Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Embryological Basis and Clinical Correlation of the Rare Congenital Anomaly of the Human Gall Bladder: - “The Diverticulum” - A Morphological Study Jaba Rajguru, Shilpi Jain, Satyam Khare, Ratna R Fulzele, Rashmi Ghai <b>Background:</b> Diverticulum of the human gall bladder is an important but distinct anatomical entity with significant clinical implications. It is one of the rarest congenital anomalies of the gall bladder being rarely discussed in literature. This article details the morphology of the diverticula found, along with the embryological basis and clinical significance of this important anatomical and clinical entity. <b>Aim:</b> To study the diverticula found, with respect to their morphology, and ascertain whether they were of congenital or acquired variety. <b>Settings and Design:</b> The present study is a retrospective study carried on hundred cadavers during undergraduate dissection, in the Department of Anatomy, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, and Department of Anatomy, Subharti Medical College , Meerut during a four year period i.e. 2008-2012 after obtaining necessary permission from institutional ethical committee. <b>Material and Methods</b>: Hundred gall bladder specimens collected from 10% formalin fixed cadavers were studied in detail with regard to their number, position, shapes dimensions and histology. <b>Results:</b> Nine, congenital (true) diverticula were found in one hundred gall bladder specimens. The diverticula were of various shapes and dimensions. They formed pouches on the luminal surface of the gall bladder. Diagnosis of congenital diverticulum was confirmed by histology. <b>Conclusion:</b> In this cadaveric study, solitary diverticulum was found in nine (9%) specimens out of one hundred specimens. Association of diverticulum with non-specific prolonged ailments, acalculus cholecystitis, cholecystitis and cholelithiasis, recurrent cholangitis and carcinoma of gallbladder has been reported in literature. This important anatomical as well as clinical entity poses challenges for radiologists and laparoscopic surgeons during interventional procedures and also should be differentiated from other types of congenital anomalies and pathological states of gall bladder. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2107-2110&id=3445 https://doi.org/10.7860/JCDR/2013/.3445 Nimesulide Induced Histopathological Changes in The Vas Deferens of Mice Thotakura Balaji, Manickam Subramanian, Vaithianathan Gnanasundaram, Sharmila Saran Raj Endran, Hannah Sugirthabai Rajila Rajendran <b>Aim:</b> Nimesulide, a preferential COX-2 inhibitor has 20 times more selectivity towards COX-2 than that of COX-1. COX-2 selective inhibitors cause frequent nephrotoxicity and hepatotoxicity following their usage. This proposes a physiological role of COX-2 in kidney and liver. Not much attention has been focused on the role of COX-2 with respect to reproduction especially in male reproduction, and the available information is scanty. <b>Aims and Objectives:</b> The present study aims to investigate the adverse effects of nimesulide in the vas deferens thereby indirectly assess the role of COX-2 in male reproductive tract. <b>Material and Methods:</b> Nimesulide was administered orally and the animals were maintained for different time periods prior to sacrifice. Results: The vas deferens of nimesulide treated mice showed extensive histopathological changes such as vacoulation and exfoliation of cells in the epithelial layer. <b>Conclusion:</b> Nimesulide administration leads to cytotoxic effects suggestive of apoptosis in the vas deferens of mice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2116-2118&id=3446 https://doi.org/10.7860/JCDR/2013/.3446 Correlation of 2 Hours and 24 Hours Creatinine Clearance in Renal Donors After Unilateral Nephrectomy Viji Devanand, S.U. Chithrapavai <b>Background:</b> The kidney performs numerous specialised functions in an effort to maintain constancy of the internal composition of body fluids. Aim: This study was done to ascertain the feasibility of estimating creatinine clearance as an outpatient procedure over a 2 hours period instead of doing the study over a 24 hours period. <b>Material and Methods:</b> Eighteen renal donors, Twelve females and Six males, who were closely related to recipients, were chosen. This study was done on renal donors who attended the Nephrology Department of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai–03 India. To estimate creatinine clearance in 24 hours urine, 24 hours urine sample was collected from 9 am on the first day to 9 am on the next day, after first emptying the bladder. Then, creatinine clearance was calculated by using standard formula, CC=UV/ Pt X 1.73m2/BSA of the individual. <b>Results:</b> There was no significant differences in mean creatinine clearance values by collecting 2 hours and 24 hours urine samples from renal donors in different stages of post nephrectomy period. It has been shown that 2 hours collection of urine sample is as good as 24 hours urine sample for estimating creatinine clearance. <b>Conclusion:</b> Hence it was proved that measurement of creatinine clearance could be done as an outpatient procedure, as the patient needed only 2 hours of hospital stay. