Journal of clinical and diagnostic research

Nevus Lipomatosus Cutaneous Superficialis - A Rare Hamartoma: Report of Two Cases

Nevus Lipomatosus Cutaneous Superficialis (NLCS) is a rare benign hamartomatous disorder in which mature collection of adipocytes are present ectopically in the dermis. NLCS usually presents as multiple, soft, pedunculated, cerebriform, yellowish or skin colored papules, nodules, or plaques, mostly involving the pelvic or gluteal region. We herewith report two cases of adult onset classical NLCS. First case had a classical presentation with lesion on lower back while second case was associated with some unusual features like occurrence on pubic area and associated comedo-like lesions.

Abdominal Epilepsy in an Adult: A Diagnosis Often Missed

Devavrat G Harshe, Sneha D Harshe, Gurudas R Harshe, Gayatri G Harshe

Abdominal Epilepsy (AE) is a variant of temporal lobe epilepsy and is commonly seen in pediatric age group. There are however, multiple reports of abdominal epilepsy in adolescents and even in adults. Chronic and recurrent gastrointestinal symptoms with one or more neuropsychiatric manifestations are often the presenting picture for a patient with AE. Such patients therefore, are more likely to consult a general practioner, a physician, a surgeon or a gastroenterologist than consulting a psychiatrist or a neurologist. We hereby present such a case of AE in an adult with review of similar reports.

Complete Heart Block in Pregnancy: A Report of Emergency Caesarean Section in a Parturient without Pacemaker

VANDANA MOHAPATRA, APARAJITA PANDA, SATYANARAYAN BEHERA, JAGADISH CHANDRA BEHERA

Management of women with Complete Heart Block (CHB) presenting without pacing, during pregnancy and labour is debatable. Temporary pacemakers have been routinely inserted for labour and birth probably to withstand any haemodynamic variations. However, due to lack of large scale prospective studies, the necessity of this procedure has not been objectively assessed. Also, the most appropriate anaesthetic technique for caesarean section in women with CHB is yet to be clarified. We report herein the case of a pregnant woman with CHB who had uneventful emergency caesarean delivery under spinal anaesthesia without temporary pacing. She was an unbooked case detected with congenital CHB first time during active labour; echocardiography showed no structural cardiac disease and her heart rate increased with atropine. We suggest further research so that guidelines could be established to prevent unnecessary morbidity and expense of temporary pacemaker insertion. Newly diagnosed cases of asymptomatic CHB in late pregnancy should be worked up for chronotropic responsiveness using atropine and responsive cases may be managed without pacemaker.

Palatonasal Fistula Repair – A Case of Unanticipated Difficult Intubation

Patients with present or previous history of facio-maxillary trauma will mostly be associated with a difficult airway. Surgical correction of these injuries might not always correct the altered airway. We report a case of palatonasal fistula following an old facio-maxillary fracture, which has led to interpretation of a difficult airway into a normal one. The patient was found to be having difficult airway during direct laryngoscopy which caused failure to intubate initially. Though, the patient was successfully intubated in the third attempt by senior anaesthesiologist making use of manoeuvres and equipment available, it made an impact for us to do a proper pre-op evaluation of patients with history of surgical correction of facial injuries and also for being prepared for can’t ventilate and can’t intubate situation in such type of cases. Through, this case report we stress the importance of airway anatomical alterations following facio-maxillary trauma and their corresponding management.

Blastomycosis-Like Pyoderma- A Rare Case Report

Amrita A. Hongal, Somashekar Gejje

Blastomycosis-like pyoderma is a rare, cutaneous bacterial infection of skin, seen in malnourished individuals, in a poor state of health and manifests as vegetating skin lesions. It is an unusual tissue reaction possibly to bacterial infection, the most common organism being Staphylococcus aureus. This case report is of a 35-year-old male who presented with thick verrucous surfaced plaques and papules on trunk and extremities since 2 months. Investigations revealed anaemia with hypochromasia, neutrophilic leucocytosis, hypo-proteinemia and hypo-albuminemia with reversal of A/G ratio. Pathergy test was negative. Pus on Gram’s stain showed plenty of pus cells, and negative for AFB and fungal stain. On culture of pus grew Coagulase negative staphylococcus species. Biopsy showed acanthosis of epidermis with moderate lymphocytic infiltrates in dermis and focally a few neutrophils and histiocytes. Patient fulfilled the criteria for diagnosis of blastomycosis like pyoderma viz., presentation of large verrucous plaques with pustules and ulcers with elevated border, histologically neutrophilic infiltration and growth of one pathogenic bacterium on culture. Patient responded to long-term cefotaxime therapy.

Immune Thrombocytopenia as a Presenting Manifestation of Tuberculosis- Challenge in Resource Constraint Settings

Deba Prasad Dhibar, Kamal Kant Sahu, Varun Dhir, Surjit Singh

Tuberculosis can infect almost any organ of our body leading to various presentations and its complication. Various haematological manifestations of tuberculosis are well known. But isolated thrombocytopenia and Immune Thrombocytopenia (ITP) in patients with tuberculosis is very rare. Here we report a case of young man who presented with acute onset of bleeding manifestations in the form of epistaxis and macroscopic haematuria with platelets count of 5×109/L. The patient was diagnosed to have ITP along with clinical and radiological evidence of active tuberculosis. The patient was treated with Anti Tubercular Therapy (ATT) along with Intravenous (IV) pulse of methyl prednisolone followed by tapering dose of oral prednisolone.

Paclitaxel Induced Acute ST Elevation Myocardial Infarction: A Rare Case Report

Gautam Rawal, Sankalp Yadav, Raj Kumar

Paclitaxel, is a frequently used anti-neoplastic agent and is included in various chemotherapy regimens. The life threatening cardio toxicity associated with its use and the still unclear pathophysiology, has limited the use of this drug. Acute myocardial infarction is a rare adverse event associated with this drug. We report a case of acute ST-elevation myocardial infarction induced by paclitaxel infusion in a patient of oesophageal carcinoma who was saved by percutaneous primary intervention. The authors emphasize the awareness of this side effect of Paclitaxel among the clinicians.

Anaesthetic Management of a Case of Down’s Syndrome with Achalasia Cardia

NEETA SANTHA, MADHUSUDAN UPADYA, SRAVANTHI VISHWANATHAM

Achalasia cardia is a disorder of the gastrointestinal tract characterized by dilatation of the oesophagus and collection of food and fluids in the oesophagus leading to massive regurgitation and aspiration of gastric contents. Down’s syndrome has multisystem effects which can also present as difficult airway. Here, we present a case of a 14-year-old girl, a case of Down’s syndrome with Achalasia cardia and mitral valve prolapse posted for Heller’s cardiomyotomy. Anaesthetic concerns were difficult airway due to Downs’s syndrome, massive aspiration risks of Achalasia cardia and haemodynamic instability due to mitral regurgitation. In spite of proper preparation of the patient there was massive regurgitation of oesophageal contents during intubation which was managed successfully. Haemodynamic changes due to mitral valve prolapse also had to be taken care of during the intraoperative period. Postoperative period was uneventful and the child was discharged after one week.

Isoniazid Induced Lupus Presenting as Oral Mucosal Ulcers with Pancytopenia

RIA SHAH, PADMARAJ ANKALE, KANISHK SINHA, APARNA IYER, T.K JAYALAKSHMI

Drug Induced Lupus Erythematous (DILE) is a rare adverse reaction to a large variety of drugs including Isoniazid (INH), with features resembling idiopathic Systemic Lupus Erythematosus (SLE). Diagnosis require identification of a temporal relationship between drug administered and symptom. It is an idiosyncratic reaction, with no pre-existing lupus. Our case highlights a rare presentation of isoniazid induced lupus with profound pancytopenia and mucosal ulcers, thus posing a diagnostic challenge. The patient was on multidrug treatment for pulmonary and knee joint tuberculosis. DILE was diagnosed on basis of strongly positive Anti Nuclear Antibodies (ANA), anti ds DNA and antihistone antibodies with clinical response to cessation of INH.

Customized Modified Haas Palatal Expansion in Mixed Dentition: A Case Report

The dental arch perimeter and transpalatal width are the most significant arch dimensions in the developing individuals. Its management during the primary, mixed and early permanent dentition are greatly important for the normal development of the dental arches and significantly improve the occlusion in adulthood. Malocclusion is a constant source of threat to the facial appearance. Severe anterior crowding and narrow maxillary arches adversely affect the smile, facial profile and consequently patient becomes handicapped socially as well as psychologically. Maxillary expansion has been used in resolving the problems of crowding, constricted arches and allow for forward growth of the mandible in growing children. This case report describes the use of a customized modified Haas appliance in intercepting the maxillary anterior crowding and gain the transpalatal width and arch perimeter of the maxilla, enhance the smile and facial profile and to allow the forward mandibular growth without any anterior occlusal interferences.

Bilateral Three Rooted Mandibular Premolars and Four Rooted Mandibular First and Second Molar: A Rare Anatomical Variant

Mrunal Manohar Shinde, Sharad Basavraj Kamat, Rutuja Vijay Chopade

The mandibular premolars and molars exhibit wide variations in the form of roots and root canals. A bilateral symmetry of three rooted mandibular first and second premolar and four rooted mandibular first and second molar in a same patient is a rare entity and one such case is presented in this case report.

Traumatic Ulcerative Granuloma with Stromal Eosinophila: A Case Report and Review of Pathogenesis

Bhushan Sharma, George Koshy, Shekhar Kapoor

Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE) is an uncommon condition considered to be a, reactive benign lesion of the oral mucosa, usually affecting the tongue. Its aetiopathogenesis is still uncertain. However, trauma has been found to be a contributing factor in a majority of the cases. Clinically, it often presents as an isolated ulcer or an indurated submucosal mass. Microscopically, it is characterized by a diffuse polymorphic cell infiltrate composed predominantly of eosinophils, B and T lymphocytes, macrophages, and large atypical cells involving the superficial mucosa and extending deep into the submucosa causing degeneration of the underlying muscle. TUGSE is rare and may be easily mistaken for a cancer or microbial infection, but it is self-limiting and tends to resolve spontaneously. Thus, awareness of this entity is important to emphasize the correct diagnosis of indurated ulcerated lesions and deliver appropriate and effective treatment. The present case highlights the clinical aspects, aetiopathogenesis and histopathology of this uncommon lesion.

A Large Pregnancy Tumor of Tongue – A Case Report

Pyogenic granuloma is a tissue overgrowth which commonly develops as a response to irritation or trauma which is usually localized. Though gingiva is said to be the common site, it also can occur on lip, tongue and buccal mucosa. Pathogenesis is unclear but trauma, infection and hormonal imbalance are attributed as reasons for occurrence. Histologically this reactive lesion is filled with immature fibroblastic connective tissue, profilerative blood vessels and inflammatory cells. This article presents a case of a large pyogenic granuloma of the tongue which is a rare site for this tumor in a 27 year old woman.

Treatment Emergent Agranulocytosis with Skin and Gingival Lesions in a Chronic Lymphocytic Leukemia Patient: A Case Report

Chronic Lymphocytic Leukaemia (CLL) is a monoclonal lymphoid malignancy characterized by progressive accumulation of small, mature but functionally incompetent neoplastic lymphocytes in the peripheral blood, bone marrow and lymphoid organs. Patients present a variable course and may not require early intervention unlike other malignancies. Patients with rapidly deteriorating blood counts, and organomegaly need treatment. Alkylating agent live Bendamustine combined with Rituximab, anti-CD 20 monoclonal antibody have shown promising results in such patients. Anaemia, neutropenia and thrombocytopenia have been reported as treatment emergent events with this combination therapy. Neutrophils are the major innate defense and their depletion can result in a wide range of opportunistic infections. This case report discusess the oral and dermal lesions which emerged with the Rituximab and Bendamustine combination therapy in a patient with CLL and their management.

Rare Occurrence of Drug Induced Subacute Cutaneous Lupus Erythematosus with Leflunomide Therapy

Harpreet Singh, Gagandeep Sukhija, Vikram Tanwar, Sameer Arora, Jaikrit Bhutani

Leflunomide is an immunomodulatory drug exhibiting anti-inflammatory, anti-proliferative and immunosuppressive effects. It has been widely used for treatment of active rheumatoid arthritis. Despite its good safety profile cutaneous side effects like alopecia, eczema, pruritis and dry skin have been reported with Leflunomide use. Skin ucleration, vasculitis, lichenoid drug rash and Subacute Cutaneous Lupus Erythematosus (SCLE) have been rarely reported with its use. A rare case of Leflunomide induced SCLE is being reported in a female patient with rheumatoid arthritis. The clinical features, histopathological and immunological characteristics were consistent with drug induced SCLE. Withdrawal of Leflunomide along with short course of topical steroids resulted in resolution of symptoms suggesting the drug to be the culprit. As this drug comes into widespread use, it remains to be seen whether more cases of DI-SCLE will occur/be reported. Fortunately, such a condition till times appears rare and is reversible once the drug is discontinued thus avoiding over evaluation and over treatment if the triggering drug is recognized.

O’Brien’s Granuloma- A Case Report

Pratik Mukesh Thacker, Kashinath Nayak, Flora Dorothy Lobo, Pavithra Govindasamy

Actinic granuloma is a self-limiting chronic disorder with elastolytic granulomas, mainly of the sun exposed skin and unknown pathogenesis. We report a case of a middle aged woman with multiple annular erythematous lesions. Histopathology revealed degenerated elastic fibres with histiocyte aggregates surrounded by multiple giant cells suggestive of elastolytic granulomas. She also had associated dyslipidemia and hypothyroidism. Actinic granuloma is relatively rare in the Indian population and needs to be differentiated from conditions like sarcoidosis and granuloma annulare.

Cystadenoma in Retromolar Region: A Case Report

Sheetal, V Ramesh, PD Balamurali, B Premalatha, Monika Chaudhary

Cystadenoma is a rare benign salivary gland epithelial tumor that is characterized by intraluminal papillary projection. Majority of the tumors are located in minor salivary glands and usually occur in palatal and buccal mucosa, but rarely found in retromolar area. Clinically it is difficult to differentiate it from other minor salivary gland tumors, and diagnosis is chiefly based on characteristic clinical features and immunohistochemistry. We present a case of Cystadenoma arising from the minor salivary gland in retromolar area of a 44 year old female patient with a special emphasis on the immunohistochemistry to rule out the metastatic follicular carcinoma of thyroid.

Breast Cancer with Synchronous Renal Cell Carcinoma: A Rare Presentation

Ravi Arjunan, Durgesh kumar, K V Veerendra kumar, C S Premlatha

Primary cancer arising from multiple organs is a well known fact. Synchronous tumours have been most commonly associated with kidney cancer. Bladder, prostate, colorectal and lung cancer are the most common synchronous primaries with Renal Cell Carcinoma (RCC) identified till date. We found metachronous tumours of breast with RCC in literature search which included both metastatic tumours as well second primaries. Overall, 25 cases of metastatic breast tumours and eight cases of second primary in previously treated RCC have been reported in the literature. Here, we are reporting a case of synchronous presentation of carcinoma breast with RCC which is very rare because most of the multiple malignancies reported in the literature are metastatic tumours or metachronous breast malignancy with RCC.

Subperiosteal Schwannoma of Pelvis- A Rare Case and Review of Literature

Devendra Lakhotia, Sunil Jeph, Swati Sharma

Schwannoma are benign tumours of the nerve sheath. They are commonly found in the soft tissue, but its presence in the bone is extremely rare. We herein present a case of 34-year-old man with two adjacent pelvic subperiosteal schwannomas. Computed Tomography (CT) scan showed osseous pressure erosion and Magnetic Resonance Imaging (MRI) showed two cystic signal intensity lesions, one near superior aspect of right posterior iliac wing and another inferior to it with adjacent cortical pressure erosion. The tumour was excised en bloc and on histopathological examination, the diagnosis was confirmed as subperiosteal schwannoma. To our knowledge, this is the first case report of subperiosteal schwannoma involving the pelvis. When a surface cystic lesion is encountered, subperiosteal schwannoma should be considered as a possible differential diagnosis.

“Histiocytosis X” – A Rare Case Report

Histiocytosis X is an idiopathic disease, characterized by a disorder of the reticulo-endothelial system in the human body. Histopathological studies carried out right from the 1800s have seen a significant similarity in the pathologic process of different stages in particular clinical syndromes showing proliferation of mature histiocytes. It was then modified by Lichenstein in 1953 as “Histiocytosis X”. The exact aetiology is unknown; hence, the name “Histiocytosis X”. The disease classically presents with three syndromes namely Eosinophilic granuloma, Letterer-Siwe disease and Hand-Schuller-Christian disease. These syndromes present with a spectrum of clinical manifestations with histiocytic proliferation in the granulomatous lesion. The disease is neither familial nor hereditary, nor does it have any microbiological pathologic origin. This disease can be conservatively managed by antibiotics and steroids or surgical curettage with radiotherapy. We report a five-year-old male child who was incidentally diagnosed to have Histiocytosis X. This patient was managed with a moderate surgical procedure with total avoidance of radiotherapy. An adequate follow-up of this patient shows total regression of the lesion and good bone healing.

Ameloblastic Carcinoma: A Report of Three Cases

Sravya Kodati, Sumit Majumdar, Divya Uppala, Madhurya Namana

Malignant odontogenic tumours are rare and represent approximately 1% of all oral malignancies. Ameloblastic carcinoma is a rare odontogenic tumour, which is aggressive in nature with extensive local bone destruction that has retained the features of ameloblastic differentiation and also exhibits cytological features of malignancy. It occurs primarily in the mandible in a wide range of age groups. It may arise de-novo or in pre-existing ameloblastoma or odontogenic cyst. The purpose of this report is to present three cases of ameloblastic carcinoma with varying presentations as central and peripheral entities.

Eosinophilic Granuloma Presenting as Palatal Swelling

B. Balaji Babu, Lakshmi kavitha Nadendla, Ginjupally Uday, Pooja madki

Swellings involving palate can be challenging to diagnose for the clinician as they have wide range of origin which can result from developmental, inflammatory, reactive or a neoplastic process. The clinical presentation of these swellings is similar and difficult to differentiate from each other. So it is important to take proper history from the patient and subject the patient to appropriate laboratory and radiographic investigations and finally biopsy is mandatory for accurate diagnosis. Thus, this article highlights on various common palatal swellings, their clinical presentation, and differential diagnosis helpful for proper diagnosis of swellings associated with palate.

A Rare Case of Pyogenic Granuloma with a Natal Tooth

NIDHI AGARWAL, DIPANSHU KUMAR, ALAKA VAISH, ASHISH ANAND

Natal teeth are teeth present in the oral cavity at the time of birth. It is extremely rare to find natal teeth in association with pathological conditions of the oral cavity. Pyogenic granuloma is a type of inflammatory hyperplasia that appears as an over exuberant connective tissue response to a stimulus or injury, in the present case the injurious agent is the natal tooth. The parents of the eight day old male infant brought the child with a natal tooth associated with a soft tissue lesion growing from the gum pad. A provisional diagnosis of pyogenic granuloma was made on behalf of the clinical findings which were confirmed by histopathology. The natal tooth was extracted and the lesion was surgically excised. Complete healing of the gumpad took place after excision of the lesion and extraction of the natal tooth and the child was able to feed normally within a week. The purpose of this case report is that Pediatric Dentist should be aware of this rare unusual clinical presentation and plan for an appropriate treatment modality in order to avoid any future complications.

Management of Recurrent Odontogenic Myxoma of Mandible: A Clinical Case Report

Yogesh Mittal, Ankita Chugh, K George Varghese, Shailendra Dwivedi, Vidhi Goyal

Odontogenic Myxoma (OM) is a slow growing painless locally aggressive tumor seen in gnathic bones and is generally asymptomatic. OM is characterized by spindle, wedge or stellate shaped cells loosely arranged in an abundant mucoid stroma. It is found incidentally on radiographs and may vary from a unilocular radiolucency to a multilocular lesion with well-defined or diffuse margins. Treatment includes surgical management that may range from simple enucleation and curettage to surgical excision including peripheral osteotomy, segmental resection, hemimandibulectomy and maxillectomy. Here we are presenting a case report on odontogenic myxoma with recurrence after conservative treatment.

Post Colonoscopy Ischaemic Colitis in a Patient without Risk Factors for Colon Ischemia: A Case Report

Ischaemic colitis is the most common form of intestinal ischaemia and is more common in the elderly and in the people having risk factors for colonic ischaemia. Colonoscopy procedure itself is a rare cause of ischaemic colitis. Fewer than 20 cases of ischaemic colitis caused by colonoscopy procedure have been reported in the english literature till date. This patient presented to us within hours of routine colonoscopy with rectal bleeding and lower abdominal pain. On repeat colonoscopy, the patient had mucosal oedema and ulcerations in the descending colon and sigmoid colon. Computed tomography of abdomen and biopsy of the involved segment confirmed ischaemic colitis. The patient recovered with conservative management.

Spontaneous Subdural Haematoma Developing Secondary to Arachnoid Cyst Rupture

Mehmet Onur Yüksel, Mehmet Sabri Gürbüz, Mehmet senol, Numan Karaarslan

Arachnoid cysts are congenital, benign, non-neoplastic, extra-axial intra-arachnoidal lesions. Arachnoid cysts rarely become symptomatic, with bleeding. Intracranial haemorrhage as a complication of arachnoid cyst is a very rare condition. It is well-known that mid-cranial fossa cysts might cause intracerebral haemorrhage or subdural haematoma secondary to traumas. However, the occurrence of spontaneous subdural haematoma secondary to arachnoid cysts, developing without any trauma, is even rarer. A 17-year-old boy presenting with diplopia and headache, with no history of trauma, was diagnosed with left temporal lobe arachnoid cyst and left fronto-parietal subdural haematoma. He was operated on, solely for his haematoma, with no intervention performed for the arachnoid cyst. Authors suggest that it is sufficient to perform an operation for the haematoma only -without arachnoid cyst resection- if there is no clinical presentation specific to the arachnoid cyst itself.

Unusual Presentation of Radial Nerve Entrapment with Lateral Humeral Condyle Fracture – A Case Report

Manoharan Muthulingam, Swagat Mahapatra

Lateral humeral condyle fracture is the second most common fracture around the elbow in pediatric age group. Acute neurological deficit as a consequence of nerve injury associated with lateral humeral condyle fractures is very uncommon. We report a rare presentation of a case of lateral humeral condyle fracture in a 13-year-old boy with acute radial nerve palsy. Patient was operated through a modified anterolateral approach to the elbow with, exploration of the radial nerve and internal fixation of the fracture. Complete fracture union at 6 weeks with good range of movements and full neurological recovery at 12 weeks was seen. We report this case due to rare combination of radial nerve injury and lateral humeral condyle fracture. Importance should be given to a thorough neurological examination during initial clinical examination and proper pre-operative planning.

Fiberoptic Guided Retrograde Intubation in an Anticipated Difficult Airway: Revival of an Antiquated Technique

Samarjit Dey, Marie Ninu, Md . Yunus, Newstar Syiemiong

Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation. This fiber optic guided retrograde intubation is a first reported case of its kind in a predicted difficult airway which can be beneficial in different difficult airway situations.

Dual Lower Respiratory Tract Infection by Burkholderia cepacia and Acinetobacter baumannii in A Neonate: A Case Report

Burkholderia cepacia (B.cepacia) and Acinetobacter baumannii (A.baumannii), the highly intrinsically resistant nonfermenters are known to cause frequent infections in immunocomproimsed or hospitalized patients with significant mortality rate. In this rare clinical presentation, both were simultaneously isolated from a case of neonatal sepsis with respiratory failure. The prompt early diagnosis and antibiogram of these nonfermenters were proved to be of tremendous help in the present case with successful treatment outcome of dual infection of B.cepacia and A.baumannii. The present case report strongly emphasises the clinical importance of early accurate diagnosis of these emerging potential fatal non-fermenters which could otherwise prove fatal in case of any slight delay or misidentification. Implementation of strict surveillance policy to monitor the growth of these non-fermenters and draconian infection control measure holds a key to success in significant reduction of the associated mortality and morbidity.

Hypersensitivity with Inhalational Budesonide: An Under Recognised Entity

Hypersensitivity reactions are commonly encountered with drugs such as beta lactams, sulphonamides, allopurinol etc., Corticosteroids are frequently employed in the treatment of drug induced allergic reactions. Therefore, it is highly unlikely that a corticosteroid itself may cause such a reaction as an adverse effect. We had encountered a rare case of hypersensitivity reaction with inhalational budesonide in an eight-year-old boy. The patient developed maculopapular rashes over the back, buttocks and legs accompanied with pruritus within four hours of administration of the first dose. The reaction subsided within two days on withdrawal of the drug and treatment with oral fexofenadine. Re-introduction of budesonide by the same route after a month resulted in appearance of similar reaction. Both the parents of the patient were known cases of allergic rhinitis suggesting allergic pre-disposition in the family. Causality analysis using WHO-UMC scale suggested certain association of this allergic reaction with inhaled budesonide.

Interpositional Gap Arthroplasty by Versatile Pedicled Temporalis Myofascial Flap in the Management of Temporomandibular Joint Ankylosis- A Case Series Study

Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material.

Effects of Lead In Various Preparatory Stages of Nagabhasma on Function and Histopathology of Cornu Ammonis of Hippocampus

Lydia S. Quadros, Hemalatha Bangera, Sushma R Kotian, Kumar M. R. Bhat

Introduction: Heavy metals are frequently used in the preparations of traditional/folk medicines. One such preparation in Ayurveda is Nagabhasma, in which lead is the main ingredient. Lead is non-essential element to the human body and is known toxic substance to many organ systems. However, it is claimed that, the highly toxic metallic lead will be converted into health beneficial organo-metallic compound when raw lead is subjected to various traditional methods of purification during preparation as mentioned in the ancient medicinal system. Aim: The present study is designed to evaluate the effect of such detoxification of lead in various stages of authentically prepared Nagabhasma on the learning and memory. Materials and Methods: Using half of the human equivalent doses of traditionally prepared Nagabhasma, at intermittent stages of its preparation were fed orally to healthy Wistar rats for 30 days. After treatment, the immediate effect and residual effect after 2 months was evaluated by subjecting them to passive avoidance test. Then rats were sacrificed and hippocampus was collected for histopathological evaluation. Results: Pure lead treated animals showed deficit in learning and memory which is indicated by spending more time in the dark compartment in passive avoidance test. However, animals treated with stage 1 to 4 Nagabhasma showed gradual increase in the memory and learning. This observation is substantiated by the findings of the histopathology of the Cornu Ammonis (CA) region of hippocampus. Conclusion: The results of the present study indicate that, the metallic toxicity of the lead used in the preparation of bhasma was gradually decreased from stage 1 to stage 4 of preparation. Therefore, the traditional way of preparing the metallic bhasma is very critical in eliminating the possible health hazardous metallic lead toxicity.

