Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Comparison of the DNA Fragmentation and the Sperm Parameters after Processing by the Density Gradient and the Swim up Methods Iraj Amiri, Marzieh Ghorbani, Safora Heshmati <b>Introduction:</b> The swim up and the density-gradient centrifu­gation are the two main techniques which are used to separate the viable motile sperm fraction in the assisted reproductive tech­nology. However, there are several published studies about these methods, but there is no sufficient evidence for recommending the superiority of one of them. This study was designed to study the efficiency of the swim-up and the density gradient techniques to recover the spermatozoa with a high degree of motility, a normal morphology and a low level of DNA fragmentation. <b>Material and Methods:</b> A total of 35 semen samples were included in the study. The semen samples were collected, one part of the semen was spread on a slide and the remainder was prepared by using the swim-up or the density gradient techniques. The recovered spermatozoa were evaluated for concentration, motility, and normal morphology. A comet assay was carried out to assay the DNA fragmentation in all the samples. <b>Results:</b> There were significant differences in the sperm parameters between the density gradient and the swim up techniques. Also, the swim-up technique showed a significantly higher level of DNA fragmentation as compare to the density gradient technique. <b>Conclusion:</b> The results of this study demonstrated several benefits of the gradients method in the separation of normal and motile spermatozoa with healthy DNA, in comparison to the swim up method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1451-1453&id=2530 https://doi.org/10.7860/JCDR/2012/.2530 Prevalence of the Persistant Median Artery Rajan Kumar Singla, Neelamjit Kaur, Gurvinder Singh Dhiraj <b>Introduction:</b> Neurovascular variations in the upper limb are common and they are well documented. An accurate knowledge of the normal and the variant anatomy of the median nerve and the median artery are important for clinical procedures and for vascular surgeries. The persistant median artery is one such anomaly which was seen in 6.6% (4) of the 60 upper limbs which were dissected in the present study, it being bilateral in one cadaver. <b>Material and Methods:</b> The present study was conducted on 60 upper limbs of 30 cadavers at the Government Medical College, Amritsar, India. The whole course of the median nerve and the persistant median artery was exposed. <b>Results:</b> In all the 4 variant limbs, the persistent median artery originated from the anterior interrosseous artery and terminated in the incomplete mediano- ulnar type of the superficial palmar arch. In three upper limbs, the persistant median artery simply accompanied the median nerve upto the palm. But in the left upper limb of the cadaver with the bilateral variation, the artery penetrated and divided the nerve into two halves which joined to form a neural loop around the artery. Thereafter, the nerve and the artery followed the same course upto the palm. Such a penetration of the median nerve by the persistent median artery is extremely rare. Further, its ontogeny and clinical implications have been discussed in detail https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1454-1457&id=2531 https://doi.org/10.7860/JCDR/2012/.2531 The Role of Serum Protein Electrophoresis in the Detection of Multiple Myeloma: An Experience of a Corporate Hospital Sunita Tripathy <b>Background:</b> Multiple Myeloma (M.M) is a neoplasm of B cell lineage characterized by excessive proliferation of abnormal plasma cells, secreting abnormal immunoglobulin causing monoclonal gammopathy which can be detected by the presence of M protein in serum and urine electrophoresis. <b>Aim:</b> To detect and quantify monoclonal gammopathy in suspected cases of multiple myeloma and to differentiate them from benign conditions, because of the vast difference between their prognosis and management. <b>Method:</b> Serum samples from 150 suspected cases of M.M were subjected to serum protein electrophoresis on cellulose acetate strip. M band detected visually and estimation of M protein was done by densitometer. Bone Marrow biopsy and clinical profile were correlated in M band positive cases. <b>Result:</b> Out of 150 cases 10.66% cases had monoclonal gammopathy. Ten percent cases were diagnosed to be multiple myeloma and one case was found to be Monoclonal gammopathy of undetermined significance. <b>Conclusion:</b> SPEP is an easy to perform laboratory test which can be used for detection and quantification of monoclonal gammopathy and should be recommended as preliminary test for suspected cases of multiple myeloma. MGUS must be differentiated from M.M, as management and prognosis of these two cases is totally different. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1458-1461&id=2532 https://doi.org/10.7860/JCDR/2012/.2532 The Roles of Glutathione, Glutathione Peroxidase, Glutathione Reductase and the Carbonyl Protein in Pulmonary and Extra Pulmonary Tuberculosis Shubhangi M. Dalvi, Vinayak W. Patil, Nagsen N. Ramraje <b>Background:</b> This study determines the protein carbonyls which cause cellular damage and glutathione, glutathione peroxidase, glutathione reductase act as antioxidants. <b>Materials and Methods:</b> This study was carried out in different categories of pulmonary and extra pulmonary tuberculosis cases of newly sputum culture positive diagnosed pulmonary categorie I (n=100), extra pulmonary patients categorie (n=35) before and after the DOTS treatment of 6 months, categorie II (n=100), categorie III (n=100) and in normal control subjects (n=100). <b>Results:</b> The serum protein carbonyl levels were significantly increased in the pulmonary and extra pulmonary tuberculosis patients. The activities of blood glutathione, glutathione peroxidase, and glutathione reductase were found to be significantly decreased in subjects of all the categories of pulmonary and extra pulmonary tuberculosis. A negative correlation between the carbonyl protein content and glutathione, glutathione peroxidase, and glutathione reductase was seen in pulmonary tuberculosis, p<0.001. <b>Conclusion:</b> Increased antioxidant defense mechanism due to increase oxidative stress in tuberculosis. The changes were reversed after 6 months of antitubercular treatment in patients with a good recovery, but the increase in the oxidative stress was not completely reversed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1462-1465&id=2533 https://doi.org/10.7860/JCDR/2012/.2533 A Cross Sectional Study on the Relationship Between the Body Mass Index (BMI) and the Audiovisual Reaction Time (ART) Deepmala Nagorao Deore, Surekha P. Surwase, Shazia Masroor, Samina T. Khan, Vinod Kathore <b>Introduction:</b> The reaction time is the time interval between the stimulus application and the proper response. The neurophysiological studies suggest a relationship of the BMI with the cognition, attention and the memory. <b>Aim:</b> To study the relationship between the Body Mass Index (BMI) and the audiovisual reaction time in young healthy females. <b>Materials and Methods:</b> This study was carried out in the Department of Physiology on 90 young, healthy females who were in the Ist year MBBS and BDS at GMC and GDC Aurangabad. The height and weight were recorded and the BMI was calculated. The subjects were divided into 3 groups: those with normal weight, underweight and overweight according to the WHO criteria. The simple reaction time was measured with the help of Audio Visual Reaction Time Apparatus in all the three groups. The data was analyzed by the one way ANOVA test by using the Graphpad Prism Software. <b>Result:</b> There was a prolongation of both ART and VRT in the underweight and the overweight individuals. When the VRT was compared, it was found to be statistically significant. <b>Conclusion:</b> Our study showed that the BMI of an individual affected the audio visual reaction time, which was an indirect measure of the sensory motor association. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1466-1468&id=2534 https://doi.org/10.7860/JCDR/2012/.2534 Study of Comparative Effects of Antioxidants on Insulin Sensitivity in Type 2 Diabetes Mellitus A.S. Udupaupa, P.S. Nahar, S.H. Shah, M.J. Kshirsa gar, B.B. Ghongane <b>Objectives:</b> This study intended to assess the effects of the antioxidants; Alpha Lipoic Acid (ALA), omega 3 fatty acids and vitamin E on the parameters of insulin sensitivity, oxidative stress, lipid metabolism and glycaemic control in patients of type 2 diabetes mellitus. <b>Methods:</b> This was a prospective, randomized, double blind, placebo controlled, single centred study. 