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2119-2121&id=3447 https://doi.org/10.7860/JCDR/2013/.3447 Dyslipidaemic Changes in Women with Subclinical Hypothyroidism N. Karthick, K.Dillara, K.N. Poornima, A.S. Subhasini <b>Background:</b> In overt hypothyroidism, many lipid abnormalities have been documented. This study was intended to demonstrate the levels of lipid in women with subclinical hypothyroidism (SH). <b>Material and Methods:</b> This was a case control study which was done at referral Centre in Chennai. Women with subclinical hypothyroidism and euthyroid women attending our master health checkup clinic were enrolled in this study.Their lipid profile, fasting blood sugar, T3,T4 and TSH levels were measured. In subclinical hypothyroidism, various parameters were compared. <b>Results:</b> Thirty euthyroid and 30 age matched subclinical hypothyroid women were enrolled in this study. There were significant dyslipidaemic changes is SH women as compared to euthyroid controls. Serum total cholesterol and triglyceride levels were significantly higher as compared to those in controls. LDL levels were higher is SH women, but did not reach statistical significance and lower levels of HDL were noticed in SH subjects as compared to those in euthyroid women. A positive association was also reported between serum TSH and lipid parameters in our study group. <b>Conclusion:</b> SH, the earliest form of thyroid failure, has negative metabolic effects on the affected subjects. SH could be one of the causes of secondary hyperlipidaemia and should be viewed as an independent risk factor for atherosclerosis, along with obesity, hypertension, diabetes, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2122-2125&id=3448 https://doi.org/10.7860/JCDR/2013/.3448 Acute Lung Function Response to Dust in Street Sweepers Smilee Johncy S., Dhanyakumar G., Vivian Samuel T., Ajay K.T., Suresh Y. Bondade <b>Background:</b> Sweepers are chronically exposed to dust raised during sweeping. Dust is regarded as the most influential agent and it is perceived as a frequent cause of respiratory system illness and may cause acute and chronic lung function impairment. <b>Aims:</b> The aim of this study was to determine the acute lung function changes in sweepers exposed to dust generated from street sweeping. <b>Material and Methods:</b> This study was conducted in central Karnataka, India, on 25 female sweepers and 25 healthy female control subjects who were comparable in age, height and weight. The pulmonary function test was performed in controls, sweepers before and after sweeping, by using RMS medspiror and results were compared by Student’s unpaired ‘t’ test. <b>Results:</b> The results showed a significant reduction in percent predicted values and mean values of FVC, FEV1, PEFR, FEF25-75% and FEF 200-1200 between sweepers and their matched controls. Pulmonary function after sweeping also showed a significant decrease. <b>Conclusions:</b> On comparing the pulmonary functions of sweepers before and after sweeping, it was concluded that inhalation of dust acutely affected the lung function of sweepers in India and that sweepers were at a risk of developing occupation related lung function impairment. We recommend that the workers should use protective face masks and do wet sweeping instead of dry sweeping during sweeping activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2126-2129&id=3449 https://doi.org/10.7860/JCDR/2013/.3449 Cardiovascular Reactivity to Stressors in Indian Young Adults with Normotensive Parents Anjali Verma, Manoj Kumar, Indu Saxena, Jayballabh Kumar <b>Backgrounds and Objectives:</b> Stress-induced increase in heart-rate and blood pressure is termed cardiovascular reactivity (CVR). Various studies are designed to monitor the CVR and use different types of experimental stressors. We have compared the CVR to three different stressors used in CVR based studies (cold pressor task, hand grip test, and video game) to identify the best suited stressor for any study design. <b>Material and Methods:</b> The study was conducted on 82 (38 female) young Indian adults with normal resting basal parameters and normotensive parents. Each volunteer was subjected to three stressors: cold pressor task (CPT), hand grip test (HGT), and video game (VG). The CVR to the three stressors was compared amongst female subjects and amongst male subjects by ANOVA, and between female and male subjects by unpaired Student’s t-test. <b>Results:</b> Maximum CVR was obtained to HGT, while maximum gender difference in CVR was obtained in case of CPT. Heart rate and blood pressure changes obtained on playing VG were not statistically significant. <b>Conclusion:</b> When the purpose of research is to generate maximum possible CVR, we suggest the use of HGT; while if the purpose of the research is to study gender related differences, the use of CPT would be more appropriate. Unlike young adults of Western countries, VG is not perceived as a challenging task or stressor by young Indian adults and produces little change in heart rate and blood pressure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2130-2132&id=3450 https://doi.org/10.7860/JCDR/2013/.3450 Effect of Yoga on Autonomic Functions and Psychological Status During Both Phases of Menstrual Cycle in Young Healthy Females Sarita Kanojia, Vivek