Evaluation of Effect of Nishamalaki on STZ and HFHF Diet Induced Diabetic Neuropathy in Wistar Rats

Introduction: Diabetic neuropathy is one of the most common complications affecting 50% of diabetic patients. Neuropathic pain is the most difficult types of pain to treat. There is no specific treatment for neuropathy. Nishamalaki (NA), combination of Curcuma longa and Emblica officinalis used to treat Diabetes Mellitus (DM). So, efforts were made to test whether NA is useful in prevention of diabetic neuropathy. Aim: To evaluate the effect of NA on diabetic neuropathy in type 2 diabetic wistar rats. Materials and Methods: Group I (Control) vehicle treated consists of 6 rats. Diabetes induced in 36 wistar rats with Streptozotocin (STZ) (35mg/kg) intra-peritoneally followed by High Fat High Fructose diet. After confirmation of development of diabetes; rats divided into six groups (n=6). Group II – VII Diabetic Control, NA low dose, NA High dose, Glibenclamide, Pioglitazone and Epalrestat. Animals received drug treatment for next 12 weeks. Monitoring of Blood Sugar Level (BSL) done every 15 days and lipid profile at the end. Eddy’s hot plate and tail immersion test performed to assess thermal hyperalgesia and cold allodynia. Walking function test performed to assess motor function. Results: Diabetic rats exhibited significant (p<0.001) hyperalgesia and increased BSL compared to control rats. Dose-dependent improvement was observed in thermal hyperalgesia & cold allodynia in NA groups. Activity of NA was more than Glibenclamide, Epalrestat and Pioglitazone in high dose and comparable in low dose. Nishamalaki improved lipid profile. Conclusion: Apart from controlling hyperglycaemia and reducing lipid levels, NA effectively prevented the development of diabetic neuropathy.

Effect of Magnetic Field on Bone Healing around Endosseous Implants – An In-vivo Study

Introduction: After implant placement, a stress-free healing period of 3-6 months is a pre-requisite to achieve good osseointegration. If this duration could be reduced, the patients would feel happier. Eventhough, immediate loading of implants is a clinically feasible concept; it is not possible in certain situations. Few studies have shown that Static magnetic field is useful to promote bone formation faster after the bone is wounded. Aim: This pilot study was intended to evaluate the tissue response after implant placement under the influence of magnetic field. Materials and Methods: Twenty Tidal Spiral implants were used for this study. Two implants were placed in each patient in the anterior mandible corresponding to the B and D regions and the implant on the D region was exposed to magnetic field using safer magnet (Neodymium Boron Iron) and the implant on the B region served as a control. Both the implants were compared for stability using Resonance Frequency Analyzer (RFA) at Days 0, 30, 60 and 90. Mean Implant Stability Quotient (ISQ) values were compared on both sides using student's paired t-test and repeated measures ANOVA (analysis of variance). There was a significant difference in the mean ISQ values, hence, a post-hoc test was done to evaluate whether there is any difference between the follow-ups. Results: The average ISQ value for implants at 0 day in the B and D regions was 68.6 and 68.7 respectively. The average ISQ value at 30th day, 60th day and 90th day was 73.25, 76.05 and 78.95 respectively on the magnetic side (D region). Whereas on the non-magnetic side (B region) at 30th day, 60th day and 90th day was 68.45, 72.05 and 74.45 respectively. Conclusion: The implant stability quotient values obtained on the magnetic side were significantly greater than on the non-magnetic side. Positive correlation exists between the magnetic field and osseointegration.

Modified Distal Shoe Appliance for Multiple Loss of First and Second Primary Molars

Yogesh Indrajit Somwanshi, Amar Narayan Katre, Ashwin Murlidhar Jawdekar

Mohr-Claussen Syndrome: A Rare Case

Manjiri Uttam Joshi, Namish Jagdish chandra Batra, Ankita Pradeep Patel

Continuous Ambulatory Peritoneal Dialysis Catheter Tunnel Breakdown and its Repair

shantajit nameirakpam, Salinita Naorem, CHETAN MAIBAM, SHARATKUMAR SINGH NAOREM

Delayed Recovery from Anaesthesia: Missing Information

Karthikeyan Kallidaikurichi Srinivasan

Proliferative Verrucous Leukoplakia - A Perpetuating Ambiguity

Monica Mehendiratta, Kanu Jain

Mercedes-Benz Sign

Binit Sureka, Kalpana Bansal

Revisited: A Prospective Study on Functional Outcome of Internal Fixation of Tibial Pilon Fractures with Locking Plate using MIPO

Rashid Anjum, Vikas Choudhary, Vivek Sharma

High Seroprevalence of Dengue Virus Infection in Blood Donors From Delhi: A Single Centre Study

Pragya Ranjan, Vidhya Natarajan, Meenu Bajpai, Ekta Gupta

Introduction: The risk of transfusion transmitted dengue has been increasingly recognized. Blood donors in an endemic area like Delhi may serve as a potential vehicle for transmission of the infection. Moreover, prevalence of infection in them would be representative of the true picture of dengue in a population. Aim: To determine the prevalence of dengue virus infection in blood donors in a tertiary care centre. Materials and Methods: A total of 200 blood donors were recruited in the study after obtaining informed consent in the Institute of Liver and Biliary Sciences, New Delhi in July and August 2012. Data regarding clinical and demographic characteristics was collected using a preformed questionnaire. Blood samples obtained were subjected to anti-dengue IgM and IgG ELISA as well as semi-nested Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for dengue RNA. Results: Of the study subjects, most were men (97%) with a median age of 28 years (range 19–51 years). Anti-dengue IgG was positive in 116 cases (58%) while IgM was seen in 27cases (13.5%). Of them, in 25 (12.5%) cases both IgG and IgM were positive, while only two (1%) cases tested positive for IgM alone. None of the blood donors were found to be viremic on screening using Nested RT-PCR. A clear increase of IgG seroprevalence with age was evident. No difference in the seroprevalence rates in urban vs. rural areas was seen. Conclusion: High seroprevalence of dengue infection was seen in healthy asymptomatic blood donors. Though evidence of acute infection was found in some, none were found to be viremic. Larger studies are required to quantify the risk and provide strong evidence for policies to be made.

Analysis of Fetal Palate to Assist Pre-natal Ultrasound

Anjali Shastry, Yogitha Ravindranath, Roopa Ravindranath

Introduction: Cleft palate is one of the major facial congenital malformation in newborns. Pre-natal detection of this malformation is limited to detection of clefting of hard palate but isolated soft palate clefting still remains challenge for sonologists. As Indian literature is limited present study was attempted to provide dimensions and position of fetal palate by digitized images. Aim: To study dimensions, position and differences in parameters between second and third trimester fetuses. Materials and Methods: Median sagittal section of 32 formalin fixed fetuses was selected from the Department of Anatomy, St John’s Medical College, Bangalore, Karnataka, India. Anatomical landmarks-The Nasion (N), Sellaturcica (S), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), tip of Uvula (U) were marked on sections. Length of hard palate (from ANS to PNS), Length of soft palate (from PNS to U), Hard palate/soft palate angle was defined. The anterior position of soft palate and its posterior position in relation to anterior cranial base were marked as N-S-PNS and N-S-U angle, respectively. The measurements were acquired directly from the digitized images using ImageJ software. Statistical analysis was done using SPSS 16. Results: The mean values of ANS-PNS and PNS-U were 23.59±3.69mm and 14.39±2.70mm, respectively. The mean values of hard palate/soft palate angle, N-S-PNS and N-S-U angle were 144.720±11.11,51.150±9.09 and 93.370±9.58, respectively. Significant difference was noted between trimesters for length of hard and soft palate but not for palatal angles. Conclusion: During Pre-natal assessment of cleft palate, it is important for sonologist to keep in mind that the dimensions of palate proportionately increased in last two trimesters while the position remains constant.

Cost-Effective Recruitment need for 24x7 Paediatricians in the State General Hospitals in Relation to the Reduction of Infant Mortality

Ranjana Chatterjee, Sukanta Chatterjee

Introduction: According to World Health Organisation (WHO), improvement of hospital based care can have an impact of upto 30% in reducing Infant Mortality Rate (IMR), whereas, strengthening universal outreach and family-community based care is known to have a greater impact. The study intends to assess how far gaps in the public health facilities contribute towards infant mortality, as 2/3rd of infant mortality is due to suboptimum care seeking and weak health system. Aim: To identify cost-effectiveness of employment of additional paediatric manpower to provide round the clock skilled service to reduce IMR in the present state health facilities at the district general hospitals. Materials and Methods: A cross-sectional observational study was conducted in a tertiary teaching hospital and district hospitals of 2 districts (Hooghly and Howrah in West Bengal). Factors affecting infant mortality and shift wise analysis of proportion of infant deaths were analysed in both tertiary and district level hospitals. Information was gathered in a predesigned proforma for one year period by verifying hospital records and by personal interview with service personnel in the health establishment. SPSS software version 17 (Chicago, IL) was used. The p-value was calculated by Fischer exact t-test. Results: Available hospital beds per 1000 population were 1.1. Percentage of paediatric beds available in comparison to total hospital bed was disproportionately lower (10%). Dearth of skilled medical care provider at odd hours in district hospitals resulted in significantly greater infant death (p < 0.0001), but was not seen in tertiary hospital. The investment for appointing four additional paediatricians for round the clock stay duty was found to be cost-effective. Conclusion: Provision of round the clock availability of skilled medical care may reduce hospital based infant mortality and it is cost-effective.

Mycobacterium tuberculosis Beijing Genotype in Western Iran: Distribution and Drug Resistance

Parviz Mohajeri, Sakineh Moradi, Sara Atashi, Abbas Farahani

Introduction: Mycobacterium tuberculosis Beijing genotype is gaining importance all over the world because this genotype is highly prevalent in several areas and is also frequently associated with drug resistance. Aim: To identify and determine the frequency of Beijing genotype and mix infection with Beijing and non-Beijing in west of Iran and analyse the association between Beijing genotype and drug resistance. Materials and Methods: This cross-sectional study was conducted on 146 Tuberculosis (TB) samples collected at the TB reference laboratory in Kermanshah west of Iran from January 2014 to February 2015, Mycobacterium tuberculosis isolates from sputum samples, detected by microcopy, biochemical tests and solid culture were included and then the confirmed samples with Cepheid Xpert MTB/RIF assay were subjected to drug susceptibility tests for rifampicin, isoniazid, ethambutol using proportional method. The prevalence rate of Beijing and non-Beijing genotype was determined by Multiplex- Polymerase Chain Reaction (PCR). Result: A total of 15/146 (10%) isolates were diagnosed as Beijing genotypes and the remaining 131/146(90%) isolates were non-Beijing genotypes by Multiplex PCR method. Among the 15 Beijing cases, 14 samples have shown mix infection indicating the presence of both Beijing and non-Beijing strains in samples. Three isolates from all cases were drug resistant. Interestingly all drug resistance isolates were from Beijing genotype which shows strong association between drug resistance and Beijing genotype. Also this genotype was more prevalent in younger age-group people (p=0.035). Conclusion: Frequency of Beijing genotype in west of Iran is more than other sites of Iran but less than Asia. According to our result, mix infections with Beijing and non-Beijing, had the most prevalence therefore we should be concerned more about mix infections. Multiplex-PCR method is feasible, trustworthy and can distinguish mix infections. It is suggested to perform spoligotyping in addition to multiplex PCR method to discriminate mix infections.

Determinants of Smokeless Tobacco Consumption and its Cessation among its Current Users in India

Almas Binnal, G Rajesh, Junaid Ahmed, Ceena Denny

Introduction: Global Smokeless Tobacco (SLT) consumption is on the rise and constitutes a major Public Health problem. Controlling SLT intake is central to containing the increasing tobacco menace. Aim: The present study was undertaken to comprehensively explore various factors involved in SLT consumption and its cessation among current SLT users. Materials and Methods: Present study was conducted among current SLT users visiting Department of Oral Medicine and Radiology, Manipal College of Dental Sciences (MCODS), Manipal University, Mangalore, Karnataka, India. A structured, pretested and self-administered questionnaire was employed for the present study. Knowledge, attitude, behaviour, worksite practices of respondents towards SLT consumption and its cessation, barriers to SLT cessation were explored. Information about socio-demographic variables was also collected. Results: Overall, 170 current SLT users participated in the present study. Results revealed that the mean knowledge, attitude, worksite related practices and barrier scores were 9.96(55.33%), 48.89(81.48%), 2.70(33.75%) and 54.25(60.27%) respectively. Correlation analysis revealed significant association of socio-demographic factors with knowledge, attitude and worksite related practices (p<0.05). SLT cessation related practices revealed that majority wished to quit (90%) and significant associations were noted amongst wish to quit with higher attitude scores; actual quit attempts with higher attitude, lower barrier scores and difficulty to quit with higher barrier scores (p<0.05). Conclusion: The present study draws attention towards involvement of complex interactions of various parameters including socio-demographic factors in SLT consumption and its cessation. Hence, it is imperative to implement multifactorial SLT control approach in order to contain tobacco menace spread across the globe.

Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study

S Tahmina, Mary Daniel, Preethy Solomon

Introduction: Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. Aim: To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. Materials and Methods: This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. Statistical Analysis: Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. Results: Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted. Conclusion: Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.

Immunohistochemical Evaluation of Role of Serotonin in Pathogenesis of Psoriasis

Sheren Fouad Younes, Ola Ahmed Bakry

Introduction: Psoriasis is a common skin disorder characterized by erythaematosquamous papules and plaques. It is known to be associated with stressful and depressive disorders. Serotonin is a neurotransmitter that plays a role in the pathogenesis of inflammatory skin disorders. Aim: To evaluate the role of serotonin in pathogenesis of psoriasis. Materials and Methods: Using standard immunohistochemical techniques, 24 biopsies from patients with chronic plaque psoriasis were examined together with 12 biopsies from age and gender-matched healthy subjects as a control group. Results: Both the percentage of positive cells (p=0.018) and H-score values (p=0.015) of serotonin expression were significantly higher in psoriasis compared to normal skin. H score of serotonin expression was significantly higher in cases with totally absent Granular Cell Layer (GCL) as opposed to those with thin/focally absent GCL (p=0.011), and in cases with moderate/strong epidermal inflammation compared to cases with mild inflammation (p=0.035). No significant correlation was detected between H score of cases and age, disease duration or Psoriasis Area and Severity Index (PASI) score. Conclusion: Serotonin might play a role in development of psoriasis through its role as a growth factor promoting keratinocyte proliferation, and as mediator of inflammation and stimulant of T cell activation. It recruits T cells to sites of cutaneous inflammation and potentiate macrophage accessory function for T cell activation. Its expression is not related to the disease severity. Future large-scaled research on population of different ethnicities including other disease variants is needed. The use of serotonin receptor antagonists and serotonin reuptake inhibitors may be evaluated on wide-based studies to put the current observation into action.

Retrospective Comparison of Clinical Characteristics and In-Hospital Outcomes among Diabetic and Non-Diabetic Adults with Acute Pyelonephritis

Shailesh C Trivedi, Sanjeev R Phatak, Renu S Trivedi

Introduction: Acute Pyelonephritis (APN) is a common infection in community. Diabetes Mellitus (DM) may have different effect on clinical characteristics and outcomes of APN compared to non-diabetic individuals. Aim: To compare clinical characteristics and assess outcomes of APN patients with and without DM. Materials and Methods: A retrospective analysis of 122 patients with DM (n=61) and without DM (n=61) was conducted at a single, private, urban set-up from Gujarat, India. Clinical symptoms, laboratory investigations, antibiotics treatment and outcomes in terms of mortality and prolonged hospitalization (10 days and above) were compared in two groups. Results: Mean age was significantly higher in diabetics than non-diabetics (55.2±12.5 vs 41.5±17.3, p<0.0001) and females were proportionally higher in both groups (65.6% Vs 62.3%, p=0.706). Fever was most frequent symptom (83.6% Vs 90.2%, p=0.283) followed by nausea/vomiting (50.8% Vs 63.9%, p=0.143), dysuria (66.7% Vs 74.4%, p=0.433) and flank pain (8.2 Vs 13.1, p=0.379). Backache/back pain (47.5% Vs 29.5%, p=0.041) and Chronic Kidney Disease (CKD) (63.9% Vs 45.9%, p=0.045) were significantly higher in diabetics than non-diabetics. Mean hospital stay did not vary significantly in two groups (7.0±3.2 Vs 6.50±2.9, p=0.346) but proportion of patients with longer hospital stay was higher in DM (16.4% Vs 8.2%). Elevated white cell count, erythrocyte sedimentation rate, C-reactive protein, serum creatinine and presence of red cell in urine (> 5/ high power field [hpf]) did not vary significantly in two groups. Cephalosporin-beta-lactamase inhibitor (Cefaperazone-Sulbactam/Cefepime-Tazobactam) was the most prescribed antibiotic in both the groups. No deaths were observed in any group during this evaluation period. Only raised ESR (>30 mm/hr) {Odds Ratio (OR): 1.58, 95% Confidence Interval (CI) 1.36-1.82, p=0.004} and presence of CKD (OR: 1.71, 95% CI 1.30-2.25, p=0.008) were found to be the significant predictors of prolonged hospitalization in overall population. Conclusion: APN in diabetic and non-diabetic patients has similar clinical characteristics. Impact of diabetes on clinical outcomes of mortality and prolonged hospitalization warrants further investigation in a large, randomized, prospective trial.

Expression of Alpha Methylacyl CoA Racemase (AMACR) in Gastric Adenocarcinoma and Its Correlation with Helicobacter pylori Infection

Introduction: Gastric cancer develops in a multistep progression and is determined by genetic and environmental factors. Over-expression of Alpha Methylacyl CoA Racemase (AMACR) is useful in diagnosis of prostate cancer. There is plenty of genetic alteration that occurs in gastric adenocarcinoma. The present study was planned to determine if AMACR can be used as a diagnostic marker in gastric adenocarcinoma similar to prostate cancer. Aim: To study the expression of AMACR in gastric adenocarcinoma and correlate its expression with density of Helicobacter pylori. Materials and Methods: This cross-sectional, prospective study was conducted from August 2013-2015. Fifty gastric cancer biopsies were taken. Adjacent biopsy from normal/reactive mucosa was also taken from 21 cases. Samples were stained with H&E for morphological details, Loeffler’s methylene blue for Helicobacter pylori and immunohistochemistry (IHC) was done to check for the expression of AMACR proteins. Statistical analysis was done using chi square test, Spearman's correlation coefficient and Fisher’s exact test. The p-value = 0.05 was taken as critical level of significance. Results: Overexpression of AMACR was observed in 88.89% of intestinal type and 78.05% of diffuse type adenocarcinoma. AMACR expression was significantly less in adjacent reactive/dysplastic mucosa. Helicobacter pylori were seen in 8/9 (88.89%) and 35/41(85.36%) cases of intestinal adenocarcinoma and diffuse adenocarcinoma respectively. When grades of Helicobacter pylori were compared with the positivity of AMACR, no significant association and correlation was found. Conclusion: The expression of AMACR in neoplastic tissue was significantly higher as compared to adjacent dysplastic, reactive or normal tissue. Thus, IHC for AMACR can be used for differentiating the cases of reactive atypia from early neoplastic lesions similar to its role in prostatic tissue. Helicobacter pylori does not affect the expression of AMACR in neoplastic gastric lesions.

Why Should Viral Markers Be Mandatory in Ocular Surgeries: A Hospital Based Retrospective Study

Anita Ambastha, Rakhi Kusumesh, Gyan Bhasker

Introduction: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus I, II (HIV-I,II) are serious global and public health problem. Knowledge of the seroprevalence would enable early diagnosis, treatment of patients and also help in prevention of horizontal spread of infection by application of universal infection control measures. Aim: To determine the seroprevalence of HBV, HCV and HIV I, II infection in patients undergoing ocular surgery. Materials and Methods: A retrospective review of 560 patients who had undergone ocular surgery between Dec 2014 to June 2015 at Regional Institute of Ophthalmology, Patna, India, was done. Blood samples of patients were tested for the presence of Hepatitis B Surface Antigen (HBsAg) and anti-HCV antibodies by Enzyme Linked Immunosorbent Assay (ELISA) method, while HIV I, II was tested by ELISA and Western Blot as per National AIDS Control Organization (NACO), India guidelines. The number of patients with positive viral serology, age, sex ratio and nature of surgery were analysed. Results: Out of 560 patients, 27 (4.8%) patients were found to be positive for viral serology. HbsAg was positive in 22 patients (3.92%). Out of these 14 patients (2.5%) were male while 8(1.4%) were females. Anti- HCV was positive in 3 (0.53%) patients. Out of these 2(.35%) were male and 1 (.17%) was female. HIV was positive in 2 patients (0.35%), both of whom were males. Conclusion: Keeping in view the number of cases of seropositivity in our study and various studies showing the presence of these viruses in aqueous and tears, we suggest that screening for viral markers should be made mandatory before ocular surgery so that early detection and treatment of patients can be done and risk of horizontal spread is minimized.

Non-O157:H7 Shiga Toxin Producing Diarrhoeagenic Escherichia coli (Stec ) in Southern India: A Tinderbox for Starting Epidemic

Shashank Purwar, Subrana Roy, Sharada Metgud

Introduction: Outbreaks due to non-O157:H7 Shiga toxin producing Escherichia coli (STEC) resulting in Haemolytic Uraemic Syndrome (HUS) have garnered much attention because of associated mortality transcending across continents and also because diarrhoea due to E.coli itself is rare in developed countries. The actual incidence of non-O157:H7 STEC in sporadic acute diarrhoea is not fully elucidated, both in developing as well as in developed countries. Due to larger extent of faecal-oral transmission in developing countries it is prudent to look for non-O157: H7 STEC in such epidemiological settings because of very high potential to spread across larger geographical regions and cause life threatening illness. Aim: To determine the extent of acute diarrhoea caused by Shiga toxin producing E. coli and measure their genotypic diversity. Materials and Methods: The study was designed as a cross-sectional study and conducted between 2009-2011 in department of Microbiology at JN Medical College Belgaum (Karnataka) and Regional Medical Research Center, Belgaum (RMRC-ICMR). Stool samples from 300 sporadic cases of acute diarrhoea were processed by microscopy, culture, for the identification of diarrhoeagenic pathogens viz. Vibrio cholera, Shigella spp., Salmonella spp. and protozoan parasites. PCR was performed for the detection of eae and stx genes in E. coli isolates. Their relatedness was determined by Random Amplification of Polymorphic DNA (RAPD). Results: PCR detected stx along with eae in 23.2% culture isolates of E.coli isolated from diarrhoea samples. Only three isolates were identified as STEC by serology as O59, O60 and O69 serotypes. Eleven clones were detected by RAPD fingerprinting in the 46 STEC isolates. Conclusion: Non-O157:H7 STEC are prevalent in this region and laboratories shall look beyond O157:H7 serotype of E.coli. These isolates have potential of causing outbreaks transcending borders. Hence they shall be reported and efforts be made to identify their sources and prevent spread.

Clinicopathological Study of Surface Epithelial Tumours of the Ovary: An Institutional Study

Nalini Modepalli, Suguna Belur Venugopal

Introduction: It is an established fact that tumours of ovary inherit a spectrum of histogenetic background, the variety being more than any other organ. Surface epithelial stromal tumours of ovary being the most common type of ovarian tumours form a complicating and baffling subject in the history of oncology and hence, are an interesting topic for study. Aim: The aim of this study was to categorize the surface epithelial tumours of ovary into benign, borderline and malignant, to study their clinical and histopathological pattern and to compare their incidences with other studies. Materials and Methods: This is a 5 year (3years of retrospective + 2 years of prospective) study conducted during the period of June 2006 to May 2011. It consisted of 139 cases (141 tumours/ lesions). The relevant clinical details about the patient were retrieved from hospital data. Results: The 141 surface epithelial tumours from 139 cases accounted for 66.2% of all the ovarian tumours encountered during the study period. The mean age of diagnosis in our study was 42.4 years. The most common clinical presentation was mass in abdomen. 90.6% of tumours were unilateral and 9.4% cases were bilateral. Right sided tumours (59.8%) were more common than left sided tumours (40.14%). 82.3% were benign tumours, 12.1% were malignant and 5.7% tumours belonged to the borderline category. Conclusion: Surface epithelial tumours present a great challenge to the gynecologic oncologist because non-neoplastic ovarian lesions can form a pelvic mass and potentially mimic a neoplasm. Their proper recognition and histopathologic classification is essential for appropriate management as malignant tumours are usually picked up at an advanced stage owing to their asymptomatic nature and inaccessible site for aspiration cytology and biopsy. Histopathological examination still remains the mainstay in diagnosis of these neoplasms.

Evaluation of Fluorescent Staining for Diagnosis of Leprosy and its Impact on Grading of the Disease: Comparison with Conventional Staining

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). Histopathological examination of skin lesion is the gold standard for diagnosis. We evaluated the possible role of fluorescent microscopy in this direction which is increasingly used for rapid screening. Aim: To compare the efficacy of auramine rhodamine stain with Ziehl-Neelsen and modified Fite-faraco staining in diagnosing M. leprae in tissue sections. Study Design: Experimental, cross-sectional and retrospective study conducted for 4 years. Methods and Materials: Skin biopsies of sixty clinically diagnosed leprosy patients were stained by Ziehl-Neelsen, Fite-Faraco and fluorescent stain. The presence of the bacilli and the bacillary index was scored for each case. The bacillary index by each staining methods were compared. Statistical Analysis: SPSS v 17 (IBM, New York) used for data analysis. Chi-Square test was used to calculate significance between differences. The p-value of <0.05 was considered as statistically significant. Pearson Correlation (r-value determined) was also used for comparison between groups. Results: Sensitivity of fluorescent stain for indeterminate and borderline tuberculoid leprosies were 100% each. Positivity rates and mean bacteriological index with fluorescent stain was higher (43.3 and 11.5 respectively) as compared to that of Ziehl- Neelsen and Fite-faraco when the bacillary load was less (bacillary index < 3). There was significant correlation between the three staining types at higher bacillary load. There was a higher mean bacillary index with fluorescent stain as well as detection of an additional multibacillary case. Conclusion: Fluorescent method is more sensitive than modified fite-faraco method in detecting lepra bacilli in tissue sections especially in cases with bacillary index less than three. With its higher sensitivity, paucibacillary cases could be upgraded to multibacillary thus affecting treatement decisions.

Decidual CD56+ Natural Killer Cells in Spontaneous Early Pregnancy Loss- An Immunohistochemical Study

Introduction: Natural killer cells are believed to promote placental and trophoblastic growth and provide immune- modulation at maternal-fetal interface in pregnancy and their role in reproductive failure has been a matter of discussion. Aim: To study CD56+ Natural killer cells in spontaneous pregnancy loss. Materials and Methods: In this prospective observational study, formalin-fixed paraffin embedded sections from products of conception from twenty women each with spontaneous early pregnancy loss (test group) and elective pregnancy termination (control group). Immunohistochemical staining with CD 56 monoclonal antibody was done by avidin-biotin peroxidase technique. CD56+ cells in decidua were counted under light microscopy by two independent observers in ten high power fields (40X) and mean cell count taken. Student’s paired ‘t’-test was used to statistically compare CD56+ NK cell population between the test and control groups. Results: The mean number of CD56+ NK cells was higher in the decidual tissue of women who had spontaneous early pregnancy loss (mean±SD, 57.55±1.79) as compared to the mean number of CD56+ NK cells in the decidual tissue from women who underwent elective termination (mean±SD, 50.9±3.46). The difference was statistically significant (difference of 6.65 with 95% confidence interval of 4.76 to 8.54, p-value <0.0001). Conclusion: This could imply that CD56+ NK cells have a role in the pathogenesis of spontaneous early pregnancy loss and further large scale studies can throw more light on the mechanism and designing of appropriate therapy.

