Journal of clinical and diagnostic research

Mixed Dentition Space Analysis in Kodava Population: A Comparison of Two Methods

Aims: To evaluate the reliability of Tanaka and Johnston and Moyer’s (75th percentile) mixed dentition prediction methods in Kodava population sample, to formulate regression equations for predicting the mesiodistal widths of unerupted canines and premolars and to construct probability tables for the Kodava population. Settings and Design: Data was obtained from Kodava subjects visiting the clinics for routine dental check up. Materials and Methods: Dental models of 30 male and 30 female Kodava subjects (age range is 16 - 23 yr) were used. Teeth measured included mandibular permanent incisors, maxillary and mandibular permanent canines, first and second premolars. Digital caliper calibrated to 0.01mm was used to record mesiodistal dimensions. The actual teeth measurements were then statistically compared with the predicted values derived from the Tanaka and Johnston’s equations and Moyers probability tables at the 75th percentile. Statistical Analysis Used: Descriptive statistics including means, standard deviations were calculated for the actual and predicted tooth sizes. Student’s t-tests were performed to compare the differences between the measured mesiodistal widths of canine, first and second premolars and the predicted values derived from Moyers. Correlation and regression analysis were performed to formulate standard regression equations. Results: Tanaka and Johnston prediction equations overestimated the mesiodistal widths of permanent canines and premolars in both the arches. Moyers 75th percentile also overestimated the actual measurements except for the maxillary arch in female subjects. The percentage of overestimation was more for Tanaka – Johnston prediction method than that of Moyers (75th percentile). Correlation and regression analysis were performed between the predicted and actual tooth size and standard regression equations were developed for the Kodava population. Probability tables were also constructed from the data obtained. Conclusion: The data from present study illustrates the limitation of Tanaka and Johnston regression equations and Moyer’s (75th percentile) chart when applied to Kodava population. From this data, regression equations and probability tables were derived for tooth size prediction for Kodava population. This would be more accurate when applied to local children of Kodava community.

Effect of Different Phases of Menstrual Cycle on Reflection Index, Stiffness index and Pulse wave velocity in Healthy subjects

Madhura M, Sandhya TA

Introduction: Arterial compliance will result in stabilizing the fluctuations in arterial pressure and blood flow. So arterial stiffness can be a good indicator for monitoring the cardiovascular system. Arterial stiffness can be measured using indices like reflection index (RI), stiffness index (SI) and Brachial Finger Pulse Wave Velocity (BFPWV). Objectives: Aim of our study was to evaluate the changes in RI, SI and BFPWV during different phases of the menstrual cycle and to correlate RI with SI in healthy female subjects between the age group of 18-30 years from Bangalore, India. Materials and Methods: Basal recordings of RI and SI were determined by Photo Pulse Plethysmography (PPG) picked up from the fingertip using BIOPAC system and BFPWV was obtained using Doppler. Recordings were obtained at three different time points during the menstrual cycle. Analysis was done using repeated measures ANOVA with Bonferroni correction. Result: There was a significant decrease in above parameters p<0.05 during the mid-cycle. Correlation between RI and SI was also significant p<0.05. Conclusion: These findings suggests that the menstrual cycle affects the arterial stiffness and one of the factor is oestrogen. Hence, women are less prone to the incidence of cardiovascular diseases before menopause. Screening for arterial stiffness in a general population, using these indices is valid, economical and reliable.

Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section

Introduction: Short interconception period after caesarean section and its associated risk of increased morbidity, mortality and surgical interventions could be avoided by postplacental IUCD insertion during the procedure. Despite the safety reports on intracaesarean IUCD insertion, obstetricians are still hesitant to extend the benefit of this long acting reversible contraception to women undergoing operative delivery. Objective: To study the clinical outcome (safety, efficacy, expulsion and continuation rates) of postplacental Copper T 380A insertion in primiparous women undergoing caesarean section. Materials and Methods: This study was a prospective observational study, carried out in the Department of Obstetrics and Gynaecology, Safdarjung hospital, which is a tertiary care hospital of Northern India. Primiparous women who delivered by caesarean section over a period of six months (July 2012 to December 2012), willing for postplacental intracaesarean IUCD insertion, and willing to comply with the study protocol, were recruited for the study. All these subjects fulfilled the WHO Standard Medical Criteria for PPIUCD insertion; follow up visits were scheduled at 1, 3, 6 and 12 months. Results: A total of 300 primiparous women underwent postpartum intracaesarean insertion of Copper T 380A. The mean age of women included in the study was 23.12 ± 2.42 years. Most common postinsertion complication observed in the immediate postoperative period was febrile morbidity (2%). Majority of women (94.33%) had hospital stay of less than 4 days. The common adverse events observed during follow-up of 12 months were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of one year, there were 16 expulsions, 21 removals, and 2 pregnancies with gross cumulative expulsion, removal, failure and continuation rates of 5.33%, 7%, 0.67% and 91%, respectively. Conclusion: Postplacental intracaesarean Copper T 380A insertion in primiparous women is a safe and effective method of reversible contraception, with low expulsion and high continuation rates.

Prognostic Significance of a Multimarker Strategy of Biomarkers in Acute Heart Failure

P Srinivas, C N Manjunath, Shaheena Banu, K S Ravindranath

Background: Heart failure (HF) is a growing public health problem. Patients often present to emergency department (ED) with acute onset dyspnea where a rapid triage is required to avoid misdiagnosis and to institute appropriate therapy. An objective risk-stratification in the ED is warranted to identify patients at high risk of adverse outcomes, so that more intensive therapy and vigilant follow-up after discharge are instituted. Methods and Results: Fifty two consecutive acute HF (AHF) patients in NYHA class III/IV were enrolled for the present study. N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hsTropT), high-sensitivity C-reactive protein (hsCRP) and Uric acid (UA) were evaluated at admission; a second sample for NT-proBNP and hsTropT was obtained 48h later. The end-point of the study, a composite of cardiovascular death, rehospitalisation for worsening HF symptoms and refractory HF was reached in 32.7% of patients during a median follow-up of 4.8mnth. Although, hsTropT (>0.014ng/ml), hsCRP (>0.5mg/dl) and UA (>5.6mg/dl for females and >7 mg/dl for males) were elevated in the vast majority of patients (92.3%, 75% and 63.5% respectively), baseline and changing patterns of NT-proBNP following treatment were the only predictors of adverse outcomes on follow-up. A significant correlation between hsTropT, hsCRP and UA was observed suggesting a link between inflammation, myocyte injury and oxidative stress in AHF. Conclusion: Baseline and changing patterns of NT-proBNP predicted adverse outcomes on follow-up suggesting that a strategy of serial measurement of NT-proBNP could prove invaluable in early risk stratification. Further research is needed to understand the link between inflammation, myocyte injury and oxidative stress in AHF which could provide potential therapeutic targets.

Plasma D-dimer as a Prognostic Marker in ICU Admitted Egyptian Children with Traumatic Brain Injury

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. This study aimed at evaluation of the D-dimer blood levels as a new marker to predict prognosis and outcome of traumatic brain injuries among children. Materials and Methods: This case control study was conducted at the Paediatric Intensive Care Unit (ICU), Alharm Hospital in Giza, Egypt during 2012-2013, on 46 Paediatric cases admitted to ICU with head injury and 20 normal age-matched controls. Clinical data and venous blood samples were prospectively collected at 1st, 3rd and 14th day of admission, in addition to examination finding as Glasgow coma scale (GCS), cranial brain computed tomography (CT), routine laboratory investigations (CBC, CRP,SGOT,SGPT, urea , creatinine, random blood glucose ,Na ,K and arterial blood gases) plasma D-dimer, INR, PT, aPTT and PC. Data analysis was carried out accordingly and ROC curve was performed to explore the discriminating ability of D-dimer through estimation of its accuracy in differentiating temporal survivorship of those with TBI. Results: Cases were classified according to outcome into survivors and non-survivors. Significant difference was observed between cases and controls and between survivors and non-survivors during 1st, 3rd and 14th day of the follow up including GCS, blood levels of D-dimer, PT and aPTT. ROC curve analysis for D-dimer showed decline in both sensitivity from 89.5% to 73.7% and specificity from 100% to 81.5% along the study days respectively. D-dimer time measurements showed significant decline among survivors from 4.2 to 0.7, while in the non survivor group this decline was much higher from 27.9 to 1.4. Conclusion: Low plasma D-dimer suggests the absence of brain injury, and good prognosis.

Evaluation of Soft and Hard Tissue Changes after Anterior Segmental Osteotomy

Harshitha.K.R, Srinath.N, Sunil Christopher, H.Nanda Kumar

Objective: To determine the relationship between the changes of soft and hard tissues after anterior segmental osteotomy and to evaluate these changes using cepahalometric and photometric analyses. Materials and Methods: Ten patients aged 18-30 years who underwent anterior segmental osteotomy were included in the study. Preoperative and postoperative records consisted of lateral cephalogram and frontal and lateral photographs. Postoperative measurements were taken six months after surgery. Results: Statistical analysis showed changes in both soft and hard tissue parameters. Changes were not uniform for all the parameters. Upper lip and upper incisor protrusion showed very large effect size whereas nasal tip inclination showed small effect and mentolabial angle showed no effect. Conclusion: Skeletal protrusion pose problem to orthodontists as they can’t be corrected by orthodontics alone. Anterior segmental osteotomy in association with orthodontia is the choice of treatment. Anterior segmental osteotomy allows for functional and aesthetical correction with good success rate and minimal complication.

Extra Large Temporal Tunnel Cataract Extraction [ETCE]

Chidanand Kulkarni, Vivekanand U.

Purpose: To determine the outcomes of extra large temporal sclero-corneal tunnel incision Cataract Surgery. Materials and Methods: This consecutive case series of eyes undergoing temporal tunnel cataract extraction with tunnel length of 8 to 10 mm was identified retrospectively. Surgical procedure details, follow up, complications, visual and astigmatic outcomes at 6wks were recorded and analysed. Results: Ninety six eyes with extra large tunnel incision were identified for analysis from a dataset of 670 manual small incision cataract surgery cases. 58% eyes had NO5 or denser cataracts. Intraoperative complications included, tunnel related problems (1 eye, 1.04%), bleeding into Anterior Chamber (10 eyes, 10.4%), Posterior Capsular Rent (2 eyes, 2.1%). Early postoperative complications included striate keratopathy (7 eyes, 7.3%). The mean Best Corrected Visual Acuity was 6/7.5 (0.1 logMAR) and 98% cases had Best Corrected Visual Acuity of 6/12 (0.3 logMAR) or better at 6wk. The aggregate Surgically Induced Astigmatism was 0.32D at 850. Conclusion: Extra Large Tunnel of length 8 to 10 mm can be self sealing with low SIA. The complication rates and visual outcomes of ETCE are comparable to those of conventional MSICS. This method can be valuable in complicated cases and during learning period.

Tobacco Cessation Counselling Practices and Attitude among the Dentist and the Dental Auxiliaries of Urban and Rural Areas of Modinagar, India

Background: The increasing use of tobacco among youths warrants the need for dental health professionals to effectively provide tobacco cessation counselling (TCC) in the office and community settings. However, there have been concerns among the dental professionals regarding TCC in dental settings. Aims and Objectives: To assess the attitude of dental professionals including the dentist and dental hygienist towards the TCC and identify the possible barriers towards the implementation of these practices in the rural and urban areas of Modinagar district. Materials and Methods: The present questionnaire based survey was carried among the qualified dentist and dental hygienist from the urban and rural areas of the Modinagar district to attitudes in tobacco cessation, practices in tobacco cessation interventions and related barriers towards implementation. The survey data were analyzed using the SPSS 16 version software package. The descriptive statistics (frequency) was generated for the each question to assess their attitude and practice. Results: The response rate of the questionnaire among the dentist and dental hygienist was 100%. The attitude of the majority of dentist towards the TCC was positive as compared to the dental hygienist. 69.2% of the dentist were of the view that the dental health professionals should provide tobacco cessation counselling as compared to 54.2% among the hygienist. Regarding the practice, only 12.5% and 5.8% of the dentist and dental hygienist had ever used the nicotine replacement therapy in their dental practice. The lack of the knowledge and information regarding TCC was the only perceived barrier among the dentists (51.7%) and dental hygienist (68.3%). Conclusion: Dental professionals must expand their horizon and armamentarium to include TCC strategies inclusive of their regular preventive and therapeutic treatment modalities. Also, the dental institutions should include TCC into the curriculum, but it should not be just theoretical knowledge rather it must have a practical component.

Estimation of Salivary and Serum Total Sialic Acid Levels in Periodontal Health and Disease

Surekha R Rathod, Farooque Khan, Abhay P Kolte, Madhur Gupta

Background: Chronic gingivitis and periodontitis are inflammatory diseases. An important function of host sialic acid is to regulate innate immunity. The aim of the study was to assess the concentration of Total sialic acid (TSA) in saliva and serum and also to find out their association if any, in periodontal health and disease. Materials and Methods: A total of 90 subjects were clinically examined and distributed into three groups (n=30) according to the periodontal status namely healthy, chronic gingivitis and chronic periodontitis.Clinical measurements including probing depth, clinical attachment level, gingival index, oral hygeine index were recorded .TSA concentration was determined in saliva and serum of all subjects. Results: In healthy group the mean salivary TSA level was 39.05mg/dl ±6.35(p<0.0001), mean serum TSA level was 49.75 mg/dl ± 4.87 (p<0.0001). In the chronic gingivitis group the mean salivary TSA level was 68.23 mg/dl ± 2.71 (p<0.0001), mean serum TSA level was 65.65 mg/dl ±3.56 (p<0.0001). In the chronic periodontitis group the mean salivary TSA was 81.33 mg/dl ±3.94 (p<0.0001), mean serum TSA level was 75.98 mg/dl ±3.58 (p<0.0001). Conclusion: The present data indicates that salivary & serum TSA levels can differentiate between chronic periodontitis patients and normal individuals. Thus it can be used as an adjunct to diagnose, monitor response to therapy, to determine the current periodontal disease status and to assess the treatment outcomes.

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

Ramesh.K , Sangeetha Gandhi, Vishwas Rao

Background: Pre-eclampsia is one of the leading causes of maternal and infant morbidity and mortality worldwide. The aetiopathogenesis of this condition involves combination of genetic predisposition and environmental factors. The aim of the study was to determine the socio demographic and other risk factors of pre-eclampsia. Materials and Methods: A case control study was conducted at a tertiary care hospital, Karnataka among 100 cases of pre-eclampsia and 200 controls without pre eclampsia. Non probability purposive sampling technique was adopted to select the study subjects. Data was collected by using a pre tested semi structured questionnaire which included information related to socio-demographic and other known risk factors of pre eclampsia. Primary data was collected by interviewing study subjects and secondary data of cases was obtained from case records. Data was analysed using SPSS. Results: Study subjects included 100 cases and 200 controls. Age of less than 20 y (OR=3.8), monthly income of less than Rs4000 (OR=6.8), age of menarche of less than 12 y (OR=13.1), family h/o pre eclampsia (OR=36.0), family h/o Diabetes (OR=44.9), family h/o hypertension (OR=16.7) and previous h/o PIH (OR=58.5) are found to be significant risk factors of pre eclampsia. Conclusion: The significant risk factors may be used for screening pre eclampsia during registration of pregnancy.

Are We Missing Hypertrophic Cardiomyopathy in Pregnancy? Experience of a Tertiary Care Hospital

Background: Controversies persist regarding risks associated with pregnancy and delivery in women with hypertrophic cardiomyopathy (HCM). To date, pregnancy outcome data for these patients is scarce. We report the experience of pregnancies with HCM in a tertiary care hospital. Materials and Methods: Data regarding cardiac illness and obstetric profile of all women attending the cardio-obstetrics clinic from January 1990 to December 2012 were studied. The records of cardiac illness of all women were checked and all patients with HCM were included in the study. Results: Out of total 2016 patients booked in the cardio-obstetrics clinic between 1990 and 2012, only 4 women were found to have a diagnosis of HCM (0.2%). Of these, 2 women with left ventricular outflow tract obstruction and one with non-obstructive HCM had only mild symptoms and tolerated pregnancy and labour well. One patient had HCM with restrictive physiology developed heart failure and intra-uterine fetal death. Conclusion: HCM is underdiagnosed and rarely identified in pregnancy. Most patients with HCM tolerated pregnancy well, howeverone patient with restrictive physiology developed heart failure during her first pregnancy.

Evaluation of the Luting Cement Space for Provisional Restoration by using Various Coats of Die Spacer Materials-An Invitro Study

Aim: The present study was to evaluate the space provided for the temporary luting cement, after the application of various coats of die spacers, during the fabrication of provisional crowns and bridges. Materials and Methods: A total of 50 specimens of dental stone with provisional crowns on all these samples were prepared and were divided into five groups based on the application of various coats of different die spacers. Later these specimens were sectioned buccolingually and were observed using a stereomicroscope under 100X magnification. The images thus obtained were evaluated and noted for the amount of space between the inner surface of the provisional crown and the specimens at five different locations using Image Pro 6.0 Express software and the values were subjected to one-way ANOVA test, and unpaired t-test. Results: There was a significant increase of luting space thickness with various die spacer applications than the specimens of control group. Conclusion: Specimens of double coat applications of silver and gold die spacers showed higher luting cement space than the separating media application specimens.

An Insight Into Research Ethics among Dental Professionals in A Dental Institute, India- A Pilot Study

Background: Research activities are increasing in all the fields of medicine including dentistry but there is dearth of information about the knowledge, attitude and behaviour of dental professionals for ethical principles in research, especially in the developing countries like India. Objective: To assess knowledge, attitude and behaviour among dental professionals pertaining to research ethics. Materials and Methods: A self-administered, close ended questionnaire survey with cross-sectional design was conducted in a private dental institute in India. All the house-surgeons, post-graduate students and the faculty of the same institute were included for the assessment of the knowledge, attitude and behaviour regarding research ethics using a 24, 8 and 8 items. Results: A total of 213 of 230 dental professionals participated (response rate of 92.6%). Mean knowledge, attitude and behaviour scores were 43.3%, 82.5% and 46.37%, respectively. Significant correlations were observed of age and gender with the attitude about the research ethics among study subjects (?2=14.383, p=0.006 and ?2=7.769, p=0.021, respectively). Conclusion: Participants had favorable attitude towards research ethics, but their knowledge and behaviour needs considerable improvements. The age and gender were associated with attitude. The present pilot study highlights the need for further nationwide study and development of research ethics curriculum in detail for dental education in India.

The Utility of Caesarean Myomectomy as a Safe Procedure: A Retrospective Analysis of 21 Cases with Review of Literature

Ramesh Kumar.R, Manjula Patil, Shruthi SA

Background: Myomectomy at the time of caesarean delivery has been discouraged because of the risk of intractable haemorrhage and increased postoperative morbidity. The aim of this study is to determine the safety and feasibility of caesarean myomectomy. Materials and Methods: A retrospective case control study done between June 2012 to May 2013 in a tertiary care teaching hospital in Karnataka, India which included 21 pregnant women with uterine fibroids who underwent myomectomy during caesarean section and were compared with 42 matched controls without uterine fibroids who had caesarean section alone during the same period. Primary outcome measures studied were incidence of haemorrhage and need for blood transfusion. Secondary outcome measures were duration of operation, length of hospital stay, postpartum fever and wound infection. Statistical analysis is done using IBMSPSS 20.0 software and students t-test. For calculation of incidence of haemorrhage Fisher’s exact test is used. Results: Mean age of the 21 cases was 31.81yrs and 47.62% were primigravida. Total 37 fibroids were removed. Subserosal were 30 cases(81.08%) while 1(2.07%) was submucous. 21(56.76%)fibroids were situated in fundal region and 3(8.11%) were in lower segment. Mean change in the haemoglobin from preoperative to postoperative period in the cases was 1.3gm/dl(±1.155mg/dl) and control was 1.05% (±.854mg/dl). Two of the cases(9.52%) required blood transfusion compared to none in control. None in either group required hysterectomy. Mean duration of surgery was 68.57min (±15.012min)and 51.55min (±9.595min) for controls which is statistically significant. Conclusion: This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.