104 patients with type 2 diabetes mellitus with insulin resistance were recruited for the study. They were given ALA, omega 3 fatty acids, vitamin E or placebo. Their weight, Body Mass Index (BMI) and Waist circumference were measured. The investigations which were fasting glucose and fasting total cholesterol. The insulin resistance was calculated on the basis of the BMI and the waist circumference. <b>Results:</b> In the intra group analysis at the baseline (V1) vs at the end of the treatment period (V5), we observed a significant decrease in the BMI, waist circumference and the total cholesterol in the three treatment groups. In the intergroup analysis at V5, ALA, omega 3 fatty acids and vitamin E showed a significant improvement in the total cholesterol as compared to the placebo and vitamin E showed the maximum improvement. <b>Conclusion:</b> ALA, omega 3 fatty acids and vitamin E showed the improvement in insulin sensitivity. Since they differ in improving different parameters all of these three can be used as an add on therapy in patients with type 2 diabetes mellitus to improve their insulin sensitivity and lipid metabolism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1469-1473&id=2535 https://doi.org/10.7860/JCDR/2012/.2535 The Recent Trends of Shigellosis: A JIPMER Perspective Jharna Mandal, Ganesh V., Jennifer Emelda, Mahadevan S., Subhash Chandra Parija <b>Background:</b> The multi-drug resistant Shigella has posed a therapeutic challenge in most parts of the world. In the last few years, there has been a tremendous change in the anti-microbial susceptibility profile of this organism. <b>Aim:</b> This present study was carried out to determine the current anti-microbial susceptibility pattern of the members of the genus, Shigella in our region. <b>Materials and Methods:</b> 2658 stool samples from patients with diarrhoea were received between 2008 and 2010. The disc diffusion testing was performed by the Kirby-Bauer method and the minimum inhibitory concentrations (MICs) of ciprofloxacin and ceftriaxone were obtained by the agar dilution method and the E-test. The double disk synergy test was used to confirm the status of the extended beta-lactamase producers. <b>Results:</b> 74 (2.78%) Shigella spp were isolated, out of which S.flexneri was 90.54%, S.dysenteriae was 2.70%, S.boydii was 1.35% and S.sonnei was 5.40%. 43 (58.108%) strains were isolated from children of 0 to &#8804;5 years, 13(17.56%) were isolated from children who were >5 years but &#8804; 15 years of age and the rest of the 18 (24.32%) were isolated from adult patients. 79% of the strains were resistant to ampicillin, followed by 51% which were resistant to nalidixic acid, followed by 50% which were resistant to ciprofloxacin (the MIC of ciprofloxacin was 16&#956;g/ml), and 39.4% which were resistant to furoxone and chloramphenicol respectively. 2 (3%) strains of S.flexneri were found to be resistant to ceftriaxone, which had MICs of > 256µg/ml. The ceftriaxone resistant S. flexneri isolates were confirmed to be extended spectrum beta-lactamase producers by the double disk synergy test. <b>Conclusion:</b> The continuous assessment of the anti-microbial susceptibility patterns and the periodic reporting in this context is important. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1474-1477&id=2536 https://doi.org/10.7860/JCDR/2012/.2536 The Isolation and the Biofilm Formation of Uropathogens in the Patients with Catheter Associated Urinary Tract Infections (UTIs) S. Niveditha, S. Pramodhini, S. Umadevi, Shailesh Kumar, Selvaraj Stephen <b>Background:</b> Urinary tract infections are the most commonly acquired bacterial infections and they account for an estimated 25-40% of the nosocomial infections. The microbial biofilms pose a public health problem for the persons who require indwelling medical devices, as the microorganisms in the biofilms are difficult to treat with antimicrobial agents. <b>Aims:</b> The present study included the isolation and the biofilm formation of the uropathogens in patients with catheter associated urinary tract infections. Methods and Materials: This prospective analysis which was carried out over a period of two months, included 50 urine samples from catheterized patients with symptoms of UTI. Following their isolation and identification, all the isolates were subjected to the biofilm detection by the tube adherence method and the Congo Red agar method. <b>Results:</b> E.coli was found to be the most frequently isolated uropathogen 35(70%), followed by Klebsiella pneumoniae 8(16%), Pseudomona aeruginosa 2(4%), Acinetobacter spp 1(2%), coagulase negative Staphylococci 3(6%) and Enterococci spp 1(2%). In the current study, 30 (60%) strains were positive in vitro for the biofilm production. <b>Conclusion:</b> To conclude, there was significant bacteriuria in all the symptomatic catheterized patients and E.coli was the most frequent isolate. Diabetes (44%) was the most common factor which was associated with the UTIs in the catheterized patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1478-1482&id=2537 https://doi.org/10.7860/JCDR/2012/.2537 Prevalence of Serum Antibodies to TORCH Infection in and Around Varanasi, Northern India M.R. Sen, B.N. Shukla, Tuhina Banerjee <b>Background:</b> The acute infections which are caused by Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV) and the Herpes Simplex Virus (HSV-2) during pregnancy are often associated with adverse foetal outcomes and reproductive failures. In the Indian context, the exact seroprevalence of these infections is not known due to unavailability of baseline data. <b>Aims:</b> The present study was undertaken to determine the serological evidence of the acute TORCH infections in women who were in the first trimesters of their pregnancies in and around Varanasi, north India. <b>Settings and Design:</b> This study was carried out in the Sir Sunderlal Hospital, Varanasi and in the Department of Microbiology, Institute of Medical Sciences, BHU, Varanasi, UP, India. The study population involved pregnant women with bad obstetric histories, who were in the first trimester of their pregnancy. <b>Methods and Materials:</b> Sera were collected from the women with Bon and they were tested for the presence of specific IgM antibodies against the TORCH infections by ELISA. <b>Statistical Analysis:</b> A 95% confidence interval was calculated for the positive cases in each of the TORCH components. <b>Results:</b> The specific IgM antibodies were found to be positive in 74(19.4%) cases for toxoplasmosis, in 126 (30.4%) cases for the Rubella virus, in 130 (34.7%) cases for CMV and in 151 samples (33.5%) for the HSV-2 infections. <b>Conclusions:</b> The study showed a high prevalence of the infections which were caused by the TORCH complex amongst pregnant women with bad obstetric histories. Therefore, all the antenatal cases should be routinely screened for the TORCH infections, for carrying out early interventions to prevent foetal loss. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1483-1485&id=2538 https://doi.org/10.7860/JCDR/2012/.2538 The Prevalence and the Characterization of the Enterococcus Species from Various Clinical Samples in a Tertiary Care Hospital S. Sreeja, Sreenivasa Babu P.R., A.G. Prathab <b>Background:</b> Enterococci form a part of the normal flora of the intestinal tract, the oral cavity, and the vagina, but in recent times, they have become emerging nosocomial pathogens. Their increasing importance is largely due to their resistance to antimicrobials. The therapeutic failures in enterococcal infections are mainly due to the intrinsic as well as transferable drug resistance. The main aim of our study was to estimate the prevalence of the Enterococcus infection and to determine the antibiogram in a tertiary care hospital. <b>Method:</b> Enterococcus was isolated from a total of 5555 clinical samples like urine , pus, tissue, blood and body fluids during the period from January to December 2008.The isolates were speciated by using conventional biochemical tests (Facklam and Collins). The antibiotic susceptibility testing was done by the Kirby Bauer disc diffusion method. Confirmation of vancomycin susceptibility was done by the Epsilometer test (E test) to determine the Minimum Inhibitory Concentration (MIC). <b>Result:</b> From various clinical samples, 128 Enterococcus species were isolated in a period of one year and the rate of the infection was estimated to be 2.3%. Among the isolates, those of Enterococcus faecalis (E.faecalis) were 97(76%) and the remaining 31(24%) were of Enterococcus faecium (E.faecium). The maximum number of isolates were from pus 55(43%), followed by the isolates from urine 40(31%). The sensitivity pattern of these isolates showed an increased resistance to penicillin, ampicillin and ciprofloxacin. A High Level of Gentamicin Resistance (HLGR) was present in 60 (47% ) isolates of Enterococcus and 35(27%) isolates were intermediately sensitive to vancomycin by the Kirby Bauer disc diffusion method. All the intermediately sensitive isolates to vancomycin were further tested by the E test and they were found to be vancomycin sensitive. <b>Conclusion:</b> Various studies have shown an increase in the rate of infection and the antibiotic resistance in the Enterococcus species. There is also a change in the pattern of the Enterococcus infection, with an increase in the isolation rate of E. faecium and other non faecalis Enterococcus species. The Kirby Bauer disc diffusion method is not an accurate method for detecting the Vancomycin Resistant Enterococci (VRE). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1486-1488&id=2539 https://doi.org/10.7860/JCDR/2012/.2539 Variations in the Oral Anaerobic Microbial Flora in Relation to Pregnancy Anuradha Basavaraju,Vijaya Durga S., B. Vanitha <b>Introduction:</b> Pregnancy gingivitis is a major oral infection. Periodontium acts as a reservoir of inflammatory mediators and sub gingival biofilms of bacteria. <b>Aim:</b> To evaluate the anaerobic oral microbial flora in pregnant women before delivery and after delivery by comparing them with control group. <b>Material and Methods:</b> The study group included fifteen cases of pregnant women before and after delivery and healthy non-pregnant women of same age as control group. Sub gingival plaque samples were collected with the help of dentists. The samples were inoculated immediately into Thioglycollate broth (MV010), transported to the laboratory, inoculated on to selective media for anaerobes (Hi-media laboratories) incubated anaerobically (Gas pack). <b>Results:</b> Prevotella, Tanerella forsythia, Porphyromonas gingivalis and Fusobacterium nucleatum, Veillonella, Peptostreptococcus were isolated. <b>Discussion:</b> The anaerobic bacteria in pregnant women were Prevotella, Tanerella forsythia and Porphyromonas gingivalis. Viellonella and Peptostreptococcus were seen in control group and after delivery. Research suggests that periodontal pathogens may travel the blood stream from the oral cavity to the placenta. <b>Conclusion:</b> Pregnancy has significant effect on periodontal tissue. There is a significant alteration of bacterial flora during and after pregnancy. Oral health has to become a part of antenatal care /check up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1489-1491&id=2540 https://doi.org/10.7860/JCDR/2012/.2540 A Simple Method for Demonstrating the Giardia Lamblia Trophozoite Monali N. Rajurkar, Niharika Lall, Silpi Basak, Sanjay K. Mallick <b>Introduction:</b> Giardia lamblia is a flagellated protozoan parasite of man. Only 2 stages i.e. the trophozoite and the cyst forms are observed in the life cycle of Giardia. The Giardia infection is acquired from drinking water or by eating food which is contaminated with cysts. The symptoms of the Giardia infection are foul smelling diarrhoea, flatulence, steatorrhoea, etc. Stool samples from the patients are examined for the detection of the motile trophozoites and cysts. As the trophozoites disintegrate rapidly, the stool sample should be observed within 15 minutes of its passage. Hence, we developed a staining method to stain the Giardia trophozoite permanently. <b>Materials and Methods:</b> Smears of the stool samples were prepared and they were fixed with methanol. The staining was done by using a 1% methylene blue solution. <b>Results:</b> All the 15 known Giardia lamblia trophozoite positive samples were also found to be positive by the Methylene blue staining. The Giardia lamblia cysts could not be stained by this method. 20 stool samples were used as negative controls. <b>Conclusion:</b> We developed the methylene blue staining for demonstrating the trophozoite of Giardia, which is a very simple permanent staining method. The slides can be kept for a permanent record. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1492-1494&id=2541 https://doi.org/10.7860/JCDR/2012/.2541 The Immunohistochemical Expression of the Oestrogen Receptor (ER), HER-2/ne u and Cytokeratin 8/18 and 5/6 in Invasive Breast Carcinoma Bharti Rattan, Mridu Manjari, S.K. Kahlon, Nikita Kalra, Amarpreet Bhalla, Surinder Paul An immunohistochemical study was done on 39 cases of invasive breast carcinoma for further sub-classification, for predicting their prognosis and therapeutic approaches. These cases were evaluated for the expression of cytokeratin Ck 8/18, ER and Her-2/neu and 28 cases were subjected to the evaluation of cytokeratin Ck 5/6, which especially included the cases which were negative for all the three markers. ER was positive in 7 cases, with Her-2/neu being positive in 8 cases and cytokeratin 8/18 being positive in 33 cases. Cytokeratin 5/6 was positive in 7 cases, with 4 cases showing Ck 5/6 and Ck8/18 positivity, 3 cases showing positivity for Ck 5/6 only and 3cases showing negativity for all the 4 markers. Thus they were classified as the luminal A, luminal B, combined, basal and the null types respectively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1495-1498&id=2542 https://doi.org/10.7860/JCDR/2012/.2542 A Prospective, Open-label Study which was done to Compare the Efficacy and the Safety of Topical Loteprednol Etabonate and Topical Flurbiprofen Sodium in Patients with Post-Operative Inflammation after Cataract Extraction Sheshidhar G. Bannale, Pundarikaksha H.P., Sowbhagya H.N. <b>Purpose:</b> To study the effect of the topical Non-Steroidal Anti Inflammatory Drug (NSAID), Flurbiprofen 0.03%, as an alternative to the topical steroids for the postoperative control of inflammation in cataract surgeries. <b>Methods:</b> The effect of the topical NSAID, flurbiprofen sodium 0.03%, was studied and compared with that of the topical steroid – Loteprednol etabonate 0.5% suspension (as eye drops) in a prospective, open labelled study. Both the groups (20 patients each) were similar in the baseline parameters. The postoperative inflammatory response following the standard, small incision, extra capsular cataract extraction was assessed in both the groups for 28 post-operative days. The parameters which were considered for the study were conjunctival hyperaemia, ciliary congestion, corneal oedema, cells in the anterior chamber, aqueous flare and ocular pain. The severity of the postoperative inflammatory responses for both the drugs was graded on the post-operative days 1, 7, 14, 21 and 28 and it was statistically analyzed. <b>Results:</b> The 2 groups did not differ statistically in the effect of the treatment for any of the variables, which included aqueous cells, flare, ciliary congestion and conjunctival congestion (p< 0.001). Both the drugs were well tolerated and no severe adverse Drug Reactions (ADRs) were caused by the topical NSAID and the topical steroid. <b>Conclusion:</b> The topical NSAID, Flurbiprofen, is as effective as the topical corticosteroid, Loteprednol and it can be used as an alternative in the routine postoperative treatment following uncomplicated cataract surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1499-1503&id=2543 https://doi.org/10.7860/JCDR/2012/.2543 The Profile of Voluntary Reported Adverse Drug Reactions at a Tertiary Care Hospital: A Fifteen Month Prospective Study Amit Dang, P. N. Bhandare <b>Objectives:</b> The present study was undertaken to provide the health professionals who were working at a tertiary care hospital, with a simple method to report Adverse Drug Reactions (ADRs) and to monitor, document and to evaluate them according to the set criteria. <b>Method and Materials:</b> This study was conducted over a period of 15 months from 1st Jan’ 2008 to 31st March 2009 at Goa Medical College and Hospital (Goa, India). The evaluation of the data was done for various parameters, which included patient