Obesity Not Necessary, Risk of Symptomatic Cholelithiasis Increases as a Function of BMI

Introduction: Obesity is a well-established risk factor for cholelithiasis. But most of the studies have actually tried to establish the risk of cholelithiasis in overweight and obese people. Very few studies have addressed the issue of cholelithiasis in patients with otherwise normal Body Mass Index (BMI). In this study we have tried to establish if there is any relationship between increasing BMI and cholelithiasis. Aim: To establish a relationship between increasing BMI and risk of cholelithiasis. Materials and Methods: Retrospective analysis was carried out after doing a prospective pilot study. Ten years data of patients admitted to surgery ward with complaints of pain abdomen was reviewed. Patients with cholelithiasis were segregated as cases and patients with some other diagnosis were selected as controls. Patients with incidental diagnosis of cholelithiasis were excluded. Appropriate analytical tools were used to draw the results using SPSS© 20. Results: Over 11,000 patients data was reviewed and 7,182 patients were selected for inclusion into the study. Major exclusion was due to incomplete availability of data. Cholelithiasis group had 2,872 patients and rest of the patients served as controls against them. Female patients outnumbered their male counterparts in cholelithiasis group. Mean age of the gallstone patients was 37.09 years, almost 2 years younger than their controls. Mean BMI of all patients was 23.55 kg/m2 and in cholelithiasis and control group was 24.93 and 22.62, respectively (df=1, F>1635.395, p<0.001). Gender specific comparison also yielded a significant difference df=3, F=547.238, p<0.001). The difference in the way the patients were distributed among the ethnic groups (Nepalis, Bhutias, Lepchas and others) was also significant (df=3, F=34.234, p<0.001). Most important outcome was that the majority of the patients in the cholelithiasis group were within the normal BMI range. Conclusion: We concluded that it’s not only the overweight or obese patients who develop symptomatic cholelithiasis but also the individuals with normal BMI. The risk of symptomatic cholelithiasis increases with every increase in BMI. Risk of symptomatic cholelithiasis also increases in women and as the age advances.

A Study on the Efficacy of the Addition of Low Dose Dexmedetomidine as an Adjuvant to Lignocaine in Intravenous Regional Anaesthesia (IVRA)

Esha Nilekani, Yvonne Menezes, Shirley Ann D’Souza

Introduction: Intravenous Regional Anaesthesia (IVRA) is a simple, effective method of providing anaesthesia for short duration surgical procedures on the extremities, its chief drawbacks are tourniquet pain, short duration of block and absence of post-operative analgesia. Dexmedetomidine is known to reduce anaesthetic requirements and also provide analgesia to the patient. Aim: To evaluate the efficacy of dexmedetomidine as an adjuvant to lignocaine in IVRA with respect to the quality of the block, tourniquet pain and post-operative analgesia. Materials and Methods: A prospective, randomized, double-blinded study was conducted on 60 patients scheduled for orthopaedic surgery of the upper limb, of American Society of Anaesthesiologist’s physical status grades I and II. They were divided into two groups of 30 each. The control group C received 40ml of 0.5% lignocaine with saline and Group D received dexmedetomidine 0.5µg/kg added to 40ml of 0.5% lignocaine. The time taken for the onset and recovery of sensory and motor block, incidence of tourniquet pain, intra-operative and post-operative Visual Analogue Scale (VAS) scores, duration of post-operative analgesia and any side effects were noted. Student t-test was used for evaluation of the demographic data, haemodynamic variables, the onset and recovery times of block, duration of analgesia and intra-operative analgesic consumption and tourniquet pain. Friedman’s test was used for intra-operative and post-operative VAS and sedation scores. Results: The onset time of both sensory and motor block were significantly shortened, the recovery of sensory and motor block was prolonged, the incidence of tourniquet pain was comparatively lesser and there was significantly increased duration of post-operative analgesia in the dexmedetomidine group. Haemodynamic parameters were similar in both groups. Conclusion: The addition of 0.5µg/kg of dexmedetomidine as an adjuvant to IVRA effectively enhances the anaesthesia and post-operative analgesia obtained with lignocaine. The low dose of dexmedetomidine was effective and did not cause any major side effects.

A Retrospective Evaluation of Clinical Profile of Second Primary Head and Neck Cancer

Paramjeet Kaur, Nupur Bansal, J Vijaya Kumar, Anil Khurana, Ashok Chauhan

Introduction: Incidence of Second Primary Malignancy (SPM) after successful treatment of primary is increasing and may cause the problem for optimal treatment. Aim: This study was conducted retrospectively to analyse incidence, disease free survival between malignancies, pattern of treatment and outcome. Materials and Methods: Sixteen out of 22 patients of previously treated cases of head and neck cancer those develop SPM of head and neck region managed over a period of January 2012 to December 2015 in Department of Radiotherapy–II, Pt. BD Sharma PGIMS, Rohtak were analyzed retrospectively. Sixteen patients with unresectable disease were given reirradiation with external beam radiotherapy. Results: Median age of presentation of first malignancy was 27 years (Ranged 26 -65 years), whereas median age was 60 years for second malignancy (range 45-71 years). All patients were smokers during first malignancy; 87.5% (14/16) had historyof smoking during second malignancy. Oropharynx (50%) was most common site of presentation of primary tumor whereas oral cavity was most common site of presentation in second primary tumor. Conclusion: Incidence of Second primary head and neck tumor after successful treatment for primary Head and neck cancer are increasing due to newer treatment strategies, longer survival and follow up. Reirradiation, surgery and or chemotherapy are treatment modalities. However second primary tumor of this region are associated with poor prognosis.

Role of Scrape Cytology as an Adjunct to Fine Needle Aspiration Cytology in Diagnosis of Thyroid Lesions

Introduction: Scrape cytology is an important diagnostic tool. It has been used in many tissue types as an adjunct or replacement for frozen section/ intra operative consultation. Aim: This study was done to evaluate the role of scrape cytology in the diagnosis of thyroid lesions, its role as an adjunct to Fine Needle Aspiration Cytology (FNAC) and application of this technique for intra-operative consultation. Materials and Methods: A prospective study on 50 thyroid neoplasms received over a period of 18 months (Nov 2014- March 2016) was conducted. Scrapings obtained from the fresh cut surface of thyroid specimens before formalin fixation, were smeared uniformly on to glass slides, and immediately fixed in 95% ethyl alcohol for rapid Haematoxylin and Eosin (H&E). Cytological findings were compared with pre-operative FNAC findings and histopathological diagnosis. Variables taken in to consideration while assessing the smears included cellularity, nuclear, cytological details and amount of colloid. Results: There were total of 50 patients. Out of the 50 patients, 15 were diagnosed as benign on scrape; of which 100% of cases were true negative for malignancy and five malignant cases were diagnosed as benign-false negative rate of 16.1%; four (8%) were deferred (non-diagnostic) with a true positive rate of 83.3%. Histopathological correlation was available in all cases. The overall diagnostic accuracy of scrape cytology was 89.1% with sensitivity and specificity of 83.87% (C.I.; 66.27% to 94.55%) and 100% (C.I; 76.84% to 100.00%) respectively. Fine Needle Aspiration results were available in 41 cases of which 2 were non-diagnostic. Of the remaining 39 cases 19 were benign and 20 were malignant with false negative rate of 40% and true positive rate of 60%. The overall diagnostic accuracy of FNAC was 64.1% with sensitivity and specificity of 60% (C.I.; 40.6% to77.3 %) and 77.78% (C.I; 39.9% to 97.1%) respectively. Conclusion: We conclude that scrape cytology can act as a useful adjunct to FNAC and is a good procedure for intra-operative consultation. It is especially helpful in neoplasms diagnosed as suspicious for papillary carcinoma on aspiration and may obviate the need for a second procedure for completion thyroidectomy.

Voluntary Blood Donation among Students - A Cross-Sectional Study on Knowledge and Practice vs. Attitude

Babita Raghuwanshi, Nand K. Pehlajani , Mithilesh K. Sinha

Introduction: The factors influencing blood donation decisions are varied and complex and one’s attitude can influence this decision. Aim: To find the factors affecting the knowledge and practice of blood donation among college students and their attitude towards the same. Materials and Methods: This cross-sectional study was conducted among 399 college going students using convenience sampling from medical, nursing and engineering colleges in Bhubaneswar city, where blood donation camps were to be held. Data was collected through self-administered questionnaires and, analysed in SPSS Version 20.0. Results: Knowledge regarding blood donation was adequate among 228 (57.1%) of the students and, 221 (55.4%) students had donated blood. Knowledge was significantly better among female students, medical stream and in those whose parents were in non-medical jobs; whereas blood donation had been done significantly more by male, non-medical stream students and by those whose parents were in medical field. Most common reason for donating blood was a sense of social responsibility and most common reason of non-donation was fear of the procedure. An 85% of the students were of the view that they would donate blood if asked. Students suggested that small incentives like certificates and arranging transport for blood donation would make it easier to donate. Conclusion: Just over half of the students had adequate knowledge about blood donation and similar percentage had donated blood. There is this large pool of safe blood in college going students who are willing, but not tapped as source of blood donation.

Bacteriological Profile of Isolates From Urine Samples in Patients of Benign Prostatic Hyperplasia and or Prostatitis Showing Lower Urinary Tract Symptoms

Prem Prakash Mishra, Ved Prakash, Kashmir Singh, H Mog, Sumit Agarwal

Introduction: The incidence of Benign Prostatic Hyperplasia (BPH) or Prostatitis is increasing considerably worldwide. The Lower Urinary Tract Symptoms (LUTS) due to bacterial aetiology are one of the common factors for the complications among the patients. Aim: To determine the bacterial agents and their antibiotic sensitivity pattern from the urine samples of patients of BPH or Prostatitis showing symptoms of LUTS. Materials and Methods: The cross-sectional study was carried out in the Department of Microbiology of Rohilkhand Medical College and Hospital of Northern India from June 2014 to May 2015. A total of 105 urine specimens from patients of BPH and/ or Prostatitis were cultured by a semi-quantitative method. The isolated bacteria were identified by colony morphology, Gram’s staining, motility and biochemical tests. Antibiotic sensitivity was done according to the CLSI 2007 guidelines by disc diffusion method. Data was analysed by SPSS and Microsoft office 2007. Proportions and percentages were used as statistical measures. Results: The urine cultures from patients with BPH and or chronic Prostatitis, showed n=66/105 (62.85%) culture positivity. Out of 66 isolates the frequency was in following order Escherichia coli 21/66 (31.81%), Klebsiella spp 19/66 (28.78%), Staphylococcus aureus 11/66 (16.66%), Pseudomonas aeruginosa (10.60%), Proteus spp, Enterococcus spp, Acinetobacter spp and Citrobacter spp. The most susceptible 1st, 2nd and 3rd line antibiotics for Gram negative isolates were ampicillin, amikacin and tigecycline respectively. Amongst the Gram positive isolates, the susceptible 1st, 2nd and 3rd line antibiotics were cefoxitin, vancomycin, teicoplanin and linezolid. Multidrug resistance was seen in Escherichia coli (n=6), Klebsiella spp (n=7), Pseudomonas aeruginosa (n=4) and Staphylococcus aureus (n=3). Conclusion: Based on the above findings we can say that accurate aetiology of the LUTS among the patients of BPH and/or Prostatitis is warranted to initiate the therapeutic management. Based on our study we state that the prime pathogens are E.coli, Klebsiella among Gram negative isolates and S. aureus among Gram positive. The most sensitive drugs are aminoglycosides, tetracyclines and carbepenems for Gram neagtive isolates and oxazolidinones and glycopeptides among Gram positive isolates.

Effect of Integrated Approach of Yoga Therapy on Male Obesity and Psychological Parameters -A Randomised Controlled Trial

P.B. Rshikesan, Pailoor Subramanya

Introduction: Obesity is a growing global epidemic and cause of non-communicable diseases. Yoga is one of the effective ways to reduce stress which is one of the causes of obesity. Aim: To assess the effect of Integrated Approach of Yoga Therapy (IAYT) yoga module on adult male obesity in an urban setting. Materials and Methods: RCT (Randomized Controlled Trial) was conducted for 14 weeks on obese male subjects with yoga and control groups. Total number of subjects were 72 and they were randomized into two groups (Yoga n=37, Control n=35).The subjects were from an urban setting of Mumbai and were doing yoga for the first time. Special yoga training of IAYT was given to yoga group for one and half hour for 5 days in a week for 14 weeks. The control group continued regular physical activities and no specific physical activity was given. The assessments were anthropometric parameters of weight, Body Mass Index (BMI), MAC (Mid Upper Arm Circumferences) of Left and Right Arm, Waist Circumference (WC), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF(Skin Fold Thickness of Biceps, Triceps, Sub scapular, suprailiac and cumulative), Percentage body fat based on SKF and Psychological Questionnaires of Perceived Stress Scale (PSS) and AAQW (Acceptance and Action Questionnaire for Weight Related Difficulty). These were taken before and after intervention for both yoga and control groups. Within and between group analysis & correlation of differences from post to pre readings among the variables, were carried out using SPSS 21. Results: The anthropometric and psychological parameters were improved in both the groups but changes were significant in yoga group. Conclusion: Incorporating the IAYT for obese male in urban setting will be effective for obesity treatment and for reducing the obesity related problems.

Association of Diabetic Nephropathy and Liver Disorders

Usha Sachidananda Adiga, BN Malawadi

Introduction: Liver disorder is known to be a risk factor for Diabetes Mellitus (DM) and diabetic patients are at risk of developing liver disorders. Association of liver and renal disease is less explored in the field of research; hence, we conducted a retrospective study on this. Aim: To compare the renal and liver profiles of type II DM patients compared to healthy controls and find the association between the two profiles in diabetics. Materials and Methods: The renal and liver profiles of 68 type II DM patients and 58 controls were compared. Estimated Glomerular Filtration Rate (GFR) (eGFR) was calculated using Modification of Diet in Renal Disease (MDRD) formula and was taken as a tool to grade different stages of diabetic nephropathy. Comparison of liver profiles between different stages of diabetic nephropathy was done. Correlations and associations were studied between eGFR and liver enzymes and Bilirubin. Results: A significant elevation in Total Bilirubin (TB) (p< 0.15), Direct Bilirubin (DB) (p< 0.0035), Aspartate Amino Transferase (AST) and Alanine Amino Transferase (ALT) (p<0.0001) levels in diabetics was noted. An elevated eGFR and a significant correlation between eGFR and liver enzymes were observed. A significant association between liver and renal disease has been obtained in diabetics (p=0.0136). Conclusion: Significantly, high liver function tests and low eGFR were observed in type II diabetics. A significant positive correlation between liver enzymes (AST and ALT) and eGFR suggest a possible association between liver and kidney functions in DM.

Efficacy of Transcutaneous Electrical Nerve Stimulation in the Treatment of Overactive Bladder

Nidhi Sharma, Kaja Rekha, Krishnamurthy Jayashree Srinivasan

Introduction: Overactive Bladder (OAB) accounts for 40-70% cases of incontinence. The etiology is unknown though detrusor instability is found in urodynamic evaluation of almost all cases. Detrusor instability or hyperreflexia can be inhibited by direct inhibition of impulses in the pre-ganglionic afferent neuron or by inhibition of bladder pre-ganglionic neurons of the efferent limb of micturition reflex. Transcutaneous Electrical Nerve Stimulation (TENS) is based on the gate control theory of abolishing the local micturition reflex arc. Aim: To assess the effectiveness and safety of TENS in idiopathic OAB. Materials and Methods: It is a prospective experimental study to evaluate the effectiveness of TENS v/s placebo in reducing OAB symptoms. (n1=20, n2 =20). Ten treatment sessions (5 sessions/week) of 30 minutes, were conducted. Results: There was a significant improvement in Overactive Bladder Symptom Scores (OABSS) in TENS group and 2 patients were completely dry following TENS therapy. Conclusion: In elderly women, patients with OAB where other co-medications have their own anticholinergic side effects and impairment of cognition is a concern, TENS can be a useful intervention. TENS units are safe, economical and easily commercially available.

Is There Any Impact of Copper Intrauterine Device on Female Sexual Functioning?

Introduction: Intrauterine Device (IUD) is the most preferred modern contraceptive method in Turkey. Female Sexual Dysfunction (FSD) is defined as lack of one or more of the components in the sexual response cycle which includes sexual desire, impaired arousal and inability achieving an orgasm or pain with intercourse. FSD has multi-factorial aetiology. Advanced age and menopause, fatigue and stress, psychiatric and neurologic disease, childbirth, pelvic floor or bladder dysfunction, endometriosis, uterine fibroids, hypertension obesity, medication and substances, hormonal contraceptives, relationship factors are known risk factors for FSD. Aim: To investigate if IUD has any impact on female sexual functioning. Materials and Methods: In this cross-sectional study subjects were divided into two groups. Study group consisted of 92 IUD-users (mean 5.1±1.2 years) and the control group consisted of 83 women with no contraception. Female Sexual Function Index (FSFI) questionnaire was performed to both two groups. Women with a total score lower than 26.5 were considered as having sexual dysfunction. Results: The prevalence of FSD was 57.1% among participants. IUD users had a lower total FSFI score comparing to control group but the difference was not statistically different (p=0.983). A positive correlation was found between total FSFI score and duration of IUD (p=0.003). Conclusion: No difference was found in terms of sexual dysfunction between IUD users and women with no contraception. The prevalence of FSD was very high in both groups which may be attributed to the socio-cultural factors such as embarrassment of women due to conservatism.

The Clinical Presentation and Outcome of the Institutionalized Wandering Mentally Ill in India

Gaurav Singh, Nilima Shah, Ritambhara Mehta

Introduction: There are estimated 400,000 wandering mentally ill persons in India, found in poor physical state wandering on streets and railway stations; mainly treated either by government run Hospitals for Mental Health (HMH) or Psychiatry units of a Government Medical College (GMC). They require psychosocial rehabilitation along with treatment. Aim: To study the presentation, clinical profile and rehabilitative outcome of wandering mentally ill admitted in government psychiatric care facilities. The objective was to establish them as a distinct psychiatric inpatient population requiring special attention. Materials and Methods: The study was a chart review of all wandering mentally ill patients institutionalized during a period of two years in two distinct government facilities. Additionally, clinical staff was interviewed for cross checking the data and for eliciting problems faced in management. The discharged patients were contacted to assess the present status. Results: Forty seven patients in HMH and 35 patients in GMC were studied. Wandering mentally ill patients were brought to mental health facility by helping person (30) and police (23). Majority of them (61) were picked up from streets and railway station. Most of them (56) belonged to <40 years age group and communication with them was difficult due to language barrier in 51. Diagnosed as Psychosis NOS (45) initially, they presented with poor physical condition, with positive viral markers (25) and pregnancy in females (4). Most common final diagnosis was schizophrenia (45) along with prominent negative symptoms and poor cognitive abilities. Forty three of them showed good improvement on treatment. Forty five gave their address; Relatives were found in 39 through police, post cards and social workers and were rehabilitated back to family. Conclusion: Wandering mentally ill constitutes a unique patient population with specific challenges different from other inpatients in management and rehabilitation. Provisions to take care of this most vulnerable group of the society and mechanisms to watch for their continuous implementation are required.

Attitudes and Perceptions of Medical Undergraduates Towards Mobile Learning (M-learning)

Introduction: Mobile technology is one of the latest extensions of technological innovations that can be integrated into medical education. With the aid of these devices, students learn faster outside the classroom by having quick access to the internet and easy retrieval of required health related learning resources to keep alongside of recent trend and development. In medicine practice one has to continuously update his/her medical knowledge and mobile learning will serve as a tool for self-directed learning. Aim: To explore the attitudes and perceptions of undergraduate students towards M-learning. Materials and Methods: This educational research included 90 third year MBBS students having clinical posting under the Department of Community Medicine from tertiary healthcare institute in Nashik. Students learning approach was studied with the help of pre-validated questionnaire to know whether they have deep or surface approach to learning. M-learning group was formed on mobile social app to supplement conventional teaching-learning. One subject topic (Tuberculosis, Dengue fever/DHF, Hypertension and Diabetes Mellitus etc.) per week was allotted and after conventional teaching on first day of week the learning materials for the topic chosen for that week were uploaded on the group and students could download as well as share their ideas, learning resources, ask doubts and answer questions at least twice weekly through this mobile platform anytime, anywhere. At the end of three months students attitudes and perceptions towards M-learning were studied by pre-validated structured questionnaires. A five point Likert scale was used (5= strongly agree to 1= strongly disagree) for answering each item of all three questionnaires. The score of 60% (90 out of 150) and the score of 75% (30 out of 40) for each item was considered as the measure that indicates whether or not the student had a positive attitude and perceived the importance of M-learning respectively. Utilisation of M-learning was also studied. Results: It was found that 47 (52.2%) students had deep learning approach, 10 (11.1%) students had surface learning approach. An 80% of students had positive attitude towards M-learning and 76.7% students had perceived the importance of M-learning. A 52.2% of students were actively involved in M-learning group for learning purpose. But 57.8% students did not download (at least twice weekly) the shared reference material, 38.9% students never read and/or replied to the questions asked and 60.0% students never asked any doubts/questions related to the discussion. Conclusion: Students had positive attitude and perceived the importance of M-learning. But when they were provided with the opportunity, they did not show appreciable M-learning utilization. This could be because, M-learning was not implemented by all departments; also it was not the part of student’s regular assessment and probably a lesser study duration.

A Comparative Evaluation of Different Diagnostic Modalities in the Diagnosis of Typhoid Fever Using a Composite Reference Standard: A Tertiary Hospital Based Study in Central India

Veena Maheshwari, Navinchandra Motiram Kaore, Vijay Kumar Ramnani, Sheil Sarda

Introduction: Enteric fever, caused by Salmonella spp. is a major cause of morbidity and mortality worldwide and endemic in many developing countries including India and other South-East Asian countries. Blood culture is regarded as the gold standard for diagnosis. Currently, the standard serological method is tube agglutination with moderate sensitivity and specificity. Dot blot assay detecting IgM and IgG antibodies to a specific 50kD Outer Membrane Protein (OMP) antigen of Salmonella spp. is a simple, reliable, affordable and rapid test which can help in the early diagnosis of typhoid fever. Aim: To systematically evaluate the different diagnostic modalities against a composite reference standard for the better diagnosis of typhoid fever in clinically suspected cases of typhoid fever. Materials and Methods: This cross-sectional, prospective analytical study was carried out at a tertiary care hospital attached to Medical College in central India from November 2011 to June 2013. A total of 163 blood samples, collected aseptically from patients clinically diagnosed of enteric fever, were tested using various component tests like blood culture, Tube Widal and Dot Enzyme Immuno Assay (Dot EIA) for IgG and/or IgM. Composite Reference Standard (CRS) was created for defining the confirmed cases of typhoid fever using the component tests, wherein culture positive and in absence of culture positivity any two component test positive patients were taken as confirmed cases. All the component tests were evaluated against the CRS for sensitivity, specificity, PPV and NPV and their significance in relation to the duration of illness using statistical tests of significance. Results: Blood culture was positive in 16 (9.81%) whereas, Tube Widal, IgM, IgG and IgM+IgG in combination were positive in 88(54%), 58(35.58%), 30 (18.40%) and 75 (46.01%) respectively. Using a two test criteria of CRS framed, a total of 104 patients were considered as confirmed cases. Though specificity of blood culture was 100%, the sensitivity was low with significant detection rate in 1st week of illness. Tube Widal showed a sensitivity of 65.38% and specificity of 89.83% with significant detection rate in 2nd week. Dot blot assay for IgM, IgG and Combined IgM and IgG showed a sensitivity of 71.15%, 65.28% and 51.72% respectively whereas, the specificity was 10.16%, 47.45% and 74.57% respectively with significant detection rate in 2nd and 3rd week of illness. Conclusion: It can be concluded that though blood culture is still the gold standard, Dot blot assay found to have high sensitivity and good specificity might be a practical alternative test for the rapid diagnosis of typhoid fever if interpreted with care particularly using a composite reference standard. Further, it is reliable, simple to perform and rapid; results being available in 1 hour when compared to 48 hours for blood culture and 18 hours for Tube Widal test.

An In-vitro Comparative Study of Shear Bond Strength of Composite Resin to Bleached Enamel using three Herbal Antioxidants

Introduction: If adhesive restorations are carried out imme-diately, the Shear Bond Strength (SBS) to bleached enamel is reduced. The use of antioxidants can be highlighted since it seems to be a more effective alternative to reduce or remove the residual oxygen and immediate improvement in SBS. Aim: The purpose of this in-vitro study was an attempt to regain the lost bond strength, for which, the comparison of SBS of composite resin to bleached enamel was carried out using various antioxidants i.e., 5% grape seed extract, 5% pine bark extract, 5% pomegranate peel extract. Materials and Methods: Labial enamel surfaces of 50 extracted human maxillary central incisors were randomly divided into 5 groups based on the antioxidant used as follows: Group I (n=10): Bleaching with 40% hydrogen peroxide gel for 10 minutes, without the use of an antioxidant; Group II (n=10): Bleaching followed by the use of 5% grape seed extract solution; Group III (n=10): Bleaching followed by the use of 5% pine bark extract solution Group IV (n=10): bleaching followed by the use of 5% pomegranate extract solution; and Group V (n=10): Control group in which no Bleaching was done. SBS of the specimens was tested using universal testing machine. The data were tabulated and statistically analyzed using computer software Statistical Package for Social Sciences (SPSS) version 16.0. One-way analysis of variance (ANOVA) followed by Mann Tukey Post hoc test. Results: Mean SBS values were compared in all the groups and there was a statistically significant difference present among the groups (p<0.05). The SBS values were observed to be significantly higher in unbleached teeth (control group) followed by 5% pine bark extract, 5% grape seed extract, 5% pomegranate extract and the group in which teeth bleached with no antioxidant used. Conclusion: The use of antioxidant immediately after bleaching the enamel surface, completely neutralizes the deleterious effects of bleaching and increases the SBS significantly. Among the antioxidants, 5% pine bark extract application after bleaching showed better bond strength.

Influence of Teaching Strategies and its Order of Exposure on Pre–Clinical Teeth Arrangement – A Pilot Study

Introduction: Teeth arrangement is a vital skill for the undergraduate dental student. The attainment of skills depends largely on the methodology of teaching. In a dental curriculum, the students are exposed to a wide variety of inputs and teaching methodologies from different sources. The educational unit in dental school must identify the sequence of teaching methods that enhance the learning and practising ability of students. Aim: The aim of this study was to evaluate the effectiveness of three different teaching methodologies for teeth arrangement and compare the differences between the orders of exposure to each teaching methodology on the development of teeth arrangement skills. Materials and Methods: The first year B.D.S students were study participants and were divided into three groups A, B, C. They were exposed to three teaching patterns namely live demonstration with video assisted teaching, group discussion with hand-outs and lectures with power point presentation. After each teaching methodology, their skill was assessed. The groups were exposed to three methodologies in different order for three arrangements. The scores obtained were analysed using Kruskal Wallis rank sum test and Dunn test for statistical significance. Results: Significantly higher scores in the teeth arrangement procedure were obtained by the Group A students who were exposed initially to live demonstration with video-assisted teaching. Difference in the scores was noted among and within the groups. The difference between Group A and Group C was statistically significant after both first and third teeth arrangement (p=0.0031, p=0.0057). Conclusion: The study suggests each pre-clinical practice should begin with a live demonstration to enhance immediate learning absorption followed by lectures with power point presentation and group discussion for retention of knowledge and memory retrieval.