Analysis of Sexual Assault Survivours in a Tertiary Care Hospital in Delhi: A Retrospective Analysis

Sweta Lal, Al pana Singh, Neelam Bala Vaid, Sanjeeta Behera

Introduction: Rape and abuse of women are common occurrences, which, many a times go unspoken due to social stigma or fear of retribution. Rape is a crime not against a single human being but against the entire humanity. For granting justice to the rape survivor it becomes necessary that such matters are properly presented before the Courts of Law. Healthcare workers play an important role in this regard because they are the first person who examine the rape victims. They prepare a documented record of medical condition of rape victim and do relevant sample collection. Aim: The objective of this study is to analyse demographic and event characteristics of rape victims who presented to the Emergency Department in tertiary care, Delhi after sexual assault. Materials and Methods: Data was retrospectively collected from the medico legal register of the Department of Obstetrics and Gynecology between June 2010 to December 2013. Result: We noted a marked increase in the number of cases. Mean age of victims was 17 and most belonged to the lower socio-economic strata of the society. Use of sedatives and physical trauma was not common. Victims often knew the perpetrator of the event. Most (58%) of them reported within one day of the incident. Major degrees of perineal tears were seen in young victims. Conclusion: By understanding the demography of the sexual assault victims, we need to train our doctors for proper evidence collection not just in a government set up but also in private clinics, to help rape victims get justice and proper medical treatment.

“Is there an Association Between Self–Reported Sleep Duration, Body Mass Index and Waist–Hip Ratio in Young Adults? A Cross–Sectional Pilot Study”

Introduction: Sleep is vital for mental and physical health of an individual. Duration of sleep influences the metabolism and regulates body weight. Objective: To assess the cross-sectional association of sleep duration with body mass index (BMI) and waist-hip ratio in Malaysian students. Methods: Eighty-nine Malaysian students of both genders, and with a mean (standard deviation) age of 21.2 (0.9) years were included. Institutional Ethics Committee clearance was obtained prior to the start of study. The subjects were interviewed regarding the average hours of sleep/day, their self-reported sleep duration was categorized as < 6hour/day (short sleep duration), 6-7hour/day and > 7hour/day. Their height (in meters), weight (in kilograms), waist and hip circumference (in centimetre) were measured. BMI and waist-hip ratio were calculated using appropriate formulas and expressed as mean (standard deviation). The duration of sleep was compared with BMI and waist-hip ratio using one way ANOVA. Results: No statistical significance was observed when sleep duration was associated with BMI (p=0.65) and waist-hip ratio (p=0.95). Duration of sleep did not affect BMI and waist hip ratio in the Malaysian students in our study. The age and healthy lifestyle of the subjects in this study may have been a reason for no significant influence of short sleep duration on the BMI and waist-hip ratio. Conclusion: No association was found between sleep duration with BMI and waist hip ratio in the Malaysian students.

Role of FNAC in the Preoperative Diagnosis of Salivary Gland Lesions

Background: The characteristic cytologic features of the common salivary gland lesions have been well-delineated in literature. However, there also exist cytologic pitfalls and overlapping features that make an accurate diagnosis difficult in few cases. The present study was designed to compare the cytologic findings of salivary gland lesions with the histologic diagnoses, in order to assess the sensitivity, specificity and diagnostic accuracy of FNAC, with an emphasis on discordant cases. Materials and Methods: Patients with suspected salivary gland enlargements, who were referred for FNAC, were included in this study, which was done over a 3 year period in a medical college hospital. FNAC was performed by using the standard procedure. Smears were stained by using Papanicolaou’s and MGG stains. Cytologic diagnosis was compared with histopathologic diagnosis wherever it was available. Results: Eighty eight patients with salivary gland swellings were included in the study. The ages of the patients ranged from 15 to 82 years, with the M:F ratio being 1.6:1. Out of 88 cases, 68 had swellings in parotid gland, 19 had them in submandibular gland and one had them in hard palate. Pleomorphic adenoma was the commonest neoplasm which was seen in our study. Mucoepidermoid carcinoma (MEC) was the only malignant lesion seen in our study. One each of Warthin’s tumour (WT) and MEC were overdiagnosed and underdiagnosed respectively, the reason being squamous metaplasia in WT and subtle nature of malignant cells in low-grade MEC. Conclusion: WT and MEC can pose problems in cytologic diagnosis. Sampling errors and interpretational errors can lead to discordant diagnoses

Relationship between 25-Hydroxy Vitamin-D and Obesity in 2-7 years old Children Referred to a Paediatric Hospital in Iran

Sakineh Mohammadian, Reyhaneh Mortezazadeh, Hossein Zaeri, Mohammad Ali Vakili

Background: Obesity is increasing in children and it can cause many complications in adulthood, such as Diabetes mellitus (DM) and metabolic syndrome. In observational studies, vitamin-D was one of the factors which were found to be associated with obesity. Aims: To determine the association between body mass index (BMI) and serum level of vitamin-D in children who were outpatients at Taleghani Paediatric Hospital, Iran. Settings and Design: This was a cross-sectional observational study done on 215 children who were 2 to 7 y old, who were referred to Taleghani Hospital in winter (1391 solar calendar) 2013. Materials and Methods: In this cross-sectional study, anthropometric indices: weight, height and waist circumference were measured by using identical instruments. BMI was also determined as per CDC 2000 criteria. Vitamin-D levels were estimated by ELISA. Statistical Analysis: Vitamin-D levels which were less than 20 nmol/L were considered as a deficiency, levels which were 20-30 nmol\L were considered as inadequate and those which were equal to or greater than 30 nmol\L were considered as sufficient. t-test, ANOVA and Pearson’s correlation coefficient at a significant level of 0.05 were applied and data were analysed by using SPSS (version 16). Results: One hundred and twenty five children (47.4%) were males and the rest were females. One hundred eighty four children (85.6%) had vitamin-D deficiency and only 31 had adequate levels of vitamin-D. The prevalence of obesity and overweight were 27%, but considering the vitamin-D status, it was found to be insignificant. However, there was a linear relationship between waist circumference and serum vitamin-D (p<0.01). The means and standard deviations of serum vitamin-D levels in girls and boys were 22.76 ±11.62 and 23.46 ± 9.30 nmol/L and this difference was not significant. Vitamin-D levels found in the three ethnic groups of Fars, Turkmen and Sistani showed significant differences (p<0.002). Conclusion: There was a high prevalence of vitamin-D deficiency in 2 to 7 year olds. There was no significant relationship between BMI and vitamin-D, but it was recorded in ethnic groups, and there was a correlation between waist circumference and vitamin-D levels. More exposure to sunlight and prescription of vitamin supplements were recommended.

Complications Associated with Blood Donations in a Blood Bank at an Indian Tertiary Care Hospital

Monika Meena, Tarun Jindal

Background: Blood donation, though safe, has a few potentially avoidable complications associated with it. They are important reasons for the failure of the donors to return for repeat donations. The aim of this study was to assess the frequency and identify the possible factors associated with increased risk of blood donation related complications so that they can be minimized. Materials and Methods: A prospective study was done over a period of four months in the blood bank of an Indian tertiary care hospital to record the donation related complications. Results: Out of 7450 blood donations, total donation associated complications were 74, of which majority were vasovagal reactions (VVRs) (n=48), followed by venous hematomas (n=24) and arterial punctures (n=2). The incidence of VVRs was more, though not statistically significant, in females, replacement/ repeat donors, donors between 21-30 y of age and who had a body-mass-index (BMI) of 18.5-24.9. VVRs were more common in April (p=0.002) and in those who donated 450ml of blood (p<0.001). Though hematomas were more frequent in females, voluntary donors, donors in age-group of 41-50, those with BMI<18.5 and in those who donated 350ml of blood, statistically significant association was seen only in repeat donors (p<0.001). Conclusion : Our study emphasizes that blood donation in our country has a complication rate of nearly 1%.

Antibiotic Resistance in Uropathogenic E. Coli Strains Isolated from Non-Hospitalized Patients in Pakistan

Ihsan Ali, Neeraj Kumar, Safia Ahmed, Javid Iqbal Dasti

Purpose: To study multidrug-resistance in Uropathogenic E. Coli (UPEC) isolated from non-hospitalized patients. Materials and Methods:Altogether, 250 bacterial samples were collected from non-hospitalized patients. Their identifications were done on basis of Gram-staining, colony morphology, biochemical testing and PCR. Susceptibility testing was performed by using standard protocols which were recommended by CLSI. Statistical analysis: For comparisons, statistical analysis was performed by using software, Graphpad Prism 5.0. Results: In total, 32% (n = 80) of the isolates were identified as E. Coli strains and their susceptibility patterns for different antibiotics were determined. The data indicated least resistance against tazocin [(TZP) -1.25%], amikacin [(AK) -1.8%], tigecycline [(TGC)- 2.5%] and nitrofurantoin [(F) -3.75%]. For both minocycline (MH) and sulzone (SUL), resistance rate was 5%, for gentamicin (CN), it was 16.25%, while higher resistances were observed against cephalothine [(KF)- 70%], cefotaxime [(CTX) -58.5%], ceftazidime [(CAZ)- 57.5%], cefepime [(FEP) -55%], cefuroxime and cefixime [(CXM) (CFM)- 53.75 %]. Resistance against ciprofloxacin (CIP) was 57.5%, for norfloxacine (NOR), it was 52.5% and incase of sparfloxacin (SPX), it remained 55%. High percentage of the isolates were resistant to cotrimoxazole [(SXT) -86%] and Amoxicillin [AMX-CLA (AMC)- 76%]. No resistance against meropenem (MEM) was observed. Conclusion: Highest level of drug-resistance was observed against trimethoprim-sulfamethoxazole (TMP-SMZ) among clinical isolates of uropathogenic E. Coli collected from non-hospitalized patients.

Primary Supratentorial Haemorrhage – Surgery or no Surgery in an Indian Setup

Introduction:<.b> Rise of hypertension among younger age group has increased the prevalence of intracranial haemorrhage. Conflicting reviews regarding the mode of treatment has been a concern to the treating physicians especially in a developing country like India. This study was undertaken to underline the importance of management and propose a local protocol for primary supra-tentorial haemorrhage. Materials and Methods: Patients presenting with primary supratentorial (ST) haemorrhage fulfilling inclusion criteria are included in the study. Decompression craniotomy done in all the patients and the patient particulars noted. The primary outcome of death is correlated with various particulars and statistical analysis done with SPSS version 16. Results: Mean age of presentation was 54.2 years, ranging from 38-71years.Male comprised 82.1% (23 patients). 7 out of 8 patients with Glasgow coma scale (GCS) =7 (87.5%) expired whereas only 3 out of 20 (15%) patients with GCS >7 expired.50% of the patients with intracranial haemorrhage (ICH) in temporo-parietal(2/4) or in basal ganglia with cortical extension(5/10) expired whereas the mortality in cases of ICH in parietal lobe and frontal lobes were 25%(1/4) and 20%(2/10) respectively. Clot volume =100ml had a mortality of 19% (4/21) whereas the mortality was as high as 85.7% (6/7) with clot volume >100ml. Conclusion: Emergency Craniotomy and Evacuation of the Hematoma could be a feasible option in between 40 ml to 100ml of Primary ST ICH without intra-ventricular extension. In cases of intra-ventricular extension of haematoma surgery is less helpful. Midline shift of 5mm or more might be a poor prognostic factor.

Is Surgical Intervention for Ectopic Pregnancy in a Low Resource Set-Up Avoidable?

Anindita Sinha Babu, Jayeeta Roy, Dipanwita Das, Dipankar Banerjee
Background: Ectopic pregnancy is one of the most common life threatening complications in the first trimester of pregnancy having significant adverse effects on future pregnancy outcome, particularly if salpingectomy is used as the modality of treatment. So medical management is now advocated. For that, cases need to be diagnosed at an earlier stage. Keeping these backgrounds in mind we took up this study to look into the feasibility of conservative management– both medical and surgical - in a tertiary care centre. Aims: To find out the demographic profile and risk factors of the ectopic pregnancy cases; the clinical presentation of the cases; the mode of treatment offered to the patients. Materials and Methods: It was a record based retrospective study.All the patients diagnosed as ectopic pregnancy in a tertiary care hospital from January, 2011 to December, 2012, was included in the study. Results: A total of 234 ectopic cases (1.5% of total deliveries) were recorded, constituting 5.4% of total gynaecological emergencies of this institute. Majority of patients were multigravida (74.4%) and of age group of 26-30years (35.9%). Fallopian tube was the most common site (99.1%) with only two cases in ovary. Ampulla (71.4%) was found to be most frequent site for implantation in fallopian tube. Pelvic inflammatory diseases (38.5%) and past history of induced abortion (35.9%) were major risk factors. Most patients (63.3%) did not use any contraceptives and 30.3% patients used OCP intermittently. No patient presented before 4weeks of gestation, while 69.2% presented between 4-7weeks and the rest beyond 7week. They presented with shock in 44.9% cases. Surgical treatment was offered in 98.3% cases, while medical treatment was offered to only four cases. Conclusion: There is a huge surgical burden due to ectopic pregnancy impinging on our hospital resources. Surgery is resorted to indiscriminately for even those cases that could have been medically treated otherwise. Hence, the need to change the mindset of the care-providers at all levels to opt for medical management of ectopic pregnancy wherever applicable.

“Comparative Efficacy of Different Doses of Fentanyl on Cardiovascular Responses to Laryngoscopy and Tracheal Intubation”

Vinod Hosalli, Adarsh ES, S Y Hulkund, Chhaya Joshi
Background: This study was conducted to determine an effective bolus dose of fentanyl, which would attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Materials and Methods: A randomised double blind controlled study was carried out on 50 healthy adult patients (ASA I and II) undergoing elective surgery under general anaesthesia. The patients were randomly allocated into two groups of 25 each i.e. group A and group B receiving fentanyl 3 ?g/kg, 5 ?g/kg intravenously three minutes before intubation respectively. The pulse rate, systolic blood pressure was recorded at induction, during intubation and at 1,3, 5 min post intubation. Results:The study showed that both the doses were equally effective in blunting the pulse rate response, but the 5?g /kg proved significantly effective in blunting the blood pressure response. The rate pressure product, a measure of cardiac O2 consumption was found to be significantly lower in fentanyl 5?g/kg compared to fentanyl 3?g/kg. Conclusion: So, we conclude that both blood pressure and rate pressure product were completely abolished by a bolus dose of fentanyl 5?g /kg in comparison with fentanyl 3?g/kg following laryngoscopy and intubation.

Comparison of Dexmedetomidine, Propofol and Midazolam for Short-Term Sedation in Postoperatively Mechanically Ventilated Neurosurgical Patients
Background: Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. Aim: The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. Materials and Methods: Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine 1 mcg/kg over 15 minutes as a loading dose, followed by 0.4-0.7 mcg/kg/h. Group P received propofol 1 mg/kg over 15 minutes as a loading dose, followed by 1-3 mg/kg/h. Group M received midazolam 0.04 mg/kg over 15 minutes as a loading dose, followed by 0.08 mg/kg/h. M easurements: Heart rate, mean arterial pressure, sedation level, fentanyl requirement, ventilation and extubation time were recorded. Results: Adequate sedation level was achieved with all three agents. Dexmedetomidine group required less fentanyl for postoperative analgesia. In group D there was a decrease in HR after dexmedetomidine infusion (p<0.05), but there was no significant difference in HR between group P and group M. After administration of study drug there was a significant decrease in MAP comparison to baseline value in all groups at all time intervals (p<0.05), except postextubation period (p>0.05). Extubation time was lowest in group P (p<0.05). Conclusion: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol. Dexmedetomidine also reduced postoperative fentanyl requirements.

The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study

Morteza Dehghan, Farinaz Farahbod
Introduction: Acute low back pain is one of the most common health problems especially in industrialized countries where 75 per cent of the population develop it at least once during their life. This study examined the efficacy of thermotherapy and cryotherapy, alongside a routine pharmacologic treatment, on pain relief in patients with acute low back pain referring an orthopedic clinic in Shahrekord, Iran. Materials and Methods: This clinical trial study was conducted on 87 patients randomly assigned to three (thermotherapy and cryotherapy as intervention, and naproxen as control) groups of 29 each. The first (thermotherapy) group underwent treatment with hot water bag and naproxen, the second (cryotherapy) group was treated with ice and naproxen, and the naproxen group was only treated with naproxen, all for one week. All patients were examined on 0, 3rd, 8th, and 15th day after the first visit and the data gathered by McGill Pain Questionnaire. The data were analyzed by SPSS software using paired t-test, ANOVA, and chi-square. Results: In this study, mean age of the patients was 34.48 (20?50) years and 51.72 per cent were female. Thermotherapy patients reported significantly less pain compared to cryotherapy and control (p=0.05). In thermotherapy and cryotherapy groups, mean pain in the first visit was 12.70?3.7 and 12.06?2.6, and on the 15th day after intervention 0.75?0.37 and 2.20?2.12, respectively. Conclusion: The results indicated that the application of thermotherapy and cryotherapy accompanied with a pharmacologic treatment could relieve pain in the patients with acute low back pain.

En–masse Retraction of the Maxillary Anterior Teeth by Applying Force from Four Different Levels – A Finite Element Study

Chetan.S, Kanhoba M Kelusk Ar, Vikram N Vasisht, Siddharth Revankar
Objective: To find out if it is possible to control maxillary anterior teeth in sagittal and vertical plane during retraction by altering the vertical levels of force application in the posterior region, i.e. identifying the type of movement of the maxillary anterior teeth which occurs when force would be applied from four different levels i.e. High, Medium, and Low pull Implants and from a conventional Molar hook and also to quantify the retraction and intrusion components of force thus setting a guideline for the implant height placement. Materials and Methods: A Finite Element Model of maxillary dentition along with alveolar bone, brackets and wire was developed with defined material properties. The model was analysed to calculate the displacement when force was applied from different levels. Results: From all points of force application, anterior teeth tipped lingually in the sagittal plane, whereas in the vertical plane extrusion was seen when retracted from molar hook and intrusion was seen when retracted from implants. For every mm of apical displacement of implant, the retraction component of force reduces approximately by around 1% and intrusion component of force increases approximately by around 0.3%. Conclusion: Based on the results of this study we can reckon that by changing the position of implant in vertical plane one will have very little effect on the type of tooth movement. As the point of force application moves apically, type of tooth movement in the sagittal plane remained almost constant and in vertical plane intrusion is slightly increased.

Perception Towards Serving Rural Population Amongst Interns from Dental Colleges of Haryana

Vatsul Sharma, Nidhi Gupta, N.C. Rao
Background: The problem of reluctance of dentists to work in rural areas is an international phenomenon. With an increase in number of dental colleges in India, there also has been an improvement in the dentist to population ratio. But still there exists a wide disparity in dentist to population ratio in rural and urban areas. The aim of this study was to find the perception of dental interns towards serving rural population and the reasons associated with their choices. Materials and Methods: To know the willingness of dental interns to serve rural population and factors associated with their decision, 504 participants from six dental colleges of Haryana were interviewed. A pre-tested self-administered structured questionnaire was used for data collection. Descriptive statistics were used for data summarization and presentation. Degree of association was measured by Chi Square test, with significance level set at p < 0.05. Results: Out of total participants, 55.95% were willing to serve in rural area. Less competition in settling (46.45 %) was the prime factor for willingness, priority for postgraduation (45.01%) was main factor for reluctance. No significant difference (p=0.365) was seen in the perception of young dentists towards serving rural or urban population. Conclusion: Even though the current statistics don’t reflect a satisfactory dentist to population ratio in rural areas, the attitudes of the dental students towards practicing in rural areas were found to be good.

Oral Hygiene Practices and Dentition Status of Public Transport Workers of India- A Cross-sectional Study
Objectives: To evaluate the oral hygiene practices and dentition statuses of transport workers who were working in a public bus transport system (C.T.U.) of Chandigarh (U.T.), India. Materials and Methods: The data were recorded on a modified W.H.O. format (1997). A total of 1008 subjects constituted the final sample size. Information was obtained regarding the oral hygiene practices and clinical examinations were conducted. Statistical analysis was done by using ANOVA and Z-test. Results: The mean age of the subjects was 45.3 ? 7.8 years. Mean DMFT of the subjects who were not using tobacco in any form was 5.02. 80.2% (808). 88.7% of the subjects brushed their teeth as least once a day. Mean number of decayed and missing teeth were 1.67 ? 2.16 and 1.46 ? 2.8, respectively and their relation with age was found to be statistically significant. Conclusion- Dental caries was found to be major indication in all the age groups. More elderly subjects than young needed extractions. This study emphasized the need of an improved dental awareness and availability of dental facilities to transport workers.

