Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Attenuation of Cardiovascular Responses to Direct Laryngoscopy and Intubation-A Comparative Study Between iv Bolus Fentanyl, Lignocaine and Placebo(NS) Gurulingappa, Md Asif Aleem, M.N. AwAwati, Adarsh S https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1749-1752&id=2619 https://doi.org/10.7860/JCDR/2012/.2619 Use of a Single Injection Femoral Nerve Block in the Patients of Total Knee Replacement with Concomitant Epidural Analgesia Thrivikrama Padur Tantry, Muralishan Kar B.G., Rajesh Hukkeryry https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1744-1748&id=2620 https://doi.org/10.7860/JCDR/2012/.2620 Brainstem Auditory Evoked Responses in Different Phases of Menstrual Cycle Navpreet Mann, Rajinder Singh Sidhu, Rashmi Babbar <b>Background and Objectives:</b> Brainstem Auditory Evoked Potentials (BAEP) show variations with age, sex and other physiological factors. The gonadal steroids may also convert the neuronal functioning, but an electrophysiological evidence is sparse. This study was undertaken to analyze the auditory evoked response in females of the reproductive age group during four different hormonal states of the menstrual cycle. <b>Methods:</b> This was a prospective, single centered, longitudinal study. The waves of BAEP were recorded in 50 young females (of the ages of 19-36 years, who used no hormonal therapy) during four different phases of the same menstrual cycle. The peak latencies of the waves, I, II, III, IV and V, IPL I-III, I-V and III-V and the amplitude ratio, V/I were recorded and statistically analyzed. <b>Results:</b> A significant increase in the peak latencies of the waves, I-V in the oestrogen peak mid cycle was observed, while a significant decrease in the progesterone peak mid-luteal phase was observed. However, IPL did not show any statistically significant change in the above two phases. All the parameters did not show significant changes in the menstrual and the pre-menstrual phases. <b>Interpretation and Conclusion:</b> The results indicated the BAEP changes in the mid follicular and the mid luteal phases of the menstrual cycle, thus suggesting the changes which were attributable to oestrogen and progesterone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1640-1643&id=2621 https://doi.org/10.7860/JCDR/2012/.2621 The Frequencies of the Urinary Anomalies which were Detected in a Foetal Autopsy Study Tulika Guptata, Kanchan Kapoor, A. Sharma, A. Huria <b>Aim:</b> The detection of foetal urinary abnormalities in the antenatal period will help in an adequate post natal management and it will also have a bearing on the decision of the termination of the pregnancy. The purpose of the present study was to detect urinary anomalies in the antenatal period by doing autopsies of the aborted foetuses. <b>Settings and Design:</b> A cross-sectional study. <b>Methods and Material:</b> A total of 226 aborted foetuses were autopsied. The urinary anomalies which were related to the renal parenchyma, the pelvi-ureteral sstem and the urinary bladder were recorded. The associated anomalies of the other organ ystems were also noted. The incidences of the different urinary anomalies among the aborted foetuses were calculated. The gestational ages at which the various anomalies were detected were also studied. <b>Results:</b> Twenty nine of the 226 fetuses were detected to have 34 urinary anomalies. Renal agenesis was the single most common anomaly. Overall, the anomalies which were related to the renal parenchyma accounted for 67.65 % of all the urinary anomalies, while the anomalies of the pelvi-ureteral ystem and the bladder constituted 20.59% of the detected urinary anomalies. The anomalies of the renal parenchyma (renal agenesis and horse-shoe and polycystic kidneys) were more frequently seen in the foetuses with a shorter gestational age as compared to the gestational ages of the foetuses which showed pelvi-ureteral anomalies. The cumulative incidence of the foetuses with urinary anomalies by 30 weeks of gestation was 12.83%. <b>Conclusions:</b> A significant proportion of the aborted foetuses was detected to have urinary anomalies. An early antenatal detection of these and associated anomalies has significance, as this may help in an early postnatal diagnosis and management. The degree and the extent of the detected anomalies could also help in the decision making regarding the therapeutic abortions and the future pregnancies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1615-1619&id=2622 https://doi.org/10.7860/JCDR/2012/.2622 Anthropometerical Association of the Craniofacial Dysmorphology with Schizophrenia Vivek Mishra, Shelja Sharma, Vasundhra Kulsreshtha, Virendra Kumar, K.C.Gurunani <b>Background:</b> Dysmorphology is more concentrated in the craniofacial region of Schizophrenic Patients. So, an early anthropometric assessment of the physical dimensions of the cranium and the face may indicate a potential clue of Schizophrenia. <b>Aims:</b> To study the craniofacial dysmorphology in schizophrenic patients and in healthy controls of the Agra region and to find out whether its evaluation could be used as a tool in the early diagnosis of schizophrenia. <b>Setting and Design:</b> This was a case-control, cross-sectional study. <b>Subjects and Methods:</b> Schizophrenic Patients well diagnosed by consultant psychiatrists on the basis of the DSM IV criteria of the S.N. Medical College Agra and the Institute of Mental health, Agra and healthy controls of Agra were selected for the study. The total facial height (trichion to gnathion), the upper facial height (trichion to subnasale) and the lower facial height (subnasale to gnathion) were measured among the various groups of patients and the controls. The mean data were statistically correlated by using the t test for the independent variables. <b>Results:</b> The total facial height (trichion to gnathion) was elongated in the Schizophrenic male patients as compared to the controls. When we compared the schizophrenic patients on the basis of the family history of schizophrenia, it was found that there was an elongation of the total facial height in the patients with a positive family history of schizophrenia as compared to the patients without a family history of schizophrenia. There was also a significant elongation of the upper facial height (trichion to subnasale ) in the schizophrenic male and female patients. <b>Conclusions:</b> There was total facial elongation and upper facial region elongation in the schizophrenia patients as compared to the controls. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1620-1623&id=2623 https://doi.org/10.7860/JCDR/2012/.2623 The Anti Mullerian Hormone- A Novel Marker for Assessing the Ovarian Reserve in Women with Regular Menstrual Cycles V.S Kalaiselvi, Saikumar P, Prabhu K, Prashanth Krishna G <b>Background:</b> Ovarian Reserve (OR) is a term which describes the functional potential of the ovary, which constitutes the size of the ovarian follicle pool and reflects the number and quality of the oocytes which are within it. Assessment of the OR helps in reflecting the reproductive potential of women. Various markers are available for assessing the OR and the best marker is the Anti Mullerian Hormone (AMH) which reflects the ovarian follicular pool in the ovary. In this study, the serum level of AMH/MIS(Mullerian Inhibiting Substance)was estimated to assess the ovarian reserve in both fertile and infertile women. <b>Objective:</b> To assess the ovarian reserve in women of the fertile and subfertile groups with regular cycles, who were in the age range of 26 -33yrs, by estimating the level of AMH and those of other hormones like FSH and E2 and also to calculate the ovarian volume and the Antral follicular count by an ultrasonographic method. <b>Materials and Methods:</b> Thirty fertile and thirty sub fertile women whose ages ranged from 26-33yrs were included as group 1 and group 2 respectively. The hormones like AMH ,FSH and oestradiol were assayed. Measurement of the ovarian volume and the antral follicular count by doing a transvaginal ultrasonogram, was done in all the subjects who were involved in both the groups. The correlation test was studied between the variables and the test of significance of the variables between the 2 groups was also analyzed by the Statistical Package Of Social Sciences (SPSS). <b>Results:</b> The Antral Follicular Count (AFC) and the ovarian volume were negatively correlated with the age. The ovarian volume was positively correlated with the AFC. The FSH negatively correlated with the AFC. The Anti Mullerian Hormone negatively correlated with the age, and it positively correlated with the AFC. The mean values of AFC, FSH, and AMH were also statistically significant between the two groups. <b>Conclusion:</b> AMH can be considered as a marker for assessing the ovarian reserve, as it is cycle independent as compared to the other hormones. The women in the subfertile group with low levels of AMH should be insisted to proceed for ART as early as possible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1636-1639&id=2624 https://doi.org/10.7860/JCDR/2012/.2624 Vitamin E, Its Beneficial Role in Diabetes Mellitus (DM) and Its Complications Anand Baburao Jain, Vaishali Anand Jain <b>Introduction:</b> Studies have shown that diabetes is accompanied by an increased oxidative damage to all the bimolecular. Enhanced oxidative stress contributes to the development of the diabetic complications. The key lipid