Comparison of Anchorage Pattern under Two Types of Orthodontic Mini- Implant Loading During Retraction in Type A Anchorage Cases

Introduction: The orthodontic mini-screws are the mainstay of direct skeletal anchorage which requires minimal compliance and provides maximal anchorage control. However, the timing of initiation of orthodontic loading of these mini-screws is not clearly established in the available studies. Aim: The purpose of this study was to determine the reciprocal effects on mini-screw implant with immediate loading in comparison to that of delayed loading during retraction. Materials and Methods: The prospective clinical study included a sample of 25 orthodontic patients in the age range of 18-25 years. All the cases were of bi-maxillary proclination with Type-A anchorage demands. All the first premolars were indicated for extraction. A split mouth technique for each patient was utilized by loading mini-implant immediately after its placement on one side and the opposite side implant was loaded after a time lag of two weeks post-insertion. Retraction force of 150g was applied for three months on each side. The displacement of the head and tail of the implant, molar anterior tooth retraction was measured on Orthopantomograph (OPG) taken at T1 (initial) and T2 (after three months). A grid method with each 1mm magnified to 500 pixels was superimposed on OPG and the relative displacements were evaluated. Student’s unpaired‘t’ test was used for comparison between left and right side and paired ‘t’ test for the parameters on the same side. The p-value equal to or less than 0.05 was taken as statistically significant. Results: The mean displacement of head of the implant on the immediate loading is 0.57mm where as the tail exhibited 0.75 mm. The head and tail of the implant on the delayed loading displaced by 0.35mm and 0.38mm respectively, on an average when data was analysed. Significant difference between the two types of loading was noted. Conclusion: Delayed loading is beneficial as compared to immediate loading during extraction space closure.

Premature Ovarian Failure: An Association with Autoimmune Diseases

Ayesha, Vandana Jha, Deepti Goswami

Introduction: Premature Ovarian Failure (POF) is the cessation of ovarian function before the age of 40 years. POF is reported to be associated with autoimmune diseases in 20-30% of cases. Aim: Patients presenting with idiopathic POF were screened for the presence of autoimmune disorders. Materials and Methods: Twenty patients with idiopathic POF were included in the study. Baseline investigation in all subjects included fasting serum FSH, LH, E2, progesterone, free T3, free T4, Thyroid-Stimulating Hormone (TSH) and Anti-Thyroperoxidase (anti-TPO) antibodies, testosterone and Dehydroepiandrosterone (DHEAS) levels. Fasting and post-glucose (2 hours after 75g of oral glucose) serum calcium and phosphate were estimated using appropriate assays in biochemistry laboratory. Results: Seven patients (35%), who presented with secondary amenorrhea, had thyroid disorders and were already on thyroxine replacement therapy. One patient also had vitiligo. There was no history of adrenal disorder. Anti-TPO levels were elevated in two (10%) patients of secondary amenorrhea group. The levels of serum testosterone were low in three patients. Serum DHEAS levels were low in 13 patients. Blood sugar levels (fasting and 2 hour post 75g glucose load) and fasting insulin levels were normal. Serum calcium and phosphate levels were normal in all the patients. Conclusion: Thyroid autoimmunity is the most common autoimmune disease associated with POF. The finding of low DHEAS in a large percentage of patients (65%), suggests possibility of adrenal dysfunction. This requires further testing for adrenal reserve and adrenal autoantibodies.

Determining Angle of Humeral Torsion Using Image Software Technique

Sachin Patil, Madhu Sethi, Neelam Vasudeva

Introduction: Several researches have been done on the measurement of angles of humeral torsion in different parts of the world. Previously described methods were more complicated, not much accurate, cumbersome or required sophisticated instruments. Aim: The present study was conducted with the aim to determine the angles of humeral torsion with a newer simple technique using digital images and image tool software. Materials and Methods: A total of 250 dry normal adult human humeri were obtained from the bone bank of Department of Anatomy. The length and mid-shaft circumference of each bone was measured with the help of measuring tape. The angle of humeral torsion was measured directly from the digital images by the image analysis using Image Tool 3.0 software program.The data was analysed statistically with SPSS version 17 using unpaired t-test and Spearman’s rank order correlation coefficient. Results: The mean angle of torsion was 64.57°±7.56°. On the right side it was 66.84°±9.69°, whereas, on the left side it was found to be 63.31±9.50°. The mean humeral length was 31.6 cm on right side and 30.33 cm on left side. Mid shaft circumference was 5.79 on right side and 5.63 cm on left side. No statistical differences were seen in angles between right and left humeri (p>0.001). Conclusion: From our study, it was concluded that circumference of shaft is inversely proportional to angle of humeral torsion.The length and side of humerus has no relation with the humeral torsion. With advancement of digital technology, it is better to use new image softwares for anatomical studies.

Day Care vs Overnight Stay after Laparoscopic Cholecystectomy even with Co-morbidity and a Possible Second Surgery: A Patient’s Choice

Aswini Kumar Pujahari

Introduction: Laparoscopic Cholecystectomy (LC) has become the gold standard for symptomatic gall stone disease. It is being practiced as a day care procedure in healthy individuals in American Society of Anaesthesialogists (ASA) grade I and II. It is not yet established in presence of co-morbidity and when a second surgery is added. In most of the study, patient’s choice and the psycho-social factors were not considered in deciding the day care procedure. Aim: To find the safety of LC and a second surgery as day care in presence of compensated co-morbidity. To study the choice of the patient whether to stay in hospital or go home after declaring them fit for day care. Materials and Methods: All the patients of symptomatic cholelithiasis with co-morbidity and associations were evaluated and made uncompromising for elective surgery. All the LC were done at 8mmHg CO2 peumo-peritoneal pressure using harmonic scalpel as the energy source for dissection of gall bladder from the liver bed. Cases with conversion and placement of drain were excluded. Results: A total of 1029 out of 1042 patients was included from Jan 2005 to Jan 2015. The age range was 38 to 91years (mean 44.65, SD 14.15). There were 634 females and 395 males. A total of 121(11.7%) of them had co-morbidity and associations. A total of 72(7%) had undergone a second surgery. Only 0.8% had real day care. A total of 95.7% had overnight stay even after fulfilling all the criteria. Only 0.2% needed re-admission in 30 days and one required intervention. Conclusion: Patients like to stay over night in the hospital even if found fit for day care after LC. Overnight stay makes them happy, psycho-socially confident in developing nation and best suited for all patients including co-morbidity.

The Effect of Stress Management Training through PRECEDE-PROCEED Model on Occupational Stress among Nurses and Midwives at Iran Hospital, Iranshahr

Introduction: Occupational stress is a major factor in hindering the performance of nurses and midwives and developing physical and mental complications in them. Given that these two groups are in direct contact with patients more than other medical staff and stress management training can be effective in the reduction of occupational stress among the nurses and midwives. Aim: This study was set out to compare the effect of a PRECEDE-PROCEED based stress management training program on the occupational stress of the nurses and midwives. Materials and Methods: This quasi-experimental study was conducted on the aforementioned nurses and midwives. Data collection instruments included the Nursing Stress Scale (NSS). The training program was held in two 4-hour-long sessions for three months from 1st January to 31st March 2013. Results: The results showed a significant increase in the PRECEDE scores of both groups by the end of the program, as compared to the baseline. A significant decrease was also observed in the stress scores of both groups. There was no difference between groups in these regards. Conclusion: The PRECEDE-based stress management training is effective in the reduction of occupational stress among the nurses and midwives.

Comparison of Gingival Health and Salivary Parameters among Autistic and Non-Autistic School Children in Riyadh

Introduction: Autism is a neuro-developmental disorder which is manifested as impairment of social interaction, communication and a repetitive behaviour. Autism can obscure dental treatment for the affected patients; furthermore, children with autism commonly have destructive oral habits. Aim: The aims of this study were to evaluate the Modified Gingival Index (MGI), Plaque Index (PI), salivary pH and buffering capacity of the saliva among autistic children compared to normal children in Riyadh City that may provide baseline data to enable comparison and future planning of dental services for autistic children. Materials and Methods: A total of 50 children diagnosed with autism (mean age 8.5 years) were selected from Azzam Autism School, Riyadh City. The control group consisted of 50 non-autistic school children (mean age 8.7 years), gender matched, selected from Outpatient Clinic, Riyadh Colleges of Dentistry and Pharmacy. MGI, PI, salivary pH and salivary buffer capacity tests were done for all participants. The buffering capacity of the stimulated saliva was grouped under ‘very low’, ‘low’ and ‘normal’. Pearson’s Chi square and one way ANOVA were used to find statistical significance if any among the autistic and the normal control group. Results: The results of the study showed that the mean ± standard deviation of MGI, PI and pH of unstimulated resting saliva for autistic group were 1.82 ± 0.65, 1.92 ± 0.35 and 6.8 ± 0.5 respectively. Normal control group had values 1.35 ± 0.85, 1.44 ± 0.43 and 7 ± 0.4 respectively. A statistically significant difference between both groups for all parameters was found. Salivary buffering capacity was found to be normal for the majority among both groups. However, 60% children among the autistic group presented with normal buffering capacity of the stimulated saliva as compared to 70% among the normal control group. However, this difference was not statistically significant (p = 0.544). Conclusion: Children with autism appear to have higher gingival inflammation, poor oral hygiene and a slightly lower salivary pH as compared to healthy control group. Special oral health programmes regarding treatment and maintenance of good oral health should be taken in consideration for autistic children.

Oral Health Related Quality of Life among Tamil Speaking Adults Attending a Dental Institution in Chennai, Southern India

Deva priya Appukuttan, Anupama Tadepalli, Dhayanand John Victor, Smriti Dharuman

Introduction: Oral Health-Related Quality of Life (OHRQoL) indicates an individual’s perception of how their well-being and quality of life is influenced by oral health. It facilitates treatment planning, assessing patient centred treatment outcomes and satisfaction. Aim: The study aimed to identify the factors influencing OHRQoL among Tamil speaking South Indian adult population. Materials and Methods: Non-probability sampling was done and 199 subjects aged 20-70 years were recruited for this observational study. The subjects were requested to fill a survey form along with the validated Tamil General Oral Health Assessment Index (GOHAI-Tml) questionnaire in the waiting area following which clinical examination was done by a single experienced Periodontist. Results: The mean score with standard deviation for physical dimension was 4.34±0.96, psychological dimension was 4.03±1.13 and pain was 4.05±1.09 on GOHAI. Greater impacts were seen for psychosocial dimensions like pleased with the appearance of teeth/denture Q7 (3.7±1.2), worried about the problems with teeth/denture Q9 (3.7±1) and pain or discomfort in teeth Q12 (3.8±1). Functions like swallowing Q3 (4.5±0.8) and speaking Q4 (4.6±0.7) were minimally affected. As age increased subjects perceived more negative impacts as indicated by lower ADD-GOHAI and higher SC-GOHAI scores (p<0.01). Subjects complaining of bad breath, bleeding gums and Temporomandibular Joint (TMJ) problems, reported poor OHRQoL (p<0.05). It was observed that as self-perceived oral and general health status deteriorated, OHRQoL also worsened (p<0.01). Subjects with missing teeth, cervical abrasion, restorations, gingival recession and mobility had more impacts on OHRQoL (p<0.05). Subjects diagnosed with periodontitis had lower OHRQoL as reported on the scale than gingivitis subjects (p<0.01). Conclusion: In this study minimal impact was seen in all the three dimensions assessed with GOHAI. Factors like age, education, employment status, income, self-reported oral health, self-perceived general health, satisfaction with oral health, perceived need for treatment and denture wearing status influenced perceived OHRQoL. Bad breath, bleeding gums, TMJ problems, more number of missing teeth, decayed teeth, cervical abrasion, gingival recession and mobility were associated with poor OHRQoL.

A Comparison of Conventional and Microwave Decalcification and Processing of Tooth and Mandibular Bone Specimens

A. Thirumal Raj, Shankargouda Patil, Roopa S Rao

Introduction: Any laboratory procedure exposes the technician and the pathologists to the hazardous effects of chemicals. Conventional procedures like decalcification and histo-processing employed in laboratories are labour intense and time consuming thereby delaying the report dispatch. The present study was an attempt to employ a kitchen microwave to hasten the process and facilitate faster and accurate reporting; thus, benefitting the technician, pathologist and the patient. Aim: To compare conventional and microwave based decalci-fication, processing and staining of tooth and mandibular bone specimens using 5% nitric acid as decalcifying agent. Materials and Methods: The sample included formalin fixed 180 tooth specimens (60 incisors, 60 premolars, 60 molars) and 60 mandibular bone specimens (approx 0.5cm each). The hard tissue specimens were subjected to varying combination of conventional and microwave decalcification, processing and staining. The entire procedure was blinded and evaluated by two examiners. Results: Conventional Decalcification (CD), processing and staining produced the utmost quality, though consuming a relatively longer duration. Microwave reduced the total decalcification time by half and retained the diagnostic quality of the specimens. On the contrary the microwave based processing and staining caused significant damage to the tissues rendering sections un-diagnostic. Conclusion: A combination of Microwave Decalcification (MD) followed by Conventional Processing (CP) and staining would be ideal to hasten the overall laboratory time with minimal compromise on tissue quality.

An Evaluation of Use of Botulinum Toxin Type A in the Management of Dynamic Forehead Wrinkles - A Clinical Study

Introduction: The pursuit of youth and beauty has undergone a resurgence of interest which is evidenced by increasing cosmetic procedures. Botulinum Toxin Type A (Botox) is one among the many procedures invented for facial rejuvenation which denervates certain muscles of facial expression responsible for facial wrinkles. It has been applied in the forehead, glabella, lateral canthal area and neck. In maxillofacial area hyperactive forehead wrinkles show sagging. Aim: This study was aimed to clinically evaluate the efficacy of Botox injection in the elimination of hyperdynamic forehead wrinkles and the objectives were to compare pre-operative and post-operative improvement in the number of wrinkles, photographic grading and patient satisfaction responses after 1st week, 4th week and 16th week. Materials and Methods: A total of 10 patients were randomly included in the present study who were cooperative, motivated and aesthetically conscious with moderate to severe forehead wrinkles. Assessment was performed clinically, photographically (using standardized photographs) and patient satisfaction responses were recorded at 1st week, 4th week and 16th week. Results: The study showed a significant difference in the elimination of wrinkles at rest and in action when assessed at 1st week and 4th week and it was consistent at 16th week. The patient showed positive satisfaction response without ptosis of the upper eyelid. Conclusion: Treatment with Botox is simple, safe and an effective modality for reduction of forehead wrinkles. It offers an alternative management in a cost-effective way when compared to surgical procedures.

Self-Reported Obstacles to Regular Dental Care among Information Technology Professionals

Introduction: Good oral health is important for an individual as well as social well-being. Occupational stress and work exhaustion in Information Technology (IT) professionals may influence the oral health and oral health related quality of life. Aim: To assess and compare self-reported obstacles for regular dental care and dental visits among IT professionals based on age, gender, dental insurance and working days per week. Materials and Methods: A cross-sectional study was conducted among 1,017 IT professionals to assess the self-reported obstacles to regular oral health care in Hyderabad city, Telangana, India. The Dental Rejection of Innovation Scale (DRI-S) was employed in this study. Comparison between means of DRI-S based on variables was done using t-test and ANOVA. The association between variables and DRI-S was determined using Chi-square test. Results: A total of 1017 participants comprising of 574 (56%) males and 443 (44%) females participated in the study. As age increased, a significant increase in mean DRI-S scores was seen for total and individual domains except for the “Situational” domain wherein higher mean score (9.42±2.5; p=0.0006) was observed among 30–39 years age group. Even though females reported higher mean scores for total and individual domains when compared to males, nevertheless significant difference was seen only for total (p=0.03) and “Lack of Knowledge” (p=0.001) domain. Conclusion: Self-reported obstacles to regular dental care was more with increasing age, increased number of working days per week, irregular dental visits and absence of dental insurance facility

A Study of Clinical Profile and Quality of Life in Patients with Scabies at a Rural Tertiary Care Centre

Pragya Ashok Nair, Rita Vipul Vora, Nidhi B Jivani, Shailee S Gandhi

Introduction: Scabies is a contagious disease primarily related to poverty and overcrowding, it rapidly spreads from person to person specially in people with poor hygiene. We come across many patients from rural areas with scabies. In India the incidence ranges from 13% to 59% in rural and urban areas. Many people complain of sleep disturbances and affection of work and leisure activities due to itching. Very few studies are done in India about the affection of quality of life in such patients. Aim: To study the demographic details, clinical profile and quality of life in patients with scabies. Materials and Methods: A prospective, observational and cross-sectional study conducted at Department of Dermatology and Venereology, rural based tertiary care centre, Gujarat for a period of 6 months from March to August 2015, after ethical approval from the institute. Study included all patients with clinical features suggestive of scabies. The data including age, sex, occupation, education, socioeconomic status, complaints, past history, family history and clinical features along with the questionnaire for affection of quality of life were recorded in predesigned proforma and detailed analysis was done. Total of 102 newly diagnosed scabies patients attending skin OPD were included in the study. Results: Out of 102 patients, 50.98% were males. The most common age group affected was 21-40 years, in 44.11% patients. Students were commonly affected with 41.17% followed by housewives with 20.58% cases. Most common lesion seen was papules in 84.3% followed by excoriations in 82.3% cases. Maximum 51.6% adults had small effect on quality of life while 62.5% children reported minimal effect on quality of life. Conclusion: Scabies is an important and commonly encountered health problem which is highly contagious and if not attended timely and adequately can affect the quality of life in the form of work affection, sleep disturbances and psychosocial problems in patients as well as its family members. This could be easily prevented if the patients of scabies are recognised and treated early and proper awareness is must to avoid recurrences. The profile of scabies patients helps in early recognition of scabies even at the peripheral centers.

Diabetes Mellitus among Newly Diagnosed Tuberculosis Patients in Tribal Odisha: An Exploratory Study

Introduction: The association between Diabetes Mellitus (DM) and Tuberculosis (TB) poses a strong public health challenge. Tribal ethnics possess a different propensity towards infectious and haematological diseases which may influence the inter-relationship of DM and TB and thus merit separate attention. Aim: To investigate the prevalence of diabetes in newly diagnosed pulmonary TB patients of tribal ethnicity in Odisha. Materials and Methods: A cross-sectional study was carried out over a period of 9 months at four designated TB microscopic centres in a tribal district (Malkangiri) of Odisha. A total of 110 tribal adults newly diagnosed with pulmonary TB were examined for Fasting Blood Sugar (FBS) level. Diagnosis of DM and Impaired Fasting Glucose (IFG) were based on cut-off value of FBS recommended by the WHO. Data was entered and analysed using SPSS version 22.0. Results: The prevalence of diabetes and IFG are found to be 13.9% and 8.9%, respectively. A significant difference (p<0.05) was observed between the mean ages of the TB only (45.9 years) and TB-DM co-morbidity patients (53.8 years). No significant association was found between gender and diabetes. Clinical characteristics of TB were similar in TB and TB-DM co-morbidity patients. Conclusion: The prevalence of high FBS was found to be higher in newly diagnosed pulmonary TB patients of tribal ethnicity thus indicating the need for intensified bidirectional screening. Further studies should be undertaken towards the risk profiling of diabetes and other lifestyle diseases in this population.

Anti bacterial Effectiveness of Electro- Chemically Activated (ECA) Water as a Root Canal Irrigant- An In-vitro Comparative Study

Introduction: Sodium hypochlorite, is the irrigant of choice for many clinicians, but its strong toxic and damaging effects on vital periapical tissues is always a matter of concern. So, the search for a root canal irrigant with a broad antimicrobial spectrum yet with a limited toxicity on vital tissues is always desirable. Aim: The study evaluated antimicrobial efficacy of Electro-Chemically Activated (ECA) water as a root canal irrigant against E. faecalis. Materials and Methods: Forty eight single rooted human teeth were decoronated to a length of 15mm. All teeth were divided into four test groups (group A – ECA anolyte, group B – 1% sodium hypochlorite, group C – 3% sodium hypochlorite, group D – distilled water) of 12 each. Only 1ml of Ringer’s solution and calibrated suspensio of E. faecalis was injected into each canal, aspirated and placed on agar plates and incubated aerobically at 37ºC for two days. The suspension was aspirated and spread onto the blood agar plate and incubated. All samples were irrigated with four test solutions and Brain Heart Infusion (BHI) solution was injected into each canal then aspirated and spread onto blood agar and incubated. After inoculations Colony Forming Unit (CFU) and optical density was measured under a microscope and spectrophotometer. The data obtained were statistically analysed by one way ANOVA and Dunkan’s multiple range test. Results: CFU reduction was not statistically significant between the test groups. The optical density showed statistically significant difference between the test groups (p=0.001). Conclusion: The antimicrobial efficacy of ECA was found to be comparable to sodium hypochlorite solutions

Assessment of Periodontal Health Status in Smokers and Smokeless Tobacco Users: A Cross-Sectional Study

Introduction: Oral smokeless tobacco consumption has been considered as a major risk factor for oral cancer, its role as a risk factor for periodontal disease is less well documented when compared to that of relationship between smoking and periodontal disease. Aim: The aim of the present cross-sectional study was to evaluate the effect of various forms of tobacco consumption i.e., smoking and smokeless tobacco forms on periodontal status. Materials and Methods: The study population included 120 subjects with the habit of tobacco consumption, based on form of tobacco use they were divided into Group 1 (smoking), Group 2 (Smokeless tobacco), and Group 3 (smokers and smokeless tobacco users). The periodontal status for each group was evaluated by measuring Oral Hygiene Index- Simplified (OHI-S) and Community Periodontal Index (CPI) for Probing Depth (CPI-PD) and Attachment Loss (CPI-AL). Results: OHI-S mean scores in Group 1 (3.53±1.03), Group 2 (3.06±0.92) and Group 3 (3.45±0.96) were similar, which were not statistically significant (p>0.076). The mean values of CPI-PD were 3.75±0.44 in Group 1, 3.65±0.48 in Group 2, 3.80±0.41 in Group 3 with no significant difference between the three Groups (p> 0.309). When the mean values of CPI-AL (0.95±0.75 in Group 1, 1.40±0.74 in group 2, and 1.55±0.60 in Group 3) were compared in between the Groups, a statistically significant difference was observed in Group 3 (p<0.001). Conclusion: The results showed that tobacco consumption in both forms caused poor periodontal status, with smokeless tobacco users having more amount of attachment loss than smokers.

Imaging Modality of Choice for Pre-Operative Cochlear Imaging: HRCT vs. MRI Temporal Bone

Introduction: Congenital inner ear malformations occur as a result of the arrest or aberrance of inner ear development due to the heredity, gene mutation or other factors. Ever since the availability of cochlear implants, pre-operative evaluation by imaging of temporal bone has gained much attention. Precise selection of the candidate for cochlear implant dependent on preoperative radiological investigations. Only CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) can provide a better picture of anatomy and pathology. Aim: To compare pre-operative imaging findings of both MRI and High Resolution Computed Tomography (HRCT) temporal bone and to find the best modality of choice in patients with bilateral profound Sensorineural Hearing Loss (SNHL). Materials and Methods: This was a prospective, longitudinal, observational study conducted between June 2010 to November 2012. A total of 144 temporal bones were evaluated in 72 children with bilateral profound SNHL with congenital inner ear malformations. Each temporal bone was considered as a single case (144 cases). All the patients underwent HRCT and high field MRI study. MRI study included T2 W axial 3D FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence. Anatomic abnormalities in each temporal bone were described and noted. For complete and better evaluation of Vestibulo-Cochlear Nerve (VCN) additional 3D oblique parasagittal view was taken perpendicular to the internal auditory canal with a small Field Of View (FOV). Results: HRCT and MRI allowed accurate detection of inner ear malformations in children with bilateral SNHL. Majority of the patients presented with multiple structural abnormalities of inner ear. The common pathologies detected in the study were semicircular canal abnormality (89/144) followed by cochlear abnormalities (39/144). Most common cochlear abnormality was Mondini’s deformity (14/144). MRI demonstrated absent of vestibulo-cochlear nerve in 15 cases. Conclusion: Few abnormalities of inner ear are better illustrated on CT, while others are better showed on MRI. Hence, neither HRCT nor MRI of the brain and temporal bones appears to be adequate imaging modality rather they are complementary to each other for pre-operative imaging of cochlear implantation.

Comparison of Mustard Oil and Ghee Consumption on the History of Coronary Heart Disease in Urban Population of India

Soumen Manna, Hanjabam Barun Sharma, Soniya Vyas, Jayant Kumar

Introduction: Coronary Heart Disease (CHD) is one of the leading causes of mortality in India, due to high consumption of mustard oil and ghee among urban population. Aim: To find out the relationship of mustard oil and ghee consumption on CHD history. Materials and Methods: By a random cross-sectional, house-to-house survey in North India, 137 people aged between 40-80 years (70 males and 67 females) were selected by dietary history of Mustard Oil (MO) and Ghee consumption (G), but having no other CHD precipitating factor. Using food frequency questionnaire, the study population was divided into two groups based on the amount of MO and G consumption; Group A (n = 75): MO >1L/month, but G <0.5Kg/month and Group B (n = 62): MO =0.2 to 0.5L/month but G >1.25Kg/month. Serum lipid profile estimation and resting ECGs recording were done from all the subjects. Results: There was no statistical significant difference in CHD history between the two groups. Mustard Oil had positive correlation with CHD history. CHD was higher by 50.9% in Group A and was independent of gender. However, the odds of CHD history were higher among males by 32.2% irrespective of the groups. Conclusion: The results demonstrated that CHD history was associated with higher relative consumption of mustard oil than ghee and CHD is positively correlated with increase mustard oil intake, blood level of TG, TC, LDL, VLDL, TC/HDL and LDL/HDL ratio.

Desmoid Tumours in Familial Adenomatous Polyposis: Review of 17 Patients from a Portuguese Tertiary Center

Marco Santos, Anabela Rocha, Vilma Martins, Marisa Santos

Introduction: Desmoid Tumours (DT) are benign tumours with an estimated incidence of 2-4 per million per year. Between 7-16% of them are associated with Familial Adenomatous Polyposis (FAP) and are mostly parietal or intra-abdominal. They are a challenge in relation to their unpredictable natural course, associated complications and difficult treatment. Aim: The aim of the present study was to review the occurrence, management and follow-up of DT on FAP patients treated consecutively at a tertiary care center. Materials and Methods: A retrospective review of clinical data from patients treated consecutively between 1993 and 2014. Patients’ data was gathered from clinical records. Data collection included the following variables: demographic data, genotype, FAP phenotype, data on FAP related surgery, DT diagnosis, location, size and number, DT treatment, patients’ status and follow-up data. Results: The study population consisted of 17 patients from 9 families; with a mean age of 41 years, mostly women (59%) and most with a mutation either on codon 232 or 554. Most tumours had an intra-abdominal component (59%) with a mean size of 5cm. Fifteen patients were first treated with pharmacotherapy (Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Tamoxifen). Five patients (29%) underwent surgery, 4 of them for complications of intra-abdominal tumours and 1 patient for abdominal wall tumours. Two patients underwent chemotherapy in relation to aggressive intra-abdominal disease. The mean follow-up time since diagnosis of DT was 123 months. Overall, 2 patients had remission, 11 patients had regression or stabilized disease, and 2 patients had progression. One patient died due to surgical complications. Conclusion: Diagnosis of DT is based on clinical symptoms, without the need for screening, although imaging plays an important role once diagnosis is suspected. The treatment approach is conservative on most patients, leaving surgery for DT related complications. The follow-up of patients with DT is also based on clinical symptoms.