Occupational Mental Health: A Study of Work-Related Mental Health among Clinical Nurses
Objective: This paper reports a study performed to investigate and assess the mental health as well as the demographic characteristics of nurses to examine their mental health status based on four physical, anxiety, social-function and depression items. Materials and Methods: This descriptive cross-sectional study was accomplished on 86 nurses working at three hospitals, affiliated to Iranian health ministry, in Ilam city(western Iran) all the cases were selected by purposeful sampling method. Data was collected by a two-part questionnaire containing individual data and GHQ -28 Standardized Questionnaire. The GHO-28 was developed by Goldberg, in 1978, as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders. The GHQ-28 is a 28-item measure of emotional distress in medical settings. Analysis was done by SPSS 18 software. Results: The majority of participants were females(50.6 vs.49.4) of 35-40 years old(27.2% ), 84 percent were married(vs.16%), 35.8 percent with 10-15 years of record(vs.33.3% less than 5), 22.2% with 5-10, and 8.6% with more than 15-years of work record. The majority of participants have worked in surgical wards of hospitals. The analysis of GHQ results showed that 43.2%(n=35) of participants were suspected to suffer from mental disorders(vs.56.8% n=46 healthy participants); of all the suspected cases, 12.3% were supposed to have physical symptoms, 16% anxiety symptoms, 42% social dysfunction, and 6.2% symptoms of depression. In general, the participants demonstrated a Mean?SD of mental health score equal to 23.65?9.43. Conclusion: Research results showed that the high prevalence of depression, anxiety and stress symptoms among nurses is alarming. It was concluded that providing efficient adequate and appropriate support services for this group can result in more healthy nurses as well as promotion of public health.

Diagnosis of Asymptomatic Bacteriuria and Associated Risk Factors Among Pregnant Women in Mangalore, Karnataka State

Annie Rajaratnam, Neha Maria Baby, Thomas .S. Kuruvilla, Santhosh Machado
Background: Asymptomatic bacteriuria (AB) is common in women and increases in prevalence with age or sexual activity. Prompt detection and treatment of this condition and associated factors decreases complications like acute pyleonephritis, intrauterine growth retardation and preterm labour. Chromogenic media is a versatile tool in rapid primary screening of the causative organisms considerably reducing daily routine workload. Aim: To determine the prevalence of AB among pregnant women in a tertiary care set-up and analyse the contributory risk factors, its effects on pregnancy and the role of chromogenic media in the laboratory diagnosis of these cases. Materials & Methods: Urine samples of all pregnant women attending pre-natal check-ups with no genitourinary complaints, history of fever or antibiotic intake were collected for Gram stain, culture and antibiotic sensitivity tests. A second urine specimen for culture and sensitivity testing was obtained from those with significant bacteriuria. The results were compared with patients showing negative urine cultures. Results: The overall prevalence of this clinical condition in our study was 13.2%. The significant isolates were Klebsiella pneumonia and E.coli and the most common risk factor was a previous history of urinary tract infection. The isolates were easily identified by using chromogenic agar ( HiCrome ) but colonies of uncommon pathogens like Acinetobacter and Streptococcus species appeared white and needed further identification. Conclusion: Screening of pregnant women for AB at first prenatal checkup helps analyse the associated factors and prevents its effects on pregnancy. The use of a chromogenic media can enhance reporting accuracy and will be an effective tool to monitor these cases routinely.

Clinicopathological Study of Prostatic Biopsies

A.Josephine
Introduction: Prostatism is a common malady in the geriatric age group. Benign prostatic hyperplasia and Carcinoma of the prostate are increasingly frequent with advancing age. The aim of the present study is to study the spectrum of prostatic lesions among the biopsies received in a rural hospital. Materials and Methods: One hundred and six cases of prostatic biopsies received in the Department of Pathology, Rajah Muthiah Medical College and Hospital ? Annamalai University were included in the present study. There were 44 needle biopsies and 62 TURP specimens. All the specimens were fixed in 10% neutral buffered formalin and 5? sections were stained with Hematoxylin and Eosin stain (H&E stain). Relevant clinical data including age, the presenting complaints and S.PSA values in suspected cases of carcinoma prostate were recorded. Results: Among the 106 biopsies received,79(74.52%) cases were of Benign prostatic hyperplasia, two cases(1.89%) were Prostatic intraepithelial neoplasia and 25 cases(23.58%) were Carcinoma of Prostate. Prostatitis was the most common associated lesion in cases of benign prostatic hyperplasia presenting in 25.31% patients. Among the Carcinoma patients, 20 cases (80%) were of Adenocarcinoma of prostate and 5 cases (20%) were Small cell carcinoma of prostate. Both Benign prostatic hyperplasia and Carcinoma prostate were common in the seventh decade. Most common clinical presentation was difficulty in micturition. Most common histological type of Carcinoma prostate was Adenocarcinoma. Serum PSA estimation was done in 49 cases of prostate biopsies. Elevations of serum PSA levels were noted in both BPH and Carcinoma prostate patients.Eight cases of BPH, had serum PSA values in the range of 0-4ng/ml. Six cases of Carcinoma prostate, had serum PSA values in the range of >80 ng/ml. Conclusion: Benign prostatic hyperplasia is the most commonly encountered prostatic lesion. Although, investigations like transrectal ultrasonogram and serum PSA estimation aids in diagnosis, a definitive diagnosis of benign and malignant lesions of prostate can be made by histopathological study of prostatic biopsies.

Case Series of Skin Adnexal Tumours
Background: Skin adnexal tumours ( SATs ) are a large and diverse group of benign and malignant neoplasms. They are uncommon. They can be single or multiple, sporadic or familial and they might be markers for syndromes associated with internal malignancies. Benign adnexal tumours are more common and malignant SATs are rare and are locally aggressive and have the potential for nodal involvement and distant metastasis with a poor clinical outcome.Therefore recognition of SATs and establishing a diagnosis of malignancy in SATs is important for therapeutic and prognostic reasons. Aims and Objectives: SATs are rare benign and malignant neoplasms. They are not commonly encountered in the routine surgical pathology practice.Hence this study aims at finding the frequency, clinical presentation and the histopathological appearances of SATS, and the differentiating features between benign and malignant tumours. Materials and Methods: This is partly a retrospective and partly a prospective study done in a tertiary care hospital over a period of four years .All the SATs reported during this period are analysed for their clinical features, age, sex incidence and their gross and histopathological features. Results: In the four years period 1,64,220 patients attended the hospital. The total number of SATS reported during this period were 21 cases (0.0128 %) Benign tumours were 19 (90.48%). Malignant tumours were 2(9.52%) The mean age for males 36.9 years and for females 35. Two years. There were 11 male patients and 10 female patients. Tumours of hair follicular differentiation were 7 (33.33%). Tumour like lesion of sebaceous origin was 1 (4.76%). Tumours of sweat gland origin were 11 (52.38%). Malignant tumours of eccrine origin were 2 (9.52%). Conclusion: SATs are not common. Their incidence in our study is only 0.0128 % of all cases. Eventhough benign SATs are more common than the malignant tumours, malignant SATs can occur both in young and elderly patients and they are aggressive and the SATs should be excised with wide tumour free margins.

Comparative Evaluation of Maximum Bite Force in Dentulous and Edentulous Individuals with Different Facial Forms
Purpose: The purpose of this study was to evaluate the mean maximum bite force in dentulous and edentulous individuals with Angle’s class-I occlusion and to assess the effect of different facial forms such as Square, Square-tapering, tapering and ovoid on the biting force. Materials and Methods: The study consisted of 160 subjects in total. Out of these 160, 80 were dentulous subjects and remaining 80 were edentulous subjects who had received treatment for his/her missing teeth by fabrication of a complete denture. The mean maximum voluntary bite force for every subject was measured using bite force measuring device,(Process indicator 3016). Face form was divided under square, tapering, square-tapering or oval types. The shape of the face was determined using digital photographs. The effect of edentulism, gender and face form on bite force was statistically analyzed using ANOVA, Scheffe and Sample t-tests. Result: Mean maximum bite force and standard deviation (S.D.) in the dentulous sample population was 41.3(13.9) kilograms (kg) which when compared with the edentulous sample population provided highly significant statistical result. The mean maximum biting force in edentulous sample population was 4.43 (2.4) kg (p<0.001). In both dentulous and edentulous categories, the mean maximum bite force was statistically higher in male patients than female patients. Mean maximum bite force was significantly higher in patients with square facial form than in subjects with other facial forms. Conclusion: Square face form contributes to higher bite force values by obtaining higher Mechanical advantage from muscles of mastication. Result also proved that patients with complete denture with any facial form have much lower mean maximum bite force when compared to dentate subjects.

Knowledge, Attitude and Practice of Emergency Contraception on Nursing Personnel

Nivedita.k, Fatima Shanthini. N
Introduction: Emergency Contraception is a grossly underutilized option of prevention of pregnancy. It is a safe and effective method which can prevent unintended pregnancies, unsafe abortions and unwanted childbirth. Knowledge and attitude of Nursing personnel who are both service providers and health educators to the community can influence the contraceptive behavior of the people exposed to them. A few studies done in our country indicate that their awareness regarding EC is low. Aim: To explore the knowledge, attitude and practice of EC amongst Nursing Personnel in a medical college hospital. Materials and Methods: In this study, 185 nursing personnel participated. A predesigned, pretested questionnaire was used to collect their responses regarding knowledge, attitude and practice of EC. Descriptive analysis of data was done. Results : Out of the total, 52.43% of the participants had good knowledge regarding the general information of EC, 51.35% had positive attitude towards EC, 47.56% had expressed willingness to use EC if indicated whereas only 22.7% had ever used EC. 72.97% had expressed willingness to attend awareness programmes on EC. Conclusion:Even though knowledge and attitude towards EC among the participants was marginally good they had many misconceptions regarding specific aspects like mode of action, indications and timing of administration. More awareness programmes would definitely clear their misconceptions and apprehensions and encourage Nursing Personnel to personally use and promote EC to others.

Diagnostic Utility of PET CT in Thymic Tumours with Emphasis on 68Ga-DOTATATE PET CT in Thymic Neuroendocrine Tumour - Experience at a Tertiary Level Hospital in India

Julie Hephzibah, Nylla Shanthly, Regi Oommen
Introduction:18 Fluorine-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F- FDG-PET/CT) is of importance in assessing high-risk thymoma and thymic carcinomas. Detection of advanced thymoma versus thymic carcinoma by routine cross sectional anatomical imaging such as computed tomography (CT), magnetic resonance imaging (MRI) often poses a diagnostic dilemma. In this case series we observed the utility of FDG uptake to predict advanced thymoma and distinguish thymoma from thymic cancer. Materials and Methods: We reviewed 18F- FDG-PET/CT scans of 12 patients (8 males, 4 females); age 24-60yrs with thymic epithelial malignancy from January 2011 to May 2013. FDG activity in lesions was quantified using maximum standardised uptake value (SUVmax) and correlated with Masaoka staging and WHO classification. All patients fasted 4 hr prior to 18F-FDG PET/CT. Images from vertex to mid-thigh were acquired 60min post injection of 3.7 -4.7 MBq/kg (Mega Becquerel)/kilogram of18F-FDG and SUV max of each tumour was measured. One patient underwent DOTATATE scan, received 138MBq of 68Gallium (68Ga)-DOTATATE injection IV and imaging was done after 60 min. Results: Higher FDG uptake of SUVmax 7.35 was seen in type B3 thymoma. FDG uptake was higher in thymic carcinoma (20.45 in primary and 17.46 in the node) or neuroendocrine differentiation (NED) than in patients with thymomas (ranged 7.35 - 3.02). No significant association was observed between higher focal FDG uptake and advanced-stage disease in thymoma. In NED 68Ga - DOTATATE imaging identified more lesions than in FDG. Conclusion: PET CT is a valuable diagnostic tool in evaluation of thymic tumours, to assess in initial workup, for treatment response and for prognostication. 68Ga-DOTATATE PET/CT is beneficial in assessing neuroendocrine thymic tumours. Focal FDG uptake cannot predict advanced thymoma but is helpful in distinguishing thymoma from thymic carcinoma, or the more aggressive thymoma B3.

Effect of Isometric Handgrip Exercise Training on Resting Blood Pressure in Normal Healthy Adults

Rinku Garg, Varun Malhotra, AvAvnish Kumar, Usha Dhar, Yogesh Tripathi
Introduction: The aim of the present study was to study the effect of isometric handgrip (IHG) exercise training on resting blood pressure in normal healthy volunteers. Materials and Methods: Hand grip spring dynamometer was used for IHG exercise training. A total of 30 normal healthy volunteers in the age group of 20-40 y were enrolled for the study. Exercise training protocol consisted of five 3-min bouts of IHG exercise at 30% of maximum voluntary contraction separated by 5 min rest periods. Exercise was performed 3 times/wk for 10 wk. Subject’s blood pressure was measured before and after exercise. Result: There was a significant reduction in resting blood pressure following 10 wk of exercise training. Both Systolic and Diastolic blood pressure reduced significantly (p<0.001). Conclusion: IHG exercise training might be a simple, effective, inexpensive and non-pharmacological method in lowering blood pressure.

Comparitive Angiographic Profile in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

Srinidhi S. Hegde, P. Mallesh, S.M. Yeli, Veeranna M. Gadad, Giri Punja M.
Background: Cardiac adversity is by far the commonest cause of mortality in patients with diabetes. Cardiac involvement in diabetes commonly manifest as coronary artery disease (CAD). Definitive diagnosis,precise assessment and anatomic severity of CAD requires invasive diagnostic modality like coronary angiography. Aims and Objectives: To study angiographic extents, type of vessels, number of vessels, severity involving coronary artery and its branches in patients with acute coronary syndrome(ACS).Compare the same in diabetics and non diabetics with ACS. Materials and Methods: Hundred patients with ACS,50 diabetics and 50 nondiabetics admitted in Bapuji Hospital ICCU attached to J.J.M. Medical College were selected randomly during a period of approximately one and half years formed the study group. RBS, FBS was done in all 100 pateints, HbA1c in all diabetics. All subjects with ACS were taken up for coronary angiography. Statistical Analysis: Chi-square test was used to determine any significant difference between two groups. p-value of less than 0.05 was considered significant. Results: In our study 22 (44%) out of 50 diabetic patients had triple or multi-vessel disease compared to 8 (16%) out of 50 non diabetics. Hundred patients with ACS, number of vessels involved were 199, of which 61.3%in diabetics and 38.6% in non diabetics.23(46%) of 50 diabetic patients required CABG as treatment outcome. HbA1c levels of >8.5%, 69.2% had triple / multi vessel disease and 19 (73.1%) of 23 patients who had to undergo CABG had HbA1c levels >8.5%. 24% of diabetics were in third decade, 40% were in fourth decade as compared to 10% and 26% of non-diabetics of similar age group. Interpretation and Conclusion: This study showed that ACS in diabetic patients presented much earlier in life, the severity and extent of CAD and incidence of triple/multi vessel disease was significantly high in diabetics when compared to nondiabetics with ACS. Diabetics with high HbA1c had more number of coronary vessel involvement and the mode of treatment required in them was CABG.

Evaluation of Proximal Femoral Geometry in Plain Anterior-Posterior Radiograph in Eastern-Indian Population

Sanchita Roy, Rajib Kundu, Shyamalendu Medda, Avanish Gupta, Baljit Kaur Nanrah
Background: The morphologic features of the proximal femur are used in preoperative planning prior to total hip arthroplasty. The standard commercially available marketed prostheses sometimes may not be the best fit to all subjects because of the large anatomic variation among different population. Orthopaedic surgeons always stress the need for a proper implant-patient match in hip joint replacements to avoid post-operative complication of mismatch which may affect the ultimate outcome of the operation. Aim: The present study was undertaken to measure the important parameters of upper end of femur in elderly Eastern Indian population which will help the prosthetist to manufacture ideal implant for the local population. This will also help the orthopaedic surgeons while positioning the implants during total hip replacement (THR) procedure in this population. Materials and Methods: Measurements were made on both sides, left and right from anterior-posterior radiograph of 102 subject (>50yrs, 42 male and 60 females) using AGFA software. Three parameters femoral head diameter (FHD), neck-shaft angle (NSA) and horizontal off-set (HO) were measured. Results: SPSS software used for data analysis. Gender- wise no significant differences were found in NSA and FHD, but HO was significantly lower in female than that of male (p<.05).The values on both sides didn’t differ significantly. Conclusion: Improved knowledge of the morphology of the proximal femora will assist the surgeon in restoring the geometry of the proximal femur during total hip arthroplasty and the data could be used as a guideline to design a more suitable implant for Eastern Indian population.

Assessment of Bmi , Serum Leptin Levels and Lipid Profile in Patients with Skin Tags

Sadaf Idris, S. Sunitha.
Background: Skin tags (ST) are benign lesions composed of loose fibrous tissue, associated with obesity and atherogenic profile. Thus help in the follow up by considering ST as a useful cutaneous sign for the risk factor of atherosclerosis. Aim: To evaluate the association of skin tags with BMI, serum leptin and lipid profile. Materials and Methods: The study was carried out in 40 cases with ST and 40 age and gender matched controls. Subjects on oral contraceptives and systemic drugs especially lipid lowering agents, pregnant women, cases with medical history of endocrine disease, acute infection, erythroderma and psoriasis, cases with a drug history of isotretinoin use in last six months were excluded from the study. Blood samples were collected. Serum lipids and serum leptin were estimated. Result: The acrochordons group showed significantly higher values of BMI, total cholesterol (TC) and TC/HDL ratio. 60% of the patients with ST were overweight and 10% were obese. There was no statistical significant difference in leptin levels between the groups. Leptin showed a positive significant correlation with BMI in the acrochordons group. Conclusion: All the above derangements confirm that ST is cutaneous findings frequently associated with obesity and dyslipidemia. Thus follow-up of these patients with regard to the development of diseases associated with atherosclerosis may be beneficial.

Impact of Amitryptiline on Migraine Disability Assessment Score

Kuldeep Moras, Hanock Nischal
Aim: Migraine headache is a common disorder, several drugs have been tried as a prophylaxis to reduce the attacks of headache. Aim of this study is to see the impact of amitriptyline on quality of life in migraneurs using Migraine Disability Assessment Score. Materials and Methods: In this study 300 patients of either gender who required prophylaxis for migraine without aura were selected. The patients were of the age group 18-60 years. The MIDAS questionnaire was administered to patients before starting treatment and again after 45 days prophylaxis. The improvement was noted. Statistical Analysis: It is a prospective study where the severity of symptoms and ‘quality of life’ in patients is assessed before and after treatment using mean, frequency, standard deviation and paired‘t’ test. Results: A total of 300 patients were subjected to migraine prophylaxis with amiptriptyline. The study showed female preponderance. The mean MIDAS score before and after treatment with amitriptyline was 11.6 and 9.4 respectively. The student‘t’ test showed p-value of <0.005 which was significant. Conclusion: Migraine prophylaxis with amitriptyline for a period of 45 days decreased the severity of symptoms and also reduction in days of migraine attacks. However the long term effects on quality of life could not be assessed. The study needs to be conducted in a large scale to evaluate the consistency and accuracy of the test.

