 but statistically not significant, p-0.21). But Pantoprazole was found to be more cost effective than Pantoprazole plus Domperidone group (ACER 9.7 vs 11.2). Cost minimisation analysis showed that Pantoprazole is the most economical medicine in hospital pharmacy as well as available in market. Conclusion: Pantoprazole monotherapy is more cost effective than combination of Pantoprazole with Domperidone in GERD patients. Substitution by Pantoprazole alone would be expected to produce cost savings. A combination should be preferred for PPI resistant GERD, patients with nausea and vomiting, in the subgroup of severely symptomatic patients.

Relation between Chromium, Iron and Copper with Gestational Diabetes in Zabol, Iran

Introduction: Diabetes is one of the most common chronic diseases. Gestational Diabetes Mellitus (GDM) is a type of diabetes that starts during pregnancy. Aim: To study the levels of chromium, iron, and copper in women with GDM compared with non-diabetic pregnant women. Materials and Methods: In this case-control study that was performed in Amir Al Momenin Hospital (Zabol-IRAN) in 2016 (from may to October). Sixty pregnant women with GDM were included in the study group and 60 non-diabetic pregnant women were included in the control group. Seven millilitres of blood was taken from the study participants for serum separation. For measuring the levels of chromium, iron, and copper Atomic Absorption Spectrometry was used. Data analysis was performed by Student’s t-test using the Statistical Package for the Social Sciences (SPSS) software version 16. Results: Serum levels of chromium (7.76±2.83 vs 6.52±2.74 ng/dL), iron (0.60±0.10 vs 0.55±0.14 µg/dL) and copper (0.97±0.22 vs 0.83±0.22 µg/dL) were lower in the case group compared with the control group. Their difference was not statistically significant (p>0.05). The average age of participitants was 34.4±8.01 years. There was no significant difference in age between groups. Conclusion: The present research showed that levels of Chromium, Iron and Copper in diabetic pregnant women were lower than that of non-diabetic pregnant women; but, these values did not had statistically significant difference.

Comparison of Retropupillary Iris-claw Intraocular Lens Implantation and Transscleral Suture Fixation of an Intraocular Lens for Aphakic Eyes

Ilona Anita Kaczmarek, Marek Edmund Prost, Jaromir Tomasz Wasyluk

Introduction: Iris-claw intraocular lens and scleral-fixation of intraocular lens are the main options for the correction of aphakia with inadequate capsular support. It is still unclear which one is the most appropriate for the management of aphakic eyes without sufficient capsular support. Aim: We compared early post-operative visual function and complications after retropupillary Iris-Claw Intraocular Lens (IOL) implantation and transscleral sutured IOL fixation for the treatment of aphakia in eyes without adequate capsular support. Materials and Methods: This prospective study included 36 aphakic eyes without capsular support. Nineteen eyes underwent posterior chamber implantation of the iris-claw lens (iris-claw group) and 17 eyes underwent transscleral suture fixation of an IOL (transscleral fixation group). Best-Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), operating time, and complications were compared between the groups. Patients were evaluated pre-operatively and at one day, one week, one month, and three months post-operatively. Results: BCVA was better in the iris-claw than in the transscleral fixation group at post-operative day one (p=0.01), but the groups did not differ significantly at one week, one month, or three months post-operatively (p>0.05). The mean operating time in the iris-claw group was significantly shorter than that in the transscleral fixation group (p<0.001). The post-operative complications in the transscleral fixation group included elevated IOP (17.65%), hyphema (5.88%), and retinal detachment (5.88%). Complications in the iris-claw group included pupil distortion (21.05%), increased IOP (5.26%), spontaneous dislocation (5.26%), and cystoid macular oedema (5.26%). Conclusion: Secondary retropupillary implantation of an iris-claw lens allows earlier visual recovery and requires a shorter operating time than does transscleral suture fixation of an IOL. In the early post-operative period, both surgical procedures are efficient and relatively safe for treating aphakic eyes without a stable lens bag.

Application of Enzyme Linked Immunosorbent Assay (ELISA) and Indirect Fluorescent Antibody Test for Serodiagnosis of Acute Scrub Typhus in and Around Puducherry, India

Selvaraj Stephen, D Gunasekaran, Velmurugan Anitharaj

Introduction: Scrub Typhus (ST) is now endemic in India and is diagnosed by Immunochromatography based rapid kits or conventional ELISA to detect IgM antibodies. Clinical picture of ST may mimic other diseases like Dengue, Leptospirosis and viral haemorrhagic fevers. Indirect Fluorescent Antibody Test/Immunofluorescence assay (IFA) is the reference standard which might help to confirm ST. Aim: To critically analyse the practical utility of the gold standard IFA vis-à-vis ELISA in identifying acute ST in patients. Materials and Methods: Archived acute blood samples from 140 febrile patients with clinical suspicion of acute ST, 70 patients with other febrile illnesses and 70 voluntary healthy blood donors were subjected to both ST IgM ELISA and ST IgM IFA. Statistical Analysis: Chi-Square test was applied and p-values =0.05 were considered statistically significant. Results: IgM IFA was positive in 120 out of 140 ST IgM ELISA positive ST patients and 16 out of 70 ST IgM ELISA negative febrile patients. All 70 blood donors were negative in both IgM ELISA and IgM IFA. Against the gold standard IFA, Sensitivity, Specificity, Positive Predictive value and Negative Predictive values for IgM ELISA were 88.24%, 86.11%, 85.71%, 88.57% respectively. Titres of =1:64 were considered as significant for IgM IFA. Conclusion: It is recommended that standardisation is required regarding significant cut-off titre for IgM IFA in different regions of India. For serodiagnosis of acute ST, IgM ELISA still remains

Role of Pulmonary Function Tests in the Assessment of Lung Impairment in Patients with Diffuse Parenchymal Lung Diseases: Association with Clinicoradiological-Histopathological Profile

Ajai Kumar Tentu, Sarvinder Singh, Rongala Laxmivandana, S K Singh

Introduction: Diffuse Parenchymal Lung Disease (DPLD) is known to be a common sequela of various lung insults. DPLD is diagnosed by various modalities such as clinical, radiological, lung function and histopathological techniques. There is a limited understanding on the potential clinical application of the non-invasive lung function tests in the evaluation of DPLD. Aim: To study the role of Pulmonary Function Tests (PFTs) in the assessment of lung impairment in DPLD patients and its association with clinicoradiological and histopathological profiles. Materials and Methods: A prospective observational study was conducted with 50 DPLD patients who were selected as per the study criteria over a period of 30 months at our tertiary care respiratory centre. Clinicoradiological evaluation and PFTs were carried out for all of the patients. Histopathological examination was done for patients with inconclusive diagnosis. Lung impairment was assessed and its association with clinicoradiologic and histopathologic profile was analysed. Results: Of the 50 selected patients, diagnosis of a specific subset of DPLD was possible in 33 through the clinicoradiological findings while in 17 through histopathological findings. Overall, idiopathic interstitial pneumonia was found to be common in 31 (62%) followed by sarcoidosis in 14 (28%). Patients showed restrictive and mixed spirometry pattern in 35 (70%), decreased lung volumes in 30 (60%) and some form of diffusion impairment in 42 (84%) while 17 (34%) patients had showed reduced 6-minute walk distance (6MWD). Significant association was noted between: (i) severe diffusion impairment and crackles (p=0.011); (ii) severe diffusion impairment and honeycombing pattern (p<0.001); (iii) decreased lung volumes and crackles (p=0.0009); and (iv) reduced 6MWD and honeycombing pattern (p<0.001). Conclusion: This study confirms the role of the PFTs in the comprehensive assessment of lung impairment in DPLD patients.

The Prognostic Value of ANGPTL-4 in Acute Coronary Syndrome: A Prospective Cohort Study

Introduction: Coronary Artery Disease (CAD) is one of the leading causes of mortality and morbidity worldwide and Acute Coronary Syndrome (ACS) is one of the predominant causes of Cardiovascular Deaths (CVD). Aim: To determine if Angiopoietin-like Protein-4 (ANGPTL-4) might be a potential predictor of Major Adverse Cardiac Events (MACE) in ACS patients. Materials and Methods: This prospective cohort study was conducted in the Department of Cardiology and Clinical Pharmacology, SRM MCH and RC, Kattankulathur, between January 2016 and March 2018. Authors measured serum ANGPTL-4 at admission in 120 ACS patients using Enzyme-linked Immunosorbent Assay (ELISA) with a commercially available (Ray Biotech Human ANGPTL-4 ELISA, GA, USA) kit. The patients were followed up through a telephonic interview to record MACE. Independent Samples t-test and chi-square test were used to compare the differences in the continuous and categorical data, between the groups respectively. Receiver Operating Curve (ROC) was plotted to predict the ability of ANGPTL-4 to predict MACE among ACS patients. Kaplan-Meier survival analysis was performed and the survival rate between those with high and low ANGPTL-4 levels was compared using the log-rank test. All statistical analyses were performed with SPSS version 16.0 (SPSS Inc., Chicago, IL). All p-values<0.05 were considered statistically significant. Results: A total of 120 ACS patients were included for the study. During the median follow-up of 24 (22-25.75) months, MACE had occurred among 14 patients. Ten patients were lost to follow-up. Kaplan Meier survival curve was plotted for patients with low and high ANGPTL-4 levels and the log-rank test failed to show a significant difference in the survival rate between the two groups (?2=0.100, p=0.75). ANGPTL-4 failed to show any significant difference in the survival rate in both diabetic (?2=0.002, p=0.97) and hypertensive (?2=0.002, p=0.96) ACS patients. Conclusion: In conclusion, the present study data failed to demonstrate that ANGPTL-4 could be a potential biomarker for the prediction of MACE among ACS patients. However, larger studies are warranted to investigate the prognostic value of ANGPTL-4 among ACS patients.

Various Clinical and Histopathological Patterns of Idiopathic Photodermatosis – An Observational Study

Introduction: The idiopathic photodermatosis have different histopathological patterns, spongiotic pattern being the most common. Aim: To study the histopathological patterns of photodermatosis and to correlate between the clinical and histopathological findings. Materials and Methods: Hundered consecutive patients with lesions of idiopathic photodermatosis were included in this cross-sectional observational study. The clinical diagnosis was made and confirmed after thorough history, clinical examination and relevant investigations, including biopsy. Results: In this study 49 participants were male and 51 were female. Maximum number (20/51) of female patients presented in the age group 26-40 years while most male patients (16/49) presented in the age group of 56-70 years. Total 95% cases had lesions on photoexposed parts of upper limbs followed by neck involvement in 51% cases. The most common presenting symptom was itching, seen in 98% patients. Polymorphic Light Eruption (PMLE) was the clinical diagnosis in 97% cases. The most common histopathological pattern observed was Spongiotic pattern which was seen in 46% cases. Conclusion: While young females in the age group 26-40 year were more commonly affected, lesions were more common in men who were in the age group 56-70 year. Population in North India may be at greater risk because their skin is suddenly exposed to sun in spring and summer after the end of winter season. The PMLE was the most common subtype. Spongiotic pattern was the most common histopathological pattern found, followed by lichenoid pattern.