demographics and drug and reaction characteristics. An assessment was also done for the outcome, causality and the severity of the drug reactions. <b>Results:</b> A total of 265 ADRs were reported. Among the drugs, the ß-lactam antibiotics were implicated the maximum number of times (54, 20.37%), followed by fluoroquinolones (35, 13.20%), antiretrovirals (33, 12.45%) and antiepileptics (31, 11.69%). Females showed more ADRs (142, 54%) than males (123, 46%). The skin was involved in about 57.73% (153) of the ADRs, while the CNS and the vascular system were involved in 8.67% (23) and 8.30% (22) of the ADRs. Most of the ADRs were categorized as “Type II” (203, 77%) against “Type I” (62, 23%) by Rawlins and Thompson’s classification. The causality assessment was done by the Naranjo Algorithm and 62.26% (165) were seen to fall in the “probable category” as compared to 29.05% (77) in the “highly probable” one. Out of all the ADRs which were reported, 34.71% (148) were “severe”, in accordance with the Modified Hartwig and Siegel’s scale. <b>Conclusion:</b> The present work was a humble attempt to set up a well organized ADR reporting system at our government hospital. The systematic tracking and monitoring of ADRs can shed light on their extensiveness and their patterns of occurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1504-1509&id=2544 https://doi.org/10.7860/JCDR/2012/.2544 The Waist Circumference Measurement: A Simple Method for Assessing the Abdominal Obesity Anuradha R., Hemachandran S., Ruma Dutta <b>Introduction:</b> Excess abdominal fat is an independent predictor of the risk factors and the morbidity of obesity related diseases such as type 2 diabetes, hypertension, dyslipidaemia and cardiovascular diseases. The Waist Circumference (WC) is positively correlated with the abdominal fat. Hence, the waist circumference is a valuable, convenient and a simple measurement method which can be used for identifying the individuals who are at an increased risk for the above mentioned diseases. <b>Objectives:</b> 1. To assess the abdominal obesity by measuring the waist circumference among the women who were aged 20 years and above in an urban slum of Chennai, India. 2. To identify the socio -demographic factors which were associated with the abdominal obesity in the above study population. <b>Settings and Design:</b> A community based and a cross sectional study was carried out in an urban slum of Chennai, India. <b>Methods and Materials:</b> The present study was undertaken in an urban slum of Chennai city, among the women who were aged 20 years and above. One slum was selected randomly and the households in the slum were sampled by a systematic random sampling method. A pre-designed and a pre-tested questionnaire was used to collect the information regarding the socio-demographic profile of the women. Their waist circumference was measured by using a flexible inch tape. As per the World Health Organization (WHO), the International Obesity Task Force (IOTF) and the International Association for the Study of Obesity (IASO)(2000), the following cut off values for the waist circumference were used to assess the abdominal obesity for women: WC<80cms – normal and WC > 80cms-abdominal obesity. <b>Statistical Analysis:</b> It was done by using the Statistical Package For Social Science (SPSS ), version 11.5. The prevalence was expressed in percentage and the Chi square test was used to find its association with the factors. <b>Results:</b> In the study population, the prevalence of abdominal obesity (WC > 80 cms) was 29.8% (95% Confidence Interval [CI] 25.9–34 %). A significant association was found between the age, religion, a higher socio-economic status and the abdominal obesity. No significant association was noted between the educational status, occupation, marital status, type of family and the abdominal obesity. <b>Conclusion:</b> Abdominal obesity among the urban slum women is on the rise. The abdominal obesity was found to be significantly higher among the slum women with increasing age and in those who belonged to the muslim religion and to a higher socio-economic status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1510-1513&id=2545 https://doi.org/10.7860/JCDR/2012/.2545 A Cross-sectional Descriptive Study to Estimate the Prevalence of Early Initiation and Exclusive Breast Feeding in the Rural Health Training Centre of a Medical College in Tamilnadu, Southern India H. Gladius Jennifer, K. Muthukumar <b>Introduction:</b> The World Health Organization and the National guidelines on infant and young child feeding recommend the practice of exclusive breastfeeding of infants for the first 6 months after their birth. The objective of this study was to estimate the prevalence of the early initiation of and exclusive breast feeding. <b>Method:</b> A cross sectional, descriptive study was done. 79 infants and children who attended the under five clinic in the Rural Health Training Centre (RHTC), Pulipakkam Village, were chosen for the study by convenient sampling. This study was conducted by interviewing 79 mothers of the children in the ages of 0–24 months, who attended the under five clinic of RHTC, Pulipakkam. The data was collected by using a pre tested, structured questionnaire to obtain the information on the breast feeding and the hygienic feeding practices among mothers. The statistical analysis was done by the authors by using the SPSS, version 16. The significance in the differences were evaluated by using the Chi square test and the relationship between the variables were evaluated by using Kendall’s tau correlation. A p value of <0.05 was considered as statistically significant. <b>Results:</b> The prevalence of the early Initiation of breast feeding was 97.5% and the prevalence of exclusive breast feeding in the study population was 68%. Inadequate exclusive breast feeding and the lack of hygienic feeding practices among the mothers were significantly associated with an increased incidence of upper and lower respiratory tract infections and gastro intestinal infections in the infants and the children. <b>Conclusion:</b> The education of the antenatal mothers on the benefits of breast feeding and hygienic feeding practices and making all hospitals baby friendly have to be focused on, in order to achieve 80% exclusive breast feeding as per the national guidelines on infant and young child feeding. We need to strengthen the MCH services in the study area in order to achieve 100% immunization. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1514-1517&id=2546 https://doi.org/10.7860/JCDR/2012/.2546 Can the Griess Nitrite Test and a Urinary Pus Cell Count of ≥5 Cells Per Micro Litre of Urine in Pregnant Women be Used for the Screening or the Early Detection of Urinary Tract Infections in Rural India? Sushama S.Thakre, Supriya S. Dhakne, Subhash B. Thakre, Amol D.Thakre, Suresh M. Ughade, Priya Kale <b>Objectives:</b> Urinary Tract Infection (UTI) is a common problem in pregnancy due to the morphological and the physiological changes that take place in the genitourinary tract during pregnancy. Screening methods may be useful, because a full bacteriological analysis could be reserved for those patients who are symptomatic or those who have positive screening test results. The exact prevalence of UTI in rural, pregnant women is unknown. The present study was undertaken to estimate the prevalence of UTI in pregnant women and for ascertaining the utility of the Griess Nitrite test and the Urinary Pus Cell Count of &#8805;5 cells per micro litre test for the screening or the early detection of UTI in them at primary health care clinics. Occurrence of urinary complaints was compared in UTI and non UTI women. <b>Method:</b> We conducted a study on 300 randomly selected, pregnant women from rural areas. Urine cultures, pus-cell counts and the Griess nitrite test were used for diagnosis of UTI. The screening tests for UTI were evaluated in terms of their sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and the percentage of correctly classified. <b>Results:</b> In the present study, the prevalence of UTI was found to be 29/300 (9.6%, 95% confidence interval 9.57-9.63). The specificities of the two screening tests were comparable (97.05% and 94.47%). Also, the negative predictive values of the two tests were almost similar (97.77% and 96.96%). The percentage of correctly classified by the Griess nitrite test and the urine pus cell count were found to be 95.33% and 92.33% respectively. The