Prevalence of Dentin Hypersensitivity and Related Factors Among Adult Patients Visiting a Dental School in Andhra Pradesh, South India
Background and Aim: Dentine hypersensitivity is a relatively common problem which may disturb the patient during eating, drinking, brushing and sometimes even breathing. It is a painful condition highly prevalent in the general adult population. The aim of this study is to determine the prevalence of dentine hypersensitivity and to examine some associated factors such as initiating stimuli among adult patients. Material and Method: The study is done under two phases. In the first phase a cross-sectional study was carried out in 665 study volunteers. Only 212 adult patients who were meeting the inclusion and exclusion criteria were conveniently selected to the study. A detailed demographic data and a structured questionnaire regarding type of response, sensitivity episodes, and duration of sensation, and stimulus for initiation were recorded by the examiner. Evidence of dentine hypersensitivity was confirmed by the use of air blast and water from the air-water jet of the dental chair and scratching the suspected tooth surfaces which is indicated by study subjects with a dental probe and noting the responses by using Visual Analog Scale. In the second phase the related factors or characteristics of DH were surveyed. Statistical analysis preformed by using methods of descriptive statistics and Kruskal Wallis test. Results: The overall prevalence of dentine hypersensitivity was found to be 32%. The most common cause was found to consuming cold food or drinks (92%) and common predisposing factor was gingival recession (28%). Probe method yields a higher Visual Analog Scale score followed by Air at 10 seconds and Water at 10 seconds which is statistically significant. Conclusion: The prevalence of dentine hypersensitivity in present study was 32% which is attributed to gingival recession as predisposing factor and cold stimuli.

Histological and Histometrical Evaluation of two Synthetic Hydroxyapatite Based Biomaterials in the Experimental Periodontal Defects in Dogs
Aim: The present study was to evaluate histologically and histometrically the efficacy of Chitra granules in the regeneration of alveolar bone and to compare it with that of OsteoGenR (HA Resorb)™ in iatrogenically created alveolar bone defects in mongrel dogs. Materials and Methods: Four dogs (16 sites) were used for this split-mouth study. The animals were divided randomly into two groups of two animals. Same animals were used as control and test. Each dog had four implantation sites. The periodontal defects were prepared by acute defect model. Animals were sacrificed at 3 months (n=2), 6 months (n=2) and histologic and histometric evaluation was carried out. Statistical Analysis: The data was analysed using statistical package Graph pad Software. Comparison of the hard and soft tissue parameters in the two groups was done using the Wilcoxan (Man Whitney), two tailed t-test. A p-value less than 0.05 were considered significant. Results: Maturing bone with immature periodontal ligament fibers were observed at three months and advanced osteogenesis at six months with both the types of bone graft materials. The mean values showed that amount of new bone formed with OsteoGenR (HA Resorb)™ was slightly more than that obtained by Chitra granules in histometric evaluation. Conclusion: Histological study showed similar healing pattern with both the types of bone graft materials with maturing bone at 3 months and advanced osteogenesis at six months in experimental intraosseous periodontal defects in dogs. However, histological evaluation for longer period is necessary to determine the time taken for complete replacement of the bone graft materials with new bone.

Dentition Status, Treatment Needs and Risk Predictors for Dental Caries among Institutionalised Disabled Individuals in Central India

Binti Rani Chand, Sadanand Kulkarni, Nanjunda Swamy K.V, Yash Bafna
Introduction: Children and adolescents with disabilities appear to have poorer oral health than their non-disabled counterparts. Individuals with disabilities or illnesses receive less oral care than the normal population. Objective: To determine the dentition status, treatment needs and risk predictors for dental caries of the institutionalized disabled individuals. Materials and Methods: A descriptive cross-sectional study was conducted with pre-tested questionnaire among 330 institutionalised disabled individuals in the age range from 3 to 22 years. The Dentition status and treatment needs were assessed by using WHO Oral health Proforma 1997. ANOVA test, chi-square test and backward conditional logistic regression analysis were performed. Results: The mean DMFT for all the groups was 1.26 and the mean deft was 0.59. Backward conditional logistic regression revealed that only age categories and disability types were significantly associated with dental caries. Individuals who were mentally retarded (OR=1.36) and in the age group of 13-17 y (OR=1.91) were more likely to develop dental caries. Conclusion: The findings of the present study showed that overall caries experience was low but the treatment need was high among these institutionalized disabled individuals.

Dental and Skeletal Maturity- A Biological Indicator of Chronologic Age

Vivek Rai, Sonali Saha, Gunjan Yadav, Abhay Mani Tripathi, Kavita Grover
Introduction: Precise evaluation of the developmental stage of a child is not only an integral part of both diagnosis and treatment of paediatric patients; it is also essential in Forensic Medicine and Dentistry. Physiologic age can be estimated by somatic, sexual, skeletal and dental maturity. Aim: Investigate the relationship between the dental age (DA) and skeletal age (SA) of children and comparing it with the chronological age (CA). Materials and Methods: The dental age estimation methods of Schour and Massler (S&M), and Demirjian and Goldstien (D&G) and skeletal assessment methods of Greulich and Pyle (G&P), and Tanner et al., (TW2) were used to analyze the orthopantomograms and hand-wrist radiographs respectively of 150 healthy subjects within the age range of 5-15 y and compared with the Chronological Age. Statistical Analysis: Data collected was statistically analysed using the SPSS version 15.0 Statistical Analysis Software. For all tests p-value of <0.05 were considered statistically significance. Results: Dental age estimation techniques were found comparable and equally reliable as the skeletal age estimation methods. Strong correlations between dental and skeletal maturation were demonstrated.

Evaluation of Antioxidative and Antidiabetic Activity of Bark of Holarrhena Pubescens Wall
Objective: The objectives of the study are to screen out various phytochemicals and to evaluate the antioxidant and antidiabetic potential of the stem bark of Holarrhena pubescens Wall ( Holarrhena antidysenterica ). Materials and Methods: The antioxidant activity was determined by the DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity where ascorbic acid was taken as positive control. The antioxidant property was later exploited and the methanolic extract of plant was tested for antihyperglycemic activity in glucose overloaded hyperglycemic mice. The extract was tested for its hypoglycemic activity at two-dose levels, 250 and 500 mg/kg respectively where Glipizide 5 mg/kg was taken as standard reference drug. All results are presented as mean ± SD (Standard Deviation). Significant differences between experimental groups were determined by Student’s t-test. Results: The methanolic and water extract showed strong antioxidant activity with inhibition of more than 90% DPPH free radicals at the concentration of 100µg/mL. The hypoglycemic activity of methanolic extract on glucose tolerance test were significant (p <0.05) for the effects of 500 mg/kg after 120 min of treatment and (p <0.01) for 250 mg/kg of extract after half hour of treatment compared to control. Conclusion: The presence of flavonoides, phenolic compounds suggested that they may be partially responsible for antioxidant and antidiabetic activity.

Estimation of Recent Transmission of Mycobacterium Tuberculosis Strains among Iranian and Afghan Immigrants: A Cluster-Based Study
Background: Iran has extended borders with high-TB burden countries (Afghanistan and Pakistan) and immigrations of these populations influences TB distribution in the region and threatens the control strategies. The aim of this study was to evaluate the extent of recent TB transmission among Iranian and Afghan cases. Materials and Methods: Spoligotyping and 15-locus variable number tandem repeat (VNTR) typing were applied to genotype 102 MTB isolates (2009 to 2010). Phylogenetic relationships were analysed by two methods: a cluster-graph method and a minimum spanning tree (MST) method. Furthermore, evaluation of recent TB transmission was assessed with three indices including, RTIn, RTIn-1 and TMI. Results: Using molecular typing, 35 different spoligotypes were detected among the studied isolates. Seventy seven cases (75.4%) were distributed into 10 clusters and the remaining 25 (24.5%) isolates had a unique pattern. The cluster sizes also ranged from 2 to 21 isolates. The most frequent spoligotype in our populations belong to Haarlem (n=30, 29.4%) followed by CAS (n= 29, 28.4%) and Beijing (n=16, 15.6%) lineages. The used indices give the following values: RTIn = 0.75, RTIn-1 = 0.65 and TMI = 0.24. Conclusion: The low rate of TB transmission in our findings (24%) showed that the mode of TB transmission in Iran is mostly associated with reactivation of a previous TB infection and that recently a transmitted disease has a minor role. However, the increasing incidence of the intra-community transmission in recent years highlights the need for establishing new strategies for control of TB.

Study of Auditory, Visual Reaction Time and Glycemic Control (Hba1c) in Chronic Type Ii Diabetes Mellitus

Muhil.M, Um apathy Sembian, Babitha, Ethiya.N, Muthuselvi.K

Comparison of Topical Anti- Fungal Agents Sertaconazole and Clotrimazole in the Treatment of Tinea Corporis-An Observational Study
Objectives: To compare the efficacy of topical antifungal agents, Sertaconazole and Clotrimazole in Tinea corporis patients. Materials and Methods: A total of 60(n=60) patients were included in the study. They were divided into two groups of 30 patients each. First group included patients treated with topical Sertaconazole as test drug whereas the second group constituted patients treated with topical Clotrimazole as standard drug. The patients were advised to apply the drug on affected area twice daily for three weeks. The parameters like erythema, scaling, itching, margins and size of the lesion and KOH mount were taken for the assessment of efficacy. This was an open labelled study and patients were followed up every week for three weeks. Results: The total score included all grades in erythema, itching, scaling, margins and size of lesion and KOH mount. There was significant reduction in erythema (p<0.02) and highly significant reduction in scaling (p<0.001), itching (p<0.001) and margins of lesion (p<0.001) among Sertaconazole group. The mean difference and the standard deviation of total scores for Clotrimazole were 7.20 and 1.69 and for Sertaconazole group 8.80 and 1.52 respectively. The p-value on application of students unpaired t- test was p<0.001 (Highly significant). Conclusion: From the present study, it can be concluded that topical Sertaconazole shows better improvement in the clinical parameters than topical Clotrimazole within a span of three weeks in the treatment of T corporis.

Morphometric Study of the Styloid Process of Temporal Bone

Sachin Patil, Suchismita Ghosh, Neelam vasudeva
Objective: Styloid process of temporal bone is clinically important, because variations in length, as well as the angulations of styloid process are associated with the symptoms of stylalgia (Eagle’s syndrome) and the surgical excision of the process could alleviate neck and cervicofacial pain in patients. This study was aimed to evaluate the length, angulation and distance between bases and tips of the styloid process. Materials and Methods: We studied 114 dry skull bones with intact styloid processes. The length of styloid process and distance between bases and tips of the styloid process were measured with the help of vernier calipers. The angulation (anterior and medial angles) of the styloid process was measured directly from the digital images by the image analysis using Adobe Photoshop 7.0 and Image Tool 3.0 Program. A styloid process longer than 3 cm was identified as an elongated styloid process. Results: The means of length of styloid process, distance between bases and tips of styloid process were 2.58 cm, 6.80 cm and 4.65 cm respectively, while means of anterior and medial angles were 62.45o and 74.15o, respectively. Significant statistical difference was seen in anterior angles between groups with normal and elongated styloid processes (p>0.001). Conclusion: Anterior angulation and distance between bases and tips decreased in elongated styloid processes while medial angulation showed no significant change. Our findings highlight the importance of the examination of styloid process in patients with symptoms of stylalgia.

Prevalence of Osteoarthritis of Knee Among Elderly Persons in Urban Slums Using American College of Rheumatology (ACR) Criteria
Introduction: Over the past several decades, the use of drug therapy in COPD has expanded, and provides an optimistic picture. Methyixanthines are used freely in COPD. Of them, Theophylline is an age old bronchodilator and anti-inflammatory agent while Acebrophylline is a newer one. Both are used as add on therapy in management of stable COPD patients on LAMA (long acting muscarinic antagonists like Tiotropium) in present day respiratory practice. This study was designed to compare the efficacy as well as tolerability/side-effects of these two drugs at recommended doses. Materials and Methods: An open randomized comparative longitudinal study was conducted on 40 moderate degree COPD patients over a period of one year. The patients were randomized into Group-1:receiving Acebrophylline 100mg twice daily and Group-2: receiving sustained release (SR) Theophylline 300mg once daily orally, in addition to 18µgm Tiotropium inhalation per day through metered dose inhaler. Spirometric variables, symptomatic benefit and adverse effects were recorded on three visits (day ‘0’, ‘21’ and ‘42’). All the data were analyzed by SPSS version 17. Results: A comparable clinical improvement of symptoms score and spirometric parameters with both the drugs has been observed (p-value>0.05). Amount of sputum, frequency of use of reliever medication and dyspnoea showed improvement with both the drugs but cardiovascular side effects are less with Acebrophylline. Conclusion: This study reaffirms the rationale of use of Methylxanthines as add on therapy with LAMA in COPD management and cardiac safety level with Acebrophylline was considerable.

The Effect of Acebrophylline vs Sustained Release Theophylline in Patients of COPD- A Comparative Study
Introduction: Over the past several decades, the use of drug therapy in COPD has expanded, and provides an optimistic picture. Methyixanthines are used freely in COPD. Of them, Theophylline is an age old bronchodilator and anti-inflammatory agent while Acebrophylline is a newer one. Both are used as add on therapy in management of stable COPD patients on LAMA (long acting muscarinic antagonists like Tiotropium) in present day respiratory practice. This study was designed to compare the efficacy as well as tolerability/side-effects of these two drugs at recommended doses. Materials and Methods: An open randomized comparative longitudinal study was conducted on 40 moderate degree COPD patients over a period of one year. The patients were randomized into Group-1:receiving Acebrophylline 100mg twice daily and Group-2: receiving sustained release (SR) Theophylline 300mg once daily orally, in addition to 18µgm Tiotropium inhalation per day through metered dose inhaler. Spirometric variables, symptomatic benefit and adverse effects were recorded on three visits (day ‘0’, ‘21’ and ‘42’). All the data were analyzed by SPSS version 17. Results: A comparable clinical improvement of symptoms score and spirometric parameters with both the drugs has been observed (p-value>0.05). Amount of sputum, frequency of use of reliever medication and dyspnoea showed improvement with both the drugs but cardiovascular side effects are less with Acebrophylline. Conclusion: This study reaffirms the rationale of use of Methylxanthines as add on therapy with LAMA in COPD management and cardiac safety level with Acebrophylline was considerable.

Health from the Hive: Propolis as an Adjuvant in the Treatment of Chronic Periodontitis - A Clinicomicrobiologic Study

Nehal N Sanghani, Shivaprasad BM, Savita S
Objectives: This study was aimed at the clinical and microbiological evaluation of the efficacy of subgingivally delivered Indian propolis extract as an adjunct to scaling and root planing (SRP) in the treatment of periodontitis. Materials and Methods: Twenty patients diagnosed with chronic periodontitis presenting a minimum of two pockets (probing depth =5 mm) were selected. Sites were assigned randomly into control sites (n=20) which received SRP alone or test sites (n=20) which received SRP and locally delivered propolis. At selected sites, the clinical parameters were assessed and subgingival plaque samples were collected at baseline, 15 days and one month. The samples were cultured anerobically for periodontal pathogens. Results: The results indicated that there was a significant improvement in both clinical and microbiological parameters (p<0.01) in the test sites compared to the control sites at the end of the study. Conclusion: Subgingival delivery of propolis showed promising results as an adjunct to SRP in patients with chronic periodontitis when assessed by clinical and microbiological parameters.

Evaluation of Masseter Muscle Hypertrophy in Oral Submucous Fibrosis Patients -An Ultrasonographic Study
Background: Oral submucous fibrosis (OSMF) is a chronic insidious disease of the oral mucosa, commonly seen in South East Asia. It occurs mainly due to the habit of quid or gutkha chewing. There is a clear dose dependent relationship between gutkha chewing and development of OSMF, also due to continuous chewing for larger intervals of time unnecessary forces are exerted on the muscles mainly the masseter muscle. So, the present study was done to evaluate the thickness of masseter muscle in OSMF patients and to compare it with normal patients. Materials and Methods: The present study involved 50 subjects, 25 OSMF patients and 25 normal individuals. The thickness of masseter muscle was evaluated by ultrasonography (5-11mHz). Results: There is a positive association between masseter muscle hypertrophy and OSMF (p-value 0.001). Thickness of masseter muscle was found to be more in OSMF patients as compared to control group and also thickness is more during contraction as compared to relaxation in both OSMF patients and normal individuals.

Effect of Four Surface Treatment Methods on the Shear Bond Strength of Resin Cement to Zirconia Ceramics- A Comparative in Vitro Study

Varsha Murthy, Manoharan, Balaji, David Livingstone
Background: Improving the retention of zirconia-based ceramics is desirable in order to avoid the failure of crowns and fixed partial dentures. This can be achieved by creating micromechanical retention using surface treatments. Therefore, it becomes necessary to constantly compare and re-evaluate the influence of different surface treatment methods on the bond strength. Aim: To evaluate the effect of four different surface treatments on shear bond strength between zirconia surface and resin cements. Settings and Design: Observational study. Materials and Methods: Twenty five Zirconia plate samples were prepared based on ISO standards and were divided into five groups and each group was subjected to following five different surface treatments: no treatment, sandblasting with 110 ?m alumina, sandblasting with 250 ?m alumina, acid etching with 9.6% hydrofluoric acid and laser radiation on the surface. All the samples were surface disinfected and were embedded in blocks of autopolymerising resin to check shear bond strength on the universal testing machine. Statistical analysis used-data was analyzed using one-way ANOVA and a Post Hoc Bonferroni test. Results: Analysis of the data showed that the highest shear bond strength values were obtained with laser treatment (18.120 ? 0.8159 Mpa). The lowest values were obtained with control group (9.166 ? 0.569 Mpa). Laser treatment increased the shear bond strength values significantly (p<0.05). Conclusion: Surface treatments increased the bond strength between zirconia and resin cement and carbon dioxide laser could be an effective surface treatment for increasing bond strength.

Comparing the Efficacy and Influence on the Quality of Life of Three Classes of Drugs Used in Bronchial Asthma - A Prospective Study
Objectives: To compare the efficacy of formoterol, montelukast and acebrophylline when used in combination with budesonide in patients with bronchial asthma and to determine their role in the improvement of the quality of life of patients. Materials and Methods: A total of 75 patients were divided into 3 groups based on treatment given – formoterol 6 mcg/ puff + budesonide 100 mcg/puff combination inhaler, 2 puffs twice daily; oral montelukast 10 mg once daily + budesonide 100 mcg/puff, 2 puffs twice daily and oral acebrophylline 100 mg twice daily + budesonide 100 mcg/puff, 2 puffs twice daily. The patients were followed-up for 4 wk after initiating treatment. Spirometry values – forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR), before and after treatment were recorded. The quality of life was assessed before and after treatment using Asthma Quality of Life Questionnaire (AQLQ). Analysis was done using repeated measures ANOVA followed by Bonferroni’s post-hoc test. Results: As compared to baseline values, FEV1, PEFR and Quality of Life showed significant improvement in all 3 groups after 4 wk of treatment (p-value < 0.01). Three patients in acebrophylline-treated group reported gastric irritation while no adverse effects were reported in the other groups. Conclusion: Formoterol, montelukast or acebrophylline combined with inhaled corticosteroids have similar efficacy in the treatment of asthma.

Comparative Study of Efficacy of Oral Ivermectin Versus Some Topical Antiscabies Drugs in the Treatment of Scabies

Pramod Kumar Manjhi, Rani Indira Sinha, Manish Kumar, Kumari Indu Sinha
Background: The conventionally used topical antiscabetics have poor compliance. Ivermectin, an oral antiparasitic drug, has been shown to be an effective scabicide and could be a useful substitute. This study was designed to compare efficacy of oral ivermectin with commonly used topical antiscabies drugs. Materials and Methods: This study was conducted on four groups including 60 patients in each group by simple random sampling. Treatment given in each group was: Group 1: Ivermectin (200 µg/kg body weight) oral in a single dose, Group 2: Topical Permethrin 5% cream single application, Group 3: Topical gamma benzene hexachloride (GBHC) lotion 1% single application and Group 4: Topical Benzyl benzoate (BB) lotion 25% single application. All of the patients were followed for improvement in terms of severity of disease and severity of pruritus at the end of 1st wk and 6th wk. Results: Efficacy of ivermectin, permethrin, GBHC and BB lotion considering improvement in severity of pruritus as parameter were 85%, 90%, 75% and 68.33% respectively at 2nd follow-up. Similarly considering improvement in severity of lesion as parameter, results were 80%, 88.33%, 71.66% and 65% respectively at 2nd follow up. Topical Permethrin (5%) was more effective as compared to topical BB lotion and topical GBHC lotion (p<0.05, significant) but statistical difference between efficacy of topical Permethrin and oral Ivermectin was non-significant (p>0.05). Conclusion: The results suggested that oral Ivermectin and topical Permethrin (5%) were equally efficacious. Oral Ivermectin is well tolerated, non irritant to skin, does not show central nervous system side effects because it does not cross blood brain barrier. So, the good therapeutic response with few side effects seen with oral Ivermectin can be useful in those patients for whom topical treatment is potentially irritant and less well-tolerated.