Kumar Sharma, Asha Gandhi, Raj Kapoor, Ajay Kukreja, Senthil Kumar Subramanian <b>Context:</b> Premenstrual stress affects 75% of women of childbearing age and yoga has been found to be beneficial in many psycho-somatic disorders. <b>Aims:</b> To investigate the effect of integrated yoga on autonomic parameters and psychological well-being during both pre and post phases of menstrual cycle in healthy young female subjects. <b>Settings and Design:</b> Present study is a randomized control trial and was conducted in the Department of Physiology, Lady Hardinge Medical College, New Delhi, India. <b>Material and Methods:</b> Fifty apparently healthy females in the age group of 18-20 years were randomized into two groups: Group I (n=25) consisted of subjects who practiced yoga 35-40 minutes per day, six times per week for the duration of three menstrual cycles. Training was given by qualified yoga instructor. Group II (n=25) subjects acted as controls. Following parameters were recorded at the beginning and after completion of three menstrual cycles in all the subjects: Height, weight (BW), Resting Heart Rate (HR), Resting Systolic (SBP) and Diastolic Blood Pressure (DBP), parasympathetic reactivity tests including Expiration-Inspiration Ratio (E: I ratio) and 30:15 ratio, sympathetic reactivity tests including BP changes due to Isometric Hand Grip (IHG) exercise, and Cold Pressor Test (CPT). Assessment of psychological status was done by administering DIPAS (Defense Institute of Physiology and Allied Sciences) inventories of Anger self report scale, Trait Anxiety, Sense of well-being and Depression scale. Statistical Analysis: Intra-group comparison of physiological parameters was done by using paired ‘t’ test, whereas intra-group comparison of non-parameteric data such as scores of anxiety, depression, anger and sense of well-being was done by Wilcoxon signed-rank test. Inter-group comparison of parameters was done by Students ‘t’ test for parametric tests and Mann-Whitney ‘U’ test for non-parameteric tests. <b>Results:</b> There was significantly higher BW, resting SBP, DBP, sympathetic activity and blunting of parasympathetic reactivity and also, significantly higher scores of anger, depression, anxiety and decreased score of well-being in premenstrual phase as compared to postmenstrual phase in both the groups in initial cycle. There was significantly higher percentage decrease in BW, HR, SBP & DBP in yoga group as compared to control group in both the phases from initial to second and onwards between second and third menstrual cycle. Also, decrease in anger, depression and anxiety and increase in well-being score was significant in yoga group as compared to control group from initial to second and third cycle in premenstrual phase while the change was significant only in depression score in postmenstrual phase. <b>Conclusion:</b> Our study shows that there was significant alteration of autonomic functions and psychological status in premenstrual phase when compared with postmenstrual phase in young healthy females. Also, regular practice of yoga has beneficial effects on both phases of menstrual cycle by bringing parasympathodominance and psychological well-being probably by balancing neuro-endocrinal axis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2133-2139&id=3451 https://doi.org/10.7860/JCDR/2013/.3451 A Study of Serum Malondialdehyde and Cytokine in Tuberculosis Patients Rashmi Kulkarni, Ajit Deshpande, Ravi Saxena, Kiran Saxena <b>Introduction:</b> Tuberculosis (TB) is a common and a deadly infectious disease which is caused by Mycobacterium tuberculi. Inflammatory cytokines play an important role during the course of the disease and they may be responsible for tissue damage which is caused by lipid peroxidation. <b>Method:</b> The present study was conducted in the Department of Biochemistry and patients were selected from Department of TB and Chest Sri Aurobindo Institute of Medical Sciences and also from Manorama Raje Tuberculosis Hospital, Indore. 32 healthy controls and 35 pulmonary TB patients were compared initially for their serum Malondialdehyde (MDA) and tumour necrosis factor alpha (TNF a) levels. Serum TNF a and MDA levels were correlated. <b>Result:</b> TNF a and MDA levels in serum were significantly increased (p<0.001) in pulmonary tuberculosis patients as compared to those of controls. Increased Serum TNF a was positively correlated to MDA levels and it was found to be statistically not significant (correlation coefficient r =0.282,p> 0.05 ). <b>Conclusion:</b> The present study supports the view that there may be a link between lipid peroxidation and cytokine response and relative roles of cytokines and lipid peroxidation in the pathogenesis of tuberculosis https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2140-2142&id=3452 https://doi.org/10.7860/JCDR/2013/.3452 A Study of Inflammatory Status in Nephropathy Patients with History of Type-II Diabetes Mellitus Undergoing Haemodialysis Indrajit Nath, Chandan Kumar Nath, Mriganka Baruah, Moushumi Pathak, R. Banerjee, Sapna Goyal <b>Introduction and Objective:</b> Diabetic nephropathy is one of the leading cause of chronic kidney failure. Local vascular inflammation is increased in diabetes mellitus (DM), which results in higher burden of microvascular and macrovascular