soluble chain breaking antioxidant,-tocopherol, is known to be deficient in diabetes. Human intervention studies have indicated the role of vitamin E in improving the endothelial function, the retinal blood flow and the renal dysfunction. The aim of the study was to find the role of vitamin E in preventing the development and the progression of the diabetic complications. <b>Methodology:</b> Both type I and II DM patients with and without complications were included in this study. They were divided separately into the test (which received insulin/oral hypoglycemic and vitamin E) and the control groups (which received only insulin/oral hypoglycemic drugs). The Fasting Blood Sugar(FBS), Post-prandial Blood Sugar(PPBS) and the Total Cholesterol(TC) were estimated and the Blood Pressure (BP) was noted at 0(beginning),12,18 and 24 months. Cardiovascular disease, retinopathy, nephropathy and foot ulcer development and progression were monitored. The data was analyzed by the Z test for the means and for the proportions. <b>Results:</b> It was evident from the analysis of the data that the PPBS, TC and the Diastolic Blood Pressure (DBP) declined gradually and significantly in the test groups. This was a beneficial development for the diabetic patients. The patients who were on the vitamin E supplementation had a delayed development and a slow progression of the complications. <b>Conclusion:</b> Vitamin E supplementation has an important role in delaying the onset of the diabetic complications as well as for slowing down the progression of the complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1624-1628&id=2625 https://doi.org/10.7860/JCDR/2012/.2625 The Oxidative Stress in Cataract Patients Jaskiran Kaur, Sahiba Kukreja, Amandeep Kaur, Naresh Malhotra, Ravneet Kaur <b>Background:</b> The recent studies on cataract formation focus on the primary role of the systemic oxidative stress which is generated outside the lens. Our research was directed to assess the oxidative stress by measuring the lipid peroxidation products in the form of the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzyme levels in the blood. The antioxidant therapy may have a role to play in delaying the onset and the progression of age related cataracts. <b>Material and Method:</b> This was a case control study. It comprised of 100 age matched subjects (50 with cataracts and 50 controls) with their ages ranging from 45- 75 years. Oxidative stresses such as the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzymes, Superoxide Dismutase (SOD) and Glutathione Peroxidase( GPX ) were investigated in all the patients and the controls. <b>Results:</b> Significantly increased levels of serum lipid peroxide in the form of Malondialdehyde (MDA ) (p<0.001) were observed in the cataract patients as compared to the controls. Significantly decreased blood levels of SOD and GPX were observed in all the patients. <b>Conclusion:</b> In the present study, it was concluded that oxidative stress plays an important role in the onset and the progression of cataracts. The pro-oxidant i.e. serum malondialdehyde (MDA) levels were increased in the cataract patients. The blood levels of the enzymatic anti-oxidants, SOD and GPX were decreased. The plasma TBARS can be used as biomarkers of the degeneration in the lens. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1629-1632&id=2626 https://doi.org/10.7860/JCDR/2012/.2626 Blood Lead in End-Stage Renal Disease (ESRD) Patients who were on Maintainence Haemodialysis Subha Palaneeswari M, P.M. Abraham Sam Rajan, Santhi Silamb anan, Jothimalar <b>Background:</b> In India, there is rising burden of chronic diseases like hypertension and diabetes. It has been estimated that 25-40% of these patients are likely to develop CKD, with a significant percentage requiring renal replacement therapy. Haemodialysis is the most common method which is used to treat advanced and permanent kidney failure. The derangements in the metabolism of several toxic and trace elements such as antimony, arsenic, cadmium, molybdenum, nickel, and selenium have been reported for several decades in patients with chronically reduced renal function. Overall, the available literature suggests that the blood levels of some elements such as cadmium, chromium, fluorine, iodine, lead and vanadium are high in ESRD. <b>Aim and Objectives:</b> Our aim was to study the levels of blood lead in the End-Stage Renal Disease (ESRD) patients who were on Maintenance Haemodialysis (MHD), and to study whether there was any relationship between the blood lead concentration and the duration of MHD. <b>Methods:</b> The blood lead level was determined in 50 healthy subjects with normal renal function and in 50 patients with ESRD who were on MHD. None of them had a history of smoking or any industrial exposure. <b>Results:</b> The results of this study revealed that the blood lead level was higher in the ESRD patients who were on MHD than in the healthy adults. The blood lead concentration was found to increase with the duration of the MHD. <b>Conclusion:</b> The mild increase in the blood lead level with an increase in the duration of MHD in the study population, may be viewed in the wider context that the prolonged exposure to lead, even at low levels may result in CKD by causing interstitial nephritis, hypertension, hyperuricaemia, an increased incidence of hypertension, cerebrovascular disease and cardiovascular disease or the progression of an already existing CKD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1633-1635&id=2627 https://doi.org/10.7860/JCDR/2012/.2627 Double Outbreak of Measles in the Talaja Block of Bhavnagar District, Gujarat, India 2011: A Need for Improving the Vaccine Coverage and the Community Participation Pankhuri P. Mishra, Naresh T. Chauhanthe <b>Background:</b> Two outbreaks of measles were reported from an urban and a village area of Bhavnagar District, Gujarat, India in January and March 2011 respectively. <b>Aim:</b> The present study was conducted to investigate and to assess various epidemiological features which were associated with the measles outbreak. <b>Settings and Design:</b> The present study was designed as a cross sectional study, which was conducted in an urban and a rural area of the Talaja block of the Bhavnagar district of Gujarat, India from December 2010 to April 2011. <b>Methods and Material:</b> The suspected cases were detected through an active case finding in the community. We defined a case clinically by the WHO criteria as the occurrence of a febrile rash with or without cough, coryza and conjunctivitis in a resident of the Talaja-urban and the Gorkhi village of the Talaja block, in the period from 1st December 2010 to 30th April 2011. Blood samples from 10 case patients were collected for the IgM antibody detection. A community based, retrospective, cohort design was carried out to find the vaccine efficacy in the Gorkhi village. <b>Statistical Analysis:</b> We entered and analyzed the data by using an MS-Excel sheet. <b>Results:</b> This study identified 27 confirmed cases of measles in the urban area of Talaja and 78 cases in Gorkhi village. All the 105 case patients belonged to the age group of 3 months-15 years. According to their mothers’ statements, out of the 105 measles cases in the two areas, 40 (38%) case patients were immunized. Ten sera from five case-patients each from both the areas were tested; all were found to be positive for the IgM/IgG antibodies by ELISA. <b>Conclusions:</b> The outbreaks occurred due to a poor community participation and the poor vaccine coverage levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1713-1717&id=2628 https://doi.org/10.7860/JCDR/2012/.2628 A Comparative Study on the Nutritional Status of the Pre-School Children of the Employed Women and the Unemployed Women in the Urban Slums of Guntur Bharani Krishna Yeleswarapu, Samson Sanjeeva Rao Nallapu <b>Background:</b> The early childhood development is most crucial and the mother’s care and attention is essential. The inevitable changes like women entering the work field have an effect on the child care and development. <b>Aim:</b> To study the selected anthropometric indices of the children of employed and unemployed women. <b>Settings and Design:</b> This study was done in the urban slums of Guntur city by using a cross sectional, descriptive design. <b>Methods and Material:</b> This study was conducted during January – April 2011 with a sample of 312 children of non working women and 311 children of working women, who were selected through the systemic random quota sampling method in 6 randomly selected slums. The data was collected through questionnaires who were named as the Mother’s schedule and the Child schedule, which consisted of close-ended questions which were coded for an easy data entry. The Mother’s schedule looked at the information regarding the mother, like the caretaker during the mother’s absence, the time which was spent with her child each day, etc. The Child schedule looked for information like whether the child was exclusively breast fed, its age in months when the weaning started, whether the government sponsored crèche services (Anganwadi center) were utilized, etc. It also included the anthropometrical measurements of the child like its current weight, current height and mid arm circumference, which were obtained by using standardized tools. <b>Statistical Analysis:</b> For each schedule, a separate table was created in a relational basis in MS Access, with suitable key fields to