Associated Factors with Male Infertility: A Case Control Study
Objective: Sperm analysis is an important step to evaluate and diagnose male’s infertility. The present study aimed to determine associated factors with males’ infertility by using semen analysis. Materials and Methods: In this study 96 men were evaluated who attended to the infertility clinics of Ilam province, western Iran between May 2010 to May 2011. Semen analysis was done using the Weili Dynamic Sperm Analysis software adapted to the WHO classification. Based on movement and speed characters, sperms were classified to either A, B, C or D classes. Participants were stratified into two groups that called “Oligospermia (OS)” with sperm counts of less than 20 million in mL (n=48) and “Non-Oligospermia (NOS)” with values more than determined cutoff point (n=48). Results: The Mean age ±SD for OS and NOS group were 29.9 ±5.1 y and 31.17 ±5.24 y, respectively (p>0.05). Overall, 62.5% of OS and 31.2% of NOS were clinically infertile (OR=3.6, CI, 1.5-8.5, p=0.01). A significant difference was found between job and live ratio(A+B+C) in NOS group (F=2.8, p<0.05). Conclusion: Prevalence of infertility was higher in the OS men compared to the NOS group. The main risk factors in the OS group were History of Varicocele surgery and residence site of patients that are totally similar to the NOS men. Further case-control studies and clinical trials are recommended to recognize infertility causes in men.

Anatomical Study of Pterygospinous and Pterygoalar Bar in Human Skulls with their Phylogeny and Clinical Significance

Kavitha Kamath. B, Vasantha. K
Background: Pterygospinous and pterygoalar ligaments present at the cranial base may sometimes get ossified leading to the formation of complete or incomplete bony bars in relation to foramen ovale. These are of clinical importance because these may obliterate the foramen ovale causing mandibular neuralgia. They may cause trouble in performing thermocoagulation and anaesthesia for trigeminal neuralgia. They may pose surgical difficulty in approaching the retro and parapharyngeal spaces and hence the anatomy of these bony bars is very important. Materials and Methods: The present study was conducted in 100 dry human skulls of unknown sex to know the incidence, side, degree of ossification (complete/ incomplete) and relation of the pterygospinous and pterygoalar bars to the foramen ovale. Results: Pterygospinous and pterygoalar bars were seen in 41 skulls which were classified into Type I (26.83%), Type II (58.54%) and Type III (14.63%) based on the presence of pterygospinous bar, pterygoalar bar or both together. Pterygospinous bars were seen in 17 skulls of which, one skull (5.88%) had complete and 16 skulls (94.12%) showed incomplete bars. Out of the 30 skulls with pterygoalar bars, complete bar was seen in one (3.33%) and incomplete in 29 skulls (96.67%). These bars were seen more on the left side of the skull than on the right. They were in close relation to the foramen ovale; the pterygospinous bar was inferior or medial to foramen ovale and pterygoalar bar was lateral, inferior or medial to the foramen ovale. Conclusion: The presence of the pterygospinous and pterygoalar bars cause variety of symptoms due to neurovascular entrapment and also obstruct surgical approaches to the base of skull. Hence the anatomical knowledge of these osseous bars is essential for anaesthetists, radiologists, dentists and neurosurgeons to increase the success of diagnostic evaluation and surgical approaches to the cranial base.

Comparative Prevalence of Antimicrobial Resistance in Community-Acquired Urinary Tract Infection Cases from Representative States of Northern and Southern India

Shivani Gupta, Suman Kapur, DV Padmavathi
Context: Urinary tract infections (UTIs) are amongst the most common infections described in outpatient settings. Increased antimicrobial resistance (AMR) of urinary tract pathogens is a matter of global public health concern. Treatment of UTI depends on both prevalence and antimicrobial resistance (AMR) of causative bacteria at any specific geographical location. Aim: This study was undertaken to compare the prevalence of uropathogens and their AMR profile in two different geographical parts of India. Materials and Methods: Clean-catch mid-stream urine samples were collected from adult patients, bacterial flora isolated from human urine was evaluated for antimicrobial susceptibility profile using Kirby Bauer’s disc diffusion method among patients from Hyderabad (Southern India), Rajasthan and Punjab (Northern India). The data were analysed using Chi-square (?2) test, confidence interval (CI), odds ratio (OR) analysis and p-value using SPSS 16 software. Results: Escherichia coli (55.1%) were the most prevalent isolates followed by Enterococcus faecalis (15.8%). Amikacin was the most active antimicrobial agents which showed low resistance rate of 14%. The present study revealed the geographical difference in prevalence of uropathogens with Klebsiella pneumoniae being the second most common uropathogen followed by E. faecalis in the states from northern India while no K. pneumoniae was seen in samples from southern India but E. faecalis was the second most prevalent organism. Conclusion: Therefore, development of regional surveillance programs is highly recommended for implementation of national CA-UTI guidelines in Indian settings.

Anti Hypertensive Prescribing Patterns and Cost Analysis for Primary Hypertension: A Retrospective Study

Rachana Pr, Anuradha Hv, Mc Shivamurthy
Objective: The present study was conducted to analyze the current prescription pattern and cost analysis of antihypertensive drugs in hypertensive patients in a tertiary care hospital. Materials and Methods: A retrospective cross-sectional study was conducted in tertiary care hospital, Bangalore for three months and utilized 300 prescriptions for the analysis. The data analysed from the prescription included patients demographics, stage of hypertension according to JNC VII guidelines, type of drug therapy, class of anti-hypertensive, and cost effectiveness of therapy. Drug acquisition costs was calculated, using the cost of the cheapest available drug and the most commonly prescribed dosage, for each drug on a daily and annual basis. Total annual drug expenditure on buying required doses of all antihypertensive prescribed in the study population for a year was calculated. Results: Monotherapy (48.94%) was leading trends of antihypertensive therapy followed by fixed dose combination (35.04%) and polytherapy (16.01%). The most frequent antihypertensive class to be prescribed were CCBs (38.59%) followed by beta blockers (24.07%). The ranking in terms of cost utilized per year from the highest to the lowest found in this study was: alpha blockers> ACE-inhibitors> ARBs> CCBs> beta blockers > diuretics. The diuretics were most cost-effective (Cost per day: 5.89 ± 2.87; Cost per year: 2129.02 ± 1080.49) in relation to the other antihypertensive prescribed.

Reaction time in Stroop test in Nepalese Medical Students

Nisha Ghimire, Bishnu Hari Paudel, Rita Khadka, P. N. Singh
Background: Stroop test is one of the widely used tests in cognitive psychology. It is used both in healthy population and also in patients to assess the selective attention. The selective attention as assessed by it is also found to be altered in bilinguals. In Nepal, most of the students are bilingual since most of the courses are in English language. Thus, they learn English language along with their native languages. This study is aimed to assess the selective attention in healthy Nepalese medical students. Objective: To study the reaction time in stroop test in medical students of Nepal. Materials and Methods: This study was conducted on 30 healthy male students aged 23.1±2.8 yrs. They were asked to read congruent (red printed in red ink) and incongruent (red printed in blue ink) tests in classical stroop cards. The reaction times for both the tests were calculated. Median with inter-quartile range was obtained for reaction time. Wilcoxon’s Sign Rank Test was used to compare reaction time and errors between congruent and incongruent cards. Results: The subjects took 82.10 (63.75-107.76) sec longer to read incongruent stroop test (p<0.001). The error made was 0 in congruent stroop test and 1.5 (0-3) in incongruent stroop test (p<0.001). No students made error in the congruent test but 60% (18) of students made error in incongruent test (p<.001) and interference percentage in incongruent was 157 (115.32-213.50)%. Conclusion: The reaction time and interferences were more in incongruent stroop test than congruent test. The interference was very high than that of previous literature’s value. This indicates that Nepalese students have delayed attention while performing classical English version of stroop test.

To Ascertain the Utility of Urinary Methyl Malonic Acid as a Potential Marker of Ischemic Heart Failure

Sonal Pruthi, Ankur Singh, Chandrawati Kumari, Ashish Goel, Seema Kapoor
Background: Methyl Malonic Acid (MMA) is known to be an integral component of the cascade of events in mitochondrial energy metabolism and since heart failure involves energy pathways, it is probable that levels of MMA could be used as a reliable biomarker to objectively identify the disease during the early stages and help in prognostication. Materials and Methods: The present study was envisaged to evaluate the relation between urinary MMA levels in patients with Ischemic heart disease and in those progressing to failure. The relationship between the severity of the disease and the level of MMA in urine were also evaluated. Analysis of urinary MMA was done by Gas Chromatography-Mass Spectrometry (GC-MS) using stable isotope dilution. Twenty patients each with Ischemic Heart Disease, heart failure and controls were recruited in this pilot study. Results: The mean value of MMA in patients with IHD was 126.71(±66.3) pmol/L and those with IHF was 390.76 (±97.99) pmol/L with the difference being statistically significant (p<0.001). Co-existing B12 deficiency was excluded as that was a potential confounder. Conclusion: Levels of MMA were significantly higher in patients with heart failure compared to those with IHF, which were significantly higher than controls. Evaluation of the correlation between MMA levels and the stage of the disease did not reach statistical significance; but this requires adequately powered studies to support this preliminary finding.

Application of Bethesda System for Cervical Cytology in Unhealthy Cervix

Indu Verma, Veena Jain, Tejinder Kaur
Introduction: Women presenting with unhealthy cervix needs to be evaluated with Papanicolaou (Pap) smear for epithelial abnormalities. Aim: To detect epithelial cell abnormalities in unhealthy cervix using the 2001Bethesda system of reporting for cervical cytology and to confirm histopathologicaly the findings of Pap smear. Materials and Methods: In this study, 125 women with clinical diagnosis of unhealthy cervix underwent conventional cytology. Cervical biopsies were taken from abnormal areas seen on colposcopy and sent for histopathology. Results: Out of 125 Pap smears, 122 were satisfactory for evaluation (19 normal, 86 negative for intraepithelial lesion or malignancy and 17 with epithelial cell abnormality) and 3 were unsatisfactory (one hemorrhagic and two severe inflammation). Out of 17 (13.60%) cases with epithelial cell abnormality, ASC- US was seen in 6 (4.80%), LSIL in 7 (5.60%), HSIL in 1 (0.80%), squamous cell carcinoma in 1 (0.80%), AGC endocervical in 1 (0.80%) and adenocarcinoma in 1 (0.80%) patients. Cervical biopsy was taken in 67 women. Diagnostic accuracy of Pap smear for preinvasive and invasive disease was 81.15% with overall sensitivity and specificity 78.57% and 88.67% respectively and predictive value of 64.71%. Conclusion: Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. The Bethesda system for cervical cytology reporting should be used universally as it will give a standardized interpretation

Prevelance of Haller’s Cells: A Panoramic Radiographic Study
Background: Infraorbital ethmoid cells, also known as Haller’s cells can be seen on panoramic radiographs. These help in identification of various pathologies and patient symptoms. Objective: To determine the prevelance and characteristic of Haller’s cells on panoramic radiographs. Infraorbital ethmoid cells are extensions of ethmoid air cells into areas of orbit and maxillary sinus. Materials and Methods: This study comprised of 1000 panoramic radiographs of healthy adults of the age 18-80 years. Each radiograph was interpreted for the presence of haller’s cells. The data collected were then tabulated and subjected to descriptive statistics and chi-square test. Results: Haller’s cells were observed in 19.2% patients. Majority of cells were present unilaterally (176 cells) while only 15 were seen bilaterally. Maximum cells were oval in shape, unilocular and single in number. Conclusion: Presence of haller’s cells helps in enumerating the differential diagnosis for orofacial pain and in avoiding surgical complications in endonasal procedures.

Comparative Study of: Non-Invasive Conservative Treatments with Local Steroid Injection in the Management of Planter Fasciitis
Background: Planter Fasciitis is an annoying and painful condition that limits function. There is pain and tenderness in the sole of the foot, mostly under the heel, with standing or walking and is considered a self limiting condition. Symptoms resolve in 80% to 90% of cases within ten months. However, this long interval is frustrating for both patients and clinicians. Aim: This study was undertaken to compare the two different modalities of non operative treatment: Non- invasive conservative methods: NSAID’s, Soft Insoles, Stretching, Ultrasound therapy and Contrast baths versus local Steroid injection therapy. Material and Methods: Patients by random sampling were divided in two groups. Group A as: Conservative group and Group B as Local Steroid Injections group, 100 patients in each. Patients were assessed as per Visual Analogue Scale (VAS) at the start of treatment and then after 4 wk and 8 wk duration on follow up. Statistical analysis used: SPSS for Windows (version 10.0) by the Chi-Square test. Results: The difference in the distribution of subjects belonging to either of the treatment modalities regarding the treatment outcome at four and eight week was found to be statistically insignificant. Conclusion: As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach because this can save the patients from the complications of steroid therapy.

Alterations in Cochlear Function after Exposure to Short Term Broad Band Noise Assessed by Otoacoustic Emissions
Background: Sudden or chronic exposure to sound alters the functioning of cochlea. This results in temporary or permanent alteration of functioning of cochlear cells. Alteration of functioning of outer hair cells (OHC) of cochlea following exposure to noise can be assessed by measurement of transient otoacoustic emissions (TEOAE). Such a measurement is of great clinical importance in early detection of the damage to the OHC. Aim: In this study we aim to study effect of noise on outer hair cell function by studying the changes in TEOAE’s amplitude following exposure to short term broad band noise in healthy volunteers. Materials and Methods: Twenty volunteers’ ten males and ten females participated in the study. They underwent pure tone and impedance audiometry to rule out ear pathology. Then pre-exposure TEOAE’s were recorded. After that they were exposed to broad band noise for two minutes. After gap of five minutes again TEOAE’s were recorded. Pre and post exposure amplitude of TEOAE’s was analysed statistically. Results: There was statistically significant difference between pre exposure and post-exposure amplitude of TEOAE’s. Pre and post exposure values for A & B amplitudes showed p-value of 0.0001 whereas values for A-B amplitude showed p-value of 0.0001. Conclusion: Measurement of TEOAE’s can detect early changes in the functioning of outer hair cells which cannot be picked by routine pure tone audiometry. Thus they can be used in assessing early changes in cochlear function following exposure to noise in individuals exposed to sudden noise or working in noisy environments. Thus preventive methods to reduce the noise induced hearing loss in such individuals can be implemented.

Qualitative Histological Evaluation of Hard and Soft Tissue Components of Human Permanent Teeth Using Various Decalcifying Agents - A Comparative Study

Sonia Gupta, Manveen Kaur Jawanda, Manjunath SM, Achla Bharti
Introduction: Decalcification is the commonly employed technique in histopathology laboratories as a part of calcified tissue preparation for the microscopic examination. Chemical agents are most commonly used for routine decalcification procedures, though some agents adversely affect the tissue integrity and staining properties. Aim: To compare the efficacy of various decalcifying agents by histological evaluation of hard and soft tissue components of teeth. Materials and Methods: The five decalcifying agents namely 10 % Nitric acid (HNO3), 10% Formal nitric acid (FNA), 10 % Formic acid (FA), 8% Potassium formate (KF) + 8% Formic acid (FA) and Neutral Ethylenediamenetetracetic acid (EDTA) were used to decalcify 60 human permanent teeth. The specimens were subjected to routine processing, sectioning and staining with hematoxylin and eosin. The stained sections were observed under light microscope by three independent observers and grading was done. Statistical Analysis: Paired sample t-test was done for inter-observer variation. One-way-ANOVA and Post-hoc test was applied to compare the effects of different decalcifying agents. Results: Considering preservation and staining characteristics of both hard and soft tissues, superior results were obtained with 10% HNO3 followed by 10% FNA and EDTA which was according to the respective mean values obtained. But statistically significant difference was shown only with 10 % FA & 8% KF + 8% FA. Conclusion: HNO3 was showing the most efficient result as it balances both tissue integrity and time factor suggesting that it can be used as a stable decalcifying agent for routine histopathological diagnosis

“Evaluation of the Effect of Ultraviolet Disinfection on Dimensional Stability of the Polyvinyl Silioxane Impressions.” an in-Vitro Study

Surekha R.Godbole, Trupti M.Dahane, Nikita A.Patidar, Sharayu V.Nimonkar
Introduction: Infection control is an important concept in the present day practice of dentistry. The prosthodontists are at an added risk of transmission because of the infection spreading through the contaminated lab equipments while working in the lab. The purpose of this study is to evaluate the effect of UV light disinfection on dimensional stability of polyvinyl siloxane impressions. Materials and Methods: Impressions were made in perforated custom tray. After polymerization of impression, half the samples were disinfected in UV light and remaining samples were not subjected to disinfection and poured in die stone which served as control group. Linear dimensions were measured on the cast with travelling microscope of 0.001accuracy. Result: The result showed that UV light disinfectant showed no significant dimensional changes on impressions. Conclusion: Hence, it can be safely used to disinfect impressions in clinical prosthodontic procedures.

Clinical Evaluation of Papilla Reconstruction Using Subepithelial Connective Tissue Graft.
Objective: The aesthetics of the patient can be improved by surgical reconstruction of interdental papilla by using an advanced papillary flap interposed with subepithelial connective tissue graft. Materials and Methods: A total of fifteen sites from ten patients having black triangles/papilla recession in the maxillary anterior region were selected and subjected to presurgical evaluation. The sites were treated with interposed subepithelial connective tissue graft placed under a coronally advance flap. The integrity of the papilla was maintained by moving the whole of gingivopapillary unit coronally. The various parameters were analysed at different intervals. Results: There was a mean decrease in the papilla presence index score and distance from contact point to gingival margin, but it was statistically not significant. Also, there is increase in the width of the keratinized gingiva which was statistically highly significant. Conclusion: Advanced papillary flap with interposed subepithelial connective tissue graft can offer predictable results for the reconstruction of interdental papilla. If papilla loss occurs solely due to soft-tissue damage, reconstructive techniques can completely restore it; but if due to periodontal disease involving bone loss, reconstruction is generally incomplete and multiple surgical procedures may be required.

Can Metabotropic Glutamate Receptor 7 (mGluR 7) be a Novel Target for Analgesia?
Introduction: The present study was carried out to study the role of metabotropic glutamate receptor 7 (mGluR7) using its agonist, N,N’-bis(diphenylmethyl)-1,-ethanediamine (AMN082) for nociceptive stimuli, in animal models. By conducting this research, we aim to introduce a novel target for acute pain management. Objective: To study the role of metabotropic glutamate receptor 7 (mGluR7), in analgesia, using mGluR7 agonist AMN082 in animal models. Materials and Methods: Swiss albino mice of either sex, weighing 20-30gm were used for the study. The animals were divided into 3 groups with 6 mice in each group: Control or Normal group received 0.5% methylcellulose in normal saline; Standard group received the drug tramadol HCl at 40mg/kg; and test group received drug AMN 082 at 5mg/kg. All the drugs were administered by intraperitoneal route. Hot plate test and Tail flick test were done to evaluate the analgesic effect of the drug. Reaction time for the end points in both the models were noted before drug administration at 0 min and after drug administration at 15, 30,60,90 and 120 min. Statistical analysis was done using One-Way-ANOVA followed by Tukeys post hoc test. p-value was considered significant at = 0.05. Results: The group that received AMN082 showed significantly lesser reaction time compared to normal and standard groups in both the analgesia models. Conclusion: The mGluR 7 stimulation by an agonist AMN082, did not show analgesic effect but induced hyperalgesia in response to thermal nociceptive stimuli.

Anencephaly and its Associated Malformations

Ravikiran Ashok Gole, Pritee Madan Meshram, Shanta Sunil Hattangdi
Introduction: Anencephaly is a serious neural tube defect in which parts of the brain and skull are not developed. But apart from this it is also associated with other malformations which are not related to neural tube in development. Aim: The present study was undertaken to find the associated congenital malformations in western region of India and establish a aetiological correlation. Materials and Methods: The study was conducted using 20 anencephalic fetuses. Results: Nearly 80% of fetuses had associated malformations. Spina bifida was seen in 9 fetuses and cleft palate in 8. Female fetus with cleft palate had other severe associated gastrointestinal and skeletal malformation. Conclusion: In cases of anencephaly other associated malformations like spina bifida and cleft palate are commonly seen.