proportion of the women with various urinary complaints was significantly higher (P<0.00) in the UTI subjects as compared to that in the non-UTI subjects. <b>Conclusion:</b> Urine culture remains the gold standard for the detection of asymptomatic bacteriuria. The Nitrite test of uncentrifuged urine was observed to be the best among the screening tests which were evaluated in terms of their efficiency and validity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1518-1522&id=2547 https://doi.org/10.7860/JCDR/2012/.2547 The Treatment of Spontaneous Epistaxis: Conservative vs Cautery Ravi Kumar Raju Mudunuri, M.A.N. Murthy <b>Aim:</b> To find the best treatment for spontaneous epistaxis by a conservative approach or by an intervention with silver nitrate cautery. <b>Study Design:</b> A prospective study with two groups which were randomly selected for the conservative management or cautery. <b>Materials and Methods:</b> 94 patients are studied in two groups of 42 patients who were treated conservatively and 52 patients who were treated with silver nitrate cautery. The patients were followed up for 1 week and the results were tabulated with regards to the recurrence of the bleeding. <b>Results:</b> Both the groups of patients who were treated conser­vatively or with cautery showed minimal recurrent bleeding with rates of 30% and 26% respectively. Statistically, there was no significant difference in the outcome. The pain was more in the cases which were treated with cautery. <b>Conclusion:</b> Both the groups of patients who were treated conservatively or with cautery showed equal rates of the outcome, with the pain being slightly more in the group which was treated with cautery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1523-1524&id=2548 https://doi.org/10.7860/JCDR/2012/.2548 The Infant Feeding Practices in an Urban Slum of Nagpur, India Abhay Shivram Bagul, Madhulika Sahebrao Supare <b>Background and Objective:</b> The feeding practices during infancy are of critical importance for the growth and the development of children. Recent studies have reported that wrong feeding practices are widely prevalent in the urban slums. With this background, this study was conducted to assess the infant feeding practices in an urban slum and to determine the the factors which influenced it. <b>Materials and Methods:</b> A community based, cross-sectional study was conducted in an urban slum of Nagpur, Maharashtra, India during June 2011 to December 2011. The study variables which were used were the mother’s religion, occupation, education, the place of delivery, the type of delivery, the sex and the age of the baby, the antenatal clinic registration , breast feeding, weaning, knowledge of the mothers, etc. For the statistical analysis, the Fisher’s exact test was used. <b>Results:</b> Out of the 384 enrolled mothers,125(32.56%) mothers had started breast feeding within 1 hour after their deliveries. Colostrum was given by 82(21.38%) mothers. Exclusive breast feeding for 6 months was given by 142(36.84%) mothers. The practice of exclusive breast feeding was more in the literate mothers and in mothers who were informed by the health personnel. This was statistically significant. <b>Conclusion:</b> Inappropriate feeding practices are common in an urban slum of Nagpur, Maharashtra, India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1525-1527&id=2549 https://doi.org/10.7860/JCDR/2012/.2549 Value of Indian Diabetes Risk Score among Medical Students and Its Correlation with Fasting Plasma Glucose, Blood Pressure and Lipid Profile Anand Vardhan, Adhikari Prabha M.R., Kotian Shashidhar M., Nithya Shankar., Sandhya Gupta, Amruta Tripaipathy <b>Introduction:</b> The Indian Diabetes Risk Score is a tool which was devised by the Madras Diabetes Research Foundation to screen people for the risk of developing Diabetes mellitus; it comprises of the family history, the abdominal circumference, age and the physical activity. <b>Aim of the Study:</b> This study was aimed at finding out whether the Indian Diabetes Risk Score (MDRF) correlated with the blood sugar levels, the lipid profile and the blood pressure readings of medical students. <b>Methods:</b> Seventy five female and 75 male students who signed the informed consent were selected for the study. Their IDRS was calculated by using a validated questionnaire which involved the family history, the abdominal circumference, age and the details of the physical activity. All of them had their blood pressure, fasting plasma glucose and lipid profiles measured. <b>Results:</b> There were 101 students with an IDRS of <30, 42 students with a moderate IDRS (30-50) and 7 who had a high IDRS of &#8805;60. The fasting plasma glucose was significantly correlated with the IDRS (P=0.001, r = 0.472), with a mean FPG of 84 ± 3.63mg/dl in the low risk groups, of 88 ± 4.93mg/dl in the moderate risk groups and of 94 ± 6.50mg/dl in the high risk groups. The total cholesterol value was r = 0.420 (P= 0.001), the total triglycerides value was r = 0.373 (P=0.001), the LDL cholesterol value was r = 0.578 (P=0.001) and the VLDL value was r = 0.566 (P=0.001), which positively correlated with the risk score and the HDL value r = -0.480 (P=0.001) correlated negatively with the risk score. There was no correlation between the IDRS and the blood pressure. <b>Conclusion:</b> Our study showed that nearly 40% of the medical students had a moderate to a high IDRS. The IDRS significantly correlated with the fasting plasma glucose and with all the components of the lipid profile. The IDRS did not correlate with the blood pressure readings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1528-1530&id=2550 https://doi.org/10.7860/JCDR/2012/.2550 Maternal Body Mass Index and Pregnancy Outcome Anjana Verma, Lalit Shrimali <b>Objectives:</b> To evaluate the impact of the maternal body mass index on the pregnancy outcome. <b>Materials and Methods:</b> Seven hundred eighty four women who had singleton pregnancies during a one year period, were categorized into 5 groups on the basis of their maternal Body Mass Index (BMI). The maternal and the neonatal outcome were noted in all the groups. <b>Results:</b> In the underweight group, the incidences of anaemia and growth retardation were more, while the overweight and the obese women had a higher risk for PIH, gestational diabetes and Large for gestational age (LGA). The groups 4 and 5 had higher incidences of LSCS, wound sepsis and neonatal ICU admissions. There was no significant increase in the perinatal mortality rate. <b>Conclusion:</b> The health of women, throughout their childbearing ages, should be addressed, to improve their obstetrical and perinatal outcomes. Also, the high risk groups should be managed at tertiary centers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1531-1533&id=2551 https://doi.org/10.7860/JCDR/2012/.2551 Pott’s Spine: Retrospective Analysis of MRI Scans of 70 Cases Prateek S. Gehlot, Shashikant Chaturvedi, Rahul Kashyap, Vivek Singh <b>Introduction:</b> Tuberculosis is the commonest of the infections world wide and it can affect almost any part of the body, most commonly the thorax. The spine is affected in 50 % of the cases of skeletal tuberculosis. A tuberculous infection of the spine causes a bony destruction and collapse of the vertebrae, with a gibbus deformity, skip lesions, an intervertebral disc involvement, an epidural abscess, a paravertebral abscess and oedema in the soft tissue planes. Magnetic Resonance Imaging (MRI) is the most valuable investigation in the patients with spinal tuberculosis, as it can clearly demonstrate all of the above findings. <b>Methods:</b> In this study, the MRI scans of 70 known cases of tuberculosis of the spine, which were done in the Department of Radiodiagnosis, R.D.Gardi Medical College, Ujjain, India, were retrospectively analyzed, to determine the pattern of occurrence of various pathological lesions. <b>Results:</b> It was found in this study, that Pott’s spine was most commonly observed in the 21-50 years age group, with a male predominance. The dorsal and the lumbar vertebrae are commonly involved and multiple vertebrae were often affected, the L3 vertebra being the commonest. An intervertebral disc involvement and pre and paravertebral collections were commonly seen, with an epidural collection occurring in more than 75 % of the cases. Cord oedema was noted in 10% of the cases. <b>Conclusion:</b> The MRI scan is highly sensitive in the detection of various pathological processes of Pott’s spine and the patterns of occurrence of these findings were analyzed in this study. Since the incidence and prevalence of tuberculosis are dependent on various epidemiologically sensitive parameters, this study can provide a benchmark, against which the results of studies which will be done in the future can be compared. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1534-1538&id=2552 https://doi.org/10.7860/JCDR/2012/.2552 Venous Chiasma Between the Basilic Vein and the Brachial Vein: A Case Report Naveen Kumar, Ashwini P. Aithal, Mohandas K.G. Rao, Satheesha B. Nayak Variations in the venous pattern of the arm are common. In this case report, we are presenting the variations of the brachial vein and the basilic vein. During the routine dissections which were done by medical undergraduate students, we observed some variations in the veins of the upper limb. In the current case, there was only one brachial vein which accompanied the brachial artery. The basilic vein originated from the medial side of the dorsal venous network, ascended along the medial side of the forearm and joined the brachial vein to form the axillary vein at the distal border of the teres major muscle. The basilic vein and the brachial vein joined with one another in the middle of the arm to form a unique venous chiasma. A large number of invasive procedures are carried out by using the veins of the upper limb, particularly in and distal to the axillary region. This type of a venous chiasma may lead to complications in these procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1539-1540&id=2553 https://doi.org/10.7860/JCDR/2012/.2553 The Bee Sting Related Wolff-Parkinson-White Syndrome Shanmuga Ravi Santhosh M., Stalin Viswanathan, Shanthi Kumar Hymenoptera stings are common reasons for emergency visits. The admissions for the hymenoptera stings occur for systemic or unusual reactions. We are reporting a man with multiple bee stings, who presented with dizziness and palpitations and was found to have ECG findings of the Wolff-Parkinson-White syndrome. He had no worsening of symptoms or new ECG changes during his hospitalization. The hymenoptera related cardiac effects have also been reviewed and summarized. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1541-1543&id=2554 https://doi.org/10.7860/JCDR/2012/.2554 A Rare Presentation of the Klinefelter’s Syndrome Sharabeh Hezarkhani, Mohammad Moujerloo, Sima Sedighi, Negar Sadat Taheri A 16 years old boy with Chronic Renal Failure (CRF) was not suspected of having Klinefelter’s syndrome until he complained of painful gynecomastia. He was under haemodialysis for 2 years. At first, he was in an approximately full pubertal development (P5, G5), but he had a small and a firm testis (length 2.2cm) and some degree of facial male pattern hair. He also had a decreased upper to lower body segment ratio and despite having chronic renal failure, he was taller than his parents and siblings. His laboratory tests showed high levels of FSH and normal levels of LH and testosterone. With regards to all these findings, we suspected that there might be an occult Klinefelter’s syndrome. So, we made his karyotype that showed a 47XXY pattern. Because there are only a few number of cases that have occult Klinefelter’s syndrome in the basis of chronic renal failure, we decided to report this case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1544-1546&id=2555 https://doi.org/10.7860/JCDR/2012/.2555 A Patient with Multiple Immune Reconstitution Inflammatory Syndrome (IRIS) Following Initiation of Antiretroviral Therapy Basavaprabhu Achappa, Deepak Madi , Nishitha Shetty, Soundarya Mahalingam The Immune Reconstitution Inflammatory Syndrome (IRIS) is an exaggerated pathological inflammatory reaction which occurs after the initiation of the antiretroviral therapy, due to the exuberant immune responses to the occult or the apparent opportunistic infections. The hallmark of the syndrome is the paradoxical worsening of an existing infection or a disease process or the appearance of a new infection or a disease process soon after the initiation of the antiretroviral therapy. The most common forms of IRIS occur in association with tuberculosis and chronic viral and invasive fungal infections. Multiple IRIS in a patient is extremely rare. Our patient had multiple manifestations of IRIS, in the form of cryptococcal meningitis, toxoplasmosis and Cytomegalovirus (CMV) retinitis after the initiation of highly active antiretroviral therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1547-1549&id=2556 https://doi.org/10.7860/JCDR/2012/.2556 Case Series: Elizabethkingia Meningosepticum Meena Dias, Anisha Fernandes, Zevita Furtado Elizabethkingia meningosepticum is a saprophyte which exists in hospital water systems and it can be a potential source for nosocomial infections. Though the infection with these bacteria is rare, one should be aware that it is resistant to most of the antibiotics and that it has the ability to cause nosocomial infections. We are reporting here, a series of cases which were caused by E. meningosepticum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1550-1551&id=2557 https://doi.org/10.7860/JCDR/2012/.2557 Mesenchymal Hamartoma of the Liver: A Case Report K.Chandramouleeswari, S.Anita, B.Shivali Hepatic mesenchymal hamartoma (HMH) is a hamartomatous growth of the mesenchymal tissue in the liver, which is of an uncertain aetiology. It is a space-occupying lesion that can potentially compress the adjacent organs, resulting in various complications, which include death. Hepatic mesenchymal hamartoma is characterized by the variable proliferation of the myxomatous mesenchyme and the malformed bile ducts. The differential diagnosis includes other paediatric hepatic masses. The diagnosis is typically made during infancy, and a complete resection is invariably curative. Here, we are reporting a case of HMH in a one year old female child who presented with abdominal distension. A clinical diagnosis of malignancy was made, based on the symptoms and imaging studies and a final diagnosis was made only after a histopathological examination. The lesion was potentially benign, with very rare chances of recurrence. This case has been presented due to its rarity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1552-1554&id=2558 https://doi.org/10.7860/JCDR/2012/.2558 Cysticercus of the Breast which Mimicked a Fibroadenoma: A Rare Presentation Karthikeyan T.M., Manimaran D., Mrinalini V.R. Human cysticercosis is an infection which is caused by the larvae of the pork tapeworm, Taenia solium. They can affect any part of the body, the most common sites being the muscle, the CNS and the subcutaneous tissues. In this report , we are presenting the case of a 32-year old woman who came with a history of a painless, freely mobile lump in the left breast. A clinical diagnosis of a fibroadenoma was made and an excision biopsy was done, which revealed the presence of cysticercus lavae, along with a foreign body giant cell reaction. A diagnosis of cysticercus at the atypical sites is rare and it depends mainly on the histopathological examination. Although it is rare, cysticercus should be considered as a differential diagnosis for a mass in the breast and in the areas of a greater prevalence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1555-1556&id=2559 https://doi.org/10.7860/JCDR/2012/.2559 A Rare Case of Primary Parapharyngeal Well Differentiated Liposarcoma with Rhabdomyoblastic Differentiation Geetha V., Bhavna N., Ruchi K. Rhabdomyoblastic differentiation in liposarcoma is a rare entity, with only few cases being reported in the literature. These cases were reported in either dedifferentiated liposarcomas or in recurrent tumours which occurred in the retroperitoneum. The present case was a rare case of a primary parapharyngeal well differentiated liposarcoma with a focal rhabdomyoblastic differentiation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1557-1558&id=2560 https://doi.org/10.7860/JCDR/2012/.2560 A Glomus Tumour Arising from the Flexor Aspect of the Forearm: A Case Report with Review of the Literature Jitendra Singh Nigam, Vatsala Misra, Anshul Singh, Veer Karuna, Smita Chauhan A 45 year old male patient presented with the complaint of a purplish nodular painful swelling on the flexor aspect of the left forearm of five years duration. A radiological examination of the lesion was not done prior to its excision. A biopsy was done and it was sent for a histopathological examination. The biopsied tissue was single, irregular, firm and globular, it measured 0.5 x 0.5cm in size and it was processed in two halves Its microscopic examination showed a well circumscribed area which comprised of sheets and nodules of monomorphic round cells with slightly vesicular, round nuclei and an acidophilic cytoplasm, amongst which were interspersed numerous blood vessels, many of which were dilated and congested, along with numerous lymphatic channels which were filled with lymph. Immunohistochemistry for SMA, CEA and CD 34 was advised, out of which only SMA turned out to be strongly positive and a final diagnosis of a Glomus tumour was made. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1559-1561&id=2561 https://doi.org/10.7860/JCDR/2012/.2561 A Malignant Transformation in a Pre-Existing Benign Scrotal Naevus Ranjan Agrawal, Mukta Kumar Malignant melanoma of the scrotum is the rarest of the primary genitourinary melanomas, with only 19 cases having been reported previously. The authors have described a rare case of a primary scrotal neoplasm. The necessity of a prompt diagnosis has been emphasized. We are presenting an additional case of this often aggressive malignancy. The pertinent literature has been reviewed and the current management strategies have been discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1562-1563&id=2562 https://doi.org/10.7860/JCDR/2012/.2562 Rare Cause of Gastric Perforation- Candida Infection: A Case Report and Review of the Literature Nalini Gupta Fungal microorganisms as a cause of gastric perforation, is very rare. Most of the cases of gastric perforation are seen as the complications of peptic ulcer disease, the intake of NSAIDs (Non Steroidal Anti-Inflammatory Drugs), neoplastic diseases, etc. We are reporting a case of a 50 year old male who presented with a sudden onset of abdominal pain and shock and was diagnosed as acute peritonitis which was caused by a gastrointestinal perforation. An emergency exploratory laporotomy was performed and a gastric perforation repair with omentoplexy was done. However, the patient died in the post operative period due to a sudden cardiac arrest. A gastric perforation edge biopsy revealed the presence of fungal hyphae. The peritoneal fluid culture revealed Candida albicans colonies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1564-1565&id=2563 https://doi.org/10.7860/JCDR/2012/.2563 Blue Rubber-Bleb Nevus Syndrome which was Associated with an Atrial Septal Defect: A Case Report Shrikiran Aroor, Chaitanya Varma, Suneel C Mundkur The Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare cause of persisting gastrointestinal bleeding. We are presenting a case which was associated with an atrial septal defect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1566-1567&id=2564 https://doi.org/10.7860/JCDR/2012/.2564 Congenital Lobar Emphysema and Intercostal Drainage Tube Insertion: The Common Fate of an Uncommon Disease Kumar Saurabh, P.K. Debata, R. Gupta Congenital Lobar Emphysema (CLE) is one of the rare cystic malformations of the lung. This malformation is generally confused with pneumothorax of the lung and most often, the placement of an intercostal drainage tube is entertained in an emergency situation, but the non- improvement of the distress and non-expansion of the lung are eye openers for a treating paediatrician. We are describing a case of a 26 days old baby who presented with respiratory distress in the Emergency Department. On the basis of the chest X-ray (CXR), we suspected it to be a case of pneumothorax and an intercostal drainage tube was inserted. But as he did not improve, CT of the chest was done and the baby was diagnosed to have congenital lobar emphysema. In spite of the advanced diagnostic techniques, the diagnosis of CLE may present a diagnostic challenge and a high index of suspicion is needed if the diagnosis has to be made promptly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1568-1570&id=2565 https://doi.org/10.7860/JCDR/2012/.2565 Can Vitamin B-Complex Aggravate the Carbamazepine Induced Toxic Epidermal Necrolysis? Mayuresh V. Fegade, Sushama A. Bhounsule, Ian Pereira Toxic Epidermal Necrolysis (TEN), which is also known as Lyell’s syndrome, is a widespread, life-threatening, mucocutaneous disease that is particularly observed secondary to drug-taking and less commonly secondary to infections and immunization. Carbamazepine is associated with benign pruritic rash in 10-15% of the patients, but the life threatening dermatological syndromes like exfoliative dermatitis, erythema multiforme, the Stevens-Johnson Syndrome (SJS) and TEN are rarely seen with the carbamazepine treatment. The 32 year old female who suffering from chronic backache, who was prescribed carbamazepine along with an intravenous combination of vitamin B-complex and calcium, developed fever, cough and mucocutaneous manifestations of TEN after 15 days of the treatment. She was treated in the hospital with systemic steroids, intravenous immunoglobulins, antibiotics, intravenous fluids and supportive care. In spite of the above treatment, the patient could not survive for more than seven days. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1571-1573&id=2566 https://doi.org/10.7860/JCDR/2012/.2566 An Adult Recurrent Diaphragmatic Hernia with a Near Complete Defect: A Rare Scenario Sathyanarayana N., Ranjith Rao M., Shivaprasada Rai B.K. A diaphragmatic hernia is usually seen in childhood and it is rare in adults. We are reporting a case of a 73 years old male who presented with pain and distension of the abdomen, breathlessness and constipation. He was operated 10 years back for a diaphragmatic hernia, during which a splenectomy, omentectomy and a mesh repair were done. X-rays and CT scans of the chest and the abdomen showed a recurrent diaphragmatic hernia on the left side. Laparotomy and left sided thoracotomy was done. The contents being the small bowel and the colon, they were reduced. The left hemi-diaphragm was completely absent, except for an anterior thin rim of tissue. A short ischaemic jejunal segment was resected. A dual mesh was used to reconstruct the left hemi-diaphragm in a contaminated field and it was fixed to the intact rim and to the other available tissues around the defect. The post-operative chest X-rays showed the mesh to be in place. The patient had an uneventful recovery. No signs of recurrence were found during 2 years of follow-up. Adult diaphragmatic hernias, once they are diagnosed, are managed surgically to prevent complications. Difficult scenarios may be encountered, for which the surgical strategy should be individualized and the immediate postoperative complications should be dealt appropriately. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1574-1576&id=2567 https://doi.org/10.7860/JCDR/2012/.2567 The Abuse of Multiple Gastrointestinal Antibiotics: A Case Report Bappaditya Chowdhury, Ramtanu Banerjee, Rudrajit Paul, Jayati Mondal, Sourav Ganguly The abuse of non dependence producing substances has been rarely reported. However, this can be a significant social problem and it may complicate psychiatric disorders like the anxiety states. We are reporting here, a case of the prolonged abuse of multiple gastrointestinal antibiotics like metronidazole, mebendazole and albendazole. The patient had fortunately not developed any overt toxicity from the overuse of these drugs. He was diagnosed with the generalized anxiety disorder with the anankastic personality disorder. He responded favourably to paroxetine and is being maintained on psychotherapy. As far as we know, this is probably the first report of this kind of abuse from India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1577-1578&id=2568 https://doi.org/10.7860/JCDR/2012/.2568 A Novel Association of the Additional Intracranial Calcification in Lipoid Proteinosis: A Case Report Sushil G. Kachewar, Devidas S. Kulkarni Lipoid Proteinosis (LP) is a genetically linked, autosomally transferred, rare, chronic multisystem disease which is characterized by a normal lipid profile, but with abnormal deposits of lipids and proteins in the body, which slowly but steadily leads to systemic manifestations. Although it affects almost all the systems of the body, it predominantly manifests as lesions on the skin and it has characteristic intracranial calcifications. Although, the intracranial calcifications can be classified, based on their aetiopathogenesis, as age-related and physiologic, congenital, infectious, endocrine