connect the information for the analysis. <b>Results:</b> The children of the unemployed mothers weighed significantly higher than the children of the employed mothers. The children of the unemployed mothers also stood significantly taller than the children of the employed mothers. <b>Conclusion:</b> In the absence of the mothers who are at work, a childcare service is essential and this should be facilitated through legislation, NGO efforts, etc. Breast feeding and the bonding time with children are to be encouraged for the employed mothers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1718-1721&id=2629 https://doi.org/10.7860/JCDR/2012/.2629 The Reference Intervals for the Haematological Parameters in Healthy Adult Population of Chennai, Southern India A.R.Subhashree, P.J Parameaswari, B.Shanthi, C.Revathy, B.O.Parijatham <b>Background:</b> The haematological parameters are influenced by various factors like age, ethnicity, diet, genetic and gender differences and hence it is important to define the specific reference values with regards to the age, gender and the region. The indices like the Red Cell Distribution Width (RDW), the Mean Platelet Volume (MPV) and the Platelet Distribution Width (PDW) are newer haematological parameters which are calculated by automated haematology analyzers. There is an increasing evidence that these are clinically valuable bio markers. But not many studies have estimated the reference intervals for these parameters in our population. <b>Aim and Objective:</b> Our primary objective was to identify the gender specific reference intervals for RDW, MPV, PDW and other haematological parameters for the healthy adult population of our region. We also aimed at comparing the study reference intervals with the existing reference ranges. <b>Materials and Methods:</b> A retrospective review of 2443 medical case sheets of the individuals who attended the preventive health check up program in a tertiary care hospital in the year 2011, was done. With 500 subjects who satisfied our study criteria, the haematological reference intervals were established. <b>Results:</b> Gender specific reference intervals were established for the newer indices as well as for the other haematological parameters. We derived the reference intervals for the newer parameters in our population as: RDW: 12.23%-15.36% in males and 12.3%-15.85% in females MPV: 7.9 fL-13.7 fL in males and 8 fL -13.28 fL in females PDW: 9 fL -16.56 fL in males and 8 fL -13.28 fL in females. <b>Conclusion:</b> Our values differed from the existing haematological reference values, thus showing the importance of developing region-specific reference intervals. Our data also showed the importance of establishing gender specific reference intervals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1675-1680&id=2630 https://doi.org/10.7860/JCDR/2012/.2630 A Comparative Study of Efficacy and Safety of Azithromycin and Ofloxacin in Uncomplicated Typhoid Fever: A Randomised, Open Labelled Study Manish Chandey, A.S. Multani https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1736-1739&id=2631 https://doi.org/10.7860/JCDR/2012/.2631 Association of the Serum Anti-chlamydial Antibodies with Tubal Infertility Ashish Surana, Vijaylata Rastogi, Prem Singh Nirwawan <b>Background:</b> Infertility is increasingly becoming a significant health problem in many areas of the world. The infection which is caused by Chlamydia trachomatis is a major cause of tubal factor infertility secondary to salpingitis. However, the data which pertains to infertility attributed to the C. trachomatis infection is limited in India. <b>Aims:</b> To evaluate the chlamydial infection in women who suffered from infertility and to investigate the possible role of the chlamydia serology as a screening test for tubal infertility. <b>Method:</b> This study was aimed at evaluating the chlamydial infection in fifty women with primary infertility and at investigating the possible role of the chlamydial serology as a screening test for tubal infertility, by the detection of the anti-chlamydial IgM antibodies by using E.L.I.S.A. <b>Setting and Design:</b> The present prospective study was carried out at a tertiary care hospital in north India. <b>Results:</b> In this study, a high seropositivity (60%) for the antichlamydial antibody was observed. 52% females showed bilateral tubal blockage, while the most common site of the blockage was the ampullary portion (36%). <b>Conclusion:</b> These findings highlighted a strong correlation between the tubal factor infertility and the antichlamydial antibodies. It also stressed on the need of the screening of infertile women for C. trachomatis with laboratory investigations, which could provide a rapid and specific diagnosis so that early therapeutic interventions could be instituted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1692-1694&id=2632 https://doi.org/10.7860/JCDR/2012/.2632 Skin and Mucocutaneous Manifestations: Useful Clinical Predictors of HIV/AIDS Shashi Chopra, Usha Arora <b>Background and Aims:</b> The HIV infection is associated with several dermatological conditions which may be the first pointer towards the existence of HIV. These may present with unusual and atypical manifestations in the course of the HIV infection. Keeping this in mind, the seroprevalence of HIV in these persons and the spectrum of the skin and the mucocutaneous lesions in the HIV positive patients was studied. <b>Methods:</b> The current prospective study was conducted over a period of 3 years (2006-2008). A total of 604 persons who had any kind of skin and mucocutaneous infections were screened for the HIV infection as per the NACO guidelines after recording their clinical and epidemiological profiles. <b>Results:</b> Out of the 604 patients who were screened, 90(14.90%) were seropositive for the HIV-I antibodies and none was positive for the HIV-2 antibodies. Seventy three point thirty three percent 73.33 of the seropositive patients were in the age group of 15-40 years, with a male-female ratio of 1:1.05. The heterosexual route was the most common mode of transmission (86.6%).A wide range of infectious and noninfectious lesions were observed. In the HIV seropositive patients, oral candidiasis (32.22%) was the most common infectious disease which was observed, followed by herpes zoster (13.33%), genital warts (7.77%) and genital herpes (6.66%). The most common noninfectious manifestation was seborrhoic dermatitis (8.88%), followed by pruritic papular eruptions (7.77%). <b>Conclusion:</b> As there is a high prevalence of the HIV infection in patients who have skin and mucocutaneous disorders, the doctors, during the investigation of these patients, must have a high level of suspicion for the HIV infection in their mind. An early detection of HIV optimizes the chemoprophylaxis for many opportunistic mucocutaneous disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1695-1698&id=2633 https://doi.org/10.7860/JCDR/2012/.2633 Phenotypic Study of Virulence Factors in Escherichia Coli Isolated From Antenatal Cases, Catheterized Patients, and Faecal Flora Shruthi N, Ravikumar, Ravishkumar <b>Introduction and Objective:</b> The bacterial strains that cause symptomatic urinary tract infections possess diverse distinctive properties that enable them to overcome the local host defenses. In Escherichia coli, virulence results from the cumulative impact of several virulence factors, which can vary according to the patient populations. Hence, a study was undertaken to assess the prevalence of the virulence factors in the E.coli isolates which were isolated from pregnant woman, catheterized patients and from the stool samples of healthy individuals. <b>Methods:</b> A total of 93 E.coli isolates were obtained from symptomatic cases of urinary tract infections and 31 E.coli faecal isolates were obtained from apparently healthy individuals and they were tested for haemolysin production, mannose resistant haemagglutination to indicate P fimbriae, cell surface hydrophobicity, and the gelatinase enzyme. <b>Results:</b> Among the 93 E.coli isolates from the cases group, 39(41.9%) were haemolytic, 38(40.9%) were MRHA positive, 29(31.2%) were hydrophobic and 18(19.4%) were positive for gelatinase. Among the 31 controls, 01(3.2%) were haemolytic, 02(6.5%) were MRHA positive and 03(9.7%) were hydrophobic and none of the isolates were positive for gelatinase. The difference between the cases and the control group was significant (P<0.001).Multiple virulence factors were observed in 10% of the isolates. <b>Interpretation and Conclusions:</b> The present study showed that the expression of the virulence factors was more in the urinary isolates of the antenatal cases and in the catheterized patients as compared to the faecal isolates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1699-1703&id=2634 https://doi.org/10.7860/JCDR/2012/.2634 Comparison of the Lowenstein-Jensen Medium, the Middlebrook 7H10 Medium and MB/BacT for the Isolation of Mycobacterium Tuberculosis (MTB) from Clinical Specimens Naveen G, Basavaraj V. Peerapur <b>Introduction:</b> Tuberculosis (TB) is the most common cause of death due to a single infectious agent worldwide in adults. India alone accounts for 30% of the global tuberculosis burden. There is a need for a method of cultivation of mycobacteria that is reliable and economical and has a short turnaround time. <b>Objective:</b> The present study was attempted to assess the feasibility of using MB BACT and Middlebrook 7h10(MB7H10) as primary isolation media for mycobacteria. They were compared with the LJ medium, which was the gold standard. <b>Materials and Methods:</b> Various clinical specimens from a total of 236 clinically suspected cases of TB were studied. All the samples were decontaminated by using the modified Petroff’s method. Each sample was subjected to ZN staining and it was simultaneously inoculated onto the LJ medium, the MB7H10 medium and MB BACT. The growth from the cultures were confirmed by ZN staining and they were speciated by using biochemical reactions. <b>Results:</b> Out of the 236 samples which were screened, 116 isolates were obtained. All the 116 were isolated from MB BACT, 82 were isolated from the LJ medium and 62 were isolated from MB7H10. 