Common Matrix Metalloproteinases (Mmp -8, -9, -25, and -26) Cannot Explain Dentigerous Cyst Expansion
Objective: Mechanisms of the dentigerous cyst formation from the normal eruption follicle is unknown but disturbances in the proteolytic activity have been suspected, since the growth of these cysts is accompanied by local bone destruction. The aim of the present study was to evaluate the expression of matrix metalloproteinases (MMP) in human dental dentigerous cysts and healthy dental follicles. Study Design: We studied 10 patients with dentigerous cysts and 10 healthy dental follicles from the lower jaw in respect to their immunoexpression of MMPs -8, -9, -25, and -26 and tissue inhibitor of metalloproteinases -1 (TIMP-1). Results: MMP-8 was expressed slightly more in cyst epithelium than in odontogenic epithelium of healthy controls dental follicle but the difference lacked statistical difference. Other MMPs and TIMP-1 did not differ regarding the studied specimens. Conclusion: Differences in MMP expression cannot solely explain the cyst expansion suggesting the potential involvement of other osteolytic mechanisms.

Photoelastic Stress Analysis in Prosthetic Implants of Different Diameters: Mini, Narrow, Standard or Wide
Purpose:This study investigated the biomechanical behavior of screwed partial fixed prosthesis supported by implants with different diameters (2.5 mm; 3.3 mm and 3.75 mm) by using a photoelastic analysis. Materials and Methods: Six photoelastic models were fabricated in PL-2 resin as single crowns or splinted 3-unit piece. Models were positioned in a circular polariscope and 100-N axial and oblique (45 degrees) loads were applied in the occlusal surface of the crowns by using a universal testing machine (EMIC). The stresses were photographically recorded and qualitatively analyzed using a software (Adobe Photoshop). Results: Under axial loading, the number of fringes was inversely proportional to the diameter of the implants in the single crown models. In the splinted 3-unit piece, the 3.75-mm implant promoted lower number of fringes regardless of loading area application. Under oblique loading, a slight increase of fringes number was observed for all groups. Conclusion: The standard implant diameter promoted better stress distribution than the narrow and mini diameter implants. Additionally, the splinted crowns showed a more uniform stress distribution.

Expression of Endoglin (CD-105) and Microvessel Density in Oral Dysplasia and Squamous Cell Carcinoma

Maharudrappa Basnaker, Shashikanth SR, Satish BNVS
Objective: To assess the expression of Endoglin (CD-105) and Microvessel Density in clinically normal oral mucosa of non-tobacco and tobacco habituated patients & also histopathologically confirmed cases of oral squamous cell carcinoma (OSCC) patients. Materials and Methods: Twenty cases of clinically normal oral mucosa with tobacco habituation in the form of chewing or smoking, twenty histopathologically confirmed cases of OSCC and twelve normal healthy oral mucosal cases without tobacco habituation in any form, served as control group, were immunohistochemically analysed for expression of Endoglin (CD-105). Chi-square test is used to determine statistical analysis and significance. Result & Conclusion: The finding of 65% of Endoglin CD - 105 positivity and microvessel density (MVD) in the mucosal specimens of tobacco users may be attributed as neoangiogenesis or angiogenic squamous dysplasia like phenomenon occurring as important pathological biomarker preceding oral cancer development, and may therefore be useful as a predictive marker of malignancy.

Inherent Suppression of Thyroid Stimulating Hormone in Newly Diagnosed Dyslipidemic Patients – Indication for Use of Thyromimetics?

Sridevi.V.Udupa, Vivian D’Souza, Vinit.A.Udupa, Poornima.A.Manjrekar
Background: Dyslipidemia triggers a sequel of metabolic derangements such as insulin resistance, hyperglycemia and oxidative stress via vicious cycle. Dyslipidemia is characterised by elevation of plasma cholesterol, triglycerides (TGs), or both, or a low level of high-density lipoprotein (HDL) which in turn can progress to atherosclerosis a forerunner for ischemic heart disease (IHD). Dyslipidemia is seen even in subclinical hypothyroid patients. Objectives: The aim of the study was to look for thyroid & glycemic abnormalities in dyslipidemic patients and compare it with euthyroid, normolipidemic group. Materials and Methods: Thirty primarily dyslipidemic patients and 30 euthyroid normolipidemic subjects aged 25-55 years were tested for fasting plasma glucose (FPG), fructosamine, lipid profile, thyroid hormones - T3, T4 and thyroid stimulating hormone (TSH). The values were compared with those of age matched euthyroid normolipidemic control group. Results: The dyslipidemic pool showed small but significant decrease in the TSH levels with comparable T3, T4 levels as compared to euthyroid group. The group also had significantly higher FPG, total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) levels and lower high density lipoprotein (HDL) levels as compared to the euthyroid normolipidemic group. The plasma fructosamine levels were similar in both the groups. The observed results reflected a picture of subclinical hyperthyroidism in dyslipidemic patients. Conclusion: The observations of the present study preclude a need to assess the thyroid status in patients of primary dyslipidemia as both conditions per se have an increased risk of cardio vascular diseases. A subclinical hyperthyroid state may essentially be helpful in maintaining the lipid metabolism. The prevailing mild hyperthyroid status also makes it important to reconsider the accuracy of long term glycemic indicators like fructosamine and possibly glycated haemoglobin in these patients. Upon establishment of their efficacy and safety, thyromimetics may have a role in the treatment of dyslipidemia.

Is Low Dose Vaginal Misoprostol Better Than Dinoprostone Gel For Induction of Labor: A Randomized Controlled Trial
Objective: To compare the efficacy and safety profile of low dose vaginal misoprostol with dinoprostone gel for induction of labor in term pregnancies. Methods: The study was conducted at Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital on 100 pregnant women with term pregnancy after application of inclusion and exclusion criteria. The women were randomized in 2 groups of 50 women each. Group I received misoprostol 25µg at every six hour vaginally for a maximum of five doses for induction of labor; while group II received dinoprostone gel 0.5 mg every six hourly for a maximum of three doses. Maternal outcomes such as mode of delivery and induction delivery interval; and fetal outcomes such as APGAR score and incidence of NICU admission were assessed in both the groups. Statistical analysis was done using student t-test and chi-square test. Results: There was no significant difference in the mean induction to delivery interval in both the groups (14.32±0.13 hours in Group I and 14.92±0.18 hours in Group II, p=0.75), mode of delivery, indication of cesarean section and perinatal outcome. However, significant difference was observed in requirement of oxytocin augmentation in both the groups (32% in Group I and 68% in Group II, p=0.005). Conclusion: Vaginal misoprostol in low doses is similar in efficacy and safety to dinoprostone gel for cervical ripening and labor induction in term pregnancy.

Role of Biochemical Investigations and Diagnostic Tools in Detection of Adverse Drug Reactions
Aim of Study: To evaluate the role of biochemical investigations (BI) and diagnostic tools (DT) in ADR detection. Materials and Methods: An observational prospective cross-sectional study was done using suspected ADR data collection form. Results: A total of 2381 ADR related events were recorded in two years. Total number/percentage of biochemical abnormalities (BA) related ADR detection rate was 14.57% and of DT was 1.091% in contrast to 84.33% recorded with clinical presentation. Maximum cases were inward patients (87.13%), 67.02% were recorded by active surveillance. ADR detection rate at one point & detection on follow up was 56.31% Vs 46.38%. ADR detection rate of ECG, endoscopy, X-ray were 0.57%, 0.22%, 0.22% and of CT scan, MRI, DEXA scan, USG and biopsy was 0.04% each. Maximum ADRs were severe/serious, latent and Type-A in nature. Anemia (4.6%), followed by liver dysfunction (2.8%), renal dysfunction, electrolyte imbalance, hyperglycemia (1.1% each), abnormal coagulation profile (1%), decrease platelet count (0.8%), hypoglycemia (0.7%) were the most common BAs. Anti retroviral drugs (ART), tirofiban and methotrexate accounted for anemia, ART and anti tubercular drugs for liver & renal dysfunction, insulin for hypoglycemia, tirofiban, paclitaxel, capecipabine and ifosfamide for thrombocytopenia, hematuria by enoxaparin & dyslipidemia with ART were common ADRs. Conclusion: BI and DT can play very important role in ADR detection.

A Qualitative and Quantitative Analysis of AgNORs in Keratocystic Odontogenic Tumor, Unicystic Ameloblastoma and Multicystic Ameloblastoma
Aims: A comparative evaluation of proliferation activity in unicystic ameloblastoma (UA), multicystic ameloblastoma (MA) and keratocystic odontogenic tumor (KCOT) using silver staining technique. Settings and Design: In the present study 21 histopathologically confirmed paraffin blocks,7 each of UA, MA and KCOT were selected and stained with silver nitrate. Materials and Methods: For quantitative analysis, 100 cells were counted at 1000x magnification for AgNORs and the mean value was calculated. Qualitative analysis of AgNORs included normal (oval shaped) and abnormal groups (bean shaped) in the lesion. Statistical Analysis: The statistical analysis of data was done by a specialist statistician using two way ANOVA and multiple comparisons with Tukey’s test in advanced excel. Results: The AgNOR count was more in KCOT when compared to MA and UA with the pattern of distribution of AgNORs more in basal than in the parabasal layer in KCOT. The qualitative analysis showed small to large oval AgNOR’s in KCOT and few clusters in MA whereas in UA irregular clusters were seen. Conclusion: This concludes the expediency of AgNOR staining in reflecting the high proliferation rate and a more aggressive behavior of KCOT in comparison to MA and UA which signifies requirement of a more hostile surgical approach in KCOT to avoid recurrences following different treatment modalities.

Cytopathological Pattern of Tubercular Lymphadenopathy on FNAC: Analysis of 550 Consecutive Cases

Priyanka Chand, Rajeev Dogra, Nidhi Chauhan, Renu Gupta, Pratima Khare
Background: Fine needle aspiration cytology (FNAC) of lymph nodes is a simple, cost effective, out-patient procedure used for diagnosis of various causes of lymphadenopathies. In tuberculous lymphadenitis, it not only used for the cytological diagnosis but also used for other ancillary testing such as Ziehl- Neelsen staining and AFB Culture. Aims: Our study was designed to evaluate the cytopathological pattern of FNAC aspirate of patients presenting with lymphadenopathy with special reference to tuberculous lymphadenopathy. Materials and Methods: In this study all the patients referred to the cytopathology lab for FNAC of lymph nodes between January 2011 to June, 2013 were included. Out of 1050 patients presenting with lymphadenopathies, there were 550 cases of tuberculous lymphadenitis. The cytopathological findings of these 550 cases were analyzed. Results: A female preponderance was noted in our study with maximum incidence in the 3rd decade. Cervical lymph nodes were the most common nodes to be involved. Gross examination of aspirate showed maximum cases (74.5.2%) of whitish material. Among the four cytological patterns on FNAC, maximum cases demonstrated caseous necrotic material with degenerated inflammatory cells. Ziehl- Neelsen staining showed overall AFB positivity of 44.54%. Maximum AFB positivity was seen in cases having caseous necrosis only. Conclusion: FNAC is a simple, cost effective technique with high degree of accuracy in diagnosing Tubercular Lymphadenitis. Despite certain limitations and pitfalls, FNAC coupled with Ziehl- Neelson staining should be the 1st line investigation in cases with lymphadenopaty, in a developing country with high prevalence rate of tuberculosis.

Electrocardiographic Qrs Axis, Q Wave and T-wave Changes in 2nd and 3rd Trimester of Normal Pregnancy

Sunitha. M., Chandrasekharappa. S, S.V Brid
Background: Pregnancy although a physiological phenomena affects all the functions of the maternal body and brings about remarkable changes in the cardiovascular system. The cardiovascular changes and many of the physiological adaptations of normal pregnancy alter the physical findings thus, sometimes misleading the diagnosis of heart disease. Pregnancy also brings about various changes in the electrocardiogram, further confusing with that of heart disease. This study is undertaken to highlight the effect of normal pregnancy on the QRS axis, Q wave and T-wave of the Electrocardiogram and thereby helps us to distinguish it from that of pathological changes. Objectives: To study the effect of normal pregnancy on the QRS axis, Q wave and T-wave in the electrocardiogram and to compare with that of normal non pregnant women. Materials and Methods: Fifty normal pregnant women in 2nd and 3rd trimester each between 20– 35 y of age and 50 normal non pregnant women of the same age group were selected for the study. A 12 lead ECG was recorded by using ECG machine with special emphasis on QRS axis, Q wave and T-wave changes and all the parameters were analysed. Results: The ECG changes observed in our study include, deviation of QRS axis towards left as pregnancy advanced, significant increased incidence of occurrence of prominent Q waves in lead II, III and avF in pregnant group (p < 0.05 ) and, T-wave abnormalities like flat and inverted T-waves in lead III, V1 – V3 were more frequent in pregnant group ( p< 0.05 ) than in non pregnant group. Conclusion: Normal pregnancy brings about various changes in ECG. These changes during pregnancy should be interpretated with caution by the physicians. It is necessary to understand the normal physiological changes which in turn help us in better management of those with cardiac disease.

Premature Ejaculation – Dose and Duration Dependent Effect of Fluoxetine: A Histological Study on Seminal Vesicle of Albino Rats

Alka Aggarwal, SL. Jethani, RK. Rohatagi, Juhi Kalra
Introduction: Fluoxetine is a prototype drug of Selective Serotonin Reuptake Inhibitors. Its active demethylated metabolite has a half life of 7-10 d. Fluoxetine is used to treat depression and is also prescribed in premature ejaculation. Aim: In the present study dose and duration dependent effects of Fluoxetine on histology of seminal vesicle of the albino rats were observed. Materials and Methods: The present study was conducted on 36 adult male albino rats. Fluoxetine was administered intraperitoneally for 2 wk, 4 wk and 12 wk with mild (10mg/kg/day), moderate (20mg/kg/day) and severe doses (40mg/kg/day). Histological slides of Seminal vesicle were prepared and stained with Hematoxylin and Eosin stain. Results: On examination through the light microscope, the proliferation of primary, secondary and tertiary villi, increased crypt/alveoli, increased thickness of lamina propria, decreased epithelial cell height, metaplasia, changes in the amount of luminal eosinophilic secretory material in the form of scanty secretion in lumen of seminal vesicle. Conclusion: Low doses for long duration and high doses for short duration of Fluoxetine produce histological changes in seminal vesicle of albino rats.

Diagnostic Accuracy of High Resolution Ultrasound to Differentiate Neoplastic and Non Neoplastic Causes of Cervical Lymphadenopathy
Introduction: Lymph nodes are normal structures distributed throughout the human body and are enlarged in various disease entities. Identifying the relevant lymph nodes is important in treating these patients. High resolution sonography (HRSG) and fine needle aspiration cytology (FNAC) play crucial role in planning the treatment. Objective: To assess the diagnostic accuracy of HRSG differentiate neoplastic and non neoplastic causes of enlarged cervical lymph nodes. Materials and Methods: HRSG evaluation of enlarged cervical lymph nodes were performed to differentiate neoplastic from non neoplastic lymph nodes followed by FNAC correlation and the accuracy of HRSG was studied. Results: One hundred and fourteen lymph nodes of 106 patients were analysed to accomplish the study objective. In our study, HRSG had 96% sensitivity and 90.6% specificity for differentiating between neoplatic and non-neoplastic cervical lymphadenopathy. Similarly positive and negative predictive values were 88.9% and 96.7% respectively. Overall accuracy of HRSG was 93%. Conclusion: Owing to high sensitivity and negative predictive value, HRSG with Doppler is an excellent first line investigating tool for enlarged lymph nodes and avoids invasive procedures like FNAC in cases of reactive/ inflammatory (non-neoplastic) lymph nodes. However, neoplastic diagnosis of HRSG needs further confirmation by FNAC.

Extra Corporeal Fixation of Fractured Mandibular Condyle
Condylar fracture is the second most common site in the mandibular fractures. Motor vehicle accident and fall are the major causes of such fractures. Because of the anatomical weakness of the condyle and the shape of the condylar head the antero-medial dislocation of the condyle is common. Open reduction and closed reduction is always debatable. The open reduction will bring back the normal function much earlier than closed reduction. Medially dislocated condylar fracture fragments are always managed with open method. In superior or high condylar fractures,exact reduction with conventional open reduction can be difficult due to the limited surgical and visual fields. In such cases extracorporeal fixation of condyle using vertical ramus osteotomy may be better choice to achieve perfect alignment and absolute maintaince of vertical height of the ramus and facial symmetry. We here present a case of extracorporeal fixation of unilateral left high condylar fracture.

Warthin’s Tumour: A Case Report and Review on Pathogenesis and its Histological Subtypes

Raghu A R, Shweta Rehani, Kundendu Arya Bishen, Shitalkumar Sagari
Warthin’s tumour/ Papillary cystadenoma lymphomatosum (PCL) constitutes a minority of salivary gland neoplasms and it is a monomorphic adenoma which primarily involves the parotid gland. Warthin’s tumour shows multiple cysts that have numerous papillations covered by bilayered columnar and basaloid oncocytic epithelium. The connective tissue portion shows proliferation of follicle- containing lymphoid tissue which necessitates careful distinction for diagnosis. Although, Warthin’s tumour presents as a clinically benign, slow-growing, usually asymptomatic lesion with low rates of recurrences and malignant transformation, but still this tumour is considered unique because of its histological appearance and unknown origin and pathogenesis. Here, we report a case of Warthin’s tumour of five years duration in a 50-year-old male patient in the right parotid gland and also review and discuss various concepts concerning the development of this tumour along with a comprehensive literature on its clinic-pathologic features.

Bilateral Absence of Musculocutaneous Nerve: A Case Report

Aniruddha Sarkar, Anubha Saha
Detailed knowledge of course and distribution of nerves in the axilla and arm is very important in the management of nerve injuries particularly in case of their variations. Bilateral absence of the musculocutaneous nerve was found during routine dissection in a male cadaver. The dissected part was cleared to see the distribution of the muscles of the arm. The muscles of the flexor compartment were supplied by the median nerve, instead of the musculocutaneous nerve. The present case report of this anatomical variation of the nerves should help in management of nerve injuries in the axilla or the arm.

Morganella Morganii Causing Abscess Over the Anterior Chest Wall- A Case Report

Vijaya D, Sathish JV, Yashaswini MK, Sulaiman S
A 17-year-old female college student presented with recurrent abscess over the anterior chest wall since one and half year. Morganella morganii was isolated from the aspirated pus. Patient was started on oral ciprofloxacin and the lesion resolved in two weeks.

Zolpidem Induced Hyponatremia: A Case Report

Shanmuga Priya S, Britto DL, Saravanan T
Zolpidem is a non-benzodiazepine hypnotic that acts by binding to GABAA receptor. This is a case report of a patient with chronic insomnia for which he had initially been receiving benzodiazepine hypnotic alprazolam and for the past three years, he had switched himself to non-benzodiazepine hypnotic, zolpidem and had progressively increased the dose to 20 mg. The patient presented with history of drowsiness, nausea and vomiting of short duration. Investigations revealed that the patient had hyponatremia. Decreased serum sodium, elevated urine sodium with normal urine osmolarity was detected. Therefore, we report this as a case of drug induced syndrome of inappropriate antidiuretic hormone (SIADH) as other likely causes were ruled out by appropriate investigations. The causality assessment was done according to the WHO scale and found to be “Probable”.

Giant Inguinoscrotal Hernia Repaired by Lichtensteins Technique Without Loss of Domain -A Case Report

Dinesh HN, Jagadish Kumar CD, Shreyas N
Giant inguinal hernia is a formidable surgical problem. It is defined as inguinal hernia extending up to mid thigh or below in standing position. Giant inguinal hernia is usually associated with compromised quality of life due to sexual discomfort and constant weight bearing. It is a challenge for the operating surgeon since it is rare. It may require multistage repair with recurrence being common. A 45-year-old male patient presented with Giant inguinal hernia and compromised quality of life due to pain and sexual discomfort. Lichtenstein’s polypropylene mesh repair was done after reducing the sac contents (omentum and transverse colon) with partial omentectomy. There was no loss of intra-abdominal domain. Postoperative period was uneventful. In literature many techniques are available to increase the intra-abdominal cavity (a) Creating progressive preoperative pneumoperitoneum (b) Creation of ventral wall defect (c) surgical debulking of hernia contents. Recurrence is prevented by reconstruction of the abdominal wall using Marlex mesh and a Tensor fasciae lata flap. Laparoscopic repair is associated with more recurrence. Lichtenstein’s technique is one of the preferred treatments.