Effect of Citalopram in Combination with Omega-3 on Depression in Post-menopausal Women: A Triple Blind Randomized Controlled Trial

Introduction: Depressive disorder is a common and disabling disorder that causes high rates of morbidity and mortality. Citalopram is an antidepressant drug, of the Selective Serotonin Reuptake Inhibitor (SSRI) class that has been used for geriatric depression since a long time ago. Prescription of omega-3 in geriatric depression has been increased recently; because of more favorable profile of their side effects. Some of the studies reported that omega-3 is effective in prevention or treatment of depressive disorders than Citalopram. However, there are contradictory studies too. Aim: This study aimed to investigate the effect of a combination of omega-3 and citalopram in the treatment of women with post-menopausal depression. Materials and Methods: This triple-blind randomized controlled trial was conducted on 60 women with post-menopausal depression who were referred to the Hamadan Fatemieh Hospital. After the participants completed the DSM-IV questionnaire and depression was confirmed by a psychiatrist, participants were assigned randomly into two-intervention and control groups. The patients in the control group received 20mg citalopram along with a placebo while patients in the intervention group received 20mg citalopram and 1g of omega-3. At baseline and at the end of the first, second, and fourth weeks, all of the participants answered the Beck’s Depression Inventory (BDI). Descriptive statistics and t-test, repeated measures analysis of variance and Bonferroni post-hoc test was used to analyse the data. Results: The depression score was 6.1±2.41 in intervention and 25.22±10.04 in control group, four weeks after intervention. A decreasing trend was observed in the mean depression scores of the intervention group during the study. Using repeated measures analysis of variance, a significant difference was observed between the mean depression scores of the two groups at the four measurement time-points (p<0.001). The mean depression scores of the intervention group were significantly lower than the control group either two weeks (p< 0.001) or four weeks after the treatments (p< 0.001). Conclusion: Using omega-3, can reduce the severity of depression in post-menopausal women.

Prevalence of Human Papilloma Virus Infection in Young Primiparous Women During Postpartum Period: Study from a Tertiary Care Center in Northern India

Introduction: Assessment of high-risk Human Papilloma Virus (HPV) prevalence is important for monitoring long-term decrease in cervical cancer after implementation of the prophylactic HPV vaccination. Aim: To determine the prevalence of high-risk HPV infection and cytological abnormalities in young primiparous women in the age group of 16-26 years. Materials and Methods: In this cross-sectional study, 214 primiparous women aged 16-26years were recruited from a public tertiary health care center postpartum clinic between June 2013 and May 2014. Cytological analysis was performed by Pap smear test and patients underwent sampling with cervical brushes for HPV-DNA detection and typing by a PCR-based assay for HPV types 16, 18, 33 and 45. Results: High-risk HPV was detected in 41 (19.2%) women. HPV 16 was found to be most prevalent with 17 (7.9%) samples testing positive, followed by HPV 18 in nine (4.2%), HPV 45 in six (2.8%) and HPV 31 in four (1.8%) women. Five women tested positive for more than one HPV types. There were no cases of intraepithelial lesions or cervical cancer. One patient who had Atypical Cells of Undetermined Significance (ASCUS) on cytology tested negative for all four HPV genotypes. Conclusion: This study provides a geographic baseline data of high-risk HPV prevalence in young Indian women before implementation of a vaccination program. The results are important for comparison with other global regions and monitoring the effect of HPV vaccination.

Effect of Tocopheryl Acetate on Maternal Cigarette Smoke Exposed Swiss Albino Mice Inbred Fetus

Janardan Chaudhary, Royana Singh, SN Shamal, K Supriya, Mona Srivastava, RS More

Introduction: Cigarette smoking is worldwide problem which can be correlated with teratogenicity. Tocopheryl acetate plays as an antioxidant against the oxidative stress evolved by cigarette smoke exposure during pregnancy. Aim: To study the effect of maternal exposure to cigarette smoke and Tocopheryl acetate on fetuses of mice. Materials and Methods: Pregnant mice randomly assigned to different groups (Group I (control), Group II (Tocopheryl acetate), Group III(soyabean oil used as vehicle for Tocopheryl acetate), Group IV (Cigarette smoke Exposed), Group V (Cigarette smoke exposed plus Tocopheryl acetate) and Group VI(Cigarette smoke exposed plus soyabean oil) were exposed to cigarette smoke 3 times a day for 20 minutes each time and Tocopheryl acetate with dose of 200mg/kg/day in 0.3ml of soyabean oil as vehicle orally through oral gavage from the 5th day of gestation to 15th day. Results: Cigarette smoke exposed mice showed significant fetal weight loss, resorption, placental anomalies, severe growth retardation, venous congestion, haemorrhage, limbs defects and enphalocele. Negligible abnormalities were seen among the control and Tocopheryl acetate group. Cigarette smoke exposed group with Tocopheryl acetate exhibited weight gain among the fetus as well as no gross abnormalities. The oxidative stress was significantly increased by increasing Malondialdehyde (MDA) 293±81.57 µmol/mg (p<0.0001) and decreasing Superoxide Dismutase (SOD) 1.43 ± 0.23mg/ml, (p<0.0001) Reduced Glutathione (GR) 0.017±0.002mg/ml, (p<0.01) and Catalase (CAT) 0.248±0.005mg/ml, (p<0.0001). Tocopheryl acetate induced group significantly maintained the oxidative stress with all p <0.0001. Conclusion: It can be concluded that Tocopheryl acetate may have an ameliorating effect on the cigarette smoke during pregnancy on fetus.

A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy

Ranendra Hajong, Debobratta Hajong, Tanie Natung, Madhur Anand, Girish Sharma

Introduction: Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. Aim: To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). Materials and Methods: This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. Results: The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=<0.05). Furthermore, the patients of the SILC group had less post-operative pain, with lesser analgesic requirements (p=<0.05), shorter hospital stay and earlier return to normal activity. Conclusion: SILC is feasible and safe in trained hands. It did not compromise the procedural safety, or lead to any complication. The operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC

Radiation Therapy in Paediatric Orbital Granulocytic Sarcomas: Experience from a Tertiary Cancer Center

Sushmita Pathy, Bhanu Prasad Venkatesulu, Supriya Mallick, Subhash Chander

Introduction: Orbital Granulocytic Sarcoma (OGS) is an uncommon manifestation associated with haematological malignancies. Chemotherapy remains the cornerstone of the treatment. The role of radiation is not well-defined. Aim: To evaluate the effect of radiation in OGS and to define an optimal dose for achieving adequate local control Materials and Methods: This was a retrospective analysis of 11 patients who received radiation therapy to orbit for Granulocytic Sarcoma (GS) between 2007 and 2014 at a tertiary cancer center in India. Radiotherapy was planned by three dimensional conformal (3DCRT) techniques. Demographic and disease characteristics, including clinical, imaging, histopathology and treatment details in this patient cohort were recorded and their response to therapy was assessed. Results: The median age was 7 years (Range: 2-16 years). There were 3 female and 8 male patients. Eight patients were diagnosed as Acute Myelogenous Leukemia (AML), two patients had Primary Orbital Granulocytic Sarcoma (POGS) and one had bi-phenotypic leukemia. Median dose was 24.5Gy (Range-15-45 Gy). Two anterior oblique field design were used most commonly. Out of 11 patients, 5 (45.4%) had complete response, 3 (27.27%) had partial response, 1 patient had stable disease (9%) and 2 developed progressive disease (18%). Median follow-up was 24 months (Range 24-84 months). At last follow-up, 7 (63.6%) patients were alive and 4 patients (37.4%) were dead due to progressive disease. Conclusion: In patients with residual orbital disease after chemotherapy, low dose radiation can be used to improve local disease control and improve quality of life. Local conformal radiotherapy of 24-30 Gy in conventional fractionation appears optimal with excellent local control and minimal morbidity.

Identification and Cost of Disposable Endourological Devices for Nephrolithiasis: A Cross-Sectional Study Among Urological Trainees

Introduction: Knowledge on health economics among urology trainees is not formally assessed. The cost of commonly utilised endourological devices may not be considered by trainees. Aim: The present study was conducted with the aim to assess whether urology trainees were knowledgeable on identification and cost of commonly used disposable devices in the management of nephrolithiasis. Materials and Methods: Forty urology trainees in Ireland were invited to complete a visual online questionnaire on the identification of 10 frequently utilised disposable endourological devices. In addition, trainees were requested to estimate the cost of 12 disposable endourological devices. Responses were stratified according to trainee grade and urological subspecialty of interest. Data are presented as a mean ± standard deviation. Results: The response rate was 70% (28/40). Endourology was the subspecialty of interest in 21% (n= 6). No trainee correctly identified all 10 endourological devices and the mean test score was 5.32 ± 2.28. No trainee accurately estimated the cost for all 12 devices assessed. The cost of endourological devices was underestimated by €67.13 ± €60.76 per device. A total of 54% (n=15) of trainees underestimated the total cost of disposable devices used during standard flexible ureterorenoscopy, laser lithotripsy and JJ stent insertion by €303.66 ± €113.83. Conclusion: Our findings indicate deficiencies in trainee knowledge on endourological devices and their associated costs. Incorporating a health economics module into postgraduate urology training may familiarise trainees with healthcare expenditure within their departments.

Association of C-Reactive Protein (rs1205) Gene Polymorphism with Susceptibility to Psoriasis in South Indian Tamils

Introduction: Psoriasis is a multi-factorial heritable T-helper Th-1/Th-17 mediated inflammatory disease, affecting the skin. It is associated with co-morbidities such as Cardiovascular Disease (CVD). C-Reactive Protein (CRP) is a good inflammatory marker. CRP rs1205 polymorphism is associated with circulating plasma CRP levels. Although there is association between the rs1205 Single Nucleotide Polymorphism (SNP) and CVD, there are no prior reports regarding the association of CRP rs1205 SNP with psoriasis susceptibility. Aim: To study the association of the genetic variant rs1205 in the CRP gene with susceptibility to the disease and protein levels in South Indian Tamils with psoriasis. Materials and Methods: In this case-control genetic study, 300 cases of psoriasis and 300 age and gender matched controls were genotyped for CRP SNP rs1205 using Taq Man 5’allele discrimination assay at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India from February 2014 to January 2016. Plasma high sensitivity (hs)-CRP levels were estimated by ELISA. Disease severity was assessed by Psoriasis Area Severity Index (PASI). Results: CRP genetic variation rs1205 was not associated with psoriasis risk in our South Indian Tamil population. However, the circulating levels of hs-CRP was significantly higher in patients with psoriasis, as compared with controls (p < 0.0001) and the protein levels were significantly associated with disease severity, as assessed by PASI scoring. No genotype was found significantly associated with PASI or CRP levels. Conclusion: Our results suggest that plasma CRP levels are higher in patients with psoriasis and correlate with disease severity, whilst CRP rs1205 is not associated with susceptibility to psoriasis in South Indian Tamils.

The Effect of Continuous Enteral Nutrition on Nutrition Indices, Compared to the Intermittent and Combination Enteral Nutrition in Traumatic Brain Injury Patients

Sakine Mazaherpur, Alireza Khatony, Alireza Abdi, Yahia Pasdar, Farid Najafi

Introduction: Nutrition support is one of the most common care, which is undertaken for patients who suffered from Traumatic Brain Injury (TBI) and are admitted in intensive care units. Literature indicates some controversies regarding the appropriate method of nutrition support in these patients. Aim: This study was conducted for determining the effect of continuous enteral nutrition on nutrition indices, compared to the intermittent enteral and combination nutrition in TBI patients. Materials and Methods: In a randomized clinical trial, 60 TBI patients who were admitted to critical care units of Taleghani Hospital of Kermanshah-Iran in 2010 recruited to the study. The samples were allocated to three groups of continuous enteral nutrition, intermittent enteral nutrition and combination nutrition supports by random sampling. The tool was a researcher-made checklist. The three methods of nutrition support were performed to the participants, then nutrition indices of patients were measured before and during three weeks. Data were analysed using SPSS software, descriptive, and inferential statistics. Results: The mean of received energy in the combination group (53.1± 18.3%) was higher than continuous (38.5±19.7%) and intermittent (32.2±14.7%) groups, significantly (p<0.001). The received protein was also greater in combination method (67.7±16.9%) than continuous (31.8±15.1%) and intermittent groups (17.2±10.1%), (p=0.001). The mean of nitrogen balance was improved in continuous method from -4.7± -1.6 to 7.2±5.2, (p<0.001) significantly. Conclusion: In this study, received energy of patients was not enough by three methods. However, the continuous method, having a positive effect on nitrogen balance, reducing hypercatabolism and maintaining the total body protein, was preferred to brain injury patients compared with intermittent enteral and parenteral methods that demand more studies.

Evaluation of Lipid Profile and Apolipoproteins in Essential Hypertensive Patients

Introduction: Essential hypertension is one of the most common diseases of the Indian population contributing greatly to the morbidity, mortality and economic burden. It has a strong association with cardiovascular disease and abnormal lipid metabolism. Not only the traditional lipid parameters, but also the novel lipid components like Apo A1 and Apo B100 also have been identified to play a role. Aim: The present study was done to evaluate serum lipid profile and Apo A1, Apo B 100 in essential hypertensive patients and correlate their values with the degree of hypertension. Materials and Methods: Fasting samples from 55 age and sex matched controls and 55 essential hypertensives were tested for plasma glucose, serum urea, creatinine, lipid profile, apo A1 and apo B100. The cases were subclassified based on the severity of hypertension according to JNC criteria. Results: The study showed a significantly raised value for serum cholesterol, triacylglycerol, Low Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL) in the hypertensive patients than the control group whereas serum High-Density Lipoprotein (HDL) registered a fall in the cases. Apo A1 revealed a non-significant fall in the hypertensive patients. In contrast, there was a rise in the serum apo B100 in the cases. Apo B100/apo A1 ratio was significantly raised in both stage I and stage II hypertensive patients in comparision to the controls. When correlated, serum apo A1 revealed a negative association where as serum apo B 100 showed a positive association with systolic and diastolic bloood pressure. Both LDL/HDL and apoB100/apo A1 and apo B100 revealed a significant positive association with both SBP and DBP. However, apoB100/apo A1 revealed a more positive association in comparision to LDL/HDL ratio (r=0.749, p<0.001, r=0.756, p<0.001 vs r=0.336, p<0.000, r=0.312, p<0.001). Conclusion: Apo B100/apoA1 has emerged as an important complementary parameter in addition to traditional lipid ratio for evaluation of risk for future cardiovascular disease.

Excessive Daytime Sleepiness in Schizophrenia: A Naturalistic Clinical Study

Payal Sharma, Reetika Dikshit, Nilesh Shah, Sagar Karia, Avinash De Sousa

Introduction: Excessive Daytime Sleepiness (EDS) and sleep problems are common in patients with schizophrenia. The symptom of EDS in schizophrenia can be attributed to various causes including neurobiological changes, sleep disorders, medication or as a symptom of schizophrenia itself. EDS as a symptom in schizophrenia has been understudied. Aim: To assess the prevalence of EDS and to the study the same in patients with first episode and chronic schizophrenia. Materials and Methods: In this cross-sectional study 100 patients suffering from schizophrenia as per International Classification of Diseases (ICD-10) criteria were evaluated for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and EDS using the Epworth Sleepiness Scale (ESS). The severity of illness was assessed by Positive and Negative Symptom Scale for Schizophrenia (PANSS) while cognition was assessed using the Frontal Assessment Battery (FAB) and the Trail Making Test A and B. The data was statistically analysed. Results: A total of 100 patients (72 male and 28 female) aged 18 to 64years (mean age 30.63 years) were studied. Poor sleep quality (PSQI > 6) was exhibited by 83% of patients. Excessive daytime sleepiness (ESS > 7) was found in 32% of patients. There was no statistically significant difference in various parameters according to the age, duration of illness or gender. However, first episode patients differed in having better sleep quality than patients with chronic schizophrenia (p=0.0002). Cognition was not affected by sleep quality. Conclusion: A high prevalence of sleepiness and poor sleep quality was noted in the entire sample but it did not have any correlation with age and gender. It also did not affect the cognitive test scores. Further research in this area is warranted.

Experience with Splenic Abscess from Southern India

Introduction: Splenic abscess is a rare entity with potentially life threatening complications. Sparse recent published data are available documenting the aetiological profile and management of patients with splenic abscess from India. Aim: To study the clinical profile of splenic abscess. Materials and Methods: We retrospectively collected data from case records of admitted patients with splenic abscesses, to Nizam’s Institute of Medical Sciences and Hospital which is a multispecialty, tertiary care referral hospital over a period of 15 months (from March 2014 to May 2015) and parameters studied were age, sex, symptoms, signs, risk factors, investigations like Ultrasound, CT scan, blood & microbiological culture, treatment and outcome. Results: Most common presenting symptom was fever (90%). Mean age was 33.5 years. Five patients (55%) had risk factors like HIV, leukaemia and diabetes. From pus culture Escherichia coli was the most common organism (22%) grown. Staphylococcus saureus, Enterococcus faecium were seen in one each, blood culture grown Cryptococcus neoformans, Pseudomonas aeroginosa in one each, Plasmodium falciparum was seen on peripheral smear in one. Three were empirically treated as disseminated koch’s. Another was treated as possible infective endocarditis. All were given antimicrobials, five (55%) were treated with antimicrobials alone, three (33%) with PCD (Per Cutaneous Drainage) and one (11%) with sub-total splenectomy. All patients recovered. Conclusion: With early diagnosis and increased use of ultrasound guided procedures like aspiration or drainage, spleenectomy can be avoided. Optimal treatment for splenic abscess is yet to be defined and customized to each patient.

The Diagnostic Value of Urinalysis in Hemodialysis Patients with Fever, Sepsis or Suspected Urinary Tract Infection

Katerina G. Oikonomou, Adib Alhaddad

Introduction: The diagnostic validity of urinalysis in asymptomatic Hemodialysis (HD) patients is low and there is limited data on the diagnostic value of urinalysis in HD patients with fever, sepsis, or suspected Urinary Tract Infection (UTI). Aim: The aim of this study was to assess the sensitivity, specificity, positive and negative predictive value of pyuria, bacteriuria, Leukocyte Esterase (LE) and nitrite positivity in symptomatic, febrile or/and septic HD patients. Materials and Methods: A single-center, retrospective study was performed at New York University Lutheran Medical Center, Brooklyn, New York City, USA, in order to investigate the diagnostic validity of pyuria, bacteriuria, LE and nitrite positivity in HD patients with admitting diagnosis of fever, sepsis or UTI from September 2008 to August 2015. Results: A total of 275 HD patients were included in the study. There was significant association between pyuria of different cut-offs (>5,>10,>50 WBC/HPF) and urine culture positivity (p<0.001) and growth of =100,000 CFU/mL (p=0.039), but there was no association with fever or sepsis. The sensitivity and specificity of pyuria >10 WBC/HPF for positive urine culture with >100,000 CFU/mL was 86% and 35% respectively (p=0.025). Pyuria >50 WBC/HPF showed a sensitivity of 66% and a specificity of 58% (p=0.032). There was also association between bacteriuria, LE positivity and positive urine cultures but not with =100,000 CFU/mL. Conclusion: Our study results suggest that urinalysis is not a reliable diagnostic tool in febrile and/or septic HD patients and a urine culture is needed. In such patients, physicians should also maintain a high level of clinical suspicion for other potential sources of infection, which may not be initially evident.

Trace Elements in Chronic Haemodialysis Patients and Healthy Individuals-A Comparative Study

Introduction: End Stage Renal Disease (ESRD) patients despite receiving adequate Haemodialysis (HD) develop significant risk of Cardiovascular Disease (CVD). Abnormality in levels of trace elements may potentiate vascular injury by producing sustained inflammation and endothelial dysfunction. Hence, the present study was undertaken to evaluate the levels of trace elements in patients receiving HD. Aim: To study the blood levels of arsenic, cadmium, mercury, lead, chromium, barium, cobalt, caesium and selenium among ESRD patients undergoing HD and compare it with healthy individuals. Materials and Methods: It was a cross-sectional, comparative study done in a tertiary care center. About 40 established ESRD patients aged above 18 years, belonging to both sexes, undergoing chronic HD for more than six months were enrolled as Group A (Cases). Patients who had history of smoking and occupational exposure to heavy metals were excluded from the study. About 40 age and sex matched apparently healthy individuals attending health check-up were enrolled as Group B (Controls). Participants of this group had normal e-GFR by Modification of Diet in Renal Disease (MDRD) equation. About 5ml of fasting venous blood sample was obtained from both groups and analyzed for trace elements. Chi-square/Fisher’s-exact test was used for comparing ratios. A p-value of <0.05 was considered statistically significant. Results: In the present study, the mean blood levels of arsenic, cadmium, chromium and cobalt was found to be significantly higher in Group A as compared to Group B with all these parameters attaining a p-value of <0.001. Similarly, the mean blood levels of lead and caesium was high in Group A with a p-value of 0.001 each. The blood levels of mercury and barium did not vary significantly between both the groups with p=0.656 and 0.096 respectively. The blood levels of anti-oxidant selenium was lower in Group A, but did not attain statistical significance (p=0.217). Conclusion: The mean blood levels of toxic trace elements were significantly elevated with a simultaneous reduction in essential trace elements in patients receiving HD, which probably may contribute to an increase in CVD.

Is the Mean Platelet Volume a Predictive Marker of a Low Apgar Score and Insulin Resistance in Gestational Diabetes Mellitus? A Retrospective Case-Control Study

Introduction: Gestational diabetes is defined as various degrees of glucose intolerance diagnosed or detected for the first time during pregnancy and is the most common metabolic complication of pregnancy. Early diagnosis and adequate treatment are important to prevent complications. Pre-eclampsia, polyhydramnios, fetalmacrosomia, and operative delivery are some of the complications seen in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM). Aim: The present study was designed to determine whether there was an association between Mean Platelet Volume (MPV) in predicting poor fetal outcome, insulin resistance, neonatal Apgar scores and gestational age for women with GDM. Materials and Methods: In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of 138 healthy controls. MPV, insulin and homeostatic model assessment (HOMA-IR) values were measured at 24–28 weeks of the pregnancy. An independent samples t-test was used to compare MPV values. Multivariate linear regression models were used to establish relations between MPV values, HOMA-IR, insulin levels and Apgar score. Results: There was a significant positive correlation between MPV values, HOMA-IR and Insulin levels and a negative correlation with Apgar score at 1 min and 5 min in the GDM group (r=0.227, p=0.02; r=0.206, p=0.03; r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively). In the multivariate logistic regression analysis, a high MPV value was most consistently associated with a low Apgar 1 min score (ß=-0.387, p=0.003) in the GDM group. An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75% for the prediction of GDM. Conclusion: We investigated the potential of MPV values in predicting low Apgar scores and insulin resistance in women with GDM.

Effectiveness of Centchroman on Regression of Fibroadenosis and Mastalgia

Introduction: Fibroadenosis and mastalgia are common among the women in reproductive age group. Treatment for these conditions is not yet standardised. Most of the drugs used for fibroadenosis and mastalgia are expensive and have side effects. Aim: To find out the efficacy of centchroman, a Selective Estrogens Receptor Modulator (SERM) on regression of fibroadenosis and mastalgia. Materials and Methods: Fifty one patients with mastalgia/fibroadenosis were treated with centchroman 30mg once daily on alternate days for a period of 3 months and followed up weekly for six months with Mastalgia chart and Visual Analog Scale (VAS) pain score. Results: Before starting treatment, four patients presented with pain score of 6 followed by, 37 patients with a score of 4 and 10 patients with a score of 2. All the patients were started on tab centchroman 30mg OD alternate days and were reviewed on weekly basis with Mastalgia chart and VAS pain score for three months. On fifth and sixth visit, 46 patients reported with pain score 0, one with pain score of 2 and four with pain score of 6. The efficacy of centchroman was found to be significant (p-value = 0.001). Three patients (5.9%) reported epigastric pain and ten patients (19.6%) reported menstrual delay. A total of 38 patients did not complain of any side effect. Conclusion: Our study proves that centchroman is a safe and cost effective drug with significant efficacy on regression of fibroadenosis and mastalgia with minimal side effect.

Assessing the Reliability of Digitalized Cephalometric Analysis in Comparison with Manual Cephalometric Analysis

Introduction: For more than seven decades orthodontist used cephalometric analysis as one of the main diagnostic tools which can be performed manually or by software. The use of computers in treatment planning is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility. Aim: This study was done to evaluate and compare the accuracy and reliability of cephalometric measurements between computerized method of direct digital radiographs and conventional tracing. Materials and Methods: Digital and conventional hand tracing cephalometric analysis of 50 patients were done. Thirty anatomical landmarks were defined on each radiograph by a single investi-gator, 5 skeletal analysis (Steiner, Wits, Tweeds, McNamara, Rakosi Jarabaks) and 28 variables were calculated. Results: The variables showed consistency between the two methods except for 1-NA, Y-axis and interincisal angle measurements which were higher in manual tracing and higher facial axis angle in digital tracing. Conclusion: Most of the commonly used measurements were accurate except some measurements between the digital tracing with FACAD® and manual methods. The advantages of digital imaging such as enhancement, transmission, archiving and low radiation dosages makes it to be preferred over conventional method in daily use.

Clinical Utility of Serum Homocysteine and Folate as Tumor Markers in Oral Squamous Cell Carcinoma - A Cross-Sectional Study

Introduction: Oral Squamous Cell Carcinoma (OSCC) is a common malignancy involving head and neck. Identifying the markers of molecular levels or biochemical markers involving the various metabolic reactions associated with the initiation and biological behavior of individual tumors are very important in diagnosis and prognosis. Aim: To measure and compare the levels of serum Homocysteine (Hcy) and serum folate in OSCC patients, smoking group and healthy subjects and also to assess the clinical utility of serum Hcy as a potential tumor marker in OSCC. Materials and Methods: The study group comprised of 60 subjects, of whom 30 were classified as OSCC cases (GROUP I) and 15 were classified as smokers without OSCC (GROUP II). The control group included 15 healthy individuals without smoking habit (Group III). Hcy was measured with High Performance Liquid Chromatography (HPLC). Folate estimation was done by Chemiluminiscence Immuno Assay (CLIA). Comparison of mean Hcy and folate values among the groups was done using ANOVA with Post-Hoc Games Howell test. Gender was compared using Chi-square test. Comparison of mean age was using ANOVA with Post-Hoc Tukey’s test. Results: The mean serum folate level in OSCC patients was 5.34ng/mL, 7.68ng/mL in smoking group and 10.99ng/mL in control group. There was a significant difference in the mean serum folate levels among the three study groups (p<0.001). The mean serum Hcy in OSCC patients was 23.58µmol/L, 17.46µmol/L, in smoking group and 10.76µmol/l in controls. There was a significant difference in the mean serum Hcy levels among the three study groups (p<0.001). Conclusion: The present study found an interesting association with serum Hcy and folate levels in OSCC which could be useful as a biochemical “Tumor Marker” and thereby providing insights into the onset and progression of the disease.

Efficacy of Ketamine as an Adjunct to Local Anesthesia in the Surgical Removal of Impacted Mandibular Third Molars – A Split Mouth Prospective Controlled Clinical Study

Anand Shah, Rajshekhar Halli, Yash Merchant, Rajesh Kshirsagar, Jyotsana Khurana

Introduction: The removal of impacted teeth is one of the most common procedures performed by oral and maxillofacial surgeons. Reduction of discomfort post-operatively and efficient local anesthesia are imperative for success in surgical practice. At sub-anesthetic doses, ketamine has a noticeable analgesic action, which can be used to supplement local anesthesia with minimal side effects. Aim: To assess the efficacy of low-dose ketamine as an adjunct to local anesthesia in the management of pain, swelling and trismus after surgical removal of impacted mandibular third molars. Materials and Methods: Twenty five patients with bilaterally symmetrical impacted mandibular third molars requiring surgical removal under local anesthesia were selected for the controlled clinical study. The third molar sites of all patients enrolled in the trial were randomly assigned into 2 groups: Local Anesthesia (Lignocaine) Alone [LAA] and Local Anesthesia plus ketamine [LAK]. 5ml of local anesthetic (Lignocaine Hydrochloride 2% with epinephrine 1:100,000) was injected in the ‘LAA’ group while the ‘LAK’ group received 5ml of local anesthetic plus 0.2mg/kg ketamine. Patients were blinded to the solution used and the operator recorded the group (LAA or LAK) and the respective site (Right or Left) for analysis. Bilaterally symmetrical impacted mandibular molars were removed at an interval of 15 days. Results: Facial swelling on post-operative days was significantly lower in the LAK group than in the LAA group (p<0.05). The pain scores on the VAS were significantly higher in the LAA group than in the LAK group (p<0.05). Conclusion: The role of ketamine in low doses as an analgesic and anti-inflammatory is evident in our study. The combination of a local anesthetic and sub-anesthetic doses of ketamine injected for surgical removal of impacted third molars provides good local anesthesia while alleviating post-operative sequelae for the patient by providing a degree of post-operative analgesia with less swelling.