complications. The present study was carried out to assess the importance of inflammatory status in nephropathy patients with Type-II DM. <b>Methodology:</b> 80 diagnosed cases of type II DM who had end stage renal disease (Nephropathy Stage-5) were selected for the study, they were further divided equally into 2 sub-categories; Group I (patients who were undergoing haemodialysis) and Group II (patients who were not undergoing haemodialysis). The control group comprised of 40 individuals who were age and sex matched healthy individuals. Inflammatory status was assessed by estimating serum C-reactive protein (CRP) and serum albumin. <b>Results:</b> A significant increase in serum CRP and a significant decrease in serum albumin were seen in test group- I and test group-2 as compared to controls. There was a positive correlation between serum albumin and GFR with r=0.904 in the Test Group-I and r=0.946 in Test Group-II. A negative correlation was observed between serum CRP and GFR r= -0.597 in Test Group-I and with r= -0.6231 in Test Group-II. Also, the correlation between CRP and albumin showed a negative trend with r= -0.848 in Test Group-I and with r= -0.78 in Test Group-II. <b>Conclusion:</b> Microinflammation is a common finding in haemodialysis patients who have a history of nephropathy with Type-II diabetes mellitus. With a proper knowledge on factors which lead to this microinflammation, we can employ preventive strategies for a better management of Type-II diabetic nephropathy patients and thereby, for improving their survival. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2143-2145&id=3453 https://doi.org/10.7860/JCDR/2013/.3453 A Study of Oxidative Stress Biomarkers and Effect of Oral Antioxidant Supplementation in Severe Acute Malnutrition Rahul A. Ghone, Adinath N. Suryakar, P. M. Kulhalli, Sonali S. Bhagat, Ramchandra K. Padalkar, Aarti C. Karnik, Prakash S. Hundekar, D. A. Sangle <b>Background:</b> Malnutrition represents one of the most severe health problems in India. Free radicals play an important role in immunological response, which induces the oxidative surplus in severe acute malnutrition. Severe dietary deficiency of nutrients leads to increased oxidative stress in cellular compartments. <b>Aim:</b> The goal of this study was to inspect impact of oxidative stress in the form of serum malondialdehyde as product of lipid peroxidation, vitamin E, zinc and erythrocyte superoxide dismutase in patients with severe acute malnutrition. <b>Material and Methods:</b> Sixty severe acute malnutrition patients were studied before and after supplementation of antioxidants for one month, and their status were compared with those of 60 age and sex matched healthy controls. The level of serum MDA was analyzed by the Kei Satoh method, serum vitamin E concentration was measured by Baker and Frank Method, serum zinc was measured by using Atomic Absorption Spectrophotometer (AAS) and erythrocyte superoxide dismutase was measured by Kajari Das Method. <b>Results:</b> Significantly increased levels of serum malondialdehyde (p<0.001) were found in the patients as compared to those in controls, and significant depletions were found in the levels of serum vitamin E, zinc and erythrocyte superoxide dismutase in patients with severe acute malnutrition as compared to those in controls. After supplementation of antioxidants for one month, the levels of malondialdehyde were found to be decreased significantly (p<0.001) and zinc and erythrocyte superoxide dismutase capacity levels were increased significantly (p<0.05). Also, there was a non–significant (p>0.05) increase in vitamin E levels as compared to those before supplementation results. <b>Conclusion:</b> Harsh deficiency of various nutrients in severe acute malnutrition leads to generation of heavy oxidative stress. These effects may be minimized with supplementation of antioxidants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2146-2148&id=3454 https://doi.org/10.7860/JCDR/2013/.3454 Apolipoprotein E Gene Polymorphism And Its Effect On Plasma Lipids In Arteriosclerosis P. D. Zende, M. P. Bankar, P. S. Kamble, A. A. Momin <b>Background & objectives:</b> Myocardial infarction and stroke are leading causes of death worldwide. Primarily, arteriosclerosis is responsible for these events. There is a strong family history suggesting a genetic cause. Apolipoprotein E (apo E) plays an important role in lipid metabolism. Apo E is polymorphic with three isoforms, ApoE2, ApoE3 and ApoE4; which translate into three alleles of the gene. Its polymorphism may be a risk determinant of atherosclerosis. <b>Methods:</b> Lipoprotein concentrations were studied, in 100 myocardial infarction and 50 cerebrovascular stroke subjects and compared with age and sex matched controls. Genotypes for apo E isoforms (E2, E3, and E4) for all above subjects and age and sex matched controls were determined by Multiplex Amplification Refractory Mutation System PCR. <b>Results:</b> There were statistically significant higher values of serum total cholesterol and LDL cholesterol in study group, as compared to control group. Study of Apo E isoforms revealed higher proportion of E4 allele in the study group as compared to control group. The occurrence of each allele frequency in study and control group was E4E4: 28.66% and 16.0%, E3E3: 39.33% and 