Anatomic Landmarks to Identify the Radial Nerve during the Posterior Approach of the Humerus: A Cadaveric Study

Mythraeyee Prasad, Bina Isaac, Prasanna Samuel Premkumar

Introduction: Identification of the radial nerve and preventing injury to it is crucial, while surgically approaching the humerus from the posterior aspect to treat fractures of the midshaft or the distal third of the bone. Aim: To identify certain anatomic landmarks, using which the radial nerve could be identified during surgical intervention, in order to prevent iatrogenic injury to the nerve. Materials and Methods: Twenty-eight arms belonging to 14 adult cadavers (10 male and 4 female) were used for this study. The distance between the radial nerve on the posterior humerus and the point of confluence of the long and lateral heads of the triceps with the triceps aponeurosis was measured. Statistical analysis using Student’s paired t-test was done between the right and left sides. In the distal third of the humerus, the distance of the radial nerve and the lateral border of the triceps aponeurosis at four sites were determined. Results: The mean distance from the point of confluence to the radial nerve along the posterior humerus was 39.7±11.8 mm. The radial nerve passed adjacent to the lateral border of the triceps aponeurosis at a distance of 12-19.5 (±3.27) mm. It was never found to be closer than 4.6±2.54 mm to the aponeurosis. Conclusion: The present study is useful for orthopaedicians while undertaking the surgical management of humeral fractures. The point of confluence and the triceps aponeurosis are two anatomic landmarks that can be used to locate the radial nerve.

Expression of Oct4 Protein in Astrocytic Tumours: Histopathologic and Immunohistochemical Study

Introduction: The majority of gliomas in adults are resistant to therapy. Therapy resistance has been attributed to the presence of Cancer Stem Cells (CSCs). Oct4 is a transcription factor required for maintaining the pluripotency and self-renewal of CSCs. It was found to be highly expressed in astrocytomas and other tumours. Aim: Assessment of immunohistochemical expression of Oct4 protein, being a target antigen for cancer immunotherapy of astrocytic tumours, and the correlation between Oct4 expression and the grades of astrocytoma. Materials and Methods: In this retrospective cross-sectional study, 66 paraffin-embedded biopsies of astrocytomas were collected including; 12 cases of Grade I, 19 cases of Grade II, 15 cases of Grade III and 20 cases of Grade IV. All the cases were studied immunohistochemically using anti-Oct4 protein antibody. Chi-square test or Fisher’s-exact test was used to examine the relationship between qualitative variables. All tests were two-tailed. The p-value <0.05 was considered significant. Results: Oct4 was expressed in 30 cases. The higher the grade of astrocytoma, the more was the expression (p-value=0.006) and the percentage of positive tumour cells (p-value=0.039). The expression was both nuclear and cytoplasmic. The intensity of expression was variable within the same tumour. Oct4 was not expressed in normal brain tissue. Conclusion: Oct4 is a stem cell marker that is involved in the development of CSCs, and accordingly, the development of many tumours including astrocytomas.

Effect of Zinc Supplementation in Children with Severe Pneumonia: A Randomised Controlled Study

Aditi Baruah, Hiranya Saikia

Introduction: Pneumonia is one of the leading cause of mortality among children under five years of age globally and responsible for 18 % of all deaths. Zinc is thought to help in decreasing the susceptibility to acute lower respiratory infections by regulating various immune functions. Aim: To evaluate the effect of zinc supplementation on clinical resolution, duration of hospital stay and recurrence in next three months in children with severe pneumonia. Materials and Methods: This was a randomised, double-blind, placebo-controlled trial done in the Department of Paediatrics of a tertiary care hospital, where in a total of 560 children, aged 2-60 months, admitted with the diagnosis of severe pneumonia {according to WHO case definition i.e., fever, cough, fast breathing (respiratory rate =50/minute in 2-12 month and =40/minute in 1-5 years of age) and lower chest indrawing}, between November 2013 to October 2015, were included in this study. Subjects were randomised blindly into zinc and placebo group in 1:1 ratio. Zinc or placebo supplementation was given (10 mg in 2-6 months and 20 mg in 7-60 months of age) orally daily once for two weeks, to each child according to randomisation. Outcome measures were calculation of time taken for clinical resolution of pneumonia, duration of hospital stay in completed days and counting the number of episodes of pneumonia in the next three months from the date of admission. Statistical analysis was done using Microsoft Excel 2007. Outcome measures were compared between zinc and placebo group by calculating p-value (p-value <0.05 was taken as significant), odds ratio and 95% confidence interval. Other variables were analysed by calculating mean, standard deviation and p-value. Results: When compared among zinc group and placebo group, zinc group showed significant acceleration in clinical resolution of pneumonia (p=0.042) and reduction in the duration of hospital stay (p=0.035). However, zinc supplementation and recurrence of pneumonia showed no significant association (p=0.52). Conclusion: Zinc supplementation can be considered in the treatment of severe pneumonia in children to accelerate the clinical resolution and thereby to reduce the hospital stay. However, zinc supplementation has no role in the prevention of pneumonia in next three months.

Can Bohler’s Angle Predict the Functional Results of Intra-Articular Displaced Calcaneal Fractures?

Sharan Mallya, Ramachandra Kamath, Atmananda Hegde, Rajendra Annappa

Introduction: Intra-articular fractures need to be anatomically reduced. In intra-articular calcaneal fractures, Bohler’s angle can be used as a tool to achieve articular congruity intraoperatively. But a debate exists whether surgical restoration of Bohler’s angle to normal range in calcaneal fractures can ensure good functional outcome. Many studies have found no correlation between Bohler’s angle and the ultimate functional outcome. Aim: To investigate whether correlation exists between the operative restoration of Bohler’s angle and the functional outcome. Materials and Methods: Forty patients with closed intra-articular displaced calcaneal fracture were studied. The injury was classified according to Sanders classification. Preoperative and postoperative Bohler’s angle was determined from radiographs. The functional outcome was assessed using American Orthopaedic Foot & Ankle Society hind foot score (AOFAS) and Visual Analogue Scale (VAS). Results: Forty patients were enrolled in the study with a follow up period of 12 months. As per Sanders classification, there were 14 Type II, 14 Type III and 12 Type IV fractures. The Bohler’s angle preoperatively did not correlate with functional outcome. Postoperative Bohler’s angle correlated significantly with AOFAS hind foot score and Visual analogue scale. Conclusion: Intraoperative restoration of Bohler’s angle to >18 degrees correlated strongly with the ultimate functional outcome. Therefore, aim of treatment in calcaneal fractures should be restoration of Bohler’s angle to near normal value.

The Correlation between Body Mass Index and Vasopressor Need after Spinal Anaesthesia for Cesarean Section

Solmaz fakhari, Eissa Bilehjani, Haleh Farzin, Ramin Barnous

Introduction: Hypotension is one of the common complications of spinal anaesthesia in mothers undergoing cesarean delivery. Vasopressor such as ephedrine or phenylephrine are the most common drugs employed to treat hypotension induced by spinal anaesthesia. Obese women have a limited physiological reserve and usually show remarkably greater complications of pregnancy and anaesthesia. Aim: To compare the requirement of vasopressor therapy for spinal anaesthesia-induced hypotension, between parturients with BMI =30 kg/m2 and those with BMI <30 kg/m2 in cesarean section. Materials and Methods: The study population included 160 healthy singleton pregnant women aged between 18 and 40 years of age with term pregnancy who underwent elective cesarean section with spinal anaesthesia. Spinal anaesthesia was performed, using 10 mg of hyperbaric bupivacaine 0.5% plus 10 µg of fentanyl. Any fall of >20% in Mean Arterial Pressure (MAP) or reduction of systolic blood pressure below 100 mmHg was considered as hypotension; it was treated with intravascular fluid, ephedrine, or phenylephrine. At the end of the study, the participants were divided, based on their Body Mass Index (BMI), into normal and obese groups (BMI <30 kg/m2 or =30 kg/m2, respectively). Using SPSS statistical software, authors compared numbers of hypotension episode, need for vasopressor, and newborn status between the two groups. Results: The mean±SD BMI of all patients was 33.24±5.73 kg/m2. In 51 mothers (31.9%), the BMI was below 30 kg/m2 and mean±SD BMI was 27.24±2.24 kg/m2. In 109 mothers (68.1%), the BMI was =30 kg/m2 and mean±SD BMI was 36.11±4.54 kg/m2. In 126 (79.7%) cases, the main indication for cesarean section was a previous experience of cesarean child-birth. Spinal anaesthesia failed in two cases (with BMI =30 kg/m2) and was changed to general anaesthesia. These mothers were excluded from the study, and the data were obtained from 158 cases. Intraoperative fluid requirement and blood loss were similar in normal and obese mothers. Hypotension rate was similar; however, in the majority of the cases, MAP was low in obese mothers. Ephedrine was administered more frequently and with high doses in obese mothers. Phenylephrine was employed in the similar manner. The newborn Apgar scores and umbilical cord acidosis rate were similar in both the groups. Conclusion: It was found that the fall in arterial blood pressure was more severe in obese mothers after spinal anaesthesia. Vasopressor was required more frequently and in high doses in these obese mothers. Furthermore, a good newborn outcome can be delivered with appropriate haemodynamic management.

Rapid Detection of Enterohaemorrhagic E.coli Using Phage-Based Bioluminescent Assay

Sabah AA Jassim, Rand R Hafidh, Zahraa Q Ali, Ahmed S Abdulamir

Introduction: There is a need for using a reliable, time-saving, and specific detection assay for coliforms, environmental E. coli, and Enterobacteriaceae worldwide. Aim: To innovate a new principle of phage-based rapid diagnostic test in detecting E. coli bacteria in low titer and short time. Materials and Methods: A phage mixture of 200 E. coli specific phages, including 22 specific for Enterohaemorrhagic E.coli (EHEC), were used in a new detection platform, a phage-based Adenylate Kinase Bioluminescence Assay (AKBA). Ten EHEC E. coli and 30 universal E.coli isolates were used for AKBA assay. Results: AKBA showed positive detection of E.coli bacteria at 1000 CFU/ml in just 20 minutes. The phage-based detection was highly specific at strain level of E.coli. The sensitivity and specificity of AKBA was 74% and 78%, respectively. Conclusion: A rapid and strain-specific diagnostic test was prepared to E.coli by using coliphages. The significance and impact of the study shows that it might be feasible to formulate a phage-based assay against any Gram negative or positive bacteria using the same approaches of the current AKBA assay with slight modifications.

A Study on Knowledge, Attitude and Practices Regarding Household Consumption of Iodized Salt among Selected Urban Women of Tripura, India

Anjan Datta, Nabarun Karmakar, Kaushik Nag, Simul Singha

Introduction: Iodine deficiency is not only responsible for endemic goiter but it is the single most common cause of preventable mental retardation and brain damage in the world today. Wide range of variation exists in household consumption of iodized salt across different states which warrant the need of the present study. Aim: To assess the knowledge, attitude and practices regarding household consumption of iodized salt and associated factors among women in an urban area of Tripura. Materials and Methods: A community based cross-sectional study was conducted among 260 randomly selected women, who were involved in day to day household cooking, residing within the field practice area of Urban Health Training Centre (UHTC), Dukli under Department of Community Medicine, Tripura Medical College and Dr BRAM Teaching Hospital, for a period of three months. A predesigned, pretested, semi-structured interview schedule was used for data collection and analysed using SPSS version 16.0 software. Data were represented in the form of frequency distribution tables; Chi-square test and Fisher’s-exact test was used to see the associations as and when required. Results: In this study, majority (64.62%) of the participants have not heard of iodized salt but showed good practice (87.3%) regarding iodized salt consumption. Good knowledge, attitude was significantly associated with higher age group, education and socio-economic class of the participants. Conclusion: Although majority of the participants showed good knowledge and practice related to iodized salt consumption at household level, time of adding salt while cooking was still faulty in most of them.