Efficacy and Safety of Intralesional Xantinol Nicotinate in the Treatment of Various Stages of Oral Submucous Fibrosis

Udita Singh

Introduction: Oral Submucous Fibrosis (OSMF) is one of the most prevalent potentially malignant disorders seen in South east population since ages. Despite the extensive amount of research held in this field, its treatment still remains a challenge. In this study, we present our experience in successfully managing OSMF with intralesional injections of a peripheral vasodilator namely xantinol nicotinate. Aim: To determine the efficacy and safety of intralesional xantinol nicotinate in the treatment of various stages of OSMF. Materials and Methods: This parallel, prospective, clinical study included 60 patients clinically diagnosed with oral submucous fibrosis divided into two groups. Group I patients were subjected to intralesional xantinol nicotinate injections bi-weekly for a period of four months while Group II patients were given intralesional saline injections biweekly for four months. All the patients were instructed to perform home mouth opening physiotherapy exercises. At each visit, parameters like increase in interincisal distance, cheek flexibility, tongue protrusion and relief from burning sensation and any side effects were measured and recorded. The drop out figure was zero. Results: At the end of four months, in Group I, there was an increase in mean values of interincisal distance, cheek flexibility and tongue protrusion (p<0.001). For burning sensation a significant decrease in mean value was observed (p<0.001). Whereas, in Group 2 the difference between pre-treatment and post-treatment values was not statistically significant (p>0.001). On comparing the results of Group 1 and Group 2, statistically significant difference was observed (p<0.001). Conclusion: Xantinol nicotinate, a peripheral vasodilator, when injected intralesionally in OSMF patients not only provides relief from burning sensation but also results in increased mouth opening, tongue protrusion and cheek flexibility.

Unmasking the Effect of Analgesics on Endodontic Diagnosis Using a Novel Bite Force Sensor Device: A Prospective, Randomized Clinical Trial

Introduction: A definitive diagnosis is of primary importance before initiating any endodontic treatment; yet, there are occasions when the dental professional is unable to accurately reproduce the patients chief complaint, as it can pose a dilemma and may require consideration of multiple variables in order to reach an accurate diagnosis. So to overcome this problem, a methodical approach in providing endodontic treatment should be implemented which includes diagnosis, definitive dental treatment and adjunctive drug therapy, known as the “3D” strategy. Aim: The purpose of this study was to evaluate the possible "masking" effect of these analgesics on endodontic diagnosis using a novel bite force sensor device. Materials and Methods: A total of 90 patients with endodontic pain were selected and they were given either a placebo or 400 mg ibuprofen (brufen) or 50mg diclofenac sodium (voveron). Both patients and operators were completely blinded to the drugs administered. Bite force tolerance values were noted before and one hour after administration of medication using the self designed bite force sensor. Results: The pre- and post-bite force tolerance values were tabulated for both contralateral and affected tooth. For the affected tooth, there was statistically significant difference between pre- and post-bite force tolerance values in Group I (i.e., ibuprofen) and Group II (i.e., diclofenac sodium) (p<0.05) with no significant difference observed in Group III (placebo). Conclusion: The easily available over the counter self administered analgesics in addition to providing symptomatic relief to patients suffering from symptomatic apical periodontitis may also cloud the definitive diagnosis of the clinician, thus jeopardising the treatment plan. The self designed bite force sensor was effective in arriving at a definitive diagnosis in teeth with chronic irreversible pulpitis with symptomatic apical periodontitis, where the allodynia has been camouflaged by the use of analgesics like ibuprofen and diclofenac sodium.

Effect of Salivary pH on Color Stability of Different Flowable Composites – A Prospective In–vitro Study

Renu Batra,Pratik Kataria,Sonali Kapoor

Introduction: Scientifically and clinically there has been lot of development in the field of aesthetic dentistry. However, there is limited or restricted information regarding the color stability of flowable composite materials. Aim: The aim of this study was to evaluate the spectrophotometric color stability of three different flowable composite materials with respect to three different pH of saliva. Materials and Methods: The study included 90 different samples. Thirty samples in each composite group; (Group A: G-aenial universal flo; Group B: Z 350 XT flowable; Group C: Esthet x flow). All samples from each group were immersed in distilled water for 24 hours. Total color difference (?E) was recorded for each sample. After this 10 samples from each group were respectively immersed in 6.5, 7 and 7.5 pH of artificial saliva. All samples were kept in dark room for seven days and then ?E for each sample was recorded and was compared to previous recorded ?E for the same sample. Results: Maximum color change was seen irrespective of material in 6.5 pH of saliva. G-aenial universal flo showed least change irrespective of pH of saliva. Conclusion: Thus, the present study reveals that acidic pH level affects the coloration of composite resins by affecting the surface integrity and as reported in previous studies, various coloring agents in beverages and other dietary components assists the process due to absorption of these coloring substances into the resin matrix.

Prevalence of Dental Caries Among Primary School Children of India – A Cross-Sectional Study

Introduction: In India, the trend indicates an increase in oral health problems especially dental caries, which has been consistently increasing both in prevalence and in severity. Children of all age groups are affected by dental caries. It becomes imperative to collect the data on prevalence of dental caries and treatment needs to provide preventive care. Aim: To assess the prevalence of dental caries and treatment needs of 6-11years old Indian school children. Materials and Methods: This was a cross-sectional study. Sampling frame consisted of 6-11years old primary school children. Study sample consisted of 13,200 children selected from 10 talukas of Belgavi District, Karnataka, India. Clinical examination for dmft and DMFT was carried out in the school premises by five teams, each consisting of one faculty, three postgraduate students and five interns from the KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India. The examiners were trained and calibrated by the principal investigator. Statistical analysis was done using Chi-square and t-test. Results: The overall caries prevalence was 78.9%, mean dmft was 2.97±2.62 and mean DMFT was 0.17±0.53. The decayed teeth component was the principal component in both dmft and DMFT indices. The mean dmft in boys was higher compared to girls and it was found to be statistically significant (p<0.05). Conclusion: This study provided us with the baseline data, using which treatment was provided to all the children screened. The children were provided treatment at the camp site/dental hospital/satellite centers and primary health care centers according to the facilities available.

Can Feulgen Stain be a Reliable Biomarker over PAP Stain for Estimation of Micronuclei Score?

Introduction: Malignant transformation of the Potentially Malignant Lesions (PML) in the oral cavity is associated with elevated mortality rate because of its aggressive and exceedingly invasive nature. Meticulous diagnosis and prompt therapy of PML may help prevent malignant conversion in oral lesions. Carcinogenic insult to oral cells results in chromosomal damage and formation of Micronuclei (Mn), before the development of clinical symptoms. Aim: To determine the genotoxic effect of smoking and chewing tobacco on target tissue using Mn assay and to evaluate the prevalence of other nuclear anomalies associated with it and to determine the reliability of feulgen stain for Mn assay over Papaincolau (PAP) stain. Materials and Methods: PAP and feulgen staining was done to study Mn in individuals who were having tobacco habits (smoking and chewing) without lesion (n=30), individuals who were having tobacco habit (smoking and chewing) with PML (n=30) and apparently healthy subjects (n=30). Data was analysed for statistical significance using SPSS 17.0 by Kruskal - Wallis Test and Bonferronii test. Results: Tobacco habits in the form of smoking and chewing have mutagenic effects on human chromosomes which is indicated by increased frequency of Mn in oral exfoliative cells. The mean Mn frequency using feulgen stain was found to be 12.27 with lesion, 10.23 with without lesion and 3.87 in controls. Whereas, metanucleated analysis revealed no significant correlation with the formation of Mn. Non-specific DNA stain (PAP) showed high numbers of Mn cells in all the groups compared to feulgen. Statistically significant difference (p<0.0001) was observed when both the stains were compared for Mn numbers. Conclusion: These findings indicate that the individuals having tobacco habits (smoking and chewing) with lesion have high number of Mn cells, thus supporting the assay to be used as a reliable biomarker to assess the genotoxic effect of tobacco in the oral mucosa. The reason for almost twice as high Mn in PAP stained smears is suggestive of cell injury which is collimated by formation of keratin bodies, resulting in its misinterpretation as Mn, leading to false positive results. Hence, it was concluded that PAP stain can be used to identify abnormal cytological changes resulting from mutagenic agent but not to interpret Mn.

Oral Health Status and Treatment Needs of Paniya Tribes in Kerala

Iris Valsan, Joe Joseph, Chandrashekar Janakiram, Shamaz Mohamed

Introduction: The tribal communities of Kerala have been largely left out of the gains of the Kerala model of development. Aim: The study was aimed to obtain baseline data of oral health status and treatment needs of Paniyas, in Kerala, India. Materials and Methods: A descriptive population based survey of adult Paniya belonging to index age groups of 35-44 years and 65-74 years was conducted. The study population comprised of 420 subjects drawn from three talukas by stratified cluster sampling. Modified version of WHO Oral Health Assessment Form (1997) was used to assess the oral health status. Results: Caries prevalence was 40%. The mean DMFT in the 35-44 years age group was 1.52±1.95 and in 65-74 age group it was 18.47 ± 13.10. Oral mucosal lesions were seen in 4.52% and 76.9% had periodontal disease. Tooth brushing was reported by 55.5% of the subjects. Paan chewing, with tobacco or without tobacco, habit was reported by 89.3%. Bi-variate analyses between the CPI scores and age groups showed high statistical significance. The maximum mean treatment requirement was for extraction (1.37 ± 4.01) and was observed in 65-74 age groups. Conclusion: The lack of basic oral health care access is important for high oral disease burden in these populations. Efforts are to be done for basic oral health care facility to these marginal populations.

Age and Environment Determined Children’s Preference Towards Dentist Attire - A Cross - Sectional Study

Introduction: The attire of the dentist has an influence on child’s behaviour in dental setup. Recent research has shown that the children have preferences towards the outfit worn by the dentist. Aim: The aim of the study was to determine the preference of children towards dentists’ attire based on various age groups and environment. Materials and Methods: A total of 534 children aged between 6-11 years participated in the study. Children were divided into three groups based on their age as younger, middle and older age groups. Photographs of the dentist in different attires such as white coat, surgical scrubs and regular outfit were shown to children and the questionnaire was evaluated by a single, qualified Paediatric dentist in two different environmental set ups, namely school and dental environment. The anxiety level was evaluated by using Modified Child Dental Anxiety Scale [MCDAS (f)]. Data was collected and tabulated. Statistical analysis was done using SPSS version 20.0. Results: A statistically significant difference was evident in the preference level of children towards dentist attire (p-value= 0.002). There was a positive correlation in the preference level of children towards dentist attire in different age groups. A statistically significant difference was evident in the preference level of children towards the dentist attire in school and dental environment (p-value <0.001). Conclusion: Younger age group children preferred regular outfit and middle and older age group preferred white coat and surgical scrubs respectively. Children preferred white coat in school environment and surgical scrubs in dental environment.

Oral Health Knowledge, Attitudes and Practice Behaviour among Secondary School Children in Chandigarh

Introduction: Oral health knowledge is considered to be an essential prerequisite for health-related practices and better oral health. Healthy practices adopted at young age are more sustainable. Aim: Present cross-sectional exploratory study was planned to assess oral health knowledge and practices of secondary school students in Chandigarh, India. Materials and Methods: A cross-sectional survey was under-taken amongst 1027 secondary level school students, in Chandigarh, India. After obtaining informed consent subjects were administered pretested self administered questionnaire addressing demographics, knowledge, attitude and practice behaviour of participants. Frequency analysis was done using descriptive statistics. Results: Survey revealed that only 40% subjects brushed twice daily. About 17% reported use of dental floss and 20% used either mouthwash or tongue cleaner as adjuncts. A total of 58% had knowledge that infrequent brushing led to dental caries, staining of teeth, dental plaque and bleeding from gums. Most of them knew sweets (92.7%) and soft drinks (67.8%) affected dental health. Only 12.9% visited dentist regularly after every 6-12 months. Conclusion: Efficacy of dental health education can be increased only if health programs are tailored to directly impinge on attitudes of targeted population, especially school children in whom healthy practices can be inculcated easily and be sustained for long times.

Prediction of Post-operative Mortality in Patients with HCV-related Cirrhosis Undergoing Non-Hepatic Surgeries

Introduction: Patients with chronic liver diseases are at great risk for both morbidity and mortality during the post-operative period due to the stress of surgery and the effects of general anaesthesia. Aim: The main aim of this study was to evaluate the value of Model for End-stage Liver Disease (MELD) score, as compared to Child-Turcotte-Pugh (CTP) score, for prediction of 30- day post-operative mortality in Egyptian patients with liver cirrhosis undergoing non-hepatic surgery under general anaesthesia. Materials and Methods: A total of 60 patients with Hepatitis C Virus (HCV) - related liver cirrhosis were included in this study. Sensitivity and specificity of MELD and CTP scores were evaluated for the prediction of post-operative mortality. A total of 20 patients who had no clinical, biochemical or radiological evidence of liver disease were included to serve as a control group. Results: The highest sensitivity and specificity for detection of post-operative mortality was detected at a MELD score of 13.5. CTP score had a sensitivity of 75%, a specificity of 96.4%, and an overall accuracy of 95% for prediction of post-operative mortality. On the other side and at a cut-off value of 13.5, MELD score had a sensitivity of 100%, a specificity of 64.0%, and an overall accuracy of 66.6% for prediction of post-operative mortality in patients with HCV- related liver cirrhosis. Conclusion: MELD score proved to be more sensitive but less specific than CTP score for prediction of post-operative mortality. CTP and MELD scores may be complementary rather than competitive in predicting post-operative mortality in patients with HCV- related liver cirrhosis

Study of Barrier to Help Seeking and its Relationships with Disability in Patients with Headache

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

Introduction: Headache is among the first three most prevalent disorders with a wide treatment gap due to barriers in help seeking. Headache has been associated with disability. However, the relationship of barriers to help-seeking and disability are unexplored. Aim: To find out the barriers to help seeking and its relationship with headache related disability in patients with headache. Materials and Methods: In this hospital based cross-sectional study, 200 consecutive subjects with headache attending a tertiary care centre were recruited as per selection criteria and assessed with Sociodemographic & Clinical Proforma, Mini International Neuropsychiatric Interview (MINI), Barriers to Help Seeking Scale (BHSS), The Henry Ford Hospital Headache Disability Inventory (HDI). Results: High mean score was observed on BHSS subscale need for control and self reliance (19.45; SD ±9.66) and minimizing problem and resignation (10.02; SD ±6.98). Mean score on the HDI was 25.65 (SD ± 14.09). Socioeconomic status of the patient was statistically significant and positively associated with need for control and self reliance (p=0.035), concrete barriers and distrust of care givers (p=0.039), emotional control (p=0.005), and privacy (p=0.002). Occupational status had significant association with need for control and self-reliance (p=0.01), minimizing problem and resignation (p=0.033), and emotional control (p=0.006). Score on hospital headache disability inventory significantly predicted the value of score on concrete barriers and distrust of caregivers domain of HDI (p=0.001). Conclusion: Autonomy and under estimation of seriousness of headache are common barriers to help seeking. Pattern of help seeking barriers may vary with socio-economic status and occupational status, while disability varies with gender and severity of headache. Headache associated disability is positively associated with concrete barriers.

Life Orientation Test- Revised (LOT-R) Versus Academic Score in Various First Year Health Professional Students

Puja Dulloo, Neeraj Vedi, Achleshwar Gandotra

Introduction: Health field per se requires mental, physical and psychological steadiness and wellbeing. In modern times decline in psychological and physical health has been observed in student after admission in health education program. Factors like perfectionism, self-esteem, personal and professional consequence have affected their academic score directly or indirectly. Life Orientation Test-Revised (LOT-R) instrument measures optimism in relation to self-esteem of individual. A better score will show more confidence level of the student. Aim: To find an association of LOT-R with the academic score of health professional students and assess gender variation. Materials and Methods: A total of 350 students enrolled for academic year 2015-16 in health professional program of medicine, dental and physiotherapy institutes of Sumandeep Vidyapeeth University were considered. Non-randomized and purposive study was done by providing LOT-R questionnaire to students. Average academic score of Anatomy and Physiology course was used for analysis excluding the biochemistry due to non-availability of tangible data at the time of study. Data was collected, analysed statistically using independent t-test, ANOVA with post-hoc and correlation analysis. Result: Statistical significant for one-way ANOVA was assessed for academic score between the group of health professional students. While no statistical correlation of significance was observed for LOT-R score with that of academic score. As per gender distribution there was no statistical significant observation for LOT-R score within the groups. Conclusion: The present study highlighted the need of student’s counseling for their approach towards health education; as their career. Psychological self-reliance and optimism improves the academic score. A study needs to be compared with the socio-economic status of the student to have a better understanding of the LOT-R.

Development and Testing of a Reliable and Valid Patient-Needs Questionnaire for Breast Cancer Inpatients in China

Ling Li, Jing Xue, Zhan-Zhan Li, Li-Zhang Chen

Introduction: Breast cancer patients are demanding more active roles in their care, especially in the initial diagnosis and treatment stages. At present, there is no suitable patient questionnaire that appropriately incorporates Chinese language, habits, and cultural differences. Aim: To develop and validate a patient-needs questionnaire for female breast cancer inpatients in China. Materials and Methods: The questionnaire structure was based on Maslow's model and a modern medical model. In the first step, a focus group was used to design 125 questions, of which 64 constituted the initial questionnaire for item screening with a group of 115 hospitalized patients with breast cancer. Items were included or excluded based on the evaluation of eight statistical analysis. Ultimately, 38 items were selected and validated. The reliability and validity of the 38-item questionnaire were determined in a cohort of 323 patients. Results: The scale was set up with the 38 selected items. The four primary areas were disease knowledge, medical environment, psychosocial parameters and sexual attitudes. Cronbach’s coefficient was 0.959. The split-half reliability value was 0.935. Principal component factor analysis extracted four common factors. Conclusion: Our new questionnaire, designed to assess the care needs of Chinese inpatients with breast cancer is reliable, sensitive, effective, independent and representative. It can be used in medical practice as a tool for a more complete assessment of patients’ needs.

Perceived HIV Related Stigma among Patients Attending ART Center of a Tertiary Care Center in Rural West Bengal, India

Saikat Datta, Sharmistha Bhattacherjee, Pasang Lahmu Sherpa, Smarajit Banik

Introduction: Despite the advent of modern technologies, India is still grappling with the HIV/AIDS pandemic. Stigma is one of the key aspects which can interfere with HIV test-seeking behaviour, care-seeking behaviour upon diagnosis, quality of care given to HIV-positive patients and perception and treatment of People Living with HIV/AIDS (PLHA) by communities, families, and partners. Aim: To determine the perceived stigma associated with HIV/AIDS and its correlates among PLHAs attending the Anti Retroviral Therapy (ART) centre of North Bengal Medical College, Darjeeling, West Bengal, India. Materials and Methods: An observational cross-sectional study was conducted over a period of four months among 454 patients aged =18years attending ART centre of North Bengal Medical College. Perceived stigma among the study subjects were assessed using a face and content validated version of Berger’s HIV stigma scale. Linear regression analysis was used for statistical analysis of the predictors of perceived stigma. Data were analysed using SPSS version 16 software. Results: The majority of the study population had moderate to low stigma. Regression analysis showed that being on treatment with ART had the highest contribution towards stigma followed by gender and HIV serostatus of the patients. Conclusion: The patients attending ART centre of North Bengal Medical College had moderate to low level of stigma. In absence of any efficacious stigma reduction programs in this region, more work needs to be done to assist PLHA in coping with stigma.

Awareness of Eco-Friendly Dentistry among Dental Faculty and Students of King Khalid University, Saudi Arabia

Introduction: Eco-friendly or green dentistry can be a reality by effectively designing dental clinics and using more eco-friendly materials in the clinical practice. Aim: To determine the awareness of eco-friendly dentistry among dental faculty and students in preparation for future implementation. Materials and Methods: Assessment of knowledge regarding eco-friendly dentistry was done using an 18 item self-administered questionnaire among 160 participants. After baseline data collection, the intervention was done by educating participants with a power point presentation. The post-intervention data was then collected for analysis. Statistical analysis was done using Wilcoxon’s signed rank test and one-way ANOVA. Results: The educational intervention increased the knowledge about eco-friendly dentistry confirming the importance of continuing education. There was a statistically significant gain in knowledge among the participants after the presentation. The gain was highest for department of Preventive Dental Sciences (PDS) followed by Substitute Dental Sciences (SDS), No specialty, Maxillofacial Dental Sciences (MDS), and Restorative Dental Sciences (RDS) respectively. (F=5.5091, p<0.05). Conclusion: Lack of knowledge of green dentistry amongst the dental fraternity is highly prevailing. The same can be substantiated with effective training in the respective fields if channelized through the curriculum in an educational set-up.

Practice Perspectives of Left-Handed Clinical Dental Students in India

SHIVAM KAPOOR, MANJUNATH P PURANIK, SR UMA

Introduction: Handedness becomes important for students during their training period. Limited literature is available regarding the same. Aim: The purpose of this study was to assess the dental practice perspectives and determine the hand preference and discomfort level among the Left-Handed (LH) clinical dental students. Aim: The purpose of this study was to assess the dental practice per Materials and Methods: A 30-item survey tool was used to conduct a cross-sectional survey among four successive LH cohorts (third and final year undergraduates, dental interns and postgraduates) in all the dental colleges of Bengaluru, Karnataka, India, during the year 2014. Results: A total of 84 students completed the survey, response rate being 100%. About one-third (37%) reported that their institution was not properly equipped to accommodate LH students. Majority felt that LH dentists were at a higher risk of developing musculoskeletal complications. Mouth mirror handling showed equal distribution for handedness as compared to the other dental activities, whereas discomfort levels were negligible (“without any difficulty”). Dental practice perspective scores significantly correlated with the difficulty levels (r=-0.333, p<0.001). Conclusion: Overall, the left-handers had a right dental practice perspective and their responses indicate a need to address their issues empathetically.

An In-vitro Evaluation of Retention, Colonization and Penetration of Commonly Used Denture Lining Materials By Candida albicans

Sushma Krishnamurthy, Rajendra B. Hallikerimath

Introduction: Colonization of the surface by Candida albicans and related Candida species is one of the major concerns of denture lining materials. Aim: We evaluated retention, colonization and penetration of the four denture lining materials namely Molloplast B, Permaflex, GC Soft Liner and Ufi Gel Hard C by Candida albicans. Material and Methods: a) Evaluation of retention: Five test discs of each material with smooth surface on one side and rough on the other were prepared and surface roughness (Ra) was measured with profilometer. Retention of C. albicans to discs was monitored after one hour of incubation (37°C) with standardized (2.8 x 106 cfu/ml) washed cell suspension. Discs were stained with acridine orange and attached cells were counted using inverted microscope; b) Evaluation of colonization and penetration: Eight test discs of each material in sterile artificial saliva, were inoculated with C. albicans and incubated for six weeks. Two sections were cut across each test disc to provide three replicate samples. Candida cells on cut disc sections were fixed, dehydrated, air dried and viewed via fluorescence microscope; c) Evaluation of antifungal action: Two test discs of each material were placed onto diagnostic sensitivity testing the agar plate. After incubation at 37°C for 24 hours, the zone of inhibition formed around the samples were measured at four places, and the mean calculated. Results: a) All rough surfaces showed higher retention of C. albicans than smooth surfaces. Among the smooth surfaces, Molloplast B and GC Soft Liner showed highest and lowest retention of C. albicans respectively (p=0.0090). Among the rough surfaces, the variation in the retention of C. albicans was not statistically significant; b) Penetration of C. albicans was observed through all three sections of the test discs of each material. There was no statistically significant difference among the test materials; c) Molloplast B and Permaflex produced a mean zone of inhibition of 16.9±4.8mm and 14.80±3.8mm respectively. Conclusion: a) Smoother surfaces retain fewer cells than rough surfaces; b) Denture lining materials permit infiltration of Candida through their structure; c) Denture lining materials have insignificant anti-fungal properties.

A Study of Evaluation and Management of Rare Congenital Breast Diseases

Introduction: Polymastia and polythelia may be asymptomatic or cause pain, restriction of arm movement, milk discharge, cosmetic problems or anxiety. Cosmesis is the main indication for surgical excision of accessory breasts in axilla. In addition it also confirms the diagnosis and allays the patient’s fear of harbouring a malignancy. Aim: To evaluate the presentation of symptoms, investigations required for diagnosis and the management to improve the treatment protocols in patients with breast diseases. Materials and Methods: This retrospective study on breast diseases presenting as supernumerary breasts and nipples was conducted in the Department of Surgery between January 2013 and January 2016 at MMIMS Research and hospital, Mullana, Ambala. Patients were evaluated for breast diseases, either benign or malignant in both genders. A total of 32 cases diagnosed as accessory breasts disease were retrieved from the hospital archive. The clinical and radiological evaluation was done in the form of ultrasound and mammography wherever necessary. Accessory breast tissues were excised under general anesthesia and histopathological examinations were done. Results: Out of 32 cases: 1(3.125%) male patient had unilateral and 1(3.125%) male had bilateral accessory nipple, 7 (21.87%) females had unilateral and 1(3.125%) had bilateral accessory nipple, 1 (3.125%) diagnosed as accessory axillary fibroadenoma in female, 16(50%) presented as unilateral and 5 (15.62%) had bilateral swelling in the axilla as accessory breast. Patients underwent surgical excision and in 8(25%) cases z- shaped incision was made in view of better cosmesis. Patients were followed up upto 6 months postoperatively. There were no residual swelling and movements of the arm over the shoulder joint were normal. In 3(9.37%) cases, wound dehiscence occurred; in 2 (6.25%) cases lymphoedema formation was seen. These were successfully managed conservatively. Conclusion: As breast swellings either fibroadenoma or carcinoma are common entities to come across everywhere but accessory breasts are rarely encountered especially in rural areas because of less awareness. The study found that there was tendency to neglect the swelling as there were minimal symptoms present. We also came across a rare entity, accessory breast and accessory nipples. A clinician should not ignore such cases taking as simple swelling because of chances of discovering a malignancy can occur.

An In-vitro Comparison of Nano Hydroxyapatite, Novamin and Proargin Desensitizing Toothpastes - A SEM Study

Rithesh Kulal, Ipsita Jayanti, Savita Sambashivaiah, Shivaprasad Bilchodmath

Introduction: Dentinal Hypersensitivity (DH) is commonly encountered clinical condition in dental practice which affects 8-57% of the adult population presenting for dental treatment, but the treatment of the same remains doubtful. Aim: The purpose of this study was to evaluate and compare the effects of three different desensitizing agents (15% nano hydroxyapatite crystals; 5% novamin and 8% proargin) on dentinal permeability and tubule occlusion in-vitro. Scanning Electron Microscope (SEM) was used to evaluate the effect of these commercially available desensitizing toothpastes. Materials and Methods: A total of 40 disc shaped dentin specimens were dissected from extracted premolars. Dentin discs of 1mm were obtained with the help of diamond discs. Ten specimens were randomly selected and allocated to the evaluation groups A (control group), B (Nano-hydroxyapatite), C (Novamin) and D (Proargin). Each treatment group dentine disc specimen was treated with the respective slurry for two minutes for a period of seven days. Each disc was subjected to a pre- and post-treatment SEM analysis to evaluate the changes occurring in the dentinal tubules. Results: The qualitative analysis showed no occlusion of the dentinal tubules in Group A (control group) and Group B (nano-hydroxyapatite) showed 98.1% tubule occlusion. Group C (Novamin) and D (Proargin) showed 83.1% and 69.1% tubule occlusion respectively. Quantitative analysis showed a statistical significant difference between Group B and D (p< 0.005) and no statistical significant difference between group B and C (p= 0.235). Similarly, there was no significant difference between Group C and D as (p=0.235). Conclusion: It was concluded that all the three desensiting agents were effective in the dentine tubule occlusion. In addition efficacy of nano-hydroxyapatite toothpaste was greater compared to the other desensiting agents.