Koch’s Disease Presenting as an Isolated Testicular Mass- An Unusual Occurance

Rachna lamichaney, Deepak Das, Mingma Sherpa
Isolated testicular tuberculosis (TB) is rarely seen. A 72-year-old, farmer presented with complaints of discharging sinus from scrotum along with pain and swelling. The patient had no sign of tuberculosis. On examination a hard mass arising from the left testis was noted along with a discharging fistula on the overlying scrotal skin. Chest x-ray and ultrasound examination of the abdomen were within normal limits. After assessing the testicular mass, an informed consent was taken thereafter left orchiectomy and fistulectomy performed. Histopathological examination revealed caseating granulomas along with numerous Langhan’s giant cells consistent with tuberculous orchitis. The patient received anti-TB treatment for six months. The rare involvement of testis by tuberculosis needs to be mentioned.

Haemoglobin S Interaction with Beta Thalassaemia- A Case Report from Assam, India

Mauchumi Saikia Pathak, Monalisha Saikia Borah, Dulal Kalita
Interaction of Hb S with beta thalassaemia is being reported here as this type of case is rare. Hb S ( ß 6 glu ? val) is a genetic disorder which occurs due to beta globin gene mutation of haemoglobin. In India, the Hb S is prevalent in the central part, in the eastern, western and southern tribal belt regions and among the tea tribe communities of Assam. The Hb S carriers (Sickle cell trait) leads a normal life but the Sickle cell disease patients show certain clinical manifestation like joint pain, anaemia and jaundice. The HPLC report of the patient showed Compound heterozygous for Hb S- ß thalassaemia. The complete blood count was measured in automated haematology analyser. Mu - tational pattern of the beta thalassaemia as well as the presence of Hb S gene was detected by PCR. The case showed severe clinical manifestations and transfusion was required due to inheritance of the IVS 1-5 G ? C ß - thalassaemia mutation with the Hb S gene.

Complete Occlusal Rehabilitation of Patient with Radiation Caries – A Case Report

Zishan Rashid Dangra, Mahesh Arvind Gandhewar
One of the most distressing and dramatic causes of xerostomia is radiotherapy for the cure of maxillofacial and neck carcinomas. Patient with radiotherapy induced xerostomia presents with challenges in prosthodontic management and in unique radiation caries control. This clinical report illustrates step by step execution of complex treatment planning that lead to successful outcome in 34-year-old man, who had been treated with Radical Neck Dissection (RND) and therapeutic radiotherapy for squamous cell carcinoma of tongue and due to radiation caries, was presented with chief complaint of difficulty in mastication. Rehabilitation was carried out with metal-ceramic fixed restorations and cast removable prostheses after extensive endodontic intervention. This article also discusses the maintenance strategies for radiation caries patient requiring complete occlusal reconstruction, who certainly presents with special needs in post- treatment management.

Revascularization of Immature Mandibular Premolar with Pulpal Necrosis - A Case Report

S.Murali Krishna Raju, Sarjeev Singh Yadav, Sita Rama Kumar .M
This case report describes the Revascularization of a Permanent Immature Mandibular Premolar with Pulp Necrosis and apical periodontitis. Access opening was done & the canal was disinfected with copious irrigation using 2.5% NaOCl and triple antibiotic paste (Ciprofloxacin, Metronidazole, and Minocycline) as intracanal medicament. After the disinfection protocol is complete, it is followed by revascularization procedure. The apex was mechanically irritated to initiate bleeding into the canal to produce a blood clot to the level just below the level of cementoenamel junction. Mineral trioxide aggregate was placed over the blood clot followed by bonded resin restoration above it. After one year follow up; the patient was asymptomatic, no sinus tract was evident. Apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls.

Management of Complicated Crown Fracture and Associated Impacted Mesiodens- Case Report with 3yrs Follow-up

Victor Samuel A, Mahesh R, Mohit Gupta Y
Mesiodens being the most common type of supernumerary tooth, usually results in malocclusion, poor aesthetics and cyst formation if it is not corrected. The management protocol involves surgical removal. The situation can be complicated in young permanent dentition where there are a lot of chances of damage to the permanent dentition during surgical removal of impacted teeth. This article reports a case of impacted mesiodens which was diagnosed during management of complicated crown fracture. The case was followed up to 3years which showed a good bone formation. The article highlights the need for regular follow-up after surgical removal of impacted teeth in young children, to see any changes or damage in the developing permanent teeth.

A Rare Presentation of Os Odontoideum with Multiple Vertebral Fusion in Type III Klippel–Feil Syndrome (KFS) – A Case Report

Shabana Begum, Tanushree Roy, Tanwi Ghosal(Sen), Indrajit Gupta
An abnormal atlas and axis with presence of os odontoideum and fusion of multiple vertebrae were noted in an intact skeleton, in the osteology museum of the Department of Anatomy of North Bengal Medical College, West Bengal, India.These multiple abnormalities at various levels along with increased thickness of antero-posterior arch of atlas pointed towards the congenital nature of the anomalies, possibly due to Klippel-Feil syndrome (KFS). These unusual findings denote a developmental background of the manifestations.The cervical instability, resultant neurodeficit and impairment of quality of life of the affected individuals, which are inherent in such cases, reveal their clinical importance

Tracheobronchial Amyloidosis- A Series of Two Cases

Kavita V, Palak D. Raiyani, Sunil S.Vyas
Amyloidosis is a rare disorder characterised by accumulation of insoluble fibrillar proteins in extracellular space. Respiratory amyloidosis presents as two tracheobronchial forms (local and diffuse) and two parenchymal forms (nodular and diffuse), of which diffuse tracheobronchial amyloidosis is the least common. We herein present two cases of tracheobronchial amyloidosis.

Adrenal Cortex Heterotopia in an Undescended Testis–A Case Report

Thulasi Raman R, Revathi Sree R, Hemanathan G, Nerune M. Savitri, Anuradha S
Heterotopic adrenal cortex is usually found in the kidney, retroperitoneum and spermatic cord. It is common among pediatric age group and rarely encountered in adults. Our case presented with swelling in the right inguinal region with on and off dragging pain. On clinical examination testis was absent in the right scotal sac which was confirmed with ultrasonogram. The clinical diagnosis was right side undescended testis. Orchidectomy was performed and on microscopic examination we incidentally found out an ectopic adrenal cortical rest in the rete testis with atropic changes in the testis. Though the ectopic adrenal tissue was indolent in our case, literature suggests that it can undergo transformations like hyperplasia, adenoma and carcinoma, leading to undesirable complications. We present this case for the rarity at this age and site, and for the awareness that it may cause complications if left untreated.

Perforated Duodenal Ulcer –A Rare Cause of Acute Abdomen in Pregnancy

Bharti Goel, Jyotsna Rani, Anju Huria, Pratiksha Gupta, Usha Dalal
Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind while dealing with cases of acute abdomen in pregnancy and to proceed with multidisciplinary approach for better feto-maternal outcome.

Button Battery Ingestion- Case Report and Review

SS Kalyanshettar, SV Patil, Gaurav Upadhye
Over the last few years there is a rise in use of button batteries in various toys and other electronic gadgets. Easy availability and small size of these batteries pose a significant risk of ingestion in small children. Button battery ingestion can lead to serious health hazards very rapidly. A case of button battery ingestion is presented in this paper.

Electrocautery Assisted Harvesting of Free Gingival Graft to Increase the Width of Attached Gingiva - An Uncommon Case Report
Procuring a free gingival autograft for the purpose of gingival augmentation has been advocated in areas of inadequate width of attached gingiva that result in gingival recession and/or accumulation of local factors. As obtaining the graft from the palatal donor site with conventional scalpel techniques can result in problems such as prolonged bleeding, increased surgical time and patient discomfort, alternative methods have been advocated to procure such grafts using lasers and electrocautery. This case report elaborates, a free gingival graft harvested for the purpose of increasing the width of attached gingiva using electrocautery principles. The parameters assessed included the extent of patient reported discomfort at the donor site and clinical gain of keratinized and attached gingival width.

Parry-Romberg Syndrome: A Case of Late Onset with Rapid Progression

Senthil Kumar, Dinesh Kumar, Ramesh Kumar, Raj Kumar, Ramachandraprabhakar
Parry–Romberg syndrome (PRS) or progressive hemifacial atrophy is rare, poorly understood condition with an unclear aetiology and characterized by slow and progressive atrophy affecting one side of the face. PRS is a syndrome with diverse presentation and the most common early sign is a painless cleft, the “coup de sabre” near the midline of the face which marks the boundary between the normal and atrophic tissues. Characteristically, the atrophy starts in the first decade of life and progresses slowly for several years before it becomes quiescent. This article describes a case of PRS in a 19-year old female patient affecting the right side of the face which is unique in the fact that it had a late onset with rapid progression.

Restoring the Lost Functional Harmony in A Mutilated Dentition using Hobo’s Twin Stage Concept of Full Mouth Rehabilitation
Reorganization of an occlusion in a mutilated dentition is the most challenging task which is ever faced by prosthodontists. An occlusal rehabilitation, though it is common, is the most complex treatment procedure which is widely practised in treating severely worn out dentitions, developmental anomalies, acquired defects, ill fitting, long span fixed partial dentures and TMJ disorders. Various factors such as vertical dimension of occlusion, centric relation, occlusal contact pattern, aesthetics and phonetics need to be considered simultaneously for both anterior and posterior teeth during occlusal rehabilitations. Different schools of thoughts have been documented for rehabilitation of such cases and the choice of the treatment plan depends on the skill and experience of the clinician. This clinical report describes the full mouth rehabilitation of a severely worn out dentition, in functional harmony with the stomatognathic system. Hobo?s Twin-stage procedure was adopted to produce a definite amount of disocclusion during eccentric movements.

Case Report and Literature Review of Carbapenem Resistant Shewanella Putrefaciens Isolated from Ascitic Fluid

Frincy Khandelwal Baruah, Rajesh Kumar Grover
Shewanella species are Gram-negative, non-fermentative, oxidase positive, motile bacilli with the major phenotypic characteristic of production of large amounts of hydrogen sulfide. Shewanella putrefaciens, primarily considered to be an environmental bacterium, is infrequently recovered from clinical specimens. Herein, we report a case of ascitic fluid infection with carbapenem resistant Shewanella putrefaciens in a patient with underlying liver disorder requiring repeated ascitic fluid tapping. Proper antibiotic therapy helped in complete recovery of the patient.

Hypersensitivity Reaction Associated with Abacavir Therapy in an Indian HIV Patient – A Case Report
Shewanella species are Gram-negative, non-fermentative, oxidase positive, motile bacilli with the major phenotypic characteristic of production of large amounts of hydrogen sulfide. Shewanella putrefaciens, primarily considered to be an environmental bacterium, is infrequently recovered from clinical specimens. Herein, we report a case of ascitic fluid infection with carbapenem resistant Shewanella putrefaciens in a patient with underlying liver disorder requiring repeated ascitic fluid tapping. Proper antibiotic therapy helped in complete The most important and unique adverse effect of abacavir (ABC) is fatal hypersensitivity reaction (HSR). The objective of this report is to describe a case of ABC induced HSR that occurred in an Indian HIV patient during treatment. Although this adverse effect is not uncommon, it is perhaps underreported or has never been reported so far in an Indian case scenario. A 44-year-old known case of HIV-1 was admitted in view of his worsening condition and very low CD4 cell counts 3 cells/?L. He was on anti-retroviral therapy since three years but not regular. On the basis of treatment failure, non-compliance and progressive low CD4 counts, the anti HIV regime was switched over to abacavir 600 mg+ atazanavir/ ritonavir 300mg/100mg Two weeks after ABC therapy he presented with maculopapular rash, headache and signs of hepatic damage (serum AST, ALP and ALT increased to 3-4 fold) suggestive of hypersensitivity reaction. As we know discontinuation of the drug is the ultimate litmus test to confirm diagnosis of drug induced adverse reaction. We did confirm ABC induced HSR by de-challenge wherein, rash disappeared within 2-3 days and LFT came back to normal within 5 days disappeared within 2-3 days and LFT came back to normal within 5 days. However, no rechallenge was done. HSR was more in favour of ABC because atazanavir failed to produce any similar reaction after re-challenge.recovery of the patient.

Multiple Splenic Artery Aneurysms: A Rare Cause of Extrahepatic Portal Hypertension and Massive Splenomegaly

Akshatha Rao Aroor, Rama Prakasha S, Raghuraj U Nazir Rahim Attar
A 39-year-old nulliparous female was admitted with massive splenomegaly. Computed tomography of abdomen revealed multiple aneu - rysms in the distal half of the splenic artery. Splenic artery aneurysms are rare in nulliparous women and most cases are reported in females with a past history of pregnancy. Splenic artery aneurysms, though very rare are clinically significant as they have a high propensity for fatal rupture. Here, we report a patient with multiple splenic artery aneurysms presenting as extrahepatic portal hypertension and massive splenomegaly.

Symmetrical Peripheral Gangrene Following Snake Bite

Minal Shastri, Mital Parikh, Dwijal Patel, Ketan Chudasma, Rushad Patell
SPG (Symmetrical peripheral gangrene) is defined as symmetrical distal ischemic damage at two or more sites in the absence of large vessels obstruction. It has been ascribed to a number of infectious and non infectious conditions including connective tissue, cardiovascular, neoplastic and iatrogenic causes. We report a unique case of SPG in a 35-year-old Indian female who developed spontaneous gangrene of the distal phalanges of the right and left index, middle, ring and little fingers and the distal phalanges of all toes of the right and left foot following a snake bite. There have been very few cases of peripheral gangrene and acute renal failure associated with snake bite in literature.

Embryonal/Fetal Subtype Hepatoblastoma: A Case Report

I Spyridakis, C Kepertis, V Lampropoulos, V Mouravas, A Filippopoulos
Hepatoblastoma is the most common primary liver tumor of childhood and after neuroblastoma and nephroblastoma the third most common abdominal neoplasm in this age group. Hepatoblastoma is an embryonal tumor classified by histology as epithelial (including pure fetal subtype, mixed embryonal/fetal subtype, macrotrabecular subtype and small cell undifferentiated subtype), mixed epithelial and mesenchymal type (with teratoid and non-teratoid features) and hepatoblastoma not otherwise specified. We present a case of a five-months old girl with embryonal/fetal subtype hepatoblastoma. The clinical presentation was asymptomatic abdominal mass. Ultrasound and MRI scan demonstrated a solid hepatic tumor. She presented thrombocytosis and serum alpha-fetoprotein was increased. A left lobe hepatectomy was performed and the pathological examination revealed complete excision of a mixed embryonalfetal subtype hepatoblastoma.

Tandem Rhomboid Flap Repair: A New Technique in Treatment of Extensive Pilonidal Disease of the Natal Cleft

Naveen N, Kamal Kumar M, Ramesh Babu K, Prema Dhanraj
Pilonidal sinus is an annoying chronic benign disease causing disability in young adults, mainly affecting the intergluteal furrow. Treatment of this condition remains controversial and is represented by a myriad of techniques available. Most of the techniques are judged against open excision and secondary healing in terms of minimizing disease recurrence and patient discomfort. More recently superiority of flap reconstruction to non-flap techniques is accepted. An ideal operation should be simple, associated with minimal pain and wound care after surgery, minimize hospital stay and have a low recurrence rate. We hereby present a new type of rhomboid flap technique for an extensive pilonidal sinus disease. This technique has given good results in our hands considering the aforementioned factors of an ideal operation. The following case report is of our first stint with the procedure.

Acute Abdomen Due to Penicillium Marneffei: An Indicator of HIV Infection in Manipur State
Opportunistic infection in HIV disease often present to clinicians in an atypical manner testing clinical acumen. Here, we report a case of Penicilliosis marneffei (PM) infection presenting to surgical emergency as acute abdomen with undiagnosed HIV status in advanced AIDS, chief complaints being prolonged fever and diffuse abdominal pain. Radiologic imaging showed non-specific mesenteric and retroperitoneal lymphadenopathy. Fine needle aspiration cytology (FNAC) of the lymph node was done and subjected to direct microscopy, gram staining and culture on Sabouraud’s dextrose agar (SDA) which showed Penicillium marneffei. He was then treated with intravenous amphotericin. This case is reported for its rarity and unusual presentation to sensitise clinicians and microbiologists to consider PM as an aetiology in acute abdomen in high risk individuals, more so, in patients from north-east India.

Non Puerperal Uterine Inversion in A Young Female- A Case Report

Setu Rathod, Sunil Kumar Samal, P Pallavee, Seetesh Ghose
We report a case of 28-year-old, primipara who presented with complaints of mass descending per vaginum along with excessive bleeding and foul smelling vaginal discharge for the past six months. Clinical examination revealed an inverted uterus, cervix and vagina with a large submucosal fundal fibroid. A diagnosis of non-puerperal uterine inversion was made. Surgical management included vaginal myomectomy with repositioning of the uterus using an abdomino-vaginal approach and a successful outcome. Histopathology confirmed the diagnosis of leiomyoma. Hence, we conclude that uterus-sparing surgery should be considered in young females desirous for future pregnancy until the final pathology is known.

Synchronous Presentation of Chronic Myeloid Leukemia with Carcinoma Penis: A Rare Presentation
We report here a case of 52-year-old male presenting with penile ulcer. On evaluation, he was diagnosed to have Carcinoma penis with concurrent CML in chronic phase. Clinical examination showed pallor, bilateral inguinal lymphadenopathy, bilateral pitting pedal oedema and hepatosplenomegaly. He was diagnosed to have chronic myeloid leukemia based on peripheral smear examination showing raised counts with shift to left and fluorescence in situ hydridisation (FISH) showing t (9:22). The ilio-inguinal block dissection specimen showed inguinal metastasis of squamous cell carcinoma (SCC). This case is being presented here in view of the rarity in combination of CML with another malignancy.

A Prosthodontic Management of Severely Resorbed Anterior Ridge Defect - A Case Report

Rathika Rai, Menaga V, Prabhu R, Geetha Kr, Suprabha R
The Dental profession has devoted most of its history to restoring the effects of dental disease. The public’s interest in Dental health and beauty has become an engine that continues to drive the demand for cosmetic dental procedures. In the past, achieving a beautiful smile required submission to extensive invasive procedures and expensive fixed dental prosthetic restorations. Advancements in restorative ma - terial formulations and adhesive technology have expanded such possibilities. Despite many recent advances in aesthetic dentistry techniques and materials, certain cases remain difficult to restore. Replacing missing anterior teeth presents a serious challenge to the clinicians especially with a large ridge defect. Such cases require not only replacement of the missing teeth but also the restoration of the bone defect, aesthetics and phonetics. While the conventional treatment approaches like fixed partial denture or an option of implant may not justify the restoration of the defects. A combination of fixed and removable restoration provides good alternative. The aim and purpose of this case report is to describe a multidisciplinary approach of managing a patient who reported with a similar com - plaint of missing anterior teeth with anterior ridge defect hoping to get not only her teeth but also her lost smile.

Lymphangioma of the Tongue - A Case Report and Review of Literature

Usha V, T. Sivasankari, S. Jeelani, G. S. Asokan, J. Parthiban
Lymphangiomas are benign tumours resulting from a congenital malformation of the lymphatic system. They are relatively uncommon and usually diagnosed in infancy and early childhood. Commonly located at head and neck, they rarely occur in the oral cavity. Intraoral lymphangiomas occur more frequently on the dorsum of tongue, followed by palate, buccal mucosa, gingiva, and lips. Lymphangioma of the tongue is a common cause of macroglossia in children associated with difficulty in swallowing and mastication, speech disturbances, airway obstruction, mandibular prognathism, openbite and other possible deformities of maxillofacial structures. We present the case of a 13-year-old female with lymphangioma of tongue. The clinical, radiological, and treatment modalities of this case are discussed.