Renal Failure: The Most Important Prognostic Factor for Morbidity and Mortality in Patients Undergoing Open Elective Abdominal Aortic Aneurysm Repair

Introduction: The elective abdominal aortic aneurysm repair leads to a remarkable decrease in the rupture of aneurysm and an increase in the life expectancy among patients. Aim: To study the mortality rate and complications of the open elective abdominal aortic aneurysm repair. Materials and Methods: This descriptive cross-sectional retrospective study was carried out on all patients who had undergone open elective abdominal aortic aneurysm repair in Rasht Hospitals, Iran, from March 2007 to March 2011. The background variables, i.e., preoperative, intraoperative, and postoperative results, as well as relevant variables including mortality and complications were recorded on a checklist. The data collected were analysed using SPSS 21.0 through univariate and multivariate analyses. Results: From the total of 61 patients, 11 (18%) were female and 50 (82%) of them were male. Nine patients (14.8%) died within 30 days from the surgery, and five patients (8.2%) suffered complications: Acute renal failure (three individuals) and sepsis (two individuals). In the univariate analysis, the Blood Urea Nitrogen (BUN) level of over 25 mg/dL (p=0.028) and the serum creatinine level of over 1.2 mg/dL (p=0.047) had a significant correlation with postoperative mortality. Additionally, the intensive care unit stay (p=0.019) and the duration of the mechanical ventilation (p=0.021) were significantly correlated with the postoperative complication occurrence. Conclusion: The BUN level of over 25 mg/dL and the serum creatinine level exceeding 1.2 mg/dL were the predictors of mortality, and the intensive care unit stay and the duration of the mechanical ventilation were the predictors of the postoperative complication occurrence after the open elective abdominal aortic aneurysm repair.

The Value of 8-iso Prostaglandin F2 Alpha and Superoxide Dismutase Activity as a Clinical Indicator of Oxidative Stress in Type II Diabetes Mellitus

Heba Kamal Morsi, Manar Mohamad Ismail

Introduction: Type II Diabetes Mellitus (T2DM) is a serious metabolic disorder in which Oxidative Stress (OS) is responsible for tissue damage and complications. An 8-iso prostaglandin F2 alpha (8-iso-PGF2a) is a stable and abundant active product of oxidative stress that could promote complications in DM and could be used as a biomarker for the detection of oxidative injury and lipid peroxidation. Aim: The study was designed to evaluate the accuracy of 8-iso prostaglandin F2 alpha (8-iso-PGF2a) and Superoxide Dismutase (SOD) activity as a biomarker of OS in T2DM and to verify their relation with the glycaemic control and lipid profile. Materials and Methods: This is a cross-sectional case control study that included 58 (20 good glycaemic control and 38 poor glycaemic control) T2DM patients from Al-Noor Specialist Hospital, Holly Makkah and 20 healthy volunteers. 8-iso-PGF2a was measured by quantitative ELISA and SOD enzyme activity assayed by colorimetric technique. Data were analysed using SPSS version 20. All numerical data were represented as mean±SD. ANOVA test was used for comparisons between the different groups. Receiver Operating Characteristic (ROC) curve was conducted to calculate sensitivity and specificity. Results: There was a highly significant increase in 8-iso-PGF2a level in the uncontrolled DM cases compared to both the control and controlled DM groups (p<0.001) and it showed positive correlation with HBA1c (r = 0.817 and p<0001). SOD activity showed a highly significant decrease in the controlled and uncontrolled DM group compared to the control group (p<0.001) with larger reduction in the uncontrolled group (p 0.009). Based on ROC curve analysis, 8-iso PGF2a at a cut-off 113.8 pg/mL showed 100% sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPP) for prediction of OS associated with poor glycaemic control. Levels lower than 2.37 SOD activity can predict OS with 87.8% sensitivity, 66.7% specificity, 90.3% PPV and 73.5% NPV. Conclusion: This study highlights the validity of 8-iso-PGF2a as a biomarker of OS with high accuracy compared to SOD in T2DM that make it worthy to move serum 8-iso-PGF2a detection from research to clinical utility.

The Effect of Care Plan Based on Roy Adaptation Model on the Incidence and Severity of Delirium in Intensive Care Unit Patients: A Randomised Controlled Trial

Hero Hamzehpour, Sina Valiee, Mohammad Azad Majedi, Daem Roshani, Jamal Seidi

Introduction: Delirium is an acute transient brain disorder which is common in patients who are hospitalised in intensive care unit. Nurses play a key role in its prevention, early detection and also in its treatment. Aim: The aim of this study was to evaluate the effect of care plan based on Roy Adaptation model on the incidence and severity of delirium in intensive care patients. Materials and Methods: This triple-blind randomised control trial was conducted on 100 hospitalised patients in intensive care units in Besat hospital, Sanandaj, Iran in 2016. Two intensive care units of hospital were selected as the intervention and control units. Nurses who were in the intervention group were trained according to Roy adaptation model. Delirium was measured by the NEECHAM Confusion Scale two times a day for seven days for each patient. Data was analysed using descriptive statistics and parametric tests. Results: There was a significant difference between intervention and control groups in terms of the mean of delirium on fourth day (17.40) in control group vs. 20.58 in intervention group with (p<0.028) and fourth night with values 16.78 in control group vs. 21.35 in intervention group with (p<0.001). The mean of delirium in the control group was less than the intervention group at different times. This difference was not significant initially but from the fourth day the difference in the mean between the groups was found statistically significant. Conclusion: The care plan based on Roy adaptation model reduced the incidence and severity of delirium in patients hospitalised in ICU. Using this model to modify incompatible behaviours in ICU patients is recommended.

Histopathological Study of Incidental or Opportunistic Salpingectomy Specimens and the Association of Tubal and Ovarian Lesions in South Eastern Nigeria

Introduction: There is heightened interest on the fallopian tube in recent times. Most reports on the subject emanate from western countries thus data on fallopian tube is lacking in Nigerian and African populations. Aim: To establish the histopathological status of grossly normal fallopian tube specimens and the pattern of gynaecological disease contributing to concomitant resection of normal fallopian tube and to determine if there are any association between tubal and uterine and or ovarian lesions. Materials and Methods: The study was a prospective cross-sectional study of incidental fallopian tubes received at University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital from 1st January 2012 to 31st December 2014. The Haematoxylin and Eosin (H&E) stained sections of the entire tube were examined. Statistical analysis was done using IBM SPSS software version 20.0. Measures of central tendency and variation were calculated for numerical variables while frequency and proportions were calculated for categorical variables. Fisher’s-Exact and chi-square tests were done as appropriate. Results: Fallopian tubes from 120 female subjects were studied. The mean age of the women was 48.7±10.1 (range: 26-79) years. Sixty one out of the 120 women (61/120, 50.8%) had fallopian tubes within normal limits. Eighty lesions were identified in fallopian tubes of 49.2% (59/120) of the women. No case of Serous Tubal Intraepithelial Carcinoma (STIC) was diagnosed. Statistically significant association was seen between ovarian sex cord stromal tumours and moderate to marked epithelial hyperplasia of the fallopian tube (p<0.001). Conclusion: Extensive sampling protocol revealed identifiable pathological, mostly benign lesions in 49.2% of grossly normal fallopian tubes. Diseases of the uterine corpus, particularly uterine leiomyoma, were the commonest cause of incidental fallopian tube resection.

Verification of Radiation Fluence using Stack Film in HDR Brachytherapy with Heterogeneity Algorithm

Introduction: It is essential that Quality Assurance (QA) need to be in line with progresses in HDR brachytherapy treatment planning and delivery to ensure an appropriate level of dosimetric accuracy and quality. Aim: To verify radiation fluence using stack films in HDR brachytherapy with heterogeneity algorithm. Materials and Methods: Gafchromic EBT2 films were stacked in different experimental setup and each film acted as dosimeter to validate AcurosTMBV algorithm in HDR brachytherapy. These films were read using Epson expression 10000 XL flatbed scanner, calibrated against the standard value and analysed with Film QA Pro 2015 software. Different criterion were set for gamma analysis which include Dose Difference (DD)/Distance-To-Agreement (DTA); 2%/1 mm, 5%/1 mm, 10%/1 mm. Results: In order to validate the point doses calculated using model based dose calculation algorithm (AcurosTM BV), a virtual phantom created in the TPS, which agreed with MC based calculation mostly within 2%. The results of each plane were analysed in all the experimental setup. In the gamma pass criteria of 2% and 1 mm, 92% passed, in 5% and 1 mm criteria 96% passed and with 10% and 1 mm criteria, almost 100% passing rate was achieved. Conclusion: Methods provide a comprehensive verification for commissioning the MBDCA-AcurosTM BV and are recommended to use stack film for QA program in HDR brachytherapy.

Differences in Heart Rate and Galvanic Skin Response among Nurses Working in Critical and Non-critical Care Units

Rakesh Sharma, Deepak Goel, Malini Srivastav, Renu Dhasmana

Introduction: Health care environment usually remains stressful for health care professionals which may have impact on their psycho-physiological health. Aim: This study was conducted to find the differences in Heart Rate (HR) and Galvanic Skin Response (GSR) among critical and non-critical care unit nurses. Materials and Methods: A comparative study was conducted to find the differences in HR and GSR value of nurses posted in critical and non-critical units. Critical and non-critical care units were classified using patient’s acuity category classification. A total of 100 nurses, 50 from critical and 50 from non-critical care units were selected by simple random sampling technique. HR and GSR were recorded on a digital polygraph (Medicaid systems). Descriptive and inferential statistics were used to analyse the data. Results: The mean heart rate (beats per minute) and GSR (Amp ~ K) score of nurses working in critical care units (88.32±9.63 and 916.9±473.4) was higher than the nurses working in non-critical units (83.56±5.82 and 687.8±270.0). The difference in the scores of critical care unit nurses were significantly higher than the non-critical unit nurses (p<0.001). Conclusion: Present study revealed that work environment has great role in the physiological health of nurses.

Physical Activity during Pregnancy and its Relationship with the Functional Status of Primiparous Women Six Weeks after Childbirth: A Cohort Study

Introduction: The transition to motherhood is a major life event that affects all aspects of psychosocial functioning. Aim: The aim of this study was to determine the relationship between physical activity during pregnancy and postpartum functional status. Materials and Methods: This cohort study was carried out on 165 Iranian women 18-35 years old referred to health centers of Tehran from April 2013 to March 2014. Pregnant women were selected by proportional distribution to each center. International Physical Activity Questionnaire (IPAQ) was completed by pregnant women in 28-34 weeks and they were categorized into two groups; low (68 patients), and moderate and high (97 cases) groups, according to the physical activity level. Follow-up in both groups continued until 6 weeks postpartum and Inventory of Functional Status after Childbirth (IFSAC) was completed at the end of six week postpartum period. Independent-t test was used for data analysis. Results: No statistically significant difference was observed between the two groups in terms of sociodemographic characteristics (p>0.05). In the low physical activity group, the mean (standard deviation) of the total score of physical activity was 1680.9 (2204.7), and in the moderate and high group, it was 3182.6 (3946.5). Two groups were not significantly different in terms of the mean score of functional status (p=0.279). Conclusion: The results of the present study showed that physical activity during the third trimester of pregnancy has no significant effects on functional status after childbirth in primiparous women. Appropriate strategies should be adopted to encourage women to participate in physical activities so as to promote maternal and neonatal health during pregnancy and after childbirth.