56.66%, E4E3: 14.66% and 9.33%, E3E2: 8.66% and 10.66%, E4E2: 4.66% and 2.66% & for E2E2: 4.0% and 4.66% respectively. <b>Interpretation & Conclusion:</b> There were significantly higher levels of serum total cholesterol, LDL cholesterol and triglyceride with E4 allele; when compared with in the study group and between study group and control group. Apo E polymorphism influences serum lipid levels and is an independent risk determinant of arteriosclerosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2149-2152&id=3455 https://doi.org/10.7860/JCDR/2013/.3455 Effect of Areca Nut Extracts on Phagocytosis of Actinobacillus actinomycetemcomitans ATCC 33384 by Neutrophils in Patients with Chronic Periondontitis Kavita Gangaram Patil, Sharada Chidanand Metgud <b>Background & Objective:</b> A higher prevalence of periodontal disease among areca nut chewers than non chewers has been demonstrated. Neutrophils, the first line of defence mechanism against microbial infection play an important role in maintaining the periodontal health. In this context our aim was to evaluate the effects of areca nut extracts on phagocytic activity by neutrophils isolated from gingival crevicular washing of healthy subjects and patients with chronic periodontitis. <b>Material and Methods:</b> Sample size consisted of a total of 60 subjects which were divided into two groups of 30 each. Group I consisted healthy subjects and Group II consisted clinically diagnosed cases of chronic periodontitis. Neutrophils isolated from gingival crevicular washings of both groups were treated with aqueous extracts of ripe areca nut (rANE) and tender areca nut (tANE) and examined for their effect on cellular viability of neutrophils using typan blue exclusion assay. The possible effects on the phagocytic activity of neutrophils against a periodontal pathogen Aggregatibacter actinomycetemcomitans(ATCC 33384) was determined by using microscopic method. <b>Results:</b> Both rANE and tANE affected the phagocytic activity by neutrophils in healthy and patients with chronic periodontitis. Ripe areca nut extract has altered the neutrophil functions more than tender areca nut in both the groups. There was no difference seen in the cell viability of neutrophils when treated with rANE and tANE in both the groups ( p> 0.05). <b>Conclusion:</b> Both ripe and tender arecanut extract affected the neutrophil function in healthy and patients with chronic periodontitis. Ripe arecanut extract significantly altered the neutrophils functions more than tender areca nut extract. Thus, alterations in these functions of neutrophils may lead to signs of clinical diseases associated with areca chewing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2153-2156&id=3456 https://doi.org/10.7860/JCDR/2013/.3456 The Spectrum and Aetiology of Mycotic Infections from a Tertiary Care Hospital from Western Part of India Nageswari Rajesh Gandham, Savita Vivek Jadhav, Moumita Sardar, ChandaVyawahare, Rabindranath Misra <b>Background:</b> In the past few years, there has been an increase in infections caused by fungal aetiology. This is mainly due to increase in sizes of populations which are at risk. Also, fungi which were previously considered as non-pathogenic have been increasingly implicated. Hence, this study was taken up. <b>Aim:</b> To assess the magnitude of mycotic infections in this set up. To assess the spectrum of fungi which are involved in various infections. <b>Material and Methods:</b> Total 704 samples taken over two and half period were included. They consisted of various samples like sputum, blood, urine, sterile body fluids, corneal scrapings. These were processed by conventional mycological techniques. These included direct microscopy after Gram staining and KOH mount, culture on Sabouraud’s dextrose agar (SDA), corn meal agar, brain heart infusion (BHI), brain heart infusion agar (BHIA) and others, as required. For non-albicans Candida, the automated Vitek 2 C system was used. Various moulds and yeasts were identified up to genus level and species level. <b>Results:</b> Of 704 samples, 336 (48%) were positive for fungal culture. Of these, 244 isolates were yeast like fungi, 81 were moulds, 7 were yeasts and 4 were dimorphic. Among blood stream infections, non-albicans Candida were the commonest isolates. In the urine samples, C. albicans was the commonest isolate. From corneal scrapings, only moulds and dimorphic fungi were isolated. <b>Conclusions:</b> Incidence of non- albicans Candidal infections is increasing. Culture and identification of mycotic infections is essential for commencement of suitable antifungal therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2157-2159&id=3457 https://doi.org/10.7860/JCDR/2013/.3457 Enteric Parasitic Infections in Relation to Diarrhoea in HIV Infected Individuals with CD4 T Cell Counts <1000 Cells/µl in Chennai, India Anand B. Janagond, G. Sasikala, David Agatha, Thyagarajan Ravinder, P. R. Thenmozhivalli <b>Aim:</b> This study was conducted to estimate the prevalence of enteric parasites in HIV patients in Chennai and to correlate with CD4 counts and diarrhoeal status. <b>Material and Methods:</b> Faecal specimens from 100 HIV infected individuals with CD4 < 1000/µl were screened for enteric parasites with wet mounts, modified acid-fast stain for coccidian parasites, modified