Primary Laryngeal Neuroendocrine Carcinoma – A Rare Entity with Deviant Clinical Presentation

Hemalatha A. L, Anoosha K, Amita K, Vijay Shankar S, AvAvadhani Geeta K
Primary laryngeal neuroendocrine carcinomas are rare neoplasms. WHO classifies them under five categories of which, the moderately differentiated neuroendocrine carcinoma is synonymous with atypical or malignant carcinoid tumour. We report a rare case of primary laryngeal neuroendocrine carcinoma with an unusual and misleading clinical presentation. The initial cytological diagnosis of secondary neuroendocrine carcinoma in the cervical lymph node led to the suspicion of primary neuroendocrine carcinoma in the larynx.

FATCO Syndrome Variant – Fibular Hypoplasia, Tibial Campomelia and Oligosyndactyly – A Case Report

Navendu Goyal, Randeep Kaur, Manu Gupta, Shiraz Bhatty, Rajesh Paul
The word aplasia/hypoplasia is used for partial or total absence of a bone. Fibula, a lower limb bone is one of the most common to be involved with this and its incidence is amongst the highest in long bone deficiencies. FATCO syndrome consisting of fibular aplasia, tibial campomelia and oligosyndactyly has been described in the literature but only one has been reported from India as per our literature review. However, it is important to know multiple regional involvement can occur along with this syndrome and prove to be a major difficulty for the child and the parents both. Due to the rarity of reports on this rare syndrome and difficulty in treatment it is important that each such case should be described to make the management easier.

Single Anterior Tooth Replacement by a Cast Lingual Loop Connector - A Conservative Approach

Shilpa Sudesh Dandekeri, Savita Dandekeri
One of the most challenging and complex treatment modality is replacement of single anterior tooth. This can be overcome by different treatment options such as implant-supported restorations as well as conventional porcelain-fused-to-metal and resin-bonded fixed partial dentures. Drifting of teeth into the edentulous area may reduce the available pontic space; whereas a diastema existing before an extraction may result in excessive mesiodistal dimension to the pontic space. Loop connector fixed partial denture (FPD) may be the simplest and best solution to maintain the diastema and provide optimum restoration of aesthetics. This article describes the procedure for the fabrication of a loop connector FPD to restore an excessively wide anterior edentulous space in a patient with existing spacing between the maxillary anterior teeth.

Sylvian Fissure Dermoid Cyst - A Rare case

Deepak Anand, Simmi Aggarwal, Divya Soin, Ravinder Garg
Intracranial dermoid cysts are rare tumours which usually occur in the midline. Sylvian fissure is a very unusual site for this lesion. This case presents a patient with unruptured dermoid cyst in the left sylvian fissure who was operated successfully without any residual deficit.

Dedifferentiated Chondrosarcoma of Temporomandibular Joint: Atypical Features of a Rare Case

Rachna Rath, B. K. Das, Manas Baisakh, S. N. Das
Chondrosarcoma (CS) is an uncommon malignant mesenchymal tumour showing cartilaginous differentiation which rarely presents in the jaws. CS represents 10-20% of all malignant bone tumours and less than 5% of tumours in head and neck region. Among the infrequent subtypes of CS, dedifferentiated CS is a sinister variant that presents with singular features and has extremely poor prognosis. We report a unique case of dedifferentiated CS that presented in the temporomandibular joint (TMJ) with extra articular involvement of the infratemporal space. This high grade CS is reviewed due to its rarity and the dentist is implored to take this variant into account when considering the differential diagnosis of destructive TMJ lesions.

An Infiltrative Angioarchitectural Variant of Arteriovenous Malformation of Temporalis
Vascular anomalies of the head and neck region pose a certain diagnostic and therapeutic paradox. Management of arteriovenous malformations (AVM) is a challenge owing to the presence of abnormal vascular communications and high recurrence. We report a case of a 19-year-old male patient, who presented with diffuse swelling in the right temporal region. Magnetic Resonance Angiography (MRA) suggested it to be an AVM in the temporalis muscle, having afferents in the ascending pharyngeal artery, with cavernous angioma. Surgical excision of the lesion was carried out under carotid control. Histopathology of the excised specimen utilizing special stains confirmed the presence of AVM. An absence of distinct nidus concomitant along with the exuberant proliferation of capillaries between the muscle fibres suggested it be an infiltrative angioarchitectural variant. The present case highlights significance of diagnosing AVM in temporalis muscle which is a rare occurrence in head and neck region. Also, the importance of ruling out other closely resembling vascular diathesis, both non neoplastic and malignant is discussed.

Malignant Adenomyoepithelioma of Breast Masquerading as Soft Tissue Lytic Lesion of Right Iliac Bone: A Rare Entity

Kalyani R., Srinivas Murthy V.
Adenomyoepithelioma (AME) of breast is a low grade malignant biphasic tumour, usually seen in elderly women as a firm, well circumscribed tumour having both glandular and myoepithelial cells. The cells may show atypical features. The tumour may harbour foci of carcinoma which may be epithelial type, myoepithelial type, both or of metaplastic cells. The behaviour is hard to predict as it can be treated by local excision, recurrence is known or it can present with distant metastasis and hence the prognosis. We present a case of 50-year-old women who presented with right iliac bone lytic lesion diagnosed as metastatic deposits. Past history revealed that patient was diagnosed and treated for AME of right breast seven years back. The metastatic deposits also showed features of AME. Hence, a diagnosis of malignant AME deposits in right iliac bone was made.

Laparoscopic Adrenalectomy in a Patient of Von Hippel Lindau Syndrome with Ventriculo-Peritoneal Shunt-Anaesthetic management
Von Hippel Lindau (VHL) syndrome has a predilection to manifest multiple haemangioblastomas in the retina and central nervous system. We report a rare case of raised intracranial pressure during bilateral laparoscopic adrenalectomy for pheochromocytoma in a patient of VHL syndrome who had a ventriculoperitoneal shunt.

Insulinoma: A Comprehensive Summary of Two Cases

Pankaj Sharma, Sonia Sharma, Shivani Kalhan, Bhanu Pratap Singh, Sonam Sharma
Pancreatic endocrine tumours are rare in occurrence. They may present with a baffling range of symptoms which pose a diagnostic dilemma. Two cases of pancreatic insulinoma are presented herewith. Both presented with neuro-psychiatric complaints and were treated symptomatically for depression, anxiety, seizures etc. The diagnosis in these patients was missed for years. Insulinoma being a great diagnostic challenge, requires reasonably high clinical suspicion, accurate biochemical diagnosis and radiological localization to avoid extensive surgery. The aim is to highlight the occurrence of this rare tumour at a tertiary care hospital.

A Lobulated Spleen with Multiple Fissures and Hila
During our dissection classes, we observed a lobulated spleen with multiple hila and fissures. The spleen presented 4 hila and 5 deep fissures. The hila were seen on the visceral surface. The fissures extended into the substance of the spleen from superior border, inferior border and the visceral surface. Because of these fissures, the spleen appeared to be lobulated, having seven distinct lobes/lobules. Knowledge of this variation could be useful to the radiologists and surgeons.

Rhinomaxillary Mucormycosis with Palatal Perforation: A Case Report
Mucormycosis are a group of invasive infections caused by filamentous fungi of the Mucoraceae family. Mucormycosis is essentially limited to immunocompromised patients with poorly controlled diabetes mellitus, hematologic malignancy, organ transplant, chemotherapy, chronic renal insufficiency, malnutrition, deferoxamine therapy and severe burns. The fungi invade arteries leading to thrombosis that subsequently causes necrosis of hard and soft tissues. Here, we present a case report of a 50-year-old diabetic patient with rhinomaxillary form of mucormycosis.

Haematological Characterisation and Molecular Basis of Asian Indian Inversion Deletions Delta Beta Thalassemia: A Case Report

Jitender Mohan Khunger, Monika Gupta, Rekha Singh, Rohit Kapoor, Hare Ram Pandey
The hereditary persistence of fetal hemoglobin (HPFH) and delta beta thalassemia are heterogeneous disorders characterised by increased levels of fetal hemoglobin and high level of this Hb continues in adulthood. The distinction between these two conditions is not always possible with routine hematologic analysis and molecular characterisation of the defect is required. We encountered such a rare case of dß thalassemia in a 10-year-old male child who presented with features of thalassemia intermedia. Hemoglobin analysis showed 100% HbF while molecular analysis revealed Asian Indian inversion-deletion G ? A ? ( dß ) zero thalassemia.

Homocysteine, Paraoxonase-1 and Vascular Endothelial Dysfunction: Omnibus viis Romam Pervenitur

Esin Eren, Hamit Yasar Ellidag, Ozguraydin,Necat Yilmaz
Increased oxidative stress, alterations of lipid metabolism and induction of thrombosis have been suggested to be pathogenic links which are present between hyperhomocysteinaemia and atherosclerosis. However, the mechanism by which homocysteine (Hcy) can promote atherogenesis is far from clear and it has been debated. In the presence of cardiovascular risk factors, endothelial dysfunction is the central commodity which converges a plenty of factors, which have been named as atherogenic. Now-a-days, there are only few studies which have presented the correlation between antioxidant enzyme HDL-associated-paraoxonase 1(PON1) and Hcy in atherosclerosis. Both PON 1 and Hcy have been implicated in human diseases which are related to endothelial dysfunction. Although paraoxonases have the ability to hydrolyze a variety of substrates, only one of them, Hcy-thiolactone, is known to occur naturally. It seems very likely that the involvement of Hcy in atherosclerotic disease is mediated through its interactions with PON1.

Relationship Between Loneliness, Psychiatric Disorders and Physical Health ? A Review on the Psychological Aspects of Loneliness

Raheel Mushtaq, Sheikh Shoib, Tabindah Shah, Sahil Mushtaq
Human beings are social species which require safe and secure social surroundings to survive. Satisfying social relationships are essential for mental and physical well beings. Impaired social relationship can lead to loneliness. Since the time of dawn, loneliness is perceived as a global human phenomenon. Loneliness can lead to various psychiatric disorders like depression, alcohol abuse, child abuse, sleep problems, personality disorders and Alzheimer’s disease. It also leads to various physical disorders like diabetes, autoimmune disorders like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease, hypertension (HTN), obesity, physiological aging, cancer, poor hearing and poor health. Left untended, loneliness can have serious consequences for mental and physical health of people. Therefore it is important to intervene at the right time to prevent loneliness, so that physical and mental health of patients is maintained.

Surgical Margins and Its Evaluation in Oral Cancer: A Review

Spoorthi Banvar Ravi, Saileela. Annavajjula
The main surgical goal while treating cancer is to remove all local malignant disease with no residual malignant cells left. Overall benefits of achieving negative resection margins in terms of disease free local recurrence and overall survival has been discussed in many studies. The quantity of normal tissue to be removed during surgical procedure has not been standardised. Local recurrence can also occur among tumours with extensive histological demonstration of adequate resection margins. Oral cavity, submandibular region, tonsil and pharynx are the sites which have high chances of recurrence, even after showing negative margins. Therefore, the current approaches for histological risk assessment and various methods of evaluation of the surgical margins with their limitations are briefed in the present article.

Enamel Regeneration - Current Progress and Challenges

Jayasudha, Baswaraj, Navin H.K, Prasanna K.B
Dental Enamel is the outermost covering of teeth. It is hardest mineralized tissue present in the human body. Enamel faces the challenge of maintaining its integrity in a constant demineralization and remineralization within the oral environment and it is vulnerable to wear, damage, and decay. It cannot regenerate itself, because it is formed by a layer of cells that are lost after the tooth eruption. Conventional treatment relies on synthetic materials to restore lost enamel that cannot mimic natural enamel. With advances in material science and understanding of basic principles of organic matrix mediated mineralization paves a way for formation of synthetic enamel. The knowledge of enamel formation and understanding of protein interactions and their gene products function along with the isolation of postnatal stem cells from various sources in the oral cavity, and the development of smart materials for cell and growth factor delivery, makes possibility for biological based enamel regeneration. This article will review the recent endeavor on biomimetic synthesis and cell based strategies for enamel regeneration.

Social Capital and Oral Health
Social determinants have always been an important element of the oral health. It has been seen that social aspects like the organizations and relations influence the health of population. A new domain named social capital has come up into limelight which refers to “features of social organization, such as trust, norms and networks that can improve the efficacy of society by facilitating coordinated actions”. The bonds between individuals, both in intimate relationships and in voluntary associations have been claimed to have health promoting effects. Oral health can never be segregated from general health as they are bidirectional in their relationship. Therefore determinants of general health and its promotion are interlinked with that of oral health. So, this review tries to figure out the effects of social capital on various aspects of oral health.

Evaluation of Antinociceptive Activity of Aqueous Extract of Bark of Psidium Guajava in Albino Rats and Albino Mice
Background: Psidium guajava is commonly known as guava. Psidium guajava is a medium sized tree belonging to the family Myrtaceae found throughout the tropics. All the parts of the plant, the leaves, followed by the fruits, bark and the roots are used in traditional medicine. The traditional uses of the plant are Antidiarrheal, Antimicrobial Activity, Antimalarial/Antiparasitic Activity, Antitussive and antihyperglycaemic. Leaves are used as Anti-inflammatory, Analgesic and Antinociceptive effects. Aim: To evaluate the antinociceptive activity of aqueous extract of bark of Psidium guajava in albino rats with that of control and standard analgesic drugs aspirin and tramadol. Materials and Methods: Mechanical (Tail clip method) and thermal (Tail flick method using Analgesiometer), 0.6% solution of acetic acid writhing models of nociception were used to evaluate the extract antinociceptive activity. Six groups of animals, each consists of 10 animals, first one as control, second and third as standard drugs, Aspirin and Tramadol, fourth, fifth and sixth groups as text received the extract (100, 200, and 400 mg/ kg) orally 60 min prior to subjection to the respective test. Results: The results obtained demonstrated that aqueous extract of bark of Psidium guajava produced significant antinociceptive response in all the mechanical and thermal-induced nociception models. Conclusion: AEPG antinociceptive activity involves activation of the peripheral and central mechanisms.

Conducting Record Review Studies in Clinical Practice

Siddharth Sarkar, Divya Seshadri
Clinical record review or chart review is a previously recorded data to answer clinical queries. Such a study can be used to answer specific clinical questions in a relatively easy and less resource intensive manner. But these studies may be constrained by the limited information retrievable and inadequacy of records. Various types of data sources may be available for conducting such reviews (like case charts, computerized registries, etc), each with specific strengths and weaknesses. The procedure usually consists of drawing up the research question, identifying the appropriate data source, devising a data extraction plan, extracting the data, checking for errors, data analysis, and appropriate archiving and dissemination of the findings. The ethical aspects in such studies primarily pertain to issues of informed consent and confidentiality. This paper provides a broad overview of how to go about a clinical record review, and serves as a ready reference for those who would like to undertake such record reviews.

How to Write Articles That Get Published

Kirti Nath Jha
Publications are essential for sharing knowledge, and career advancement. Writing a research paper is a challenge. Most graduate programmes in medicine do not offer hands-on training in writing and publishing in scientific journals. Beginners find the art and science of scientific writing a daunting task. ‘How to write a scientific paper?, Is there a sure way to successful publication ?’ are the frequently asked questions. This paper aims to answer these questions and guide a beginner through the process of planning, writing, and correction of manuscripts that attract the readers and satisfies the peer reviewers. A well-structured paper in lucid and correct language that is easy to read and edit, and strictly follows the instruction to the authors from the editors finds favour from the readers and avoids outright rejection. Making right choice of journal is a decision critical to acceptance. Perseverance through the peer review process is the road to successful publication.

Drug Induced Erythema Multiforme: Two Case Series with Review of Literature

Shreyas N. Shah, Girish R Chauhan, B.S Manjunatha, Kapil Dagrus
Erythema multiforme, (EM) an uncommon, acute inflammatory reactive mucocutaneous disorder and primary allergies confined to the oral mucosa. However the subsequent attacks can produce more severe forms of EM involving the skin. Manifestations of EM are varied and present a diagnostic dilemma because infections (particularly herpes simplex and mycoplasma pneumoniae) and drugs seem to predispose towards development of EM. We report two cases of erythema multiforme in which drugs (Dioclofenac sodium & Amoxycilline) seems to be precipitating factor. In addition, the article reviews various aspects of EM as relevant to dental practice and highlight the associated potential etiologic agents, pathogenic mechanisms and therapies.

Acute Mesenteric Ischemia with Intrasplenic Gas: A Rare Occurence

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan

Pneumocystis Pneumonia – A Novel Complication in a Non–HIV Dengue Patient

Swapndeep Singh Atwal, Swapnil Puranik, Shibani Mehra, Umesh Chandra Garga

Ameloblastoma Variant

Seroprevalence of Toxoplasma IgG Antibodies in Hiv Positive Patients in and Around Khammam, Telangana State

Basavaraju Anuradha, Chilupuri Preethi

Pseudohypoparathyroidism

Beuy Joob, Viroj Wiwanitkit,

Poor Tolerance of Motor Cortex rTMS in Chronic Migraine
Background: Two small studies had evaluated the efficacy of rTMS in migraine. One tested high frequency rTMS over the dorsolateral prefrontal cortex while the other evaluated 1 Hz rTMS over the vertex. Aim: To test the feasibility of 10 Hz rTMS of motor cortex as an adjunctive therapy in patients with chronic migraine. Materials and Methods: We randomized (2:1 ratio) chronic migraine patients on medical preventive treatment to receive either rTMS or sham therapy for 10 sessions. rTMS (80% resting motor threshold, 10Hz, 20 trains, 5 secs/train, inter-train interval 1 min, total 1000 stimuli/session) was applied over the right motor cortex. Result: Nine patients were randomized. Six received rTMS and three had sham therapy. Three patients in the rTMS arm withdrew from the study due to increased headache frequency and discomfort from the treatment. The remaining six cases (3 rTMS, 3 sham) completed the study. The study was prematurely stopped due to the significant worsening of headache from rTMS. No significant differences in outcome measures were found between real and sham rTMS. Conclusion: Although the study was terminated prematurely, the high dropout rate (50%) due to worsening headaches suggested that rTMS over the motor cortex is poorly tolerated in chronic migraine.

Question Vetting: The Process to Ensure Quality in Assessment of Medical Students

S.Gopalakrishnan, P.M.Udayshankar
Over the past decade, medical schools have made new efforts to provide accurate, reliable, and timely assessments of the competence of trainees. All methods of assessment have strengths and intrinsic flaws. Written examination questions forms an important item in knowledge assessment and are typically classified according to whether they are open-ended or multiple choices. At present questions are prepared casually just before the examination and are not put through any quality check to correct any possible mistakes or ambiguity in the questions. This may lead to confusion or wrong understanding of the questions by the students which will be reflected in their answers as well. Question Vetting is the process when an expert person examines or evaluates and edits questions to make it free of any mistakes. The importance of vetting and re-vetting of examination questions cannot be overstated in the present scenario of medical education. There is a prescribed structure and protocol of question setting and vetting for examinations in medical education programmes. The areas that need to be examined during question vetting are for technical accuracy, content level and language aspects. The use of the prescribed structure and protocol of question vetting ensures a consistently high standard of question presentation during examinations which will help the students to understand the questions better and to answer them correctly. This article is intended to highlight the importance of introducing question vetting in our medical education scenario in order to improve the quality of assessment of medical students.

Correction
Swati Tripathy, Satyajit Mohapatra, Muthulakshmi M, Anjalakshi Chandrasekhar, Induction of Ovulation with Clomiphene Citrate Versus Clomiphene with Bromocriptine in PCOS Patients with Normal Prolactin: A Comparative Study (Published in Journal of Cilinical and Diagnostic Research. 2014 November: 7(11):). 2541-2543 In this article Corrections have been done in Materials and Methods of abstract.In Materials and Methods Dose of bromocriptine 0.8mg replaced with 2.5mg. Materials and Methods: On the basis of inclusion and exclusion criteria, seventy four PCOS patients with normal prolactin level (< 20 ng/ml) and BMI between 20-30 were randomly assigned into two groups. One group (n=38) received 50 mg clomiphene citrate (CC) from day3 to day 7. The other group (CC+Bcrt) was given 50 mg of clomiphene citrate from day3 to day7 along with 0.8mg of bromocriptine daily for full cycle (n=36). Both the groups were treated for 3 cycles. The outcomes were measured by the hormonal status, follicular size, ovulation rate and pregnancy outcomes.