and metabolic, vascular, and neoplastic; the symmetric calcifications in LP are a distinct entity. To one who is aware of this entity, LP is usually an incidental diagnosis. No permanent cure is available for LP till date. Only symptomatic medical treatment is being given. With the increasing awareness on this entity, LP can now be detected in its early phase and it can be better managed. As this condition is rare, it is necessary to spread awareness on this entity in the scientific community and hence this case is being reported. This case report is the first to demonstrate a novel association of an additional intracranial calcification in Lipoid Proteinosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1579-1581&id=2569 https://doi.org/10.7860/JCDR/2012/.2569 A Rare Case of Cockayne Syndrome-MRI Features praveen mundaganur The Cockayne Syndrome is a rare syndrome of congenital originwhich is charcterized by growth retardation, facial dysmorphism, facial naevi,retinopathy and mental retardation, which are associated with the changes in the brain parenchyma. The findings of MRI of the brain support the clinical diagnosis of the Cockayne Syndrome. We would like to highlight the MRI findings of this rare syndrome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1582-1583&id=2570 https://doi.org/10.7860/JCDR/2012/.2570 A Rare Case of a Giant Epidermoid Cyst of the Ovary Nidhi Sharma, Manimekalai, Sulochana Sonti, Meenakshisundarum Epidermoid cysts of the ovary are rare benign lesions and they are usually an incidental finding in hysterectomy specimens. We are presenting the largest reported case of an epidermoid cyst of the ovary which measured 17x10x10 cm, in a 50 year old lady with a preoperative diagnosis of a fibroid uterus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1584-1586&id=2571 https://doi.org/10.7860/JCDR/2012/.2571 Frenectomy: A Review with the Reports of Surgical Techniques Devishree, Sheela Kumar Gujjari, Shubhashini P.V. The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present aesthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. The management of such an aberrant frenum is accomplished by performing a frenectomy. The present article is a compilation of a brief overview about the frenum, with a focus on the indications, contraindications, advantages and the disadvantages of various frenectomy techniques, like Miller’s technique, V-Y plasty, Z-plasty and frenectomy by using electrocautery. A series of clinical cases of frenectomy which were approached by various techniques have also been reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1587-1592&id=2572 https://doi.org/10.7860/JCDR/2012/.2572 The Management of a Persistent Periapical Lesion Caused by an Apicomarginal Defect, Associated with a Root End Fracture in an Endodontically Treated Tooth: A Clinical Report Shruthi S., Punit Vaibhav Patel, Sheela Kumar An apicomarginal defect can be defined as a complete loss of the buccal alveolus which extends from what was once the crestal bone, to the apex of the tooth. This is a case report of the presentation and the management of an apicomarginal defect which was associated with a root end fracture in an endodontically treated tooth. In spite of a successful Root Canal Treatment (RCT), if the fractured root end is left intact, considering inadverdent ankylosis or resorption, it may progress to the development of a bony dehiscence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1593-1596&id=2573 https://doi.org/10.7860/JCDR/2012/.2573 Osteosarcoma of Mandible Jitendra V. Kalburge, Sunil K. Sahuji, Vaishali Kalburge, Yogesh Kini Osteosarcomas are malignant neoplasms of the bone which commonly affect the long bones. The involvement of the jaws are rarely noticed. These neoplasms often shows a typical clinical behaviour as well as varied radiological appearances. Similarly, their histological growth pattern can be quite diverse. Confirmation of the final diagnosis of an osteosarcoma often requires a histopathological examination of the multiple biopsy specimens and vigorous discussion amongst the experts. All these clinical features, radiographic appearances and histological diagnostic difficulties were encountered in a case of osteosarcoma of the mandible in a 29-year old female. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1597-1599&id=2574 https://doi.org/10.7860/JCDR/2012/.2574 The Management of Retrograde Peri-Implantitis: A Case Report Jumshad B Mohamed, Md Nazish Alam, Gurudeep Singh, S. C. Chandrasekaran Peri-Implantitis is defined as an inflammatory reaction with the loss of the supporting bone in the tissues which surround a functioning implant. The peri-implantitis lesions are often asymptomatic and they are usually detected during the routine recall appointments. Careful probing around the teeth and the implants should be done routinely along with the radiologic evaluation during these check-up appointments. Retrograde peri-implantitis may sometimes prove even more difficult to identify, resulting in the loss of the implant. This paper presents a report of the extensive and the meticulous management of retrograde peri-implantitis and the implant being finally restored to health and the full functional status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1600-1602&id=2575 https://doi.org/10.7860/JCDR/2012/.2575 Five Developmental Anomalies in a Single Patient: A Rare Case Report Freny R. Karjodkar, Santosh Mali, Subodh Sontakke, Kaustubh Sansare, Darshana J. Patil Developmental dental anomalies are marked deviations from the normal colour, contour, size, number, and the degree of the development of teeth. Local as well as systemic factors may be responsible for these developmental disturbances. Such influences may begin before or after birth and hence the deciduous or the permanent teeth may be affected. These anomalies not only affect the aesthetic appearance of the teeth but also pose difficulties during the dental treatment and sometimes are the cause of dental problems. A rare case of dental developmental fusion of the permanent right lateral incisor with two supernumerary teeth, with dens invagination, dilacerations, talon’s cusp and a periradicular lesion reported to the Department of Oral Medicine and Radiology, NHDC. The clinical and the radiographical findings led to the diagnosis of fusion of the permanent lateral incisor with two supplementary teeth. All the 3 involved teeth showed dens invaginatus, dilacerations of the roots and a talons cusp with a chronic periapical lesion. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. A multidisciplinary approach, with different specialists working together, can contribute to the success of a treatment plan. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1603-1605&id=2576 https://doi.org/10.7860/JCDR/2012/.2576 A Type III Dens Invaginatus with Unusual Helical CT and Histologic Findings: A Case Report Satyaranjan Mishra, Lora Mishra, Sujit Ranjan Sahoo Dens Invaginatus (DI) is a rare developmental anomaly which affects the tooth, which shows an infolding of enamel and dentine which extends into the pulp chamber and sometimes into the root. The aim of this case report was to describe its radiographic findings, to emphasize the bizarre morphology and the difficulties which are encountered in the diagnosis by using conventional radiographic techniques and the importance of computed tomography as a valuable diagnostic aid. Dens Invaginatus is clinically significant due to the possibility of an early pulpal involvement and the chronic periapical lesions are often associated with this anomaly without any clinical symptoms. Difficulties are encountered during the endodontic treatment, owing to the complex root canal anatomy; therefore, a proper radiologic evaluation by using different imaging modalities, is essential for its successful treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1606-1609&id=2577 https://doi.org/10.7860/JCDR/2012/.2577 Screening of young Adults for Future Risk of Type 2 Diabetes Mellitus - A Big Concern for Society & Nation Pranita A, AV Phadke, JS Kharche, B. Balsubramaniyan, AR Joshi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1610-1611&id=2578 https://doi.org/10.7860/JCDR/2012/.2578 An Instant Diagnosis for Depression by Blood Test Rohit Kumar Verma, Satpal Kaur, Sheba Rani David https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2012&month=November&volume=6&issue=9&page=1612-1613&id=2579 https://doi.org/10.7860/JCDR/2012/.2579