trichrome stain for Microsporidia, before and after the stool concentration. Agar plate culture for Strongyloides was put up. Chi-square and ANOVA tests were used for statistical analysis. <b>Results:</b> Study group comprised of 38 subjects with acute diarrhoea, 30 with chronic diarrhoea (> 2 weeks) and remaining 32 without diarrhoea. Enteric parasites were detected in 33% of subjects; Isoapora belli (21) being the commonest followed by E.histolyt/Entamoeba dispar (5), Entamoeba coli (2), Cryptosporidium spp (2), Hookworms (2), Strongyloides stercoralis (2), Giardia lamblia (1) and Microsporidium spp (1). There was a significant inverse relation between CD4 counts and duration of diarrhoea. Opportunistic parasites were isolated from the subjects with wide range of CD4 counts and different diarrhoeal status but most commonly from chronic diarrhoea patients. <b>Conclusion:</b> The prevalence of intestinal parasitic infections in HIV patients is high in Chennai, India, especially at CD4 <1000/µl, I.belli infection being the commonest. Routine screening of all HIV patients with low CD4 counts for coccidian parasitic infections by using simple stool microscopic techniques can help in early diagnosis and treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2160-2162&id=3458 https://doi.org/10.7860/JCDR/2013/.3458 Water Borne Hepatitis A and Hepatitis E in Malwa Region of Punjab,India Deepak Arora, Neerja Jindal, Ravinder K Shukla, Renu Bansal <b>Introduction:</b> Hepatitis-A virus infection (HAV) and Hepatitis E virus infection (HEV) are faecally contaminated water borne infection of great public interest in developing countries. HAV has a world-wide distribution and affects infant and young children in developing countries and its epidemics are not very common. HEV is restricted to tropical countries and affects older children and young adults and its epidemics are common. Studies suggested that HEV is etiologically responsible for 10%–95% of admitted cases of hepatitis. Exposure rates over a period of time are different in different parts of the country and in different socio-economic groups. <b>Aim of the study 1.</b> To study the prevalence of HAV and HEV in the outbreak of hepatitis in certain areas of Malwa region of Punjab,India. 2. To determine the age specific prevalence rates of HAV and HEV. 3. To determine any change in the epidemiology of these infections. <b>Material and Methods:</b> This study was conducted in the Department of Microbiology in GGMC and Hospital Faridkot, A leading Tertiary care hospital and the major referral centre of malwa region of Punjab,India. Collection and Serological Tests: 1.Venous blood samples of patients of acute hepatitis were taken. 2.Relavent information regarding their Age, Sex Education, Socio-economic status, personal and community hygiene were recorded. All of the sera were screened for IgM Antibody to HEV and HAV using IgM capture ELISA Kit (ASIA-LION Biotechnology for HEV and GENERAL BIOLOGICAL CORPORATION for HAV ) in accordance with the manufacturer’s instructions. <b>Result and Conclusion :</b> 1.The outbreak was due to hepatitis A &E virus(HEV predominating resulting from fecal contamination of drinking water). 2.Hepatitis E is more widely prevalent 3.There is a change in the epidemiology of HAV so,more cases are seen in age group of more than 20 years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2163-2166&id=3459 https://doi.org/10.7860/JCDR/2013/.3459 In-vitro Inhibition of Biofilm Formation in Candida albicans and Candida tropicalis by Heat Stable Compounds in Culture Filtrate of Aspergillus flavus Sayan Bhattacharyya, Prashant Gupta, Gopa Banerjee, Amita Jain, Mastan Singh <b>Background:</b> Invasive candidiasis, caused mostly by Candida albicans and C. tropicalis is one of the most common causes of bloodstream infection with a substantial attributable mortality. This disease is associated with formation of structured, multilayered microbial communities known as biofilms over indwelling devices. Treatment is rendered difficult owing to factors like poor drug penetration through biofilms and high cost of the available antifungal drugs. Hence there is imminent need of developing low-cost natural compounds inhibiting Candidal biofilm formation in vitro. Organohalgen compounds derived from crude culture filtrate of Aspergillus flavus have been documented to impair in vitro Candidal survival. <b>Aim:</b> We aimed to detect the effect of preheated and unheated crude culture filtrate of Aspergillus flavus on biofilm formation of Candida albicans and C. tropicalis in vitro. <b>Setting and Designs:</b> Ours was a laboratory-based observational study with clinical isolates of the microorganisms selected randomly. <b>Material and Methods:</b> In this study, we showed for the first time by microtitre plate method that heat stable compounds which were present in preheated and unheated culture filtrates of Aspergillus flavus inhibited biofilm formation of Candida albicans and C. tropicalis and also lipase activities of these pathogens, and filtrate was non-toxic on human cell line as checked microscopically. <b>Statistical Analysis used:</b> Z-test of significance was used to calculate significant difference between Candidal biofilm formation in normal liquid medium and culture filtrate, respectively. <b>Results