Correspondence: Osho Dynamic Meditation’s Effect on Serum Cortisol Level

Han Suelmann

The Relationship between Resilience and Quality of Life in Family Caregivers of Patients with Mental Disorders

Introduction: In the past, patients with mental disorders were often isolated, but these patients now-a-days enter the society, as therapeutic interventions have advanced. Family members play an important role in the life of many adults with mental disorders and are under considerable amounts of stress that may affect caregiver’s physical health, quality of life and resilience. Aim:The present study aimed to determine the relationship between the resilience and quality of life in family caregivers of patients with mental disorders. Materials and Methods: The present cross-sectional, correlational, descriptive study was conducted on 238 family caregivers of patients with mental disorders. The Short Form Health Survey (SF-36) was used to measure the quality of life and the Connor and Davidson Resilience Scale was used to measure resilience in the participants. The SF-36 consists of two general dimensions and eight domains of health and the resilience scale consists of 25 items. The data obtained through the questionnaires were analysed in SPSS version 16.0 using Pearson’s correlation test. Results: The majority of the family caregivers were the patients’ mothers. The results showed a significant direct relationship between resilience and quality of life (p<0.001, r=0.40). Conclusion: Resilience is a personal resource that affects quality of life directly. Resilience can enhance quality of life. The design and implementation of programs to enhance resilience and improve quality of life in family caregivers in line with the emerging needs of this group are therefore necessary.

Effect of Ultrasonic Bath Immersion on Physical Properties of an MMA-based Orthodontic Base-plate Material

Wadjakorn Thummawanich, Chairat Wiwatwarrapan, Chintana Sirichompun

Introduction: Self-cured Methyl Methacrylate (MMA)-based acrylic resin is commonly used for fabricating removable orthodontic appliances. However, residual monomer can leach out and cause mucosal irritation. Furthermore, it can reduce the physical properties of the appliance. Using ultrasonic immersion with ethanol solution is an effective method to reduce the level of residual monomer. However, its effect on the physical properties has not been reported. Aim: To investigate the effect of ultrasonic bath immersion in water or ethanol solutions on the physical properties of an MMA-based orthodontic base-plate material. Materials and Methods: Eighty rectangular and 80 disc-shaped specimens of an MMA-based orthodontic base-plate material (Orthoplast, Vertex-Dental) were prepared in stainless steel moulds as per the manufacturer’s instructions and randomly divided into eight groups: Group I, untreated control; Groups II and III, immersed in 25°C water for 24 and 72 hours respectively; Groups IV-VIII, immersed 10 minutes in an ultrasonic bath at 50°C of water, 10%, 20%, 30% and 40% ethanol, respectively. The flexural strength and flexural modulus were measured with a universal testing machine and microhardness was measured with a microhardness indenter. Water sorption and solubility were measured per ISO 20795-2. The data were analysed by one-way ANOVA, followed by Tukey’s HSD test (p<0.05). Results: The flexural strengths of Groups IV and VIII were significantly higher compared with Group I, while the others were not significantly different from Group I. For flexural modulus, Groups II, IV, VI, VII, VIII were significantly higher than Group I, however, Groups III and V were not significantly different. There were no significant differences in microhardness between the groups. The water sorption of Groups VI, VII, and VIII were significantly lower compared with Group I while that of the others were not significantly different. The water solubility of the experimental Groups were not significantly different compared with that of Group I, except for that of Group IV, which was higher. Conclusion: An ultrasonic bath immersion with either 50°C water or 50°C ethanol (10%, 20%, 30% and 40%) resulted in improved or unaltered physical properties of an MMA-based orthodontic base-plate material.

Early Radiographic Features of Maxillary Canine Impaction for Orthodontically Diagnosed Children Aged Between 8-14 Years Old

Ahmed Almahdy, Ali Alqerban, Omar Aljasir, Zyad Alsaghir, Suliman Alhammad

Introduction: The early detection and diagnosis of maxillary canine impaction affect the planning of its treatment. Certain radiographic features may be used in order to diagnose such impaction. Aim: To study the radiographic features for detection of the maxillary canine impaction in children and the changes associated with these features over time. Materials and Methods: This was a retrospective cross-sectional study that included 37 children aged between 8-14-years-old. Each patient must be diagnosed orthodontically with canine impaction by the failure of its eruption clinically and by using Panoramic Radiographs (PRs). The patient must have at least two PR with at least a one-year interval (T1 and T2) between them both. The following radiographic features have been used to identify maxillary canine impaction: 1) the vertical canine crown height; 2) the degree of canine overlap in relation to any adjacent teeth; 3) the magnitude of canine to lateral incisor angle and 4) the magnitude of the canine to midline angle measurement. The null hypothesis for this study was that there is no difference in the radiographic features between impacted and non-impacted canines in children overtime. Results: An assessment of the panoramic radiographs that were obtained at a later stage (T2) was carried out, which revealed that 56.76% of the canines were impacted whilst 43.24% had erupted normally. Impacted canines showed a significantly higher vertical crown height in relation to the adjacent teeth at T1 (p=0.01). Around 60% of the non-impacted canines were located in a normal position apical to the primary canine. However, the crown of impacted canine was around 75% placed either distal or mesial to the permanent lateral incisor (p<0.001). The mean values for both the canine-lateral incisor angle and the canine to midline angle were increased significantly (p<0.01) in the impacted canines. The canine to midline angle was decreased significantly (p=0.02) by an average of 5° over time in the non-impacted cases, whereas it did not change in the case of impacted canines. Conclusion: The radiographic features can help to identify canine impaction at an early stage if it is: 1) located at a higher vertical position than the adjacent teeth; 2) overlapped with the lateral incisor 3) a canine-lateral incisor angle of more than 30° is present; and 4) the canine angulation in relation to the midline is more than 54.1°.

Swyer Syndrome in Phenotypic Female with 46,XY Karyotype

D Prashanth Shetty, Meenakshi Arumugam, Jayarama S Kadandale, Suchetha Kumari

Individuals with Swyer syndrome have an XY karyotype and are phenotypically female. The prevalence of Swyer Syndrome is about 1 in 30,000 and it is an extremely rare condition. The present study aimed to describe the phenotypic and genotypic variations of two patients with Swyer syndrome. Case 1: A 24-year-old female who presented with primary amenorrhea, infertility with increased FSH level (59.91 mLU/mL) and Case 2: A 29-year-old female with primary infertility was referred. A 2 mL of peripheral blood was drawn for karyotyping. Cytogenetic analysis was carried out using standard GTG banding technique. Cytogenetic analysis revealed a 46,XY karyotype in Case 1 and 46,XY,15cenh+ in Case 2. Q-Banding confirmed the presence of Y chromosome. In addition, Fluorescence In Situ Hybridization (FISH) using CEP X and Y probe and LSI SRY/CEPX probe confirmed the presence of SRY on the Y chromosome. The result showed the presence of sex-determining region of the Y chromosome and also validating the cytogenetic and molecular cytogenetic interpretations. Earlier diagnosis is important and karyotyping is mandatory in these cases.

Study on the Role of Social Capital in Student’s Health at Kermanshah University of Medical Sciences: The Role of Demographic Variables

ARASH ZIAPOUR, PARVIN ABBASI, GÜLCAN DEMIR ÖZDENK, NEDA KIANIPOUR

Introduction: The concept of social capital is associated with almost all human, social and health issues due to its nature and content. Social capital represents the characteristics of social life, networks, norms and trust that enable participants to work together towards common goals, and it is recognised as an important determinant of health. Aim: The present study aimed to study the role of social capital in students’ health at Kermanshah University of Medical Sciences and the role of demographic variables in 2017. Materials and Methods: In this descriptive and analytical study, the statistical population consisted of 450 students at the Medicine, Dentistry and Pharmaceuticals Schools at Kermanshah University of Medical Sciences in 2017. The sample size was determined through the Cochran's sample size formula, and 450 students were selected through simple random sampling. Further, for data collection, a demographic questionnaire and the Onyx and Bullen’s social capital scale were employed. Then, data were analysed through the descriptive (percentage, mean, and standard deviation) and inferential statistics (ANOVA and t-test) in the SPSS Statistics Software Version 23.0. Results: In the present study, the mean score and standard deviation of students’ social capital measured 2.81±0.45. In addition, it was shown that the dimensions of the communication with family members and friends and feeling security and trust had the highest and lowest means, respectively. Also, the results demonstrated that there was a significant relationship between the students’ social capital and each of gender, age, marital status, education, faculty, and residence (p <0.05). Conclusion: The results revealed that the students’ social capital correlated with each of gender, age, marital status, education, faculty, and residence. Therefore, promotion of the social capital of university students requires holding workshops and training courses by planners.

Serum Creatine Kinase Activity among Hypertensive Patients and its Role as a Predictor for Failure of Antihypertensive Treatment

Surankita Sukul, Jyotirmayee Bahinipati, Saurav Patra, Kandasamy Ravichandran

Introduction: Creatine Kinase (CK), a key enzyme of cellular energy metabolism helps the cells to function under high demands by involving in contractile processes and active trans-membrane transport by readily providing Adenosine-5’-triphosphate (ATP). Higher CK activity increases cardiovascular trophic responses and development of arterial hypertension. Hence, high CK activity may increase hypertension risk and may also be a cause behind the hypertensive treatment failure. Aim: In the present study, serum CK levels are compared between hypertensive and normotensive study subjects and association of serum CK in hypertensive treatment failure cases. Materials and Methods: A total of 75 known hypertensive patients who were under antihypertensive treatment for =3 months were taken as cases. Further grouping of the patients was done based upon the response to antihypertensive treatment into treatment control (n=40) and without treatment control (n=35) groups. Forty individuals age and sex matched normotensive control were taken. Serum Creatine Kinase, BMI, Systolic Blood Pressure, Diastolic Blood Pressure, was measured in the study group. Kruskal Wallis test was done to compare the parameters in all the three study groups. Correlation of serum CK with other parameters was done. Cut-Off value for serum CK was calculated in hypertensive cases. Results: CK was found to be higher in hypertensive cases with treatment control (99.55±31.34) U/L compared to normotensives (72.66±25.42) U/L. Significantly higher CK level was found in hypertensive treatment failures (313.92±133.12) U/L compared to treatment control cases. Statistically significant correlation was found between serum CK with SBP and DBP in hypertensive treatment failure cases. A cut-off value of 168.5 U/L was found out in hypertensive patients. Conclusion: Serum CK was found to be associated with severity of blood pressure and failure of antihypertensive therapy.

Comparative Study of the Flexural Strength of High Impact Denture Base Resins Reinforced by Silver Nanoparticles and E-Glass Fibres: An In-Vitro Study

Ashita Vijay, Nayana Prabhu, Dhanasekar Balakrishnan, Aparna I Narayan

Introduction: In spite of being proven a promising material of choice as a denture base material, the fracture resistance of conventional poly methyl methacrylate could be enhanced. Aim: This in vitro study was conducted to evaluate and compare the flexural strengths of three types of commercially available heat cure, high impact denture base resins reinforced with either silver nanoparticles or E-glass fibres. Materials and Methods: Three commercially available heat cures, high impact denture base resins (Trevalon HI- Dentsply, Acryl H - PyraxPolymars and Acralyn H - Asian Acrylates) were selected for the study. The three types of resins were further subdivided into three subgroups (Control group, Resin incorporated with 0.5% silver nanoparticles and Resin incorporated with 2% E-glass fibres) of 10 samples each achieving a total of 90 samples. The samples were subjected to a 3-point bending test for evaluation of flexural strength. The data were analysed using one-way ANOVA. Results: Acralyn H resin group showed the highest result for mean flexural strength for all the three subgroups. There was an increase in the flexural strength of Trevalon HI and Acralyn H resin groups on addition of either silver nanoparticles (AgNPs) or E-glass fibres (p<0.05), but a decrease in flexural strength on addition of AgNPs to Acryl H resin group and negligible change on addition of E-glass fibres. Difference in flexural strength between the three types of materials was observed but there was no significant difference in between the subgroups of each type of denture base resin except type 2 (Trevalon HI- Dentsply) where a significant change was observed. Conclusion: The addition of E-glass fibres or silver nanoparticles causes a change in flexural properties of high impact, heat cure denture base resins. However, the change in mechanical properties is highly dependent on the brand of material used.