82 isolates were obtained from MB BACT and the LJ medium, 62 were obtained from MB7H10 and MB BACT, 58 were isolated from LJ and MB7H10 and 58 were isolated from LJ medium, MB7H10 and MB bact. Neither the L J medium nor the Middlebrook 7h 10 medium could isolate mycobacteria exclusively. It showed that the combination of media did not prove to be superior over the use of MB BACT alone. The average isolation time of L J, the MB7H10 medium and MB BACT was 30.81 days, 31.06 days and 18.70 days. <b>Interpretation and Conclusion:</b> MB BACT is a better medium as compared to the L J medium and the MB7H10 medium, both in terms of the number of isolates and the isolation rate. The MB BACT method proved to be a very speedy method and it could isolate mycobacteria 7-10 days earlier as compared to the L J medium and the Middlebrook 7 H10 medium. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1704-1709&id=2635 https://doi.org/10.7860/JCDR/2012/.2635 The Prevalence of the Hepatitis B Core Antibody and the Occult Hepatitis B Infection Among Voluntary Blood Donors in Chennai, India Maheswari K S, Arun R , Arumugam P <b>Introduction:</b> The infection with the Hepatitis B Virus (HBV) is a global health problem which affects 2 billion people worldwide. In India, the prevalence of the Hepatitis B infection is 4% in the general population. The prevalence of the HBV infection in voluntary blood donors is 1-3%. It has been reported that the viraemia continues even after the clinical recovery from the acute HBV infection. Some blood donors who were negative for the surface antigen but positive for the core antibody have been reported to transmit HBV, leading to acute hepatitis. This study was done to determine the seroprevalence of the hepatitis B core antibody in voluntary blood donors in Chennai, India. <b>Materials and Method:</b> This prospective study was conducted in our department during 2008-2009. A total of 9100 donor samples were screened for the Hepatitis B surface antigen and the Hepatitis B core antibody (IgM and IgG) by ELISA. The samples which were positive for the core antibody were subjected to Real-time PCR for the Hepatitis B DNA detection. <b>Results:</b> Among the 9100 donors, 911 (10.01%) donors were positive for the core antibody. The Hepatitis B Surface antigen was positive in 199 (2.18%) donors. Among the 911 donors who were positive for the core antibody, 820 (90.01%) donors were negative for the HBsAg and 2 donors were positive for Hepatitis B DNA. <b>Conclusion:</b> If a routine screening of the sera for the core antibody is not done, the low-level HBV viraemia may not be identified. The absence of the surface antigen in the blood of apparently healthy individuals may not be sufficient to ensure the lack of the circulating virus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1710-1712&id=2636 https://doi.org/10.7860/JCDR/2012/.2636 Ocular Manifestations in Patients with HIV Infection/AIDS who were Referred from the ART Centre, Hassan, Karnataka, India Pavana Krishnaraj Acharya , Kavitha Chikk anayakanahalli Venugopal, Dada Peer Karimsab, Balasubramanya S <b>Background:</b> Ocular involvement in HIV infection/AIDS is very common and it includes various clinical presentations which may be asymptomatic or atypical or they may be the initial manifestations of the underlying disease. The severity of these lesions increases as the immune competency decreases, leading to visual impairment or blindness. <b>Objective:</b> The purpose of this study was to determine the prevalence and the types of HIV associated ocular conditions and their effect on the vision in patients with HIV/AIDS. <b>Methods:</b> This cross sectional study was based on the patients with HIV infection/AIDS, who were referred to the Ophthalmic OPD, District hospital, Hassan. These patients were referred from the District ART Centre for a complete ophthalmic evaluation, irrespective of their immune status and the presence or absence of symptoms. All the patients underwent a complete ophthalmic examination, which included both anterior and posterior segment evaluation and colour vision assessment. <b>Results:</b> Out of the 553 patients, 66% belonged to the age group of 21-40 years. 87% of the patients had a BCVA of >6/18, whereas 4.7% had very poor vision. 37.6% of the patients had ocular manifestations. Anterior segment, posterior segment and neuro-ophthalmic manifestations were seen in 7%, 9.94% and 5.79% of the patients respectively. The most common anterior segment manifestation was recurrent lid infections, while HIV microangiopathy was the most common posterior segment manifestation. The other unusual findings included an abnormal colour vision in 6.3% of the patients and bilateral lid retraction in 8.5% of the patients. <b>Conclusion:</b> Since ocular manifestations are very common and as they can occur at any time during the course of HIV infection, an awareness on various patterns of the ocular disease and the screening of all the patients with HIV infection/AIDS is a must. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1756-1760&id=2637 https://doi.org/10.7860/JCDR/2012/.2637 Evaluation of the Nurses’ Job Satisfaction, and Its Association with Their Moral Sensitivities and Well-being Molouk Jaafarpour, Ali KhaniIt <b>Background and Aim:</b> Several researchers have described the nurses’ work as stressful and that the incidence of the occupational stress-related burnout in the profession was high. The aim of this study was to establish the relationship between the nurses’ satisfaction, their psychosocial work environment, the levels of their reported moral sensitivities and their well - being in Iran. <b>Material and Methods:</b> This descriptive-correlation study was performed at the ILAM general hospitals, IR, during the year 2011. The research instruments which were used were the Psychosocial Work Environment (PWE), the Moral Sensitivity (MS) and the well-being profile of the nurses. A sample of 120 Registered Nurses (RN) were enrolled in the study by using a simple random sampling method. The descriptive statistics and the Pearson’s correlation test were performed by using SPSS. <b>Result:</b> The relationship of the nurses’ satisfaction and their psychosocial work environment was moderate (M=106.5, SD= 7.2) . The nurses’ moral sensitivity was moderate (M=112.3, SD= 11.2).This study found that there were significant correlations between the PWE factors score and the MS subscale (P< 0.05, p<0.01). In addition, significant correlations were found between the nurses’ well-being and the PWE factors (P< 0.05, p<0.01). <b>Discussion and Conclusion:</b> These findings proved that the nurses perceived their PWE as stressful. The supporting nurses may have a positive effect on their perceptions of well-being. The attending nurses reported less physical symptoms, reduced anxiety and fewer feelings of not being in control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1761-1764&id=2638 https://doi.org/10.7860/JCDR/2012/.2638 Uterine Artery Embolisation for Management of Refractory Postpartal Haemmorhage Vishalakshi Urundady, Vrinda Shetty Management of Postpartal Haemorrhage (PPH) refractory to medical management continues to be a formidable condition, further compounded by unstable haemodynamic condition and associated coagulopathy, usually associated with this condition. Though surgical exploration is the usual therapeutic option for such patients, selective pelvic arterial embolisation is gaining the popularity in view of its safety and efficacy profile. Uterine preservation further adds to its advantages. We present our experience of managing 5 such patients with Uterine Artery Embolisation (UAE). The current status of UAE as therapeutic modality for management of refractory PPH is discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1753-1755&id=2639 https://doi.org/10.7860/JCDR/2012/.2639 Analysis of BRCA1 Gene Rearrangements in Breast Carcinomas by RT-PCR and ER, PR, HER2NEU Status by IHC and HPE Correlation Srivatsa Prakhya, Geetha Prakash <b>Aim:</b> An attempt to analyze invasive ductal carcinomas of the breast, based on the histopathological sub classification and grading, the hormonal status on immunohistochemistry (IHC) and the BRCA1 gene expression. <b>Methods:</b> Fifty patients were selected from the Kancheepuram area on the basis of their admissions to the Surgical Out-Patients Wing of the Meenakshi Medical College and Hospital over a period of 3 years from 2008-2011. <b>Results:</b> Among the fifty patients who were selected in the case series, the most common age group was 41-60 years (23 patients). The grade 3 tumours were the commonest. An immunohistochemical evaluation of the hormone receptors revealed most of the tumours to be of the luminal subtype. BRCA1 gene mutation