Comparison of Antibacterial Efficacy of Turmeric Extract, Morinda Citrifolia and 3% Sodium Hypochlorite on Enterococcus faecalis: An In-vitro Study

Introduction: Sodium hypochlorite (NaOCl), the most commonly used irrigant, has many potential properties like its unique ability to dissolve pulp tissue, excellent antimicrobial activity, but has a cytotoxic effect when injected into periapical tissues. It is also known to produce allergic reactions, foul smell and taste, and potential for corrosion. Facultative organisms such as Enterococcus faecalis and aerobes like Staphylococcus aureus are considered to be the most resistant species and one of the possible causes of root canal treatment failure. So there is a need to find an alternative to sodium hypochlorite to act against these resistant microorganisms. Aim: To evaluate and compare the antibacterial efficacy of morinda citrifolia and turmeric extract with 3% NaOCl as a root canal irrigant, against E. faecalis and S.aureus. Materials and Methods: The antimicrobial efficacy was assessed in vitro using agar well diffusion method. Agar plates were prepared using Brain-Heart Infusion (BHI) agar. Cultures of E.faecalis and S.aureus were grown in nutrient broth at 37°C. Plates were incubated for 24 hours at 37°C and microbial zones of inhibition were recorded. Statistical analysis was performed using ANOVA. Results: NaOCl (3%) showed larger zones of inhibition than herbal irrigants against both the microorganisms. Among the herbal irrigants, morinda citrifolia showed larger zones of inhibition than turmeric hydro-alcoholic extract and turmeric water extract which was statistically significant (p<0.05). Conclusion: NaOCl (3%) showed maximum antibacterial activity against E. faecalis, followed by morinda citrifolia and turmeric extracts. Considering the potential for undesirable properties of NaOCl, use of herbal alternatives in endodontics might prove to be advantageous.

Assessment and Correlation of Urea and Creatinine Levels in Saliva and Serum of Patients with Chronic Kidney Disease, Diabetes and Hypertension– A Research Study

Divya Pandya, Anil Kumar Nagrajappa, K.S Ravi

Introduction: Serum urea and creatinine are most widely accepted parameters to assess Chronic Kidney Disease (CKD)status as well as to assess renal status in susceptible diabetic and hypertensive subjects. Aim: To assess and correlate the serum and salivary urea and creatinine levels of CKD, diabetes mellitus and hypertensive subjects. Materials and Methods: This cross-sectional study was done on 120 subjects involving 30 CKD, 30 diabetic, 30 hypertensive subjects and 30 healthy controls. After collection of saliva and blood samples, urea was analyzed by enzymatic calorimetric method and creatinine by Jaffe’s method. Kruskal Wallis test and Mann Whitney U test were used for comparison between different groups and correlations between serum and salivary parameters were evaluated by applying Spearman’s correlation test. The p-value <0.05 was considered statistically significant. Results: The median serum and salivary urea and creatinine levels were highest in CKD group followed by diabetic, hypertensive groups and controls. The correlation coefficient for serum urea and salivary urea was 0.977 and for serum creatinine and salivary creatinine was 0.976, with p-value <0.001. Conclusion: This study showed that there is a significant positive relationship between salivary and serum urea and creatinine. Thus, salivary urea and creatinine levels can be used non-invasively to detect serum urea and creatinine levels respectively in renal disease and diabetic and hypertensive nephropathic cases.

Comparison of Therapeutic Efficacy of Placental Extract with Dexamethasone and Hyaluronic Acid with Dexamethasone for Oral Submucous Fibrosis - A Retrospective Analysis

Introduction: Oral Submucous Fibrosis (OSMF) is a potentially malignant disease of the oral cavity associated with betel nut chewing. The management of OSMF has been a subject of controversy and no definitive and widely accepted treatment is currently available for this condition. Aim: To retrospectively evaluate the therapeutic efficacy of two treatment regimens (placental extract with dexamethasone and hyaluronic acid with dexamethasone) for the treatment of OSMF. Materials and Methods: The records of the patients diagnosed with OSMF were obtained from the departmental archives. A total of 25 records were selected and divided into two study groups based on the treatment regimens, as Group A (placental extract + dexamethasone) and Group B (hyaluronidase + dexamethasone). The records were studied for improvement in mouth opening and reduction in burning sensation. Descriptive statistics, paired t test and student’s t test were used for statistical analysis. Results: In Group A and Group B, the average increase in mouth opening from baseline record to 8th week of treatment was 3.53±1.26mm and 3.65±1.42mm respectively and average decrease in burning sensation, noted by VAS scale, was 5.13±1.13 and 4.90 ±1.29 respectively. The pre- and post-treatment differences were found to be statistically significant for both the groups (p<0.001) and for both the treatment outcomes. When the average difference of the treatment outcomes was compared between the two study groups, no statistically significant difference was noted (p>0.05). Conclusion: The results of the present study indicate that both the treatment regimens studied are equally effective in the treatment of oral submucous fibrosis.

Evaluation of Efficacy of Three Different Materials Used in Cheiloscopy –A Comparative Study

Introduction: The imprint produced by the lip is termed as ‘lip print’ and the name given to the examination of lip print is referred to as cheiloscopy. Aim: The present study was done to compare the efficacy of three different materials used in cheiloscopy – Sudan III, Indigo and Aluminium powder. Material and Methods: A total of 60 individuals belonging to the age group of 18-25 years were included in this study. Visible and latent lip prints were reproduced on white cotton fabric, white satin fabric and white clay cup. The results were statistically analysed using chi square test. Results: Sudan III dye and Aluminium powder showed significant results when used for the development of visible lip prints (p<0.05), but didn’t give any significant results for development of latent lip prints. Indigo dye gave significant results for development of both visible and latent lip prints (p<0.05). Conclusion: The study reveals the usefulness of visible and latent lip print in individual identification.

Psychological Analysis of Oral Cancer Patients during Pre-operative Period in South Indian Population: A Prospective, Quantitative, Multicentre Study

Introduction: Oral cancer is prevalent worldwide with high incidence of mortality and morbidity. It is associated with poor prognosis and low survival rate. Moreover, patients affected are more likely to develop psychological issues and thus, addressing psychological needs of such patients is crucial. Aim: The aim of our study was to assess the quality of life of oral cancer patients in the pre-operative period, thereby providing them with the necessary psychological support. Materials and Methods: A total of 206 patients, scheduled to undergo treatment for oral cancer were selected from various cancer centres in South India. After informed consent, 171 patients were finally analysed for their quality of life using Functional Assessment of Cancer Therapy-General (FACT-G) version 4; and Functional Assessment of Cancer Therapy Head and Neck (FACT-H&N), as a Quality of Life (QOL) survey. Result: Most of the patients had poor quality of life and were found to be emotionally distressed pre-operatively as they did not have proper emotional support from society. Conclusion: From the study it was observed that catering to the psychological needs of oral cancer patients is important and psychological counselling should be a part of a comprehensive treatment plan for such patients.

A Randomized Prospective Study of Concurrent Chemo-Radiotherapy vs Accelerated Hyperfractionation in Advanced Cancer of Head and Neck

Himanshu Mishra, Ritush a Mishra, Uday Prataap Shahi, Abhijit Mandal

Introduction: Locally advanced unresectable squamous cell carcinoma of head and neck has poor locoregional control when treated with conventionally fractionated Radiation Therapy (RT) alone. However, Concurrent Chemo-Radiotherapy (CRT) and altered fractionated RT schedules like Accelerated Hyperfractionation (AHF) are two different treatment strategies that have shown to be associated with better efficacy as compared to conventional RT alone in such cases. Aim: Aim of the study was to compare these two treatment strategies i.e., CRT and AHF radiation treatment to know which is better in terms of clinical outcome and toxicity in patients of locally advanced unresectable squamous cell carcinoma of head and neck. Materials and Methods: A prospective randomized trial was done to compare the effect of CRT and of AHF radiation treatment in locally advanced unresectable head and neck cancer on 15 patients in each arm and followed up over three months period. Results: At the end of three months after completion of treatment protocol, complete response was 62% in CRT arm and 53% in AHF arm. In CRT arm and AHF arm, Grade 3 skin reactions were observed in 100% and 87%, grade 3 mucosal reactions were in 62% and 67% of cases, respectively. Three patients died in CRT arm (two due to myelosuppression and associated infection; one during the treatment and another after two weeks of treatment completion. The third patient expired after one month of treatment completion at his native place due to unknown reason). One patient died in AHF arm (during treatment due to cardiac event). Conclusion: Efficacy of AHF was comparable to CRT with lesser toxicity. So the present study suggests that AHF should be preferred over CRT in locally advanced, unresectable, squamous cell head and neck cancer followed over three months non-treatment period.

Evaluation of the Central Corneal Thickness with Anterior Segment Optical Coherence Tomogram after Penetrating Keratoplasty

Anuradha Raj, Renu Dhasmana, Harsh Bahadur, Ramesh Chander Nagpal

Introduction: Graft central thickness evaluates the graft quality which affects the outcome of Penetrating Keratoplasty (PK). It varies at different point of time after PK. Anterior Segment Optical Coherence Tomography (ASOCT) can measure graft's central thickness with quite high precision. Aim: The purpose of the study was to monitor the Central Corneal thickness (CCT) with ASOCT after PK and to evaluate its relationship with the pre-operative diagnosis. Materials and Methods: This is an observational retrospective study where records of optical PK done in December 2012 and June 2015 were reviewed. Graft central thickness were analysed by ASOCT for all the patients post-operatively at first post-operative day, 3 and 6 months post PK by pachymetry scan and the images captured were analysed for CCT with inbuilt calipers. Results: Fifty one eyes of 50 patients with age range of 17-80years (mean 51.64years ±SD 18.45 years) with clear grafts were reviewed in the present study. All subjects recruited were analysed for the indications of PK. Adherent leucoma 20(39.21%) was most common indication for PK. Mean CCT were 647.31±90.40, 605.31±75.08,564.66±66.26 and 537.37±64.09 respectively on first post-operative day, 1, 3 and 6 months. Graft CCT significantly decreased between first post-operative day and 1 month and it showed further decrease at 3 to 6 months post PK. The CCT at 6 month post-surgery showed a strongly positive correlation with the Intraocular Pressure (IOP) (r=0.66) and weakly positive correlation with Best Corrected Visual Acuity (BCVA) (r=0.28). Conclusion: Graft central thickness is considered to be quantitative method for evaluating corneal oedema post PK. CCT decreases in post-operative period irrespective of indications of PK.

Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India

Nikhil Gupta, Subhash Giri, Vinita Rathi, Gajender Singh Ranga

Introduction: Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification. Aim: To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls. Materials and Methods: Eighty male patients of MI aged =45 years, who presented to the Cardiac Care Unit and Department of Medicine of Guru Teg Bahadur Hospital, Delhi, India, from November 2010 to April 2012 were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. Six weeks after MI, FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy controls. Results: The FMD was lower among young patients of MI than controls (p<0.001). CIMT was higher among cases than controls (p=0.001). ABI was lower among cases than controls (p<0.001). Compared to controls, PP was higher among cases (p=0.001). In all subjects, a negative correlation between FMD and CIMT (r=–0.220, p=0.005) and a positive correlation between FMD and ABPI (r=0.304, p<0.001) was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups (r=–0.209, p=0.007). Conclusion: Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite six weeks of treatment among young male patients of MI, various biophysical parameters were still deranged

Estimation of Skin to Subarachnoid Space Depth: An Observational Study

Rajib Hazarika, Dipika Choudhury, Sangeeta Nath, Samit Parua

Introduction: In a patient, the skin to Subarachnoid Space Depth (SSD) varies considerably at different levels of the spinal cord. It also varies from patient to patient at the same vertebral level as per age, sex and Body Mass Index (BMI). Estimation of the skin to SSD reduces complications related to spinal anaesthesia. Aim: To measure the skin to SSD in the Indian population and to find a formula for predicting this depth. Materials and Methods: Three hundred adult patients belonging to American Society of Anaesthesiologist class I and II, undergoing surgery using spinal anaesthesia in various surgical specialities of Gauhati Medical College were selected by systemic sampling for this prospective, observational study. Patients were divided into three groups: Group M containing male patients, Group F containing non-pregnant female patients, and Group PF containing pregnant female’s patients. SSD was measured after performing lumbar puncture. The relationship between SSD and patient characteristics were studied, correlated and statistical analysis was used to find a formula for predicting the skin to SSD. Statistical analysis was done using Statistical Package for Social Sciences (SPSS 21.0, Chicago, IL, USA). One-way ANOVA with post-hoc(Bonferroni correction factor) analysis was applied to compare the three groups. Multivariate analysis was done for the covariates followed by a multivariate regression analysis to evaluate the covariates influencing SSD for each group separately. Results: Mean SSD was 4.37±0.31cm in the overall population. SSD in adult males was 4.49±0.19cm which was significantly longer than that observed in female’s 4.18±0.39cm which was comparable with SSD in parturient 4.43±0.19 cm. The formula for predicting the skin to SSD in the male population was 1.718+0.077×BMI+0.632×Height, in nonpregnant female population was 1.828+0.077×BMI+0.018×Height+0.007×Age and 0.748+0.209×BMI+4.703×Height-0.054×weight in parturient females, respectively. Conclusion: Skin to SSD correlated with the BMI in all the patients in our study.

Smokeless Tobacco and Stroke - A Clinico-epidemiological Follow-up Study in A Tertiary Care Hospital

Introduction: Among the modifiable risk factors for stroke, tobacco smoking is well recognized. In some studies the use of Smokeless Tobacco (ST) has also been contributed as a risk factor for ischemic stroke. Use of ST is very common in South-East Asia. The form of ST varies according to the geographical and cultural variation. Aim: To study the various clinical symptoms and radiological findings of stroke due to different types of ST. Materials and Methods: This was a prospective hospital based study carried out over a period of 2 years. All the cases within age group of 16 – 60 years and with a clinical and radiological diagnosis of acute stroke were included in the study. The Fagerström Test for Nicotine Dependence for ST of more than 6 was taken as the inclusion criteria. Patients having other addictions like smoked tobacco, alcohol, etc., and with important risk factors like hypertension, diabetes, dyslipidemia were excluded. The cases were extensively investigated and followed up for at least 6 months. Analysis was done using the Statistical Package for Social Sciences (SPSS- version 16.0). Descriptive statistics like percentage, mean were used wherever appropriate. Results: During a period of 2 years, a total of 54 patients were studied. Forty two (77.7%) were males and 12(22.3%) were females. The mean age at presentation was 42.72(± 8.6) years and among all 96.3% patients were diagnosed as ischemic stroke. Among ST, pan was most commonly used in 21(38.9%) patients with an average of 14.6(±3.27) years of addiction. Hemiplegia was the predominant symptom on presentation (46, 85.2%). According to Oxfordshire Stroke Classification, partial anterior circulation infarct was most common in 20(38.4%). The mean Modified Rankin scale after 5 days of hospital stay was 3.83(±1.03) and after 6 months of follow-up was 2.1(±0.8). Patients were counseled for deaddiction and after 6 months follow-up 48(88.8%) patients had quit ST. Conclusion: ST is an important etiological factor for young ischemic stroke. This is the first study depicting clinical symptomatology of ST addicted ischemic stroke patients from India. Considering the increasing prevalence of ST use in south-east Asia, further long term studies are needed from this region.

Urban Rural Comparison of Anthropometry and Menarcheal Status of Adolescent School Going Girls of Jodhpur, Rajasthan, India

Introduction: Adolescence is the formative period of life. Poor adolescent health translates into poor maternal health leading to increased maternal morbidity with inter-generational consequences. Aim: To compare anthropometric, socio-demographic, menstrual and nutritional status of rural and urban adolescent school going girls of Western Rajasthan, India. Materials and Methods: A cross-sectional comparative study was conducted in two rural schools and one urban school of Jodhpur region. Anthropometric, socio-economic (family history, menstrual history, maternal education) and dietary habit data of 327 (137 urban and 190 rural) school going adolescent girls aged 11–16 years were collected using structured questionnaires by a school based survey after consent from parents and school officials. Height and weight were taken using the standard procedure. Stunting (height for age) and thinness [Body Mass index (BMI) for age] were calculated as per the National Center for Health and Statistics (NCHS) standards. Statistical analysis was done using student t-test, fisher-exact test and Chi-square test. Results: Mean height was significantly higher in urban girls while mean BMI of adolescents was significantly higher in rural areas as compared to their urban counterparts. Growth spurt was between 12-13 years showing maximum increase in mean height, coinciding with or immediately post-menarche. Menarche was one year earlier in urban girls as compared to rural girls (p<0.001). Thinness was more prevalent among females in urban areas and stunting was more common amongst girls residing in rural areas. Conclusion: Life style habits (poor dietary habits, sedentary life style) of the urban girls may contribute to an early menarche but rural girls despite having a later onset of menarche; have a lower final height which may be attributed to their poor nutritional status. Improving nutrition of rural girls and modifying the life style of urban girls and educating their mothers will reduce the disparity and lead to better health and development of adolescent girls in this region and this could be expected to improve maternal health in future.

Platelet Rich Plasma: Efficacy in Treating Trophic Ulcers in Leprosy

V. Anandan, W. Afthab Jameela, P. Saraswathy, S. Sarankumar

Introduction: Trophic ulcers secondary to leprosy pose a great stigma to the patients and remain a challenge to the treating dermatologists. The discovery of Platelet Rich Plasma (PRP) with its favourable role in wound healing is a boon for the patients. PRP introduces the growth factors directly into the wound and aids in rapid healing. Aim: To study the efficacy and safety of PRP in the healing of trophic ulcers secondary to Hansen’s disease in a tertiary care centre in Southern India. Materials and Methods: Based on inclusion and exclusion criteria, 50 patients were enrolled in the study. PRP was prepared by manual double spin method. After wound bed preparation, activated PRP was sprayed over the ulcer and occlusive dressings were applied. Same procedure was repeated every week until complete re-epithelisation or up to six sittings whichever occurred earlier. Results: In our study, 46 patients (92%) showed complete healing. In 4 patients (8%), there was marked reduction in wound size with partial re-epithelization. In 88%, complete healing was seen after the fourth sitting. Mean time for ulcer healing was around 4.38 weeks. Conclusion: PRP therapy leads to faster rate of induction of granulation tissue with rapid healing. Healing had no direct statistical correlation with the size, site and duration of ulcer, the leprosy spectrum and associated motor deformities. It is a simple, safe and cost effective in-office procedure, albeit requiring an optimal set-up and expertise.

Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures

Introduction: Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. Aim: To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. Materials and Methods: This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. Results: Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal-union (one case) during the course of our study, but were completely treated by the end of the study. Conclusion: Positive results can be obtained by distal femur locking plate alone as it is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation and taking benefit of the mechanical properties of a locking plate.

Emerging Trends of Intentional Firearm Injuries in Northern India: A Study

Iram Khan, Mohammad Shakeel, Jawed Ahmad Usmani, Syed Abrar Hasan

Introduction: Many developing countries are facing rise in firearm injury cases owing to communal and ethnic clashes, political violence, armed robberies and suicide causing huge economic loss to society. On the basis of intention, injuries can be categorized as intentional and unintentional or accidental injuries. Intentional injuries will include suicidal, homicidal and assault related injuries. Aim: This study was undertaken to document the trends and patterns associated with intentional firearm injuries in order to suggest ways to curb the emerging trends. Materials and Methods: This was a cross-sectional and descriptive study conducted at Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, UP, India from May 2007 to April 2008. The parameters studied were month wise distribution of cases, age and sex distribution of victims of intentional gunshot injuries, body part injured, alleged assailant and medical management provided to the victim. The observed data was entered onto a worksheet and descriptive statistics were used. Results: A total of 140 cases of intentional firearm injuries were studied, 133 were assault cases and 7 were suicide by means of firearm. Maximum number of intentional gunshot injury cases were reported during the month of September (17.14%) and October (14.29%) and least during month of December (2.14%).For intentional injuries, 21-40 years was the high risk age group (91 or 65% cases) with male preponderance (95.71%) and male to female ratio of 22:1. Preferred site for assault was the trunk, with 50.38% cases with chest abdomen and back injuries. Family feud (20.71%) was the leading cause of assault and assailant was not known (47.86%) to the victim in majority of cases of assault injuries. Conclusion: Increasing cases of firearms as a means of assault and suicide, calls for limiting the number of handgun purchase, regulations to check illegal trade of firearms, accountability of ammunition used and to develop standardised hospital based data collection system so that trend and patterns associated with intentional firearm injuries can be determined.

Effect of Oral Iron on Markers of Oxidative Stress and Antioxidant Status in Children with Iron Deficiency Anaemia

Zeeba Zaka-ur-Rab, Mohammad Adnan, Syed Moiz Ahmad, Najmul Islam

Introduction: Conflicting reports are available on the relationship of Iron Deficiency Anaemia (IDA) and iron therapy with oxidative stress. Aim: To study the levels of markers of oxidative stress and anti-oxidant status in children with IDA and to assess the effect of iron therapy on the same. Materials and Methods: This prospective, single centre, hospital based study was a sub-study of a randomized controlled trial conducted in the Department of Paediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh in collaboration with the Department of Biochemistry (of the same institution) between October 2009 to February 2011. The sub-study was conducted in two parts: in the first part, levels of a biomarker of oxidative stress {Malondialdehyde (MDA)} and anti-oxidant enzymes {Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx)} were assessed and compared between 67 children with IDA and 31 non-anaemic controls; in the second part, the effect of oral iron (6mg/kg/day) for eight weeks on these markers was studied in a subset of 35 children with IDA. The Bivariate correlations procedure was used to compute pair wise associations for a set of variables. T-tests (Independent samples t-test/Paired sample t-test) and Non-parametric tests (Mann–Whitney test/Wilcoxon signed-rank test) were applied as applicable for normally and non-normally distributed data, respectively. Results: Levels of anti-oxidant enzymes were significantly lower (p<0.001) in children with IDA as compared to controls, viz., SOD {median, 8.63 (IQR, 8.60-8.66) vs. 9.46 (IQR, 9.14-9.62) units/mg protein}, CAT {median, 8.49 (IQR, 8.46-8.50) vs. 9.10 (IQR, 9.04-9.14) µmol H2O2/min/mg protein} and GPx {median, 49.19 (IQR, 48.99-49.60) vs. 56.94(IQR, 56.80-57.14) mol NADPH oxidized /min/ mg protein}. Whereas, levels of MDA were significantly higher (p<0.001) in IDA group {median, 1.50 (IQR, 1.48-1.52) vs. 1.24 (IQR, 1.20-1.27) moles/ml of serum}. Levels of Haemoglobin (Hb) and markers of iron status (serum iron, transferrin saturation and ferritin) had a very strong, highly significant positive correlation (p<0.001) with levels of anti-oxidant enzymes (SOD, CAT, and GPx) but a very strong, highly significant negative correlation (p<0.001) with MDA. Total Iron Binding Capacity (TIBC) on the other hand, had a strong, highly significant (p<0.001) negative correlation with SOD, CAT, and GPx but a strong, highly significant positive correlation (p<0.001) with MDA. After eight weeks of daily iron therapy, a highly significant rise (p<0.001) from baseline was observed in levels of SOD, CAT, and GPx in subjects with IDA. On the other hand, MDA levels declined significantly (p<0.001). Conclusion: Lipid peroxidation is increased and anti-oxidant defenses lowered in IDA. These changes, however, may be mitigated effectively with oral iron therapy.

Serum FRAP Levels and Pre-eclampsia among Pregnant Women in a Rural Community of Northern India

Introduction: There is a balance between the oxidative and the anti-oxidative forces in human body. Some studies document decreased level of anti-oxidant in pre-eclampsia while other studies showed normal level of anti-oxidant in pre-eclampsia and the evidence is equivocal. Aim: The aim of the present study was to assess enzymatic anti-oxidant activities in pre-eclamptic women and compare it with normotensive pregnant women with period of gestation between 28 to 36 weeks. Materials and Methods: A community-based cross-sectional survey was conducted (from November 2012-December 2013) at the Ballabgarh Health and Demographic Surveillance System (HDSS) site which was managed by Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India. All registered pregnant women with period of gestation between 28 weeks – 36 weeks were eligible for inclusion in the study. All eligible pregnant women were contacted through home visit. A total of 217 pregnant women were enrolled out of which 209 blood samples were collected from pregnant women. About three ml of blood from antecubital vein was drawn without use of tourniquet, under aseptic conditions. It was later analysed for the serum anti-oxidative measures {Malanoaldehyde, Vitamin C, Ferric Reducing Ability of Plasma (FRAP) levels}. Data were entered on Epi-Info version 3.5.4. Data management and analysis was carried out in Stata 11. The means were compared using t-test and p-value stated. Categorical data was analysed using chi-square test. Logistic regression was used and adjusted p-value was stated. Results: A total of 217 pregnant women were eligible for the study and all were enrolled. Out of the 217 blood samples collected, eight samples accidently got destroyed. A total of 28 out of remaining 209 pregnant women (13.4%) had pre-eclampsia. Mean age (SD) was 22.4 (2.3) years, mean height (SD) was 156.6 (6.9) cm, mean weight (SD) was 65.1 (9.7) kg in pre-eclampsia group. In pre-eclampsia group mean serum levels of malanoaldehyde, vitamin C and FRAP was 4.2 (0.26) ng/dl, 0.83 (0.11) mg/dl, 678.0 (35.6) µmol/L. It was 4.5 (0.09) ng/dl,0.88 (0.03) mg/dl, 599.3 (13.3) µmol/L in normotensive pregnant women group respectively. The difference was statistically significant for FRAP levels only. Conclusion: Serum anti-oxidant levels are not raised among women with pre-eclampsia.

Paediatric Urinary Tract Infection: A Hospital Based Experience

Introduction: Paediatric Urinary Tract Infection (UTI) is one of the commonly encountered entities by paediatricians. Studies have shown easy vulnerability of paediatric urinary tract in any acute febrile illness and a miss in diagnosis could have long term consequences like renal scaring with its adverse effects. Bearing these evidence based preludes in view we designed our study to know the prevalence of UTI in Kashmir province. Aim: Aim of the present study was to know the prevalence of UTI in febrile children and to know the sensitivity of different imaging modalities like Renal and Urinary Bladder Ultrasonography (RUS), Voiding Cystourethrography (VCUG) and Dimercaptosuccinic Acid (DMSA) scan in diagnosing UTI. Materials and Methods: A total of 304 patients, between 2 months to 10 years, with axillary temperature of = 100.4oF (38oC), who did not have a definite source for their fever and who were not on antibiotics were included in the study. Detailed history and through clinical examination was done to rule out any potential or definite focus of infection as per the predesigned proforma. Routine urine examination with culture and sensitivity, followed by RUS and VCUG was done in all patients where routine urine examination was suggestive of UTI. DMSA was done in only culture proven cases after 6 months to document the renal scarring. Results: Out of 304 children, 140 were males and 164 were females, UTI was present in 40 patients who had fever without any apparent cause giving a prevalence of 13.2%. Escherichia coli (E. coli) were the commonest isolated organism, followed by Klebsiella and Citrobacter species. Renal and Urinary Bladder Ultrasonography (RUS) detected Vesicoureteral Reflux (VUR) in 25% (10/40) while VCUG showed VUR in 55% (22/40) giving a RUS sensitivity of 45% for detecting VUR. DMSA done only after 6 months in UTI diagnosed patients showed a renal scarring in 25% (10/40) patients. Conclusion: Missing a febrile paediatric UTI, can prove a future catastrophe if not timely diagnosed and treated.