Oral Impact on Daily Performance among School Teachers in Kanpur, India: A Cross-sectional Study

Antima Saxena, Ramesh Nagarajappa, Gayathri Ramesh

Introduction: Teachers are considered as a dynamic force of the school. Their educational experience and contact with students can actively contribute to student’s health promotion provided their physical, psychological and social aspects are not affected. Aim: To assess the prevalence of oral impacts on routine performances and to evaluate the relationship between OIDP (Oral Impact on Daily Performance) and clinical parameters among school teachers of Kanpur city, India. Materials and Methods: A descriptive, cross-sectional study was conducted among 414 school teachers of Kanpur, India. Data were collected using OIDP questionnaire and clinical examination included the assessment of Dentition Status and Treatment Needs along with Community Periodontal Index as per the guidelines of World Health Organization. Chi-square, Student’s t-test, Mann-Whitney U and regression analysis were used for statistical evaluation. Results: The prevalence of oral impact reported was 38.6%. Items most commonly affected were eating and chewing food (16.2%) followed with cleaning teeth (9.2%). Dental caries prevalence was higher among males (mean DMFT = 2.98±2.66) which was statistically significant (p<0.05). Bivariate analysis showed a significance (p<0.05) amongst the participants who reported having at least one impact and presence of dental caries (85%), presence of periodontal pockets (51.2%) and loss of attachment (47.5%). Conclusion: The prevalence of OIDP in this study was low and affected the participant’s daily life chiefly through difficulty in eating and the most prevalent reported causes were tooth loss and toothache.

Antimicrobial Resistance in Clinical Isolates of Streptococcus Pneumoniae: Mechanisms and Association with Serotype Patterns

Introduction: Serotypes and antimicrobial resistance patterns of pneumococcus are dynamic and need close monitoring. The present study describes serotypes and antimicrobial resistance of pneumococcus from clinical samples and compares them with a study done two decades ago from the same hospital. Aim: To determine the antimicrobial resistance and its mechanisms among pneumococci and its association with serotypes. Materials and Methods: Antimicrobial susceptibility was tested according to CLSI-2014 guidelines. Serotyping was performed by multiplex-PCR using primers based on CDC protocols. The macrolide and tetracycline resistance genes were detected using published primers. Appropriate statistical tests were employed to study association between resistance and serotypes. Results: Of the 134 isolates tested, three isolates were non-typable. Highest resistance rates were found for trimethoprim-sulfamethoxazole (89/134; 66.4%), followed by macrolides (47/134; 35.1%) and tetracycline (46/134; 34.3%). Eight isolates from cerebrospinal fluid (CSF) and one isolate from sputum were resistant to penicillin. Among macrolide resistant isolates, ermB predominated (22/47; 46.8%) and both ermB and mefA/E were found in 17% (8/47), while tetM was the only gene in all tetracycline resistant isolates. Macrolide resistance was significantly associated with serotype/groups 6 and 23 F, and resistance to trimethoprim-sulfamethoxazole with serotypes 23F and 3. There was a significant increase in antibiotic resistance from 1996-2000 to 2014-17. Conclusion: A marked increase in antimicrobial resistance was observed in the current study. Use of antibiotics need to be closely monitored in India where changes in susceptibility profiles can hamper the treatment of pneumococcal infections.

Pregnancy Induced Hypertension and Feto-Maternal Outcome in a Tertiary Care Hospital in Eastern India: A Prospective Study

Introduction: Pregnancy Induced Hypertension (PIH) is known for its maternal and perinatal complications. Aim: To assess incidence of PIH and eclampsia in a tertiary care hospital and maternal and perinatal complications associated with it. Materials and Methods: This is a prospective observational study conducted in the department of obstetrics and gynaecology of Institute of Medical Sciences (IMS) and SUM hospital, Siksha O Anusandhan (SOA) University from July 2015 to December 2017. All deliveries during this period were analysed for incidence of PIH, all PIH cases were analysed for maternal and foetal outcome. All cases delivered during the study period, were diagnosed to have PIH when systolic blood pressure =140 mmHg and/or diastolic blood pressure =90 mmHg measured on two occasions 4-6 hours apart beyond 20 weeks of pregnancy. Early onset PIH is defined as; when cases diagnosed before 34 weeks. PIH cases with convulsion were defined as eclampsia. All cases of chronic hypertension due to essential hypertension, chronic renal disease, connective tissue disorder were excluded. Maternal complications studied were cases of HELLP syndrome, Abruptio placentae, PPH, neurological complications, ICU admissions and maternal death. Perinatal complications expressed in terms of stillbirth, NICU admission and incidence of low birth weight. Statistical analysis was done with SPSS version 20.0 software using Yate’s corrected chi-square test and unpaired t-test. Results: Out of 5139 pregnancies 338 (6.57%) had PIH, 40 (0.77%) had eclampsia. PIH is more prevalent in primigravidas (67.4%). Eclampsia is prevalent in adolescents, as age advances incidence of eclampsia reduces and preeclampsia increases, and in elderly, preeclampsia is predominant, proved by unpaired t-test (p=0.003). Late onset preeclampsia is common in our population (93.5%) and 68.1% were term pregnancies. Maternal complication was present in 22/338 (6.5%) cases. It was significantly higher in early onset disease (p=0.001). LSCS rate (p=0.00891) and stillbirth (p<0.001) were significantly higher than general population. NICU admission and low birth weight incidence were also increased. Conclusion: Pregnancy induced hypertension still remains an important cause of maternal and perinatal morbidity and mortality. Late onset PIH is common in our population. Maternal complications are significantly higher in early onset disease than late onset disease. Early detection by proper antenatal care and timely proper intervention can reduce the complications. Adolescent primigravidas are more prone for eclampsia, the severe form of disease. Avoiding early marriage and explaining need of contraception to this group can reduce adolescent pregnancies and its dreaded complications.

Comparative Evaluation of Shear Bond Strength of Resin Modified Glass Ionomer Cement and Biodentine as Dentin Substitutes to Bonded Silver Amalgam and Composite Resin

Riddhi Thakkar, Sandya Kini, Nagaraja P Upadhya

Introduction: The bond strength between the restorative material and the tooth, as well as between the restorative material and the base, is an important factor and can determine the longevity of a dental treatment. Aim: Comparative evaluation of shear bond strength of Resin modified glass ionomer cement and Biodentine as dentin substitutes to Bonded silver amalgam and Composite resin. Materials and Methods: Acrylic resin blocks of dimension 3x1.5x1.5 cm were made. A total of 40 acrylic blocks containing a central hole (wells) with 4 mm diameter and a 2 mm height were prepared. The samples were randomly divided into two groups- Group 1 and Group 2 having 20 samples each. The wells of Group 1 and Group 2 were filled with Resin Modified Glass Ionomer Cement (RMGIC) and Biodentine, respectively according to manufacturer’s instructions. The samples of each group were further divided into four subgroups (n=10): Group 1A, 1B, 2A, 2B. The surface of Group1A and 2A were etched and then treated with adhesive (Adper single bond-2, 3M ESPE) and restored with nanohybrid composite resin and specimens of 1B and 2B were etched and treated with adhesive (Meta P & Bond- MetaBiomed) respectively and were restored with silver amalgam. All the samples were stored in artificial saliva for 24 hours at 37.5°C, 100% humidity and were subjected to shear bond strength testing. Results: Group 1A (RMGIC + Composite) showed the highest shear bond strength values-29.58 MPa followed by Group 2A (Biodentine + Composite resin) - 5.59 MPa, Group 1B (RMGIC + Bonded silver amalgam) - 3.96 MPa and least was seen in Group 2B (Biodentine + Bonded silver amalgam) - 0.445 MPa. Conclusion: This study concluded that combination of Composite resin and RMGIC or Composite resin and Biodentine showed higher shear bond strength values as compared to a combination of RMGIC and Bonded silver amalgam or Biodentine and Bonded silver amalgam.

Malnutrition among Children in Karnataka: A Systematic Review and Meta-Analysis

Introduction: Malnutrition is a leading cause of childhood mortality and morbidity. It is a silent emergency which results from combination of factors and conditions. Growing children are most vulnerable to its consequences. Aim: To determine the prevalence of malnutrition among preschool children in Karnataka. Materials and Methods: A systematic review and meta-analysis was done to find out the pooled estimation of prevalence of malnutrition. An extensive literature search of International and National electronic databases were carried out. The criteria used for the search were limited to descriptive studies, cross- sectional studies, and epidemiological studies in English language. Out of 2183 studies, 28 papers were assessed for methodological quality and finally 24 papers were included in the review based on the inclusion and exclusion criteria. These studies were then subjected to quality of assessment using the STROBE guidelines. Results: Out of 24 articles, 19 articles were graded prevalence of malnutrition as per New WHO 2006 child growth standards and five studies were graded malnutrition as per IAP classification. The pooled prevalence of malnutrition as per IAP classification was 41% with 95% CI (0.23- 0.59). The pooled prevalence of Underweight as per WHO child growth standard was 44% with 95% CI (0.38–0.49), stunting 35% with 95% CI (0.31-0.40), and wasting 28% with 95% CI (0.17–0.38). Conclusion: The findings of this review indicate that malnutrition is still an important problem in children. There is a need for finding the risk factors for malnutrition and a consistent effort from departments and parents concerned to improve the nutritional status further to reduce morbidity among children.

Brainstem Auditory Evoked Potentials in Uncontrolled Diabetes Mellitus with and without Complications

Roopali Mittal, Lokesh Kumar Singh, Abha Gupta, Vinay Agarwal

Introduction: Diabetes mellitus is a metabolic disorder known to affect all body systems especially neurons, retina and kidneys. Peripheral neuropathy has been widely studied but the exploration of central neurons is limited. Aim: To evaluate the magnitude of changes in Brainstem Auditory Evoked Potentials (BAEP) in uncontrolled diabetics with or without complications. Materials and Methods: Fifty uncontrolled Non-Insulin Dependent Diabetes Mellitus (NIDDM) patients of both sexes including 20 with neuropathy and 10 with retinopathy but having no hearing loss were evaluated for absolute and inter peak latencies by brainstem evoked potentials. This pilot study was conducted in the Department of Physiology, Lala Lajpat Rai Memorial Medical College, Meerut, India, between the periods of November 2016 to July 2017, To evaluate the results, ANOVA, unpaired Student's t-test and Pearson’s correlation coefficient was used. Results: The study revealed that almost all the absolute (AL) and Inter Peak Latencies (IPLs) were increased significantly (p<0.001) in patients with complications. Also, the threshold stimulus of median nerve was greater in them. The increase in latencies was not associated with either blood sugar level or duration of illness. Conclusion: It appears that diabetes mellitus has ototoxic role and regular BAEP test may detect the hearing loss at an early stage.

Comparative Analysis of Colour Doppler Ultrasonography and CT Angiography in Peripheral Arterial Disease: Studying effects of Vessels Wall Calcification on Diagnostic Evaluation

Rahul Dev, RP Tripathi, Manju B Popli

Introduction: Peripheral Arterial Disease (PAD) is one of the most common causes of morbidity in diabetes mellitus in Indian population. Aim: To analyse comparative role of CDUS (Colour Doppler Ultrasonography) and CTA (Computed Tomography Angiography) in evaluation of PAD and to evaluate impact of vascular calcification on disease assessment as well as predictors for the same. Materials and Methods: A prospective study was conducted on 40 patients having risk factors as well as signs and symptoms of PAD undergoing CDUS followed by CTA. A comparative analysis of arterial system was done by both gray scale and colour spectrum doppler analysis on CDUS as well as by CTA for luminal narrowing or thrombosis, vascular calcification as well as distal flow pattern using Chi-square test. Results: A total of 510 arterial segments were studied by CDUS and 560 by CTA. Luminal irregularity and <50% stenosis were better detected on CDUS, whereas >50% stenosis and occlusions were better seen on CTA. The false positive cases on CTA were attributed to vascular calcification and areas of eccentric stenosis, whereas false positive cases on CDUS were seen in anatomical complex locations and in cases of proximal long segment stenosis. Significant statistical difference exists between CDUS and CTA. The overall sensitivity, specificity and accuracy of CDUS as compared to CTA in our study were 91%, 87% and 89%. Conclusion: CDUS can be used as first line investigation for evaluation of PAD especially in femoropopliteal segments, low grade stenosis and eccentric stenosis. CTA on the other hand, is more sensitive in detecting segments of total occlusion and infrapopliteal segments.