analysis showed that all the 50 cases of breast cancer elaborated an up-regulation of the selected base-pair fragment. <b>Conclusion:</b> Among the various determinants of breast cancer development, this study proved that age, the histological tumour grade and the immunohistochemical analysis also formed the important factors that aided in the diagnosis of breast cancers and their classifications. Also, genetic studies could provide useful insights by helping in the determination of the presence or the absence of gene mutations, which could revolutionize the treatment. This would be possible by using gene therapy in the future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1663-1668&id=2640 https://doi.org/10.7860/JCDR/2012/.2640 Soft Tissue Cysticercosis: Study of 21 Cases Ranjan Agrawal <b>Aim:</b> To evaluate the clinico – pathological profile of patients with cysticercosis cellulosae. <b>Materials and Methods:</b> The clinico – pathological data of patients with cysticercosis cellulosae who were reviewed during the last 5 years, were retrospectively analysed. <b>Results:</b> Of the total 6805 biopsies analysed , 21 cases of cysticercosis in the soft tissues were observed. Excisional biopsy was performed to diagnose the lesion. The pattern of distribution was striated muscles in 11(52.4%), eye in 6 (28.6%), subcutaneous tissues in 2(9.5%), tongue in 1(4.8%) and breast in 1(4.8%) patient. Anterior abdominal wall was the most involved site. <b>Conclusion:</b> Cysticercosis, a parasitic infestation caused by Taenia solium is a major health problem in the developing countries. It is a diagnostic and therapeutic dilemma for the clinicians. Steps towards control and possible eradication of the disease are needed, as the disease causes not only chronic morbidity, but also contributes to economic losses in an already impoverished population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1669-1671&id=2641 https://doi.org/10.7860/JCDR/2012/.2641 Are Unstained Smears, Effective Tools in the Evaluation of the Cytological Sample Adequacy? Hemalatha A.L. Umarani M.K., Asha U., Gayathri M.N. <b>Background:</b> Cytologists are often under time pressure due to a constant need and a demand for quick despatch of reports, which calls for an early assessment of sample adequacy. <b>Objective:</b> To study whether unstained smears are effective in evaluation of sample adequacy of cytology aspirates. <b>Materials and Methods:</b> The study had 3 groups. Assessment of sample adequacy of cytology aspirates was done on unstained smears in Group I (200 cases), Group II (100 cases out of Group I) and Group III ( 80 cases out of Group II ) by a Professor, Assistant Professor and a junior resident respectively. The results were compared with assessment of adequacy on stained smears and statistical analysis was done. <b>Results:</b> Evaluation of adequacy of cytology aspirates by examination of unstained and stained smears by 3 observers of varied experience revealed no significant difference between the observers and between the stained and unstained smears (p<0.001). <b>Conclusion:</b> Unstained smear study offered advantages over the stained smears in the evaluation of sample adequacy. Hence, it maybe recommended as a routine practice in cytology clinics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1672-1674&id=2642 https://doi.org/10.7860/JCDR/2012/.2642 Doxofylline and Theophylline: A Comparative Clinical Study MD Faiz Akram, Mohammad Nasiruddin, Zuber Ahmad, Rahat Ali Khan <b>Objectives:</b> COPD is one of the major public health problems worldwide. Theophylline has been used in the treatment of COPD for decades. Doxofylline a new theophylline congener has been claimed to have better safety profile. The study was undertaken to compare theophylline and doxophylline at doses recommended and commonly used in clinical practice. <b>Methods:</b> The study was conducted in patients of COPD in TB chest department of a medical college hospital. It was randomized, prospective and open label. A total of 154 patients were divided in two group .Group I was administered 400 mg theophylline SR once daily and group II was administered doxofylline 400 mg twice a day orally. Spirometric variables symptom score, and adverse effects were recorded on day 0, 7 and 21 of therapy. Data were compared and analysed using SPSS version 16. <b>Results:</b> Results of the study showed that there was no statistically significant difference with respect to spirometric variables and symptom score in the two groups and there was no significant difference in two groups with respect to side effects (p>0.05). <b>Conclusions:</b> It is concluded that doxophylline has no advantage over theophylline in terms of either efficacy or safety on the doses commonly used in current clinical practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1681-1684&id=2643 https://doi.org/10.7860/JCDR/2012/.2643 Antidiabetic and Hypolipidemic Effect of Salacia Oblonga in Streptozotocin Induced Diabetic Rats Bhagyajyothi M. Bhat, Raghuveer C.V. , Vivian D’Souza, Poornima A. Manjrekar <b>Objectives:</b> The present study was conducted to evaluate the effect of a standardized hydroalcoholic root extract of Sala¬cia oblonga (SOE) on the Random Blood Glucose (RBG) levels, serum insulin, glycated haemoglobin (HbA1c) and the serum lipid profile in long standing, experimentally induced Diabetes Mellitus (DM) with glibenclamide (Glb) as the standard. <b>Materials and Methods:</b> Streptozotocin (STZ) induced, dia-betic, Wistar rats of either sex were treated with two oral doses of SOE, 100 and 50mg/kg body wt /day, for a period of 16 weeks. The RBG was estimated at day-1 and at the end of the 16 weeks by using a glucometer. The fasting serum insulin was determined by an ELISA technique. The plasma HbA1c was evaluated by a Turbidimetric Inhibition Immunoassay (TINIA) and the lipid profile was estimated enzymatically. <b>Results and Analysis:</b> A 45% decrease in the RBG was seen after the treatment with the higher dose of SOE, whereas a 44% decrease was observed with the lower dose as com¬pared to the diabetic control. Serum insulin was significantly increased (P<0.05) in all the treated groups as compared to the diabetic control. Plasma HbA1c was significantly decreased (P<0.05). The serum Triacyl Glycerol (TG) levels were signifi¬cantly decreased (P<0.05) in the treated rats as compared to the diabetic control. A significant increase in HDL-cholesterol (P<0.05) in the diabetic rats as a result of the 100mg/kg SOE treatment was a remarkable finding. <b>Conclusion:</b> SOE improves the glycaemic parameters in diabetic rats after a prolonged treatment. The serum TG levels were normalized on treatment. A higher dose of the extract could not alter the parameters significantly, except for HDL-C. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1685-1687&id=2644 https://doi.org/10.7860/JCDR/2012/.2644 Pharmacovigilance of the Cutaneous Drug Reactions in Outpatients of Dermatology Department at a Tertiary Care Hospital Inbaraj S.D., Muniappan M., Muthiah N.S., Arul Amutha, Glory Josephine I., Farhana Rahman <b>Objective:</b> To study the various clinical patterns, causality, severity, and preventability of cutaneous drug reactions among the out patients of the Dermatology Department in a tertiary care hospital. <b>Methods:</b> One hundred eighty one patients with suspected drug allergy were screened and 59 patients with Cutaneous Drug Reactions (CDRs) were recruited for this observational study which was conducted among the outpatients in the Department of Dermatology from June to December 2011. The history of drug intake, the morphology of the cutaneous reactions and their causality, severity and preventability were analyzed. <b>Results:</b> The mean age of the patients with the cutaneous drug reactions was 30.5 years. Most of them were in the age group of 26-37 years, with 52.5% females and 47.5% males. The most common reactions observed were urticaria (32.2%), fixed drug eruptions (25.4%), acneform eruptions (13.6%), morbilliform eruptions (6.8%), maculopapular rashes (5.1%), and angio-oedema (3.4%) . The most common drugs which caused the reactions were Non Steroidal Anti-Inflammatory Drugs (NSAIDs) (39.1%), Quinolones (22.1%), Amoxicillin (8.5%) and Corticosteroids (8.5%). Most of the reactions were mild to moderate in severity and all of them were preventable. <b>Conclusion:</b> The patterns of the cutaneous adverse drug reactions and the drugs which caused them varied in our study population according to the pattern of the drug intake, the associated illness and the susceptibility of the patients. A sound knowledge of the adverse drugs reactions, a careful history taking and a cautious approach during the prescription of new drugs can prevent most of these adverse drug reactions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1688-1691&id=2645 https://doi.org/10.7860/JCDR/2012/.2645 Analysis of the Degree of Insulin Resistance in Post Menopausal Women by Using Skin Temperature Measurements and Fasting Insulin and Fasting Glucose Levels: A Case Control Study Sathya Bhama C.V., Balaji S., Seethalakshmi A. <b>Introduction:</b> In addition to being associated with the termination of the reproductive life in women, menopause coincides with an increase in several co-morbidities which include insulin resistance. An increase in the insulin resistance is associated with an increased risk of diabetes, cardiovascular disease and breast cancer. <b>Aim:</b> To analyze the degree of insulin resistance in post menopausal women by using skin temperature measurements and to confirm the insulin resistance from the fasting insulin and the fasting glucose levels. <b>Methods:</b> The insulin insensitivity was assessed by using skin temperature measurements and this was further proved by assessing the fasting insulin and the fasting glucose levels, and by incorporating the values for the Homeostatic model assessment (HOMA) and the Quantitative insulin sensitivity check index (QUICKI). <b>Statistical Analysis:</b> This was a case control study and the association was found by applying Fischer’s exact test and the P value was estimated. The statistical significance was set at p < 0.05. Student’s t test was applied to determine the significant difference in the skin temperature measurements. Results: By using the HOMA index, only 15 subjects out of the 25 post menopausal women were identified to be insulin resistant. 