Visual Function and Ocular Status in Children with Disabilities in Special Schools of Northern India

Gurvinder Kaur, Satish Thomas, Mahesh Jindal, SM Bhatti

Introduction: Children with disabilities (other than visual impairment) are at a higher risk of visual impairment as compared to normal population. Majority of the ocular disorders, like refractive errors and strabismus, are easily treatable. As these children depend on their visual inputs for social and academic activities, an early detection and prompt treatment of even a minor visual problem is of utmost importance for them. Aim: To assess the visual function and ocular status of children with disabilities other than visual impairment and to identify the preventable and treatable causes of visual impairment. Materials and Methods: The study was conducted on children aged 3-16 years who were studying in special schools/ rehabilitation centers in Ludhiana. After prior permission, detailed ocular examination of all the children was done using standard examination techniques. Cycloplegic retinoscopy and refraction was also done and spectacles were prescribed. Children requiring further evaluation were referred to base hospital. Results: A total of 404 children with disabilities (other than visual disabilities) studying in 7 rehabilitation centers/ special schools were enrolled. These included children with Cerebral palsy (12.1%), with Hearing impairment (35.3%), with Attention Deficit Hyperactive Disorder (ADHD) (3.7%), with Autism (8.6%), with Down syndrome (12.8%) and with Mental retardation (27.2%). Ocular disorders were seen in 174(43%) children. The most common ocular disorders seen in these children were refractive errors (23%) and strabismus (18.1%). A total of 93(23%) children were prescribed spectacles and 37(9.2%) children were referred for further evaluation. Conclusion: Ocular problems are common in children with other disabilities. Delay in the detection and treatment of these disorders compounds the already existing disability in these children. Lack of awareness and sensitization among the parents and teachers is a matter of great concern. Therefore, strategies regarding increasing awareness, mandatory ocular examination in these children and early detection and treatment of the ocular disorders is the need of the hour.

Effect of Enhanced External Counter Pulsation Treatment on Aortic Blood Pressure, Arterial Stiffness and Ejection Fraction in Patients with Coronary Artery Disease

Introduction: Enhanced External Counter Pulsation (EECP) is a non-invasive treatment option for patients with Coronary Artery Disease (CAD). The treatment has shown to augment diastolic pressure and reduce Left Ventricular (LV) after-load by reducing systemic vascular resistance. The effect of EECP in standard brachial blood pressure and central haemodynamic parameters are not known. Aim: We hypothesized that EECP may have differential effect in CAD patients with low systolic blood pressure when compared to normal systolic pressure and the mechanism underlying this differential effect may be due to improvement in LV function. Materials and Methods: A total of 72 consecutive patients who underwent EECP treatment for symptomatic CAD with LV dysfunction were divided into two groups based on cut-off value of 100mmHg for systolic blood pressure. First group had patients with brachial systolic blood pressure of >100mmHg and second group had patients with brachial systolic blood pressure of =100mmHg. We measured central aortic systolic pressure, pulse pressure, augmentation index and augmentation pressure by SphygmoCor device and Ejection Fraction (EF) was measured by echo-cardiography. All these measurements were carried out prior to and after completion of 35 days of EECP sessions. Results: Central systolic pressure, brachial systolic pressure, aortic pulse pressure, augmentation pressure and augmentation index significantly decreased in patients with normal brachial systolic pressure with baseline moderate LV dysfunction. Brachial systolic, aortic systolic and aortic pulse pressure significantly increased with no change in augmentation index and pressure is observed in patients with baseline severe LV dysfunction associated with low systolic pressure post EECP treatment. Conclusion: EECP treatment has haemodynamically favourable differential effect in normal and low brachial systolic pressure and this is mainly driven by improvement in LV function in patients with symptomatic CAD with LV dysfunction.

MRI in Dentistry– A Future Towards Radiation Free Imaging – Systematic Review

Introduction: Magnetic Resonance Imaging (MRI), being a technique with huge potential, has become the primary diagnostic investigation for many clinical problems. Its application now has been successfully used in dentistry to maximize the diagnostic certainty. Aim: The present review aims to analyze the applicability, feasibility and efficacy of MRI in the field of dentistry. Materials and Methods: A literature search was performed in main databases like Pub Med Central, Cochrane Library, Embase and Google Scholar from 1970 up to December 2015. The 2672 titles that appeared, 25 fulfilled the criteria and were included in the review. Two articles were hand searched and three articles through e-mail were also included. Results: The review highlights the increasing role of MRI in dentistry. In the available literature, it was found that T1 and T2 weighted images were the acceptable diagnostic images for detection of dental related diseases. Conclusion: MRI can be used in diagnosis and treatment planning of implants, jaw lesions, diseases of Temporomandibular Joints (TMJ), orthodontic treatment, endodontic treatment etc., to achieve better prognosis.

Techniques to Evaluate Dental Erosion: A Systematic Review of Literature

Mahasweta Joshi, Nikhil Joshi, Rahul Kathariya, Prabhakar Angadi, Sonal Raikar

This article reviews different techniques for evaluating dental erosion, weighs the advantages and disadvantages of these techniques, and presents the latest trends in the study of dental erosion. In May 2014, an initial search was carried out in the PubMed/MEDLINE database of indexed journals from 1975 to 2013 using the following keywords: dental erosion; dental erosion In-vitro; and dental erosion in-vivo. Bibliographic citations from the papers found were then used to find other useful sources. The authors categorize the techniques into three classes: in-vitro, in-vivo and in-vitro/in-vivo. The article discusses the instrumentation required to use each of these techniques, as well as their rationale, merits and applications. The emergence of in-vitro/in-vivo techniques offers the potential to accurately quantify tooth wear in clinical situations. Cross-sectional as well as longitudinal studies show that these techniques will improve diagnosis, treatment planning and management of dental erosion.

Is Optimal Management of Recurrent Aphthous Stomatitis Possible? A Reality Check

Shesha prasad ranganath, anuradha pai

Recurrent Aphthous Stomatitis (RAS) is a condition in which aphthous ulcers repeatedly occur in the oral cavity. It is prevalent in developed countries, occurring in all ages, geographic regions and races and about 80% of people have one episode of oral aphthous ulcers before the age of 30 years. With no laboratory procedures to confirm the diagnosis, treatment is mainly empirical in nature and focuses on short-term symptomatic management. Although numerous treatment modalities have been recommended, only a few are evidence based and can be considered for the optimal management of RAS. Biologic agents are a new category of drugs which acts by blocking specific pathways associated with the pathophysiology of neoplastic or immune-mediated diseases. These agents have targeted immunosuppressive or anti-inflammatory actions. In patients of RAS who were not responding to standard therapy, etanercept, adalimumab, infliximab and Interferon-Alpha (INF-a) were found to be useful. The objective of this review was to propose and review a treatment protocol to be followed for the optimal management of RAS. We reviewed several evidence-based studies and through this review we recommend topical interventions as the first-line of therapy since they are associated with low risk of systemic side effects. Due to limitations in the number of evidence-based trials and the insufficient data to support or refute the efficacy of the therapies prescribed, larger evidence-based clinical studies and literature reviews are needed to further improvise the optimal methodology for the effective management of RAS.

Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease

Bhargav Dave

Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD). Bioresorbable Scaffolds (BRS) represent a novel approach in coronary stent technology. Complete resorption of the scaffold liberates the treated vessel from its cage and restores pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. In this review article, we describe the advances in this rapidly evolving technology, present the evidence from the pre-clinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.

Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review

Janmejaya Samal

Introduction: The Revised National Tuberculosis Control Programme’s (RNTCP) passive case finding approach strongly influence the health seeking behaviour of patients and the timing of health seeking as well. Aim: A systematic review was carried out to understand the health seeking behaviour, related delays and the knowledge and attitude regarding Tuberculosis (TB) and the health services linked with it. Materials and Methods: A manual search strategy was adopted using PUBMED and Google Scholar search engines to obtain research papers in the said subject. Of 113 articles obtained by the end of this search process 10 full text articles were finally selected for the purpose of this review. Results: Of the 10 studies identified, the results were delineated in 7 thematic areas such as: (1) Knowledge and perception of TB patients regarding TB and health services for TB; (2) Delays in seeking help; (3) Facility based health seeking behaviour; (4) Reasons for not seeking care/Delay in seeking care; (5) Geographical pattern (Rural-Urban) of health seeking; (6) Socio-cultural factors associated with health seeking; and (7) Gender based health seeking behaviour. Conclusion: Health seeking behaviour and related delays are of utmost importance in TB care from two important perspectives; firstly TB requires timely treatment and secondly it requires protracted treatment. Required level of knowledge and positive health behaviour helps the patients in taking timely help from appropriate health facility.

When Pulmonary Function Test is Available, Should we Wait for the COPD Symptoms to Develop?

Varshil Mehta, Nimit Desai, Smit Patel

Adolescent smokers are more likely to be addicted to nicotine and develop a chronic habit. Chronic smoking has a direct impact on quality of life and life expectancy. Repeated environmental exposure and smoke inhalation can be deleterious to health. In order to evaluate the core functioning of the lungs, Pulmonary Function Tests (PFTs) are conducted. This panel of tests should be advised for all patients complaining of shortness of breath. Since clinical features resulting from chronic smoking tend to appear late in the course of the disease, PFTs are immensely useful for early identification of abnormalities in asymptomatic adult smokers. Numerous studies have shown that normal PFT parameters begin to deteriorate immediately after smoking is initiated. However, most physicians prefer to wait for characteristic signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD) to develop before proceeding with PFTs in the patients. This leads to inadvertent and often dangerous delay in reaching a definitive diagnosis and initiating treatment. Therefore, we undertook this review to determine whether conducting PFTs in asymptomatic adult smokers can facilitate the early detection and/or prevention of COPD. We reviewed and analyzed articles from PubMed, Google Scholar, Index Medicus, WHO Global Health Library and Scopus, which specifically demonstrated the presence of abnormal PFT changes in asymptomatic adult smokers. With PFTs, we now have the advantage of diagnosing early changes in the lung volumes. Hence, we conclude that PFTs should be performed early in smokers and cessation of smoking should be encouraged to check the increasing incidence of COPD.

Herbal Fixed Dose Combinations in Nepal: Growing Concerns in a Developing Country

Arjun Poudel, Kadir Alam, Subish Palaian, Mohamed Izham Mohamed Ibrahim

Herbal medicines are mostly prepared as a combination therapy that has been used since therapeutic was first practiced. Combination products, also known as Fixed Dose Combinations (FDCs) of herbal remedies are in widespread use in Nepal. Herbal FDCs are in common practice because it is believed to have better adherence, less side effects and easy accessibility. Nevertheless, combination products possess greater risk of adverse effects, increases costs associated with treatments and leads to an ineffective dosages. Herbal FDCs are used extensively in Nepal although the rationality beyond the use of these combinations is still unidentified and at times are questionable. Legislations governing the use of herbal medicines is lacking in Nepal. Many herbal FDCs are not supported by any scientific data and test for the presence of ingredients mentioned in the package insert/container label is always difficult. A FDC of herbal products must be based on clear criteria that guarantee consumer safety and appropriate indications. These criteria helps to protect the consumers or patients from the misleading claims and risk associated with the use of unjustifiable combination of herbal substances. Strict monitoring from the regulatory body and the public awareness on the cost as well as advantages and disadvantages of herbal FDCs is urgently required.

Suboptimal Performance in Cleft Lip/Palate Children- Who is Responsible?

Bhavana B. Lakhkar

Information in this article is from an observational study comparing intelligence in children with cleft lip and palate with normal children. Both groups performed “draw a man test”, the investigator noted the attitude and behaviour of children and their parents. The study shows low, but normal intelligence quotient in children with oral defects as compared to normal. The probable reason for sub-normal performance appeared to be overprotective attitude of parents and poor self esteem of children with oral defects.

Unusual Presentation of Acute Leukaemia: A Tripod of Cases

Manjari Kishore, Vijay Kumar, Sadhna Marwah, Abhay S Nigam

Acute Leukaemia is one of the common haematological malignancies encountered with varied clinical and haematological presentation. In acute leukaemia, complications like bleeding and infection cause significant morbidity and mortality, thus overshadowing the thromboembolic events. Among the various malignant haematological disorders, the association of thromboembolic events is often noted with acute promyelocytic Leukaemia, though the overall frequency of such events remains very low. Acute Lymphoblastic Leukaemia (ALL) is, however, more common than Acute non-lymphoblastic Leukaemia. Usually patients present with symptoms because of cytopenias, organomegaly, lymphadenopathy and bone pain, including other skeletal abnormalities. Granular Acute lymphoblastic Leukaemia (G-ALL) may be misdiagnosed as Acute Myeloid Leukaemia (AML) because of the presence of cytoplasmic granules in the lymphoblasts. This variant of ALL is usually noted in children, but may be seen in adults too. It is also important to note that asymptomatic skeletal involvement can be seen in 40-60% of patients with ALL, but pathological fractures and osteolytic lesions along with hypercalcemia at the time of presentation are very rare. Herein, we present a series of three cases of acute Leukaemia presenting with unusual clinical and other rare haematological findings

Giant Cervical Osteophyte: An Unusual Cause of Dysphagia

Dysphagia due to skeletal causes is a rare entity. A large cervical osteophyte can cause mechanical compression of the pharyngo-oesophageal segment leading to dysphagia. Large cervical osteophytes can occur in cervical spondylosis, ankylosing spondylitis or Diffuse Idiopathic Skeletal Hyperostosis (DISH). A 60-year-old female came with progressive dysphagia due to a giant cervical osteophyte anterior to C4 and C5 vertebral bodies causing compression of the pharyngo-oesophageal segment. The patient was treated by surgical excision of the osteophyte by orthopaedic surgeons. The patient had complete relief of dysphagia following excision of the osteophyte.

A Case of Immune Thrombocytopenic Purpura Secondary to Pulmonary Tuberculosis

The haematological abnormalities associated with active pulmonary tuberculosis were known to human beings since decades but Immune Thrombocytopenic Purpura (ITP) secondary to pulmonary tuberculosis have been reported only in a couple of instances. We report a 27 year-old male patient who was admitted to our hospital with fever, shortness of breath, haematuria, epistaxis and generalized petechiae. The sputum positivity for Acid Fast Bacilli (AFB) and chest X-ray reports were suggestive of active pulmonary tuberculosis in our patient. Clinical and laboratory parameters including bone marrow aspiration cytology diagnosed the case to be ITP. Patient was put on Directly Observed Treatment and Short course (DOTS) category-1 Anti-Tuberculosis Therapy (ATT) and prednisone following which thrombocytopenia was corrected and there was complete recovery of the patient without recurrence of thrombocytopenia.

Is dilution important: Factitious Total Creatine Kinase in case of Rhabdomyolysis?

Sunil Kumar Nanda, Asha Dinakaran , Lopamudra Ray

Factitious test reports may result in incorrect diagnosis and incorrect management. Such incorrect diagnosis can be prevented by a vigilant biochemist. We report a case of Rhabdomyolysis presenting with extremely low total Creatine Kinase (CK) levels which was factitious. Running the sample in dilution resulted in a very high value of total CK which could have been missed if the sample was not run in dilution and the diagnosis of Rhabdomyolysis could have been missed.

Is Transoesophageal Echocardiography Necessary for the Percutaneous Management of Lutembacher Syndrome: A Case Report

Lutembacher syndrome is defined as a combination of congenital Atrial Septal Defect (ASD) with an acquired Mitral Stenosis (MS). There are various challenges involved in the percutaneous management of Lutembacher syndrome. Here, we present a case that had a very small Left Atrium (LA) and Left Ventricle (LV) cavities with an anteriorly placed ASD. We used Transoesophageal echocardiography (TEE) to take a separate interatrial septal puncture and complete the Balloon Mitral Valvotomy (BMV) procedure. Finally both the defects in interatrial septum were closed with the help of a large device.

Panvascular Disease in Familial Hypercholesterolaemia Treated with Endovascular Simultaneous Bilateral Carotid Stenting

Anand Alurkar, Lakshmi Sudha Prasanna Karanam, Shripapal Shah, Pandurang Mare

Familial Hypercholesterolaemia (FH) is a monogenic autosomal dominant disorder affecting 1 in 500 individuals. We report a case of 32-year-old female with FH, previously not on any treatment, who presented with recurrent bilateral Middle Cerebral Artery (MCA) territory strokes and dyspnoea on exertion due to severe panvascualar disease involving descending aorta, innominate, subclavian, common carotid, internal carotid and coronary vessels. Her complete clinical work up was done and was started on lipid lowering drug treatment and low calorie diet. She underwent simultaneous bilateral carotid stenting followed by coronary artery bypass surgery at a later date. In the present scenario we want to emphasize the importance of early detection and treatment of individuals with FH, failing of which results in premature and accelerated atherosclerosis causing multisystemic vascular disease with significant morbidity and mortality. Screening of first degree relatives is important owing to the autosomal dominant inheritance pattern of the FH.

Composite Hemangioendothelioma: Report of a Rare Case

Amoolya Bhat, Vijaya Chowdappa

Composite Hemangioendothelioma (CHE) is a new entity classified under the Heman gioendothelioma (HE) group of tumours. It is an extremely rare vascular neoplasm of low to moderate malignancy. Very few cases have been described in the literature. We herein report a case of CHE arising in a 31-year-old male who presented with a history of painless slow growing swelling on upper back since 1year. Clinically, the surface of firm and mobile swelling of 1.5x1.5cm showed focal ulcerations. The histopathological findings were consistent with the diagnosis of composite hemangioendothelioma. The patient underwent wide local excision and at the end of five months of follow up there were no features of local recurrence or metastasis. To the best of our knowledge, this is the first reported case of CHE from India.

A Commonly Missed Well Known Entity- Acute Intermittent Porphyria: A Case Report

Acute Intermittent Porphyria (AIP) usually presents with abdominal pain, peripheral neuropathy and psychiatric manifestations. Incidence of AIP being 5 in 1,00,000. We present a case of an 11-year-old male child with multiple cranial nerve involvement, quadriparesis, focal convulsions, hypertension, hyponatremia with history of recurrent abdominal pain. His complete haemogram, ultrasonography (USG) abdomen, renal function tests were normal, he was also evaluated for tuberculosis which was negative. On further evaluation Electroencephalography (EEG) was suggestive of a generalised seizure disorder, MRI Brain suggestive of Posterior Reversible Encephalopathy Syndrome (PRES), Electromyography revealed a sensory motor axonal polyneuropathy and urine UV fluoresence test was positive for porphobilinogen which clinched the diagnosis of AIP.

Abnormal Course of Right Coronary Artery Together with Variant Left Coronary Artery and Partial Atresia of Cicumflex Artery

Rajani Singh

Heart is supplied by right and left coronary arteries. Therefore, the knowledge of normal and variant anatomy of both these arteries and their configurations is indispensable for proper understanding of diagnosis and treatment of dreaded cardiac diseases. During routine cadaveric dissection, a heart of an adult female with anomalous course of Right Coronary Artery (RCA), new variant of trifurcated Left Coronary Artery (LCA) and partial atresia of circumflex (CX) artery was detected. Trifurcation of LCA into anterior interventricular, CX and a ramus intermedius without giving accessory branches has been reported. But in the present case, a variant trifurcation was found having rare configuration i.e., the interventricular branch gave two additional branches, a new variant along with ramus intermedius also giving an additional branch another new variant followed by partially hypoplastic circumflex artery. Besides this, RCA has an aberrant course modifying normal supply of heart. This rare configuration of coronary arteries will facilitate the cardiac surgeons to improve the understanding of defects of coronary arteries and planning of angiography, coronary by bypass grafting and other surgical interventions, radiologists for refining interpretation of imagery and anatomists for new variants.

Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases

Chi-Yuan Liao, Fuh-Jinn Luo

Amniotic Fluid Embolism (AFE) is a catastrophic complication of pregnancy with high mortality rate. The most common clinical presentation is an abrupt onset of cardiopulmonary collapse. Here, we present an uncommon variant involving isolated disseminated intravascular coagulation that developed without antecedent cardiopulmonary disturbances. Both patients developed symptoms soon after delivery. Blood test was sent at 14 minutes postpartum for the second patient due to suspected amniotic fluid embolism. Fetal components were observed in the uterine veins of the lower uterine segments in both cases. Amniotic fluid embolism with disseminated intravascular coagulopathy typically progresses faster than disseminated intravascular coagulopathy associated with other causes and symptoms. It usually develops within two hours of delivery. Prompt recognition and treatment of this entity is crucial to survival.

Bellini Duct Carcinoma: A Rare Entity

Bellini duct carcinoma of kidney derives from collecting duct and is associated with an aggressive course and extremely poor prognosis.Here, we report an interesting case of Collecting Duct Carcinoma (CDC) with Inferior Vena Cava (IVC) thrombus and large retroperitoneal lymph nodes and diffuse desmoplastic reaction. The patient underwent left open radical nephrectomy with IVC thrombectomy and regional lymphadenectomy. Based on morphological and immunohistochemical analysis, diagnosis of collecting duct (Bellini duct) carcinoma was made. Presently, patient is on adjuvant chemotherapy with gemcitabine and cisplatin and under follow-up.

Endoscopic Excision of Symptomatic Simple Bone Cyst at Skull Base

Seizure is a classical feature of intra axial brain parenchymal lesion. Simple bone cyst is an unusual bony pathology at skull base presenting with unexpected symptoms of complex partial seizures. Skull base neuro-endoscopy has managed such lesions more effectively with reduced post-operative morbidity as compared to transcranial approach. This case report discusses a 20-year-old male who presented with 3 episodes of seizure over a time period of 10 months. MRI brain revealed T1 hypo and T2 hyper intense cystic lesion in middle cranial fossa with no enhancement on contrast administration. CT scan showed cystic lesion involving greater wing and pterygoid plate of sphenoid on left side. CT cisternographic evaluation showed CSF outpouching in the sphenoid air sinus. Excision of the cystic lesion was carried out through endoscopic transmaxillary transpterygoid approach. Histopathological examination showed the lesion to be a simple bone cyst.

Successful Pregnancy Outcome in a Patient with Solitary Kidney Affected by Angiomyolipoma: A Rare Case

Renal angiomyolipoma is a rare benign tumour and its occurrence during pregnancy is even rare. It is usually diagnosed incidentally. It can increase in size during pregnancy and can present acutely as rupture with retroperitoneal haemorrhage, mechanism of which is still unclear. We present a case of successful pregnancy outcome in a patient with congenital solitary kidney affected by angiomyolipoma, diagnosed incidentally at 19 years of age. The patient had conceived twice. Her antenatal and post partum period was uneventful both the times.

An Unusual Evolution of Krukenberg Tumour: A Case Report

Krukenberg tumours are rare metastatic tumours of the ovaries characterized by the presence of mucin-producing neoplastic Signet Ring Cell Carcinoma (SRCC). At first glance, this tumour may be confused with a primary ovarian tumour. Surgery and chemotherapy combination have led to improvement in prognosis, but it still remains severe. We report the case of a 60-year-old woman with a Krukenberg tumour rising from a low differentiated gastric adenocarcinoma. The patient was clinically stable for 26 months after surgery until she experienced a prompt decline and died of cerebral haemorrhage within two weeks. The aim of this article was to give an overview of the Krukenberg tumour starting from our case report and comparing it with clinicopathological characteristics of this pathology derived from a review of recent literature.

Successful Obstetric Outcome in Dextrocardia with Situs Inversus and Moderate Pulmonary Hypertension- Rare Case

Deepika, Leena Wadhwa, Chandna Shekhar, Jyoti Saini, Monica Chetani

Situs inversus is a rare congenital anomaly, which is characterized by right sided heart (Dextrocardia) and inversely rotated visceral organs of abdomen. In present case, the patient reported with G3p2l2, 34 weeks of gestational period along with breathlessness accompanied and labour pains. On further investigation, she was diagnosed as dextrocardia with situs inversus and moderate pulmonary artery hypertension along with severe iron deficiency anaemia. Patient had normal vaginal delivery with intra-partum and post-partum period. Normally, any patient having situs inversus has a normal life expectancy and is not associated with any significant morbidity or mortality.

Ruptured Sinus of Valsalva with Infective Endocarditis Complicated with Post-Infectious Acute Glomerulonephritis: A Rare Case Presentation

Aditya Singh Kutiyal, Mradul Kumar Daga

Ruptured Sinus of Valsalva (RSOV) is a rarely seen disease condition. RSOV can have varied presentations from being asymptomatic with just a cardiac murmur to profound hypotension. There has been simultaneous occurrence of RSOV with Infective Endocarditis (IE) in literature. Glomerulonephritis has also been reported in approximately 20% patients with IE. Large amount of proteinuria or decline in kidney functions is rarely encountered and mostly this finding has been incidental on routine evaluation. The co-existence of all the three conditions in a single patient is rare. This case was diagnosed to have RSOV with IE and was also diagnosed with post-infectious glomerulonephritis on renal biopsy. Patient was advised corrective cardiac surgery, but due to financial constraints, patient could not be operated and he died. Here, we report for the first time an unusual presence of both RSOV and sub-aortic membrane with IE complicated by glomerulonephritis.

Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis

Mohamad Adam Bujang, Tassha Hilda Adnan

Sensitivity and specificity analysis is commonly used for screening and diagnostic tests. The main issue researchers face is to determine the sufficient sample sizes that are related with screening and diagnostic studies. Although the formula for sample size calculation is available but concerning majority of the researchers are not mathematicians or statisticians, hence, sample size calculation might not be easy for them. This review paper provides sample size tables with regards to sensitivity and specificity analysis. These tables were derived from formulation of sensitivity and specificity test using Power Analysis and Sample Size (PASS) software based on desired type I error, power and effect size. The approaches on how to use the tables were also discussed.

A Case of Interosseous Membrane Calcification

Cotoneaster and Neonatal Jaundice

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

Desire of Bearing a Child took a Wrong Turn!!

Sharad Hernot, Raman Wadhera, Madhuri Kaintura

Correct Blood Sampling for Blood Gas Analysis

Prabhat Kumar Nigam

Evaluation of Hospitalized Intractable Epileptic Children with SPECT Scan in Ahvaz, South West of Iran

Introduction: Seizures are the most frequent neurologic disorder seen in childhood. Epilepsy is a group of disorders that includes an abnormally increased susceptibility to seizures. Aim: To examine the effectiveness of SPECT (Single Photon Emission Computerized Tomography) in detecting seizure foci in 21 Iranian children who had medically refractory epilepsy. Materials and Methods: Children between 2 to 15 years of age with uncontrolled seizures were investigated using SPECT scan as a standardized protocol. Results: In 16 cases (76.2%), likely seizure foci were evident, as were seen in the form of decreased regional blood flow, while in 5 cases (23.8%), SPECT scan results were normal. Left temporal lobe was the most common area which had decreased regional blood flow. Conclusion: SPECT scan can potentially be used to investigate children with uncontrolled seizures.