Profile of Inflammatory Bowel Disease in a Tertiary Care Centre of Eastern Nepal

Introduction: Inflammatory Bowel Disease (IBD) is a chronic, relapsing inflammatory disorder of gastrointestinal tract that encompasses chronic Ulcerative Colitis (UC) and Crohn’s Disease (CD). Traditionally, it was believed to occur mainly in western countries like North America and Europe, but now perhaps with increasing westernisation, it has become a global disease with accelerating incidence in Africa and Asian countries like India and Nepal, which has also mirrored the growth compared to its neighbouring countries, where there has been an increased detection of this disease over the past few years. Aim: To review the experience in the disease profile and management of IBD in our surgical unit. Materials and Methods: This was a retrospective analysis of prospectively maintained data from January 2009 to May 2017 at BP Koirala Institute of Health Sciences, a tertiary care centre at the Eastern region of Nepal. The patients were grouped into two periods (first: January 2009 to March 2015; second: April 2015 to May 2017). We managed 30 cases (UC-19 and CD-11) in the surgical unit. Results: Eleven vs nineteen IBD patients were managed in the first and second time periods respectively. The median age of the patient with UC was 45.1 years. The most common presenting symptom was rectal bleeding. Pancolitis and left sided colitis was each seen in 42% and 52.6% of patients, respectively. Severe to fulminant colitis was seen in 36% of patients. Seven patients requiring surgical intervention (staged restorative total proctocolectomy-6 and total proctocolectomy with end ileostomy-1), while the remaining 12 cases were managed with a non operative treatment. Similarly, the median age of patient with CD was 55 years. The most common presenting symptom was pain abdomen. Eight patients had predominant small bowel involvement, two colonic, while one patient had both small and large bowel involvement. All patients required surgical intervention for symptoms related to it. At one year of follow-up, three patients had recurrence, two requiring initiation of anti-tumour necrosis factor therapy. Conclusion: IBD is no more a rare disease in a country like Nepal. With the global rise in incidence, there has been increased detection of IBD cases at our centre (9.5 cases/year in the second period vs 1.8 cases/year in the first period) probably due to increased awareness and establishment of a separate Gastrointestinal unit with a specialist team trained from high volume centre.

Relation between Mindfulness and Depression among Adolescent Orphans

Dayal Sharma Shambhu, Sasidharan K Rajesh, P Subramanya

Introduction: Even though children in orphanages experience’s multifaceted psychosocial problems, limited research has focused on psychological protective factors that can lessen the effect of orphanhood. Aim: To examine associations between mindfulness and psychological factors (i.e., depression, cognitive function, positive emotion, and negative emotion) among adolescent orphans. Materials and Methods: This was a descriptive correlation study and 140 orphan children living in three orphan homes, Tamil Nadu, India were recruited. Study’s instruments included Child and Adolescent Mindfulness Measure (CAMM), Cognitive Functioning Scale (CFS), Short Mood and Feelings Questionnaire (SMFQ) and Positive and Negative Affect Schedule for Children (PANAS-C). Results: There was significant correlation observed between mindfulness and depression among orphan adolescents (r=-0.53, p<0.01). Further, mindfulness had significant relationships to cognitive function (r=0.30, p<0.01), positive affect (r=0.33, p<0.01) and negative emotion (r=-0.38, p<0.01). Regression analysis showed that depression accounted 39% of variance in the model containing mindfulness, positive affect and negative affect. Conclusion: This study supports the emerging literature on the benefits of mindfulness construct. Present findings will encourage the mindfulness-based interventions targeting well-being of an orphan adolescent.

Comparative Evaluation of the Dimensional Accuracy of Closed Tray and Open Tray Impression Technique for Dental Implants using Two Different Impression Materials

Arpita Tandon, Nilesh S Bulbule, Amit K Jagtap, Dilip M Kakade

Introduction: In the era of fixed prosthodontics where implant restorations are being routinely used, it is imperative for the dentist to correctly record the position and orientation of the implant. This necessitates the application of correct impression procedure, impression material and accurate die materials. Aim: This study aims at evaluating and comparing the effect of closed tray and open tray impression technique with polyvinyl siloxane and polyether as impression materials on the dimensional accuracy of implant definitive casts. Materials and Methods:This in vitro study is about implant definitive casts made using the open tray and closed tray impression technique using two different impression materials i.e., polyvinyl siloxane and polyether. The Co-ordinate measuring machine was used to evaluate the dimensional accuracy of the casts, then tested at the Tata Autocomponents-Interiors and Plastic Division (IPD), Pune. A total of 60 implant definitive casts were made. A total of 30 casts were made using each impression technique. These casts were further subgrouped wherein, 15 casts were made using polyvinyl siloxane as the impression material and 15 casts were made using polyether. The unpaired t-test was used for comparison. Results: Both the open tray and closed tray impression technique are comparable to each other and there is no statistically significant difference between the two. Also, the impression materials are equally good for impression making of implants (p>0.05). Conclusion: Either of the impression techniques and material used in the study can be used to make implant definitive casts.

Awareness of Breast Cancer and Its Screening among Indonesian Women

Solikhah Solikhah, Monthida Sangruangake, Supannee Promthet

Introduction: Breast cancer has a high morbidity and mortality rate worldwide. However, most developing countries with resource constrained setting, like Indonesia, encounter several difficulties to implement mass screening for breast cancer. Aim: To investigate knowledge, barriers, and behaviours of women regarding breast cancer screening among rural and urban Indonesian women. Materials and Methods: This cross-sectional study was conducted among 864 Indonesian women aged =18 years. A self-administered questionnaire using a validated instrument was administered from March to May 2016. The ordered logistic regression model analysis was performed to further evaluate five domains of awareness regarding breast cancer screening and its determinants. A p-value under 0.05 was considered significant. Results: Overall, 864 women participated in this study (response rate of 98.28%). The mean age of women was 30.01±11.01 years. Ordinal logistics regression analysis showed that urban women demonstrated better knowledge of risk factors for breast cancer, while they had poorer behaviours for the breast cancer screening method. A higher level of education (relative to no formal education) was associated with better behaviours for the breast cancer screening method, whereas being married and women living in East Nusa Tenggara were significantly related to barriers for breast cancer screening. Conclusion: Urban Indonesian women had poor breast cancer screening practice, whereas they were highly educated. Participant’s characteristics like marital status and locality were found as barriers to breast cancer screening. It is likely to provide valuable insight among women in general for breast cancer screening behaviours, which in turn, will improve targeted breast health promotion.

To Study the Prevalence of Arrhythmias in Valvular Heart Disease and their Correlation with Echocardiographic Variables

Sanja Sameer Behra, AVS Anil Kumar, Harkirat Singh, K Satyanand

Introduction: Valvular Heart Disease (VHD) is an important cause of arrhythmia which may manifest as syncope or palpitations or may be asymptomatic. VHD is very common in India and Rheumatic Heart Disease (RHD) contributes maximally to it. There are a substantial proportion of patients in whom arrhythmias go undetected due to paucity of typical symptoms. The patients with arrhythmias are highly prone to Cerebro Vascular Accidents (CVA) due to thromboembolic phenomenon. Hence, it is important to detect arrhythmias early so that timely preventive measures can be put in place. Aim: Establishing the overall prevalence of arrhythmias in VHD, proportion of asymptomatic arrhythmias, the type of arrhythmias occurring in this population subset and the factors which increase the risk of occurrence of arrhythmias. Materials and Methods: The study included 268 consecutive patients of VHD enrolled between July 2015 to Jun 2016. Patients were evaluated with complete history and clinical examination along with relevant haematological and biochemical investigations, echocardiography and 24 hour ambulatory Holter monitoring. For baseline comparison of patients, chi-square (?2) test was used for descriptive variables. Quantitative variables were compared using the independent sample t-test. Results: It was found that 122 (45.5%) patients had arrhythmias, out of which Atrial Fibrillation (AF) contributed the most 100 (37.3%), followed by Premature Ventricular Contraction (PVC) in 22 (8.9%) patients. There were 19 (12.5%) of the 152 asymptomatic patients who had arrhythmias. Patients of mitral valve disease with AF had a mean Mitral Valvular Area (MVA) of 1.20±0.39 cm2, Mean-transmitral Gradient (MG) of 14.03±3.10 mm of Hg. The mean Left Atrial (LA) diameter for all the VHD (100 cases) with AF was 48.73±3.57 mm. The mean Left Ventricular Internal Dimension in Diastolic (LVID D) and systolic (LVID S) phase was evaluated for cases of Mitral Regurgitation (MR), Aortic Regurgitation (AR) and Aortic Stenosis (AS) for all the arrhythmias and were found to be 48.74±6.25 mm and 36.69±5.18mm respectively. Conclusion: There is significant proportion of patients with VHD having asymptomatic arrhythmias; hence 24-hour Holter monitoring should be used to detect these early. Echocardiographic variables like LA diameter, MG, MVA, LVID S and LVID D for arrhythmias. The critical point beyond which the patient is more prone to get an arrhythmia as per our study was when LA diameter >43 mm, MVA <1.7 cm2, MG >09 mm Hg, LVID D >50 mm and LVID S >39 mm. Patients with multivalvular involvement are more prone for arrhythmia.

Pneumococcal Vaccination among Adults with Respiratory Diseases-Indications, Adherence and Roadblocks

Divya Ramachandran, Rajesh Venkitakrishnan, Jolsana Augustine, Melcy Cletus

Introduction: Globally, invasive pneumococcal disease poses a major challenge to the health system and causes significant economic burden. Pneumococcal vaccination is a recommended and well adhered practice among paediatric age groups as opposed to adult population, where it is often overlooked or ignored. CDC recommends pneumococcal vaccination in all subjects more than 65 years. In subjects less than 65 years, those with certain associated medical conditions are targets to pneumococcal vaccination strategy. Aim: To evaluate the indications for pneumococcal vaccination in adult subjects admitted with respiratory diseases to a tertiary care facility, as well as to examine the adherence to pneumococcal vaccination protocols. In those who were not vaccinated as per guidelines, to determine the reasons for non-compliance to vaccination guidelines. Materials and Methods: This was a retrospective observational study, which was carried out in the pulmonary medicine unit of a tertiary care hospital in Kerala, Southern India. Subjects admitted to the respiratory unit with various diseases over a three month period from January 2018 to March 2018 were included in the study. The demographic data, primary disease and medical comorbidities were noted. The indications to pneumococcal vaccination as per the CDC recommendations were evaluated. The actual subjects who underwent vaccine administration were noted down and reasons for non-compliance were recorded. The collected data were analysed using descriptive statistical methods, in which categorical variables were expressed as frequency and percentage, and continuous variables were analysed using mean and standard deviation with the Word excel software. Results: A total of 284 patients were admitted to the respiratory unit in the study period due to varying primary respiratory diseases and comorbidities. Of these 268 patients were eligible for pneumococcal vaccination as per CDC criteria. Of these 268 patients 216 patients (80.59%) were vaccinated with either PPV or PCV depending on patient preference. A total of 52 patients were not vaccinated (19.4%). The reason for non-adherence to vaccination in these patients was variable. Sixteen patients (30.77%) received vaccination from another health care centre outside our hospital prior to admission. Three patients (5.77%) were transferred to another department for further care, but vaccination was not done at either units. A total of 26 patients (50%) with suspected Obstructive Sleep Apnea (OSA), who were admitted for overnight polysomnography, were not given vaccination although all of them had indications. One patient expired and two patients (3.84%) refused due to social reasons. Active counselling and vaccine recommendation was found to be missing in the case records of four patients, (7.69%) probably due to overlooking on the part of medical team. Conclusion: A pneumococcal vaccination adherence rate of 81% was noted in the present study. Indications for pneumococcal vaccination were overlooked in a sizeable inpatient population being admitted for overnight polysomnography. Active counselling and vaccination recommendation was also missing in a small number of subjects.