11 of them were also identified by QUICKI. No premenopausal woman from the recruited population showed insulin resistance with the HOMA and the QUICKI indices. The skin temperature measurements showed significant correlations with the HOMA and the QUICKI indices. There was a significant decrease (p value < 0.0001) in the skin temperature in the postmenopausal women as compared to that in the premenopausal women. The mean ± SD was found to be 0.3834 ± 0.1666 in the premenopausal women, and it was 2.192 ± 3.943 in the postmenopausal women. <b>Conclusion:</b> This study suggests a linear correlation between the skin temperature measurements and the insulin resistance. An increased prevalence of insulin resistance was seen in the postmenopausal women as compared to the premenopausal women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1644-1647&id=2646 https://doi.org/10.7860/JCDR/2012/.2646 The Role of Mental Distraction on the Pain Response in Healthy Young Indian Adults Manoj Kumar, Jayballabh Kumar, Indu Saxena <b>Background and Objectives:</b> The pain sensitivity of a person depends on the type of pain, his/her genetics, racial and cultural factors. Its dependence on the gender is debatable. The significance of the psychological or the behavioural intervention in pain management is gaining importance, along with a reduction in the doses of the analgesics. We wished to investigate (a) whether Indian subjects showed a pain response which was similar to that which was reported for American subjects, (b) whether sex-related differences in the pain response were present in the Indian population, and (c) which method of mental distraction (from a choice of the presence of a male/female attendant, preferred music, and solving simple arithmetic problems) was best suited for the Indian subjects. <b>Methods:</b> The cold pressor task was performed on a group of 80 subjects (38 females who were in the proliferative or the secretory phase of the menstrual cycle) under the conditions which have been mentioned above, as well as in the absence of mental distractants. <b>Results:</b> The female subjects endured pain for a longer duration while they listened to the music of their choice; the male subjects endured pain longer while they were in conversation with the female attendants. <b>Interpretation and Conclusions:</b> A comparison with the reported data showed the Indian males to be more pain-sensitive than the American males. Sex related differences in the pain sensitivity were absent in the Northern Indian subjects. Preferred music was the most effective mental distractant for females, while a conversation with the female attendants was the most effective distractant for the male subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1648-1652&id=2647 https://doi.org/10.7860/JCDR/2012/.2647 Footdrop in the Farmers in Punjab: A Retrospective Electrodiagnostic Study Ruchika Garg , Khushdeep Singh Ar ora, Nitin Bansal, Naveenta Gupta, Harpreet Kaur <b>Aim:</b> This study was performed to find out the occurrence of the common footdrop which was due to peroneal nerve palsy in the farmers in Punjab, India. <b>Methods:</b> This study consisted of 100 male subjects of which 50 were farmers (who were aged between 20 to 50 years), who were suffering from a unilateral foot drop and 50 were normal, healthy, age matched controls who were not involved in farming activities. The nerve conduction parameters (the nerve conduction velocities, latencies and amplitudes) of the common peroneal nerve and the tibial and the sural nerves were measured distally at the ankle and proximally at the knee on both the lower limbs of the subjects. <b>Results:</b> On comparative evaluation, the data showed a significantly reduced conduction velocity and amplitude on the affected side as well as on the contralateral side in the common peroneal nerve of the farmers as compared to those in the controls. The F wave latency was increased in both the limbs of the farmers in comparison to the controls. <b>Conclusions:</b> The patients presented with a unilateral footdrop which was due to peroneal palsy, but a decreased peroneal nerve conduction was observed on the contralateral side as well. Thus, it suggested the involvement of the common peroneal nerve bilaterally. The position of sitting during harvesting or weeding was also important in inducing footdrop along with the type of the hand activity, because of occurrence of the footdrop on the side of the dominant hand. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1653-1657&id=2648 https://doi.org/10.7860/JCDR/2012/.2648 Assessment of the Cognitive Status in Diabetes Mellitus Shuba N, Karan <b>Background and Objectives:</b> Diabetes is considered as an independent risk factor for cognitive impairment and dementia. In this study, we assessed the cognitive status of diabetics and non diabetics by the Mini Mental Status Examination (MMSE) and the Modified Mini Mental Status Examination (3MS) and also found a correlation of age, sex, the duration of diabetes and HbA1C with the cognitive status among the diabetics. <b>Materials and Methods:</b> Thirty males and females above the age of 50 years, with and without diabetes, were included in the study. Both the groups underwent a cognition assessment by MMSE and 3MS and they scored 30 and 100 respectively. The correlation of age, sex, the duration of diabetes and HbA1C among the diabetics with 3MS was also done. <b>Statistical Analysis:</b> The analysis was done by using the SPSS software, version 13. The unpaired t test and one way ANOVA were used for various analyses. A p value of < 0.05 was considered to be statistically significant. <b>Results:</b> The diabetics showed decreased MMSE and 3MS scores (p<0.001). 63.33% of the diabetics had a decreased cognition, based on the MMSE and 70% of the diabetics had a decreased cognition, based on the 3MS. The correlation of age, sex, the duration of diabetes and HbA1C among the diabetics with cognition status was not significant. <b>Conclusion:</b> Diabetes is associated with lower levels of the cognitive function. By the early implementation of MMSE, we can detect even a mild cognitive impairment, so that adequate treatment can be given, to prevent dementia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1658-1662&id=2649 https://doi.org/10.7860/JCDR/2012/.2649 Ultrasound Guided Reduction of an Ileocolic Intussusception by a Hydrostatic Method by Using Normal Saline Enema in Paediatric Patients: A Study of 30 Cases Shastri Mona Digant, Seth Rucha, Desai Ekta <b>Introduction:</b> The conventional hydrostatic reduction of an intussusception with barium enema or the pneumatic reduction of an intussusception is associated with considerable ionizing radiations and a risk of perforation; while the hydrostatic reduction of an intussusception under ultrasound guidance is a very safe method because the whole procedure is visualized with real time ultrasound. Also, being a non-invasive method with a high success rate, this procedure has emerged as a useful alternative to a surgical intervention. <b>Aim:</b> The aim of this study was to evaluate the role of ultrasound and colour Doppler studies for the guidance of the hydrostatic reduction of a childhood intussusception by using normal saline. <b>Method:</b> Among 41 children who were evaluated with ultrasonography for the confirmation of the presence of intussusceptions, hydrostatic reduction of intussusception were performed under a sonographic guidance in 30 patients, whereas 11 patients were excluded due to clinical contraindications. <b>Results:</b> This disease was observed mostly at the ages of 6 months to 24 months. In 80% of the patients, there was a recent history of gastroenteritis and 40 % had a history of common cold. The most common site of the intussusception was the transverse colon near the hepatic flexor of the colon (90%), with a mean duration of 22.1±17.3 hours. The overall rate of a successful reduction was 87% and the mean reduction time was 14 minutes. None of the cases showed recurrence within 24 hrs. No complications were observed. <b>Conclusion:</b> We conclude that ultrasound with colour Doppler study is very useful for the diagnosis of intussusceptions, as well as for guided hydrostatic reductions by using normal saline enema. This is an optimal, simple, and a safe procedure for the treatment of intussusceptions in paediatric patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1722-1725&id=2650 https://doi.org/10.7860/JCDR/2012/.2650 Congenital Malformations in Perinatal Autopsies – A Study of 100 Cases Uma S Andola, Anita AM, Mukta Ahuja, Sainath K Andola <b>Background:</b> Congenital malformations remain a common cause of perinatal deaths and even though ultrasonogram can give fairly accurate diagnosis, perinatal autopsy is essential to confirm the diagnosis and look for associated malformations. <b>Objectives:</b> To emphasize the importance of perinatal autopsy in diagnosing congenital malformations and to compare the same with the prenatal ultrasound findings. <b>Methods:</b> The present study comprises 100 consecutive perinatal autopsies conducted after obtaining the approval from the Institutional Ethics Committee. In cases where prenatal ultrasound findings were available they were compared with the autopsy findings. <b>Results:</b> Out of 100 perinatal autopsies, 44 cases were congenital anomalies with M:F = 1:1.5. Majority of the fetuses with congenital malformations (36.36%) were therapeutically terminated, CNS malformations being the commonest indication. The most common timing of therapeutic termination being 20 -24weeks. Congenital malformations were common between 35-39 weeks gestational age and birth weight range 350- 1000g. The malformations involving the CNS were commonest, seen in 15 cases (34.09%) followed by renal anomalies in 9 cases (20.45%) and multiple malformations in 7cases ( 15.91%). Autopsy confirmed the prenatal ultrasound findings in 50% of the cases, added to diagnosis in 29.54%, while it completely changed the primary diagnosis in 9.09% of the cases. <b>Conclusion:</b> This study highlights the importance of perinatal autopsy in confirming the diagnosis of congenital anomalies by prenatal ultrasound findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1726-1731&id=2651 https://doi.org/10.7860/JCDR/2012/.2651 Placental Thickness & its Correlation to Gestational Age & Foetal Growth Parameters- A Cross Sectional Ultrasonographic Study T Karthikeyan, Ramesh Kumar Subramaniam, WMS Johnson, Prabhu K <b>Background:</b> The Gestational Age (GA) is frequently over or under estimated, as the conventional gestational estimation is based on the Last Menstrual Period (LMP) and on ultrasonography (USG). Many people are unaware of their LMP and irregular menstruations and USG is bound to have a bias, thereby posing difficulties in the GA estimation. <b>Aim:</b> This study was aimed at estimating the (Placental Thickness) PT and at investigating the relationship between PT and the foetal growth parameters in normal singleton pregnancies. <b>Materials and Methods:</b> Two hundred eleven pregnant women were recruited in a cross sectional prospective study. The pregnancies were between 11 to 40 weeks and they were not complicated by either maternal or foetal diseases. The Biparietal Diameter (BPD), the Abdominal Circumference (AC), the Head Circumference (HC), the Femur Length (FL) and the PT were measured by USG by using a 3.5 MHz transducer. <b>Results:</b> The maximum mean PT in the 1st, 2nd, 3rd and the combined trimesters were 16.5 mm, 23.78 mm, 35.81 mm and 28.49 mm respectively. The correlation between PT and the other foetal parameters was investigated by Pearson’s correlation analysis. The values were expressed as mean + standard deviation. The statistical tests were two-tailed, with a p value of < 0.01, which indicated the statistical significance. There was a strong positive correlation between PT and GA, with the correlation coefficient values for the 1st, 2nd and 3rd trimesters being r = 0.609, r = 0.812 and r = 0.814 respectively. There was a significant positive correlation between PT and BPD, AC, FL, ABC, HC and FW also. The mathematical relationships between PT and GA, BPD, AC, FL, ABC, HC, FW were derived by regression analysis. The regression equation which was derived was (x - 22.92) = (0.3604) (w-27.86446) + (1.0256)(y-1.1678) + (0.0015)(z-216.2841) + (0.1047) (t-43.1555) + (0.027) (u.192.79000) + (0.0042) (v-60.3725), where x = GA in weeks, w = PT in mm, y = FW in kg, z = HC in mm, t = FL in mm, u = AC in mm and v = BPD in mm. <b>Conclusion:</b> We conclude that PT can be used as a predictor of the GA. The subnormal PT for the corresponding GA should be evaluated for any disease condition. So, the measurement of PT should therefore be carried out routinely during the obstetric USGs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1732-1735&id=2652 https://doi.org/10.7860/JCDR/2012/.2652 The Role of a Single Dose of Sublingual Nifedipine in Managing Hypertensive Emergencies in the Patients who Undergo Haemodialysis Jagjit Singh, Rajiv Kumar, Vitul K. Gupta, Arun Kumar Maria, Rubina Paul, Simerpreet Kaur, Prabhnoor Singh Hayer <b>Introduction:</b> The hypertensive emergencies in haemodialysis require immediate therapy, usually by parenteral drug administration; however, sublingual medications may have a potential in this special condition. <b>Methods:</b> A prospective, non randomized, case control study was carried out to know the effectiveness and the safety of a single dose of 5mg Nifedipine (sublingual) in this subset of patients. About 100 patients were studied, who were on maintained haemodialysis and were having high Blood Pressure (BP) during the haemodialysis. The patients were monitored for about 5 hours. <b>Results:</b> The patients who had chronic renal failure, who were maintained on regular haemodialysis, who had high systolic and diastolic blood pressure of >220 (systolic) and >125 (diastolic) respectively, were subjected to the study. These patients were of the 20-70 years age group, who visited our hospital between January 2010 to January 2011. Out of the 100 patients 30% were females and the rest (70%) were males. A single dose of nifedipine (5 mg by the sublingual route) was prescribed to determine its effectiveness and safety in the treatment of hypertensive emergencies during haemodialysis. The side effects of the drug were closely monitored. The blood pressure and the heart rate were measured continuously up to 280 min post-dose. The response rates were 90 % for nifedipine. The significant hypotensive effects of sublingual nifedipine occurred at 10 min, and a maximum reduction occurred after 30 mins and it continued up to 120 min. <b>Conclusions:</b> We concluded that sublingual nifedipine was effective and that it seemed to have less side effects. It may be an excellent drug in the urgent treatment of hypertensive emergencies in haemodialysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1740-1743&id=2617 https://doi.org/10.7860/JCDR/2012/.2617 Anaesthesia for TMJ Ankylosis with the Use of TIVA, Followed by Endotracheal Intubation Mohan K, Mohana Rupa L, Gopala Krishna Murthy S, Greeshma P.G, Bhavana U TMJ ankylosis, though it is not common, is an anaesthetic challenge, as it is a difficult airway situation with a moderate to a severely limited mouth opening. Fiber-optic intubation is the gold standard for such cases, but it may not be readily available at all centres. Blind nasal intubation, retro-grade intubation and tracheostomy are the other alternatives, but they require patient co-operation and are associated with considerable morbidity. We are presenting a case of unilateral TMJ ankylosis in a 12 years old boy who was posted for condylectomy and interpositional arthroplasty. He was maintained on TIVA for condylectomy and was then intubated for the remaining procedure. The procedure and the recovery were uneventful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1765-1767&id=2605 https://doi.org/10.7860/JCDR/2012/.2605 Transient Hypertension after an Interscalene Block-The Presentation of a Rare Complication with an Anatomical Explanation Sameer Mahamud Jahagirdar, C. Rajesh Prabhu, S. Parthasarathy We would like to report 2 cases where we encountered a rare complication of hypertension without tachycardia after the administration of an interscalene block. We have tried to explain the same with the anatomical correlations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1768-1769&id=2606 https://doi.org/10.7860/JCDR/2012/.2606 A Case of Flax Seed Induced Rhabdomyolysis Anushre Prasad, Ritesh Kumar, Harini Ramanan, Nalini Khandige, Krishnananda Prabhu Rhabdomyolysis is a clinical and a biochemical syndrome that occurs due to a skeletal muscle injury. The main cause of rhabdomyolysis is a muscle crush injury, toxins, ischaemia and metabolic disorders. Rare cases of rhabdomyolysis have been reported which had been caused by drugs and after insect stings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1770-1771&id=2608 https://doi.org/10.7860/JCDR/2012/.2608 A Primary Ovarian Pregnancy with a Contralateral Ruptured Corpus Luteum: A Case Report Farah Ziyauddin, Tamkin Khan, Dalia Rafat, Meher Aziz, Nazima Haider A primary ovarian pregnancy is one of the rarest varieties of ectopic pregnancies. The conditions which are most commonly confused with an ovarian pregnancy are, a ruptured corpus luteal cyst, a haemorrhagic corpus luteum and a ruptured endometriotic cyst. This case presents the clinical and the histological findings of a ruptured ovarian pregnancy, along with a ruptured corpus luteal cyst in the contralateral ovary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1772-1774&id=2609 https://doi.org/10.7860/JCDR/2012/.2609 Retained Intra- Thoracic Surgical Pack Mimicking as Recurrent Aspergilloma Ruquaya Mir An intrathoracic gossypiboma is a rare condition. We are reporting a case of intrathoracicgossypiboma which was misdiagnosed as a recurrent aspergilloma. In our patient, the gossypiboma manifested as a pleural- based extra pulmonary mass which had a large contact area with the pleura and it displayed an extra pulmonary location. A retained surgical swab (gossypiboma) is a rare but an important complication of an intra- thoracic surgery. The diagnosis is usually overlooked, as in our case, resulting in delay of treatment, complications and a prolonged hospitalization. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1775-1777&id=2610 https://doi.org/10.7860/JCDR/2012/.2610 Secondary Chondrosarcoma of the Lumbosacral Region: Are any Bones Spared in the Multiple Hereditary Exostoses? Hemalatha Anantharamaiah, Kalyani R., Harendra Kumar M.L., Manohar P.V. Osteochondromas are the most common benign bone tumors. Usually solitary, multiple osteochondromas (exostoses) are seen in patients with Multiple Hereditary Exostoses (MHE). Chondromatous transformation of lumbar osteochondroma in a patient with multiple exostoses is a rare phenomenon. We present a rare case of secondary chondrosarcoma of lumbar exostoses with patient presenting with symptoms of pain in the right lumbar region and paresis of right lower limb. Patients with multiple exostoses are prone to develop chondrosarcoma early in life. These patients need long term follow up with regular clinical and radiological examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1778-1780&id=2611 https://doi.org/10.7860/JCDR/2012/.2611 Cavernous Hemangioma of the Spinal Cord: A Rare Case Sonti Sulochana, Meenakshi Sundaram Cavernous hemangiomas are composed of dilated vessels which are filled with blood. Their common sites of occurrence include the skin, liver and the superficial and the deep soft tissues. We are presenting a rare case of cavernous hemangioma of the spinal cord. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1781-1782&id=2612 https://doi.org/10.7860/JCDR/2012/.2612 The Budd-Chiari Syndrome in a Child: A Case Report and Review of the Vatsala Misra, Kachnar Verma, Dharmendra Kumar Singh, Sri Prakash Misra The Budd-Chiari Syndrome is associated with hepatic venous outflow obstruction. This syndrome is rare in infants and children. As this syndrome is uncommon, especially in the paediatric age group, misdiagnoses and delays in the diagnosis are frequent. A high index of clinical suspicion along with a radiological aid and a histopathological correlation can lead to an early diagnosis and an appropriate management in such cases. This case report highlights the occurrence of this rare condition in the paediatric age group as well as it redefines the salient features of this syndrome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1783-1785&id=2613 https://doi.org/10.7860/JCDR/2012/.2613 Tacrolimus Associated Localized Thrombotic Microangiopathy Developing in Early Stage after Renal Transplantation Clement Wilfred Devadoss , Mysorekar Vijaya V., Mahesh E., Raju Venkataramana S., Girish M.S. Calcineurin inhibitor induced thrombotic microangiopathy is a rare but well recognized complication of a renal transplantation that occurs in 1% of the patients who are on tacrolimus immunosuppression. Among the other aetiological factors of the “de-novo” Thrombotic Microangiopathy (TMA), the condition especially has to be differentiated from an antibody mediated rejection, as both have different pathogenesis, therapeutic connotations and outcomes. We report a case of a middle aged female renal transplant recipient treated with tacrolimus, who developed localised thrombotic microangiopathy in the early post transplantation period. Despite the normal trough levels of tacrolimus, a diagnosis of “Tacrolimus induced TMA” was rendered after excluding other causes of the “de-novo” TMA, which included an antibody mediated rejection, a meticulous clinico-pathological correlation and serological studies. The treatment included the substitution of tacrolimus by rapamycin, with the subsequent normalization of the renal function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1786-1788&id=2614 https://doi.org/10.7860/JCDR/2012/.2614 Eosinophilic Gastroenteritis: A Diagnosis Behind the Curtains Neha Agrawal, K. Usha Rani, Rohini Sridhar, S. Dhamayanthi Eosinophilic gastroenteritis (EG) typically presents with a combination of chronic nonspecific gastrointestinal symptoms which include abdominal pain, nausea, vomiting, diarrhoea, weight loss, and abdominal distension. Approximately 80% of the patients have symptoms for several years. A high degree of clinical suspicion is often required to establish the diagnosis, as this disease is extremely rare. We are presenting the case of a 19 year old boy who presented with growth retardation and markedly decreased secondary sexual characteristics. Taking the full clinical history and a meticulous investigation finally led to the diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1789-1790&id=2615 https://doi.org/10.7860/JCDR/2012/.2615 Circulating MicroRNAs as Biomarkers in Health and Disease V. Kuzhandai Velu,R.Ramesh,A.R.Srinivasan In the recent years, circulating nucleic acids have emerged as new biomarkers. Among these, microRNAs(miRNA) have evolved as promising and potential markers of both physiological and pathological conditions. MiRNA are transcribed from DNA like the other mRNA molecules. Their secretions and functions have to be still explored in humans, though many theories have been proposed. It is a small non coding RNA which plays an important role in the regulation of the gene expression, cell-cell communication, cell division and apoptosis. MiRNAs are stable and tissue specific and they can be identified and quantitated, which make them ideal biomarkers. This review highlights the secretion,mechanism of action and the role of miRNA in the diagnosis and the management of different disease conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1791-1795&id=2653 https://doi.org/10.7860/JCDR/2012/.2653 Understanding Redox Homeostasis and Its Role in Cancer Jayshree Shriram Dawane, Vijaya Anil Pandit When a cell is damaged or altered without repair to its system, it usually dies. But if such damaged or unrepaired cells do not die and proliferate with uncontrolled growth; a mass of cancer cells develop. Cancer has a complex aetiology with multiple risk factors that involve the interplay between genetic and environmental influences. The redox dysregulation originates from metabolic alterations and it is dependent on mitogenic and survival signalling through reactive oxygen species. There is a delicate balance between the production and the destruction of reactive species; for this, we need to understand the role of redox homeostasis in cancer. So, the specific vulnerability of the malignant cells can be selectively targeted. This article will outline the redox homeostasis and the relationship between the disturbances in it and cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1796-1802&id=2654 https://doi.org/10.7860/JCDR/2012/.2654 The Relevance of Mast Cells in Oral Squamous Cell Carcinoma Vineet Singh Cheema, V. Ramesh, P. D. Balamurali <b>Context:</b> The commonly occurring oral neoplasm – Oral Squamous Cell Carcinoma (OSCC) has an association with the chronic inflammation in the adjacent connective tissue. Mast cells are the local residents of the connective tissue. They are said to be pro inflammatory and immune-amplifying in action and they produce mitogenic cytokines. They exhibit a phenotypic plasticity with a change in the microenvironment, thus making the role of the mast cells in this disease even more intriguing. Mast cells have also been reported to play a role in tumour progression and metastases by promoting angiogenesis. <b>Aims:</b> The present study aimed at comparing the Mast Cell Density (MCD) in the Normal Oral Mucosa (NM) and among the various grades of OSCC and at analyzing the possible role of the mast cells. <b>Settings and Design:</b> The MCD was assessed by using the 1% Toluidine blue stain in a study sample of 102 cases of different grades of OSCC and in 07 cases of clinically normal oral mucosa. <b>Statistical Analysis Used:</b> By using the Student’s ‘t’ test and one way ANOVA, the Mast Cell Density (MSD) was found to be significantly higher in well differentiated squamous cell carcinoma and in moderately differentiated squamous cell carcinoma as compared to that in the poorly differentiated oral squamous cell carcinoma (P=< 0.01) which was significant at a 1% level. The Spearman’s Rank Correlation Co-efficient revealed a significant correlation between the density of the mast cells and the increasing grade of the OSCC. <b>Conclusions:</b> These findings denote that as the squamous cell carcinoma enters the poorly differentiated state, there may be some change which is reflected as a decrease in the mast cell density. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1803-1807&id=2616 https://doi.org/10.7860/JCDR/2012/.2616 The Prosthodontic Management of a Young Edentulous Patient with the Papillon Lefevre Syndrome- A Rare Case Report Sreeramulu B, Haragopal S, Shalini K, Sudha Madhuri D, Kiran G https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1808-1811&id=2607 https://doi.org/10.7860/JCDR/2012/.2607 Purpura Fulminans in a Child: A Case Report Shrikiran Aroor, Chaitanya Varma, Suneel C Mundkur Purpura Fulminans is a life threatening condition characterised by cutaneous haemorrhage and gangrenous necrosis. We present such a case in an eight year old child. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=December&volume=6&issue=10&page=1812-1813&id=2618 https://doi.org/10.7860/JCDR/2012/.2618