Correlation of Width of Attached Gingiva, Depth of the Vestibule on Gingival Health and Oral Hygiene Maintenance in Malaysian Young Adults

Hari Padmini, Kacharaju Kranthi Raja, Zhi Yen Hoe, Yu Jiet Teh, Chui Jin Ting

Introduction: Attached gingiva is an important factor affecting periodontal health which enhances the plaque removal around the gingival margin, improves aesthetics and reduces inflammation around a restored teeth. The role of minimum width of attached gingiva and vestibular depth on gingival health and oral hygiene is inconclusive. Aim: To evaluate the clinical correlation between width of the attached gingiva and gingival recession, inflammation and oral hygiene maintenance. The correlation of depth of the vestibule with gingival recession and width of attached gingiva was also studied. Materials and Methods: A cross-sectional clinical study was designed. Data was collected from 165 young Malaysian adults. Width of the attached gingiva and vestibular depth of six anterior teeth was measured using digital caliper after histochemical staining with Lugol’s iodine. Periodontal parameters including OHI(S), bleeding index, modified gingival index, periodontal pocket depth, Clinical Attachment Loss (CAL) and gingival recession were recorded for each individual. Statistical analysis was done using Pearson’s correlation test, Chi-Square test and Paired t-Test. Results: A 39.4% (65/165) of the subjects examined had inadequate width of attached gingiva. The overall prevalence of gingival recession was 28.5%. An inverse correlation was found between the gingival recession and width of attached gingiva both in maxilla and mandible, respectively. The frequency of root exposure was also significantly correlated with width of attached gingiva (p<0.001). The depth of the vestibule showed a weak negative significant correlation with mandibular gingival recession (p=0.05). Neither width of attached gingiva nor depth of the vestibule showed any significant association with gingival inflammation or oral hygiene maintenance. No notable correlation was observed between width of the attached gingiva and depth of the vestibule (p>0.05). Conclusion: A weak negative correlation was found between width of attached gingiva mandibular vestibular depth and gingival recession. No significant correlation was shown between width of attached gingiva or vestibular depth and gingival inflammation and oral hygiene maintenance.

Validation of the Short Form of the Adherence to Refills and Medications Scale in Iranian Elders with Chronic Disease

Introduction: Evaluating medication adherence in chronic diseases is important to understand the effectiveness of treatment. A reliable, valid, and practical measure is needed to assess medication adherence for Iranian patients. Aim: To translate and validate the Short Form of the Adherence to Refills and Medications Scale (ARMS-SF) in Iranian elders with chronic disease. Materials and Methods: The ‘forward-backward’ procedure was applied to translate the scale. One hundred patients aged 60 years and older with chronic disease were included in the study. Construct validity was evaluated with exploratory factor analysis and criterion validity was evaluated with the Morisky Medication Adherence Scale (MMAS-8). Cronbach’s alpha coefficients and the test-retest procedure were used to assess the scale reliability. Results:The results of exploratory factor analysis indicated a two-factor solution for the scale that jointly accounted for 67.26% of the variance observed. The criterion validity showed high and significant correlation between ARMS-SF and MMAS-8. Cronbach’s alpha of the total scale was 0.74 and test-retest reliability (ICC) within two weeks was greater than 0.80 in all dimensions. Conclusion: The ARMS-SF is reliable and valid for measuring medication adherence among Iranian elders with chronic disease. Further research is required to measure the sensitivity and specificity of the scale.

Variation of Platelet Indices among Patients with Diabetes Mellitus Attending Tertiary Care Hospital

Tanima Dwivedi, Reshma Davangeri

Introduction: Diabetes Mellitus (DM) is a pandemic health problem. It is considered as a prothrombotic state with enhanced platelet activity. The platelet activation may alter platelet morphology and function which may result in the development of microvascular and macrovascular complications of this metabolic disorder. Platelet Indices i.e., Mean Platelet volume (MPV), Platelet Distribution Width (PDW) and Platelet Large Cell Ratio (PLCR) are routinely available in almost all the laboratories but are underutilised. Aim: To evaluate abnormal platelet indices in diabetic patients and to study the correlation between platelet indices with diabetic complications and glycaemic control. Materials and Methods: The present prospective and cross/sectional study was conducted in the Department of Pathology, Jawaharlal Nehru Medical College, Belgaum over a period of one year from January 2013 to December 2013 on 210 patients who were suffering from Type 2 DM and attended Outpatient Department (OPD). A total of 210 patients suffering from diabetes mellitus attending the OPD were included in this study. Platelet Indices were measured using automated haematology analyser. Statistical evaluation was performed using SPSS version 16.0. Results: Majority of the patients had higher PDW and PLCR (except MPV). A 74.7% (157 out of 210) patient was suffering from diabetic complications. 94 patients out of 157 were suffering from cardiovascular complications. Patients suffering from diabetic nephropathy had the highest value of platelet indices. When patients with diabetic complications were compared with patients without complications, we found that there was statistically significant difference between the groups with regard to the number of males and females affected, duration of diabetes, Fasting Blood Sugar (FBS), Haemoglobin A1c (HbA1c), lipid profile and the platelet indices (MPV, PDW and PLCR). On comparing platelet indices with glycaemic control, patients with bad glycaemic control had higher platelet indices than patients with glycaemic controlled diabetes and this was statistically significant. There was positive and statistically significant correlation between the platelet indices and duration of diabetes, FBS, HbA1c, lipid profile and diabetic complications and negative correlation between platelet indices and platelet count which was not statistically significant, in contrast negative correlation between platelet indices and HDL, was statistically significant. Conclusion: Platelet Indices is simple, easy method to evaluate the platelet hyperactivity in DM.

An Insight for the Future Development of Diagnostic Tool by Exploiting Novel Leishmania Donovani Recombinant Hypothetical Protein

Introduction: Assenting diagnosis of Visceral Leishmaniasis (VL) relies on the detection of Leishmania donovani (L. donovani) in splenic and bone marrow specimens obtained by invasive techniques. Thus, the development of inexpensive, non-invasive serological test encompassing high specificity, sensitivity and diagnostic efficacy is urgently needed. Aim: To assess the significance of recombinant proteins possessing B-cell epitopes in VL diagnosis. Materials and Methods: Employing immunoinformatics approach, the B-cell epitope footprint of L. donovani hypothetical proteins (derived from earlier studies) were decrypted holding good antigenic character with numerous epitopes. L. donovani hypothetical proteins XP_003860226.1 and XP_003861271.1 were first time cloned as His-tagged fusion proteins and purified as novel recombinant protein antigens, designated rLdhyb and rLdhyc respectively. Sanger sequencing method was exploited to sequence gene insert (GeneBank accession number MH479406). Results: B-cell epitopes revealed 100% conservancy with L. infantum. Immunoinformatics data revealed no significant sequence similarity with homo sapien and the causative agent of other diseases like tuberculosis, typhoid, malaria etc., resembling in symptoms to VL. Sequencing chromatogram of cloned gene Ldhyb and Ldhyc revealed 98% and 94% identity with L. donovani. ELISA revealed the absolute specificity with sensitivity of 95.4% for rLdhyb and 91% for rLdhyc. Area under curve for rLdhyb, rLdhyc and SLA were 0.99, 0.99 and 0.961, with standard error 0.002, 0.007 and 0.019 respectively. The in silico data was coherently supported by in vitro result. Conclusion: Absolute specificity, high sensitivity and diagnostic efficacy (rLdhyb: 98%; rLdhyc: 97%) advocated their excellent biomarker property. The present findings provide some basic insights for the future development of novel hypothetical proteins based non-invasive diagnostic tool for VL detection.

Are the Media Enabled Anti-tobacco Campaigns Effective? A Pilot Study

Introduction: Globally, tobacco is a major factor for the cause of increased morbidity and mortality rates due to oral carcinoma. Despite the efforts of Government of India on anti-tobacco advertisements and campaigns, there is an increase in the number of consumers whereas the percentage who have attempted to quit the habit stands at a mere 3%-5%. Aim: To evaluate the effectiveness of media enabled Government of India initiated anti-tobacco and anti-smoking advertisement and campaigns and understand behavioural/psychological response among tobacco users and non-users towards such campaigns. Materials and Methods: This was a questionnaire-based study. A total of randomly selected general public, 250 young adults in the age group of 18 to 25 years, 158-tobacco users and 92-non-tobacco users, in South Bengaluru, India was interviewed on one to one basis in the study. A self-administered questionnaire was used to collect the data on basic personal details, specific questions related to Government of India initiated anti-tobacco advertisements, and psychological tests namely Sentence completion test, Thematic Apperception Test (TAT) and Inkblot test were used to check the responses among tobacco and anti-tobacco users. The SPSS version 22.0 software IBM, Corp was used to do the descriptive statistical analysis and the level of significance was set at p<0.05. Results: Of the overall 250 participants, 63.2% were tobacco product users and 36.8% were non-tobacco users. All 100% participants watched the Government of India initiated anti-tobacco and anti-smoking campaigns. Among overall subjects 49% gave up watching the advertisements due to fear or monotony, 23% of them reduced watching, and 28% felt like giving up the use. Among tobacco users, 48.73% discontinued the habit after watching the advertisements and 51.27% continued with the habit. The Government of India initiated anti-tobacco advertisements were ineffective in 65.19% of the tobacco users. The non-tobacco user group gave a favourable response in Sentence Completion Test and Rorschach Inkblot Test. There was no significant difference in the response seen in the TAT. Chi-Square test analysis was applied to determine the statistical significance between the psychological tests and the effectiveness of Government of India initiated anti-tobacco advertisements among tobacco and non-tobacco users. Conclusion: It was observed that the Government of India initiated anti-tobacco and anti-smoking advertisements had more favourable response among the non-tobacco users whereas, with the current tobacco users, it did not have the desired impact. Psychological tests like TAT was statistically significant with respect to the effectiveness of advertisements (p<0.05) in non-tobacco users.

Unilateral Paravertebral Block: An Alternative to Conventional Spinal Anaesthesia for Unilateral Uncomplicated Inguinal Hernia Repair

Pooja Hemant Kumar Joshi, Shailesh Shah

Introduction: Inguinal hernia repair can be performed under general anaesthesia or various regional anaesthesia techniques like spinal, epidural or nerve blocks like hernia block or Paravertebral Block (PVB). Though Spinal Anaesthesia (SA) is a preferred technique in many centres, PVB has regained interest in the field as a technique of anaesthesia and/or postoperative analgesia for many surgeries. Aim: To compare paravertebral block and conventional spinal anaesthesia with respect to onset and duration of blockage, duration of postoperative analgesia, intraoperative haemodynamic changes and postoperative complications in patients undergoing unilateral inguinal hernia repair. Materials and Methods: This study is a prospective comparative study conducted at BJ Medical College and Civil Hospital Ahmedabad, Gujarat, India. Fifty Male patients, aged between 18 to 60 years and ASA Status I and II undergoing elective unilateral uncomplicated inguinal hernia surgery was randomly allocated into one of the two groups i.e., PVB and SA. Time required to perform the procedure, time for onset and duration of blockage, duration of postoperative analgesia, haemodynamic changes and postoperative complications were noted in both the groups. Results: Procedure time for PVB was 16.30±2.41 minutes and for SA it was 3.32±0.74 minutes. Onset of sensory effect was within 5.3 minutes and 4.5 minutes in PVB group and SA group respectively. Time to reach surgical anaesthesia was 14.5 minutes in PVB group and 6.6 minutes in SA group. Duration of postoperative analgesia was 370.8 minutes in PVB group and 212.7 minutes in SA group. There were minute haemodynamic changes in SA group, while patients in PVB group were haemodynamically stable. Postoperative complications like nausea, vomiting, hypotension, bradycardia and urinary retention were reported in SA group and not in PVB group. Conclusion: Paravertebral block has got advantages over spinal anaesthesia in terms of intraoperative haemodynamic stability, prolonged postoperative analgesia and less postoperative complications. Time required to perform PVB is more than that for SA because PVB is needed to be given at multiple levels.

Managing Viral Haemorrhagic Fever in the Emergency Department

The Emergency Department, regarded as the gateway to healthcare, is frequently the first point of contact for significantly ill patients. Because the initial presentation of a Viral Haemorrhagic Fever (VHF) case is largely non-specific, the role of Emergency Department (ED) staff is pivotal in curtailing a Formidable Epidemic Disease (FED) outbreak. An immediate action plan describing appropriate, safe, effective, yet simple steps to be taken is of utmost value. This manuscript discusses aspects pertaining to ED preparedness and readiness in the event of a suspected VHF case presentation, including facility readiness in safely receiving a patient, protection of staff and others, decontamination of equipment and personnel, initial steps in containing the disease and prevention of an outbreak.

The Efficacy of Plaque Control by Various Toothbrushing Techniques-A Systematic Review and Meta-Analysis

Chandrashekar Janakiram, Farheen Taha, Joseph Joe

Introduction: Efficient removal of dental plaque plays a key role in the maintenance of oral health. Dental Plaque is responsible for the occurrence of dental caries and periodontal diseases. Aim: To compare the various toothbrushing methods in effective removal of plaque. Materials and Methods: Systematic review with meta-analysis methodology developed by Cochrane Corporation was used in this review. Computerised searches Medline, the Cochrane Register of Controlled Trials and the Google Scholar for randomised controlled trials were searched up to May 2017 to identify appropriate studies. Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate. A meta-analysis was attempted on two trials. The test group was using ‘modified Bass technique’ and the control group was using ‘horizontal scrub technique’ in both the selected trials. Standard Mean Deviation (SMD) was calculated using random-effects models. Results: In total, 664 unique papers were found, of which seven met the eligibility criteria. The meta-analysis of two studies showed that the modified Bass technique provided significantly better plaque control (SMD=-1.22, p<0.001) as compared to the horizontal scrub technique. Conclusion: Inadequate data, but with a low risk of bias, showed that the modified Bass technique/ Bass technique was more effective in the efficient plaque removal compared to the other toothbrushing techniques.

The Generalised Mutation Theory of Oncogenesis

Vladimir Knigavko, Marina Bondarenko, Olga Zaytseva

Several theories of oncogenesis are known at present, the most accepted of which is the mutational theory. However, none of the theories explain the whole set of phenomena associated with the initiation and development of cancer. The aim of the review was to try to develop a consistent theory of oncogenesis which generalises and supplements some of the already known concepts of the essence of malignization processes in cells with the new developments by the authors in the field of oncogenesis. It was concluded that the evolutionary aspect of oncogenesis allows to find out the causes of biochemical changes in a malignant cell as well as the nature of chromomeres and their functions in oncogenesis. Among the most important results of the proposed review are the suggestions on the role of evolutionary factors, the role of the genome instability of the malignant cells and the role of chromomeres in these cells.

Brain Derived Neurotrophic Factor as a Treatment Modality: The Future of Clinical Neurosciences

Brain Derived Neurotrophic Factor (BDNF) is one of the Neurotrophic factors responsible for the survival, growth, differentiation and maturation of neurons. BDNF has been reported to have multiple physiological functions including synaptic transmission, neurogenesis, synaptic plasticity, and has a major role in regulation of pain, learning and memory, endothelial and cardiac cells, lipid metabolism and even immunity and inflammation. Besides physiological role, BDNF also has been associated with multiple neurodegenerative and neuropsychiatric diseases and disorders including, Huntington’s disease, Alzheimer’s disease, Bipolar Disorder, Major Depressive Disorder, Schizophrenia, Anxiety-related disorders, and Epilepsy. Role of BDNF has also been studied in Diabetes, Metabolic disorders, Deafness and Blindness. A lot of factors have therefore also been studied to validate their properties to enhance levels of BDNF in different tissues, especially brain. This review is aimed to comprehensively collect all the medical literature in support of BDNF’s physiological and pathological role and also to compile evidence in support of different factors that have been reported to increase BDNF levels, thus paving for an expanded view of BDNF as a treatment modality and maybe even the future of Clinical Neurosciences.

Induction of Myocardial Infarction in Experimental Animals: A Review

Syarifah Aisyah Syed Abd Halim, Norzana Abd Ghafar, Zakiah Jubri, Srijit Das

Myocardial Infarction (MI) is a major health problem worldwide. Animal models have been used extensively in scientific research. This was intended to help researchers to understand the underlying pathophysiology of MI, compensatory mechanisms involved and efficacy of treatment. Although, it is difficult to create necrosis similar to those found in human heart, various large and small animals were used to create experimental model of MI. Each of these animals and method of selection offers various advantages and disadvantages in relation to clinical studies. In the present review, we aim to highlight the different methods used to induce MI in experimental animals. These methods may be beneficial for academicians and researchers concerned with the treatment of MI.

A Case of Concomitant Psoriatic Exfoliative Dermatitis and Pulmonary TB with Adverse Drug Reaction to Rifampicin

Neethu Mary George, Veena Thimmappa, Narendra Gangaiah, Amruthavalli Potlapati

Erythroderma or exfoliative dermatitis is scaling and erythema of skin involving more than 90% of total skin surface area and is a serious and difficult condition to treat because of large areas of involvement and multiple associated complications. Psoriasis is an important cause of exfoliative dermatitis and so is adverse drug reaction. Pulmonary tuberculosis, common in India, is usually ruled out before starting any systemic treatment like immunosuppressants in the latter. Development of tuberculosis in a psoriasis patient is a challenging situation wherein the clinician has to look for the pros and cons before choosing each step in management as one can aggravate the other. The condition becomes more troublesome if it is superadded by adverse drug reaction to one of the Antitubercular (ATT) drugs. Here, authors present a case with psoriatic exfoliative dermatitis, psoriatic arthritis and pulmonary tuberculosis with adverse drug reaction to Rifampicin from Category 1 ATT; which was identified following a drug-rechallenge test and eventual management of all the conditions concurrently.

Successful Surgical Management of Cardiac Fibroma with Recurrent Ventricular Tachycardia: A Case Report

Cardiac fibromas are rare tumours of the heart. We present a case of cardiac fibroma in a four-year-old child in view of rarity of the case and success achieved in its management. The child had presented with a history of intermittent palpitations. Electrocardiography (ECG) showed monomorphic Ventricular Tachycardia (VT). She was initially managed with intravenous Metoprolol and Amiodarone infusion but had recurrent VT. Echocardiography revealed a mass in the apical septum. A Contrast Enhanced Computed Tomography (CECT) showed a homogeneous mass involving the anterolateral and apical aspect of interventicular septum causing expansion of the septum and indentation and compression of both ventricles. The tumour was approached through median sternotomy under Cardiopulmonary Bypass (CPB). The adventitia over the exposed part of the tumour was incised and the tumour was dissected out of the interventricular septum. A bovine pericardial patch was used to close the septal defect. Most of the small tumours dispersed around Left Anterior Descending Artery (LAD) were excised. The patient was weaned off CPB easily. In the postoperative period, Amiodarone infusion was continued with no recurrence of arrhythmias. Histopathology revealed classical features of fibroma. The child is stable and is on outpatient follow-up. Our patient had a huge fibroma and we could successfully resect it avoiding need for transplant. We hereby conclude that in children with a huge intracardiac fibroma involving almost a complete cardiac chamber, success can be achieved through resection and reconstruction in selected cases and the need for transplant may be obviated.

Bitendinous Palmaris Longus Muscle: A Case Report

Janani Maheshwari V Vyas , Senthil Kumar Sampath Kumar

Palmaris Longus Muscle (PLM) is one of the common flexor muscles of the forearm. Classified as a phylogenetically retrogressive muscle, it often exhibits anatomic variations such as agenesis and variation in location, morphology and attachment. A Bitendinous PLM was identified in a female cadaver on the left side; the tendon of insertion bifurcated into lateral and medial tendons and inserted into the base of the Thenar eminence and Palmar aponeurosis, respectively. The lengths of the muscle and the tendons of insertion, the point of bifurcation and width were measured. PLM tendon is highly valued as an ideal donor for tendon grafts. The knowledge of such a variant will benefit anatomists, hand surgeons, orthopaedicians and plastic surgeons.

Antihyperglycaemic and Antihyperlipidemic Effect of Gymnema Sylvestre in Protracted Diabetes Mellitus in Wistar Rats

Bhagyajyothi M Bhat, CV Raghuveer, Vivian D’Souza, Poornima A Manjrekar

Introduction: Dysregulation in glucose and lipid metabolism have been observed in the early phases of Diabetes Mellitus (DM) which may further lead to insulin resistance and beta-cell failure. Effective control of these metabolic alterations may delay the clinical onset of diabetes. A proven herbal medication with antihyperglycaemic activity used in the treatment of Diabetes is Gymnema sylvestre (GSE). An extensive study regarding its benefits in treating long standing diabetes and associated dyslipidemia is obligatory. Aim: To study the effects and optimal dosage of a standardized hydroalcoholic leaf extract of GSE on glycaemic and lipid parameters in diabetic rats. Materials and Methods: Wistar rats of either sex were divided into five groups with eight rats in each group. Single dose of Streptozotocin (STZ) (50mg/Kg body weight) was used to induce DM. The diabetic rats were treated with two oral doses of the GSE at 1g and 2.5 g/kg body wt/day and Glibenclamide (Glb) (500 µg/kg body weight) for a period of 16 weeks. Fasting Blood Glucose (FBG) was checked at day-1 and at the end of 16 weeks. Plasma glycated Haemoglobin (HbA1c), serum insulin, serum Triacylglycerol (TG), Total Cholesterol (TC) and High Density Lipoprotein fraction of Cholesterol (HDL-C) were measured at the end of the study. Statistical analysis was done using the software SPSS-20. Results: Significant decrease in FBG in a dose dependent manner was observed along with increase in serum insulin and decrease in HbA1c levels. Treatment with GSE decreased TG levels significantly and was comparable with Glb. Improvement in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was not significant, but that of Triglyceride Glucose Index (TGI) was significant. GSE at the dose of 2.5g/kg body weight showed a positive correlation between HOMA-IR and TGI (p=0.01) and was comparable with the results of Glb. Conclusion: GSE had a sustained and dose dependent effect in improving glycaemic parameters and TG in diabetic rats of protracted duration. Insulin resistance did not vary significantly from the diabetic control rats.

Effect of Acrylamide Ingestion on Reproductive Organs of Adult Male Wistar Rats