and Conclusion:</b> Heat stable compounds present in culture filtrate of Aspergillus flavus inhibit biofilm formation of Candida albicans and C. tropicalis and also in-vitro lipase activity of these pathogens and could pave the way for development of low-cost alternatives to treat invasive candidiasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2167-2169&id=3460 https://doi.org/10.7860/JCDR/2013/.3460 Changing Trend in the Antibiotic Resistance Pattern of Pseudomonas Aeruginosa Isolated from Wound Swabs of Out-Patients and in-Patients of a Tertiary Care Hospital Noyal Mariya Joseph, Sheela Devi, P. Shashikala, Reba Kanungo <b>Context:</b> Pseudomonas aeruginosa is the most common gram negative bacteria associated with nosocomial infections. Active surveillance of trends in antibiotic resistance of P. aeruginosa is necessary for the selection of appropriate antimicrobial agent for empirical therapy. <b>Aim:</b> To assess the rates of antibiotic resistance and multidrug resistance among P. aeruginosa isolates and to observe the trend in its resistance pattern over a period of 5 years. <b>Materials and Methods:</b> Pseudomonas aeruginosa isolated from wound swabs during January to June 2007 and January to June 2012 were included in the study. Isolates were identified by conventional tests and antibiotic susceptibility was determined by disc diffusion method according to CLSI guidelines. <b>Results:</b> A total of 307 Pseudomonas aeruginosa isolates were included in the study. Among these isolates, 165 were isolated during Jan-June 2007 and 142 were isolated during Jan-June 2012. Among in-patients, there was a significant reduction in resistance rates of the isolates to ciprofloxacin (49% to 33%), ceftazidime (50% to 33%), meropenem (35% to 19%) and imipenem (28% to 14%) in 2012. Similarly, the rate of MDR Pseudomonas aeruginosa among the in-patients decreased from 37.9% in 2007 to 23.7% in 2012 (p value 0.0241). There was no significant difference in the resistance rates of the isolates from out-patients during the two study periods. <b>Conclusion:</b> There was a significant decreasing trend in the resistance rates of the isolates to ciprofloxacin, ceftazidime, meropenem and imipenem. Reduction in the use of ciprofloxacin could be probable reason for the decreased resistance among P. aeruginosa isolates, which needs to be further investigated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2170-2172&id=3461 https://doi.org/10.7860/JCDR/2013/.3461 Prevalence and antibiogram of Extended Spectrum Beta-Lactamase (ESBL) producing Gram negative bacilli and further molecular characterization of ESBL producing Escherichia coli and Klebsiella spp. Meeta Sharma, Sati Pathak, Preeti Srivastava <b>Background and Objectives:</b> Resistance to a wide variety of common antimicrobials has made the proliferation of Extended spectrum ß-lactmase (ESBL) producing strains a serious global health concern that has complicated treatment strategies. The high proportion of ESBL producers among the Enterobacteriaceae and the complex molecular epidemiology with diverse types of ESBL genes are alarming. This study was undertaken to identify ESBL production in various Gram negative bacilli isolated and to further characterize ESBL producers among Escherichia coli and Klebsiella spp by PCR, which were initially screened by phenotypic method. <b>Materials and Methods:</b> A total of 722 isolates of Gram negative bacilli were isolated. Presence of ESBL positivity was detected using the double disk synergy test (DDST). Their antibiogram was studied. PCR analysis for ß-lactamase (bla) genes of the family TEM, SHV and CTX-M was also carried out using designed primers in 20 ESBL isolates each of Escherichia coli and Klebsiella spp. <b>Results:</b> Among 722 Gram negative bacilli isolated 379 (52.49%) were ESBL producers. The major source of ESBL producers were respiratory tract samples, highest ESBL production was observed in Klebsiella sp. (67.04%). Resistance to multiple classes of antibiotics was observed among ESBL producers. Among ESBL producing genes prevalence of bla-CTX-M (82.5%) was highest, followed by bla-TEM (67.5%) and bla-SHV (57.5%) in the present study. The frequency of ESBL producing strains among clinical isolates has been steadily increasing. Advance drug resistance surveillance and molecular characteristics of ESBL isolates is necessary to guide the appropriate and judicious antibiotic use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2173-2177&id=3462 https://doi.org/10.7860/JCDR/2013/.3462 Nosocomial Infections and Drug Susceptibility Patterns in Methicillin Sensitive and Methicillin Resistant Staphylococcus aureus Nitish Kumar Sharma, Raina Garg, Shrikala Baliga, Gopalkrishna Bhat K. <b>Aim:</b> Staphylococcus aureus is one of the leading causes of nosocomial infections and is known for its ability to develop resistance to antibiotics. The drug susceptibility pattern of Methicillin Sensitive S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA) may vary. <b>Aims and Objectives:</b> This study was carried out to determine and compare the drug susceptibility patterns in nosocomial MSSA and MRSA. <b>Material and Methods:</b> The study was conducted between September 2009 and August 2011. Standard conventional methods were used for the isolation and identification of S. aureus. MRSA was identified by the cefoxitin (30 µg) disk method. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method and the interpretation of the results was done using CLSI guidelines. <b>Results:</b> Out of 685 strains of S. aureus studied, 173(25.25%) were MRSA and 512 (74.25%) were MSSA. Out of 173 MRSA strains, 114(65.89%) were isolated from pus, 22(12.71%) from vaginal swab, 18(10.40%) from central catheter tip and the remaining from other specimens. All isolates were susceptible to vancomycin and least number of isolates were susceptible to penicillin. MRSA displayed significantly higher resistance to other antibiotics. 45.7% of MRSA strains were resistant to clindamycin, 64.7% to ciprofloxacin, 87.3% to cotrimoxazole, 54.3% to erythromycin, 17.3% to gentamicin, 16.8% to netilmycin, and 58.38% to tetracycline. Inducible clindamycin resistance was detected in 37 (21.38%) strains of MRSA. <b>Conclusion:</b> Nosocomial infections caused by MRSA is a significant problem. MRSA and MSSA differ with their susceptibility to antibiotics. All MRSA isolates in our hospitals were susceptible to vancomycin. Proper selection of the antibiotics based on antibiotic susceptibility test results is needed for effective treatment and prevention of emergence of resistance in MRSA and MSSA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2178-2180&id=3463 https://doi.org/10.7860/JCDR/2013/.3463 Do Health Professionals have Positive Perception Towards Consumer Reporting of Adverse Drug Reactions? Mohammed Ahmed Alshakka, Mohamed Izham Mohamed Ibrahim, Mohamed Azmi Ahmad Hassali <b>Aim:</b> The aim of this study was to evaluate the perceptions of general practitioners (GPs) and community pharmacists (CPs) in Penang, Malaysia, towards consumer reporting of Adverse Drug Reactions (ADRs). <b>Methodology:</b> A cross-sectional mail survey was adopted for the performance of the study. Survey questionnaires were sent to 192 CPs and 400 GPs in the state of Penang, Malaysia. Reminders were sent to all the non-respondents after 3 weeks of the initial mailing. Data which were collected from the questionnaires were analyzed by using the Statistical Package for Social Science (SPSS), version 15. The Chi-square test was used to determine as to whether there was any significant difference between expected and observed frequencies at the alpha level of 0.05. <b>Results:</b> Only 104 respondents (47 CPs and 57 GPs) returned the survey, with a response rate of 18.0%- a figure which could be considered to be low. This study indicated that GPs and CPs were aware about the importance and benefits of consumer reporting. A majority of them (88.0%) thought that consumer reporting would add more benefits to the existing pharmacovigilance program. Similarly, 97% of the respondents agreed that reporting of ADRs was necessary and 87.0% respondents had seen ADRs among their patients. However, 57 of them (6.0%), had not been aware that the national program in Malaysia allowed consumers to report ADRs. A majority of them (97.0%) agreed that consumers needed more education regarding ADR reporting. Most of them (84.0%) thought that consumers could not write valid reports which were similar to reports which were made by healthcare professionals (HCPs). A majority of the respondents (68.0%) had not heard about the consumer reporting program in Malaysia and half of them did not believe that consumer reporting could overcome under-reporting, which was the main problem of the national pharmacovigilance program in Malaysia. <b>Conclusion:</b> The GPs and CPs were aware about the importance and benefits of consumer reporting. Such reporting will add more benefits to the existing programmes in Malaysia, although the barrier that we are facing now is the doubt that they hold over patients’ ability to write valid reports which are similar to reports which are made by healthcare professionals (HCPs). Therefore, the consumers need to be educated more about their medications, on how to validate any complaints that they had about the drug consumption and on how to file a proper report and channel it to the ‘right’ person or bodies. Equally importantly, the media and the non-governmental organizations (NGOs) should play an important role in determining the success of consumer reporting. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2181-2185&id=3464 https://doi.org/10.7860/JCDR/2013/.3464 Estimation of total Length of Femur From Its Fragments in South Indian Population Shweta Solan, Roopa Kulkarni <b>Introduction:</b> Establishment of identity of deceased person also assumes a great medicolegal importance. To establish the identity of a person, stature is one of the criteria. To know stature of individual, length of long bones is needed. <b>Aims and Objectives:</b> To determine the lengths of the femoral fragments and to compare with the total length of femur in south Indian population, which will help to estimate the stature of the individual using standard regression formulae. <b>Material and Methods:</b> A number of 150, 72 left and 78 right adult fully ossified dry processed femora were taken. The femur bone was divided into five segments by taking predetermined points. Length of five segments and maximum length of femur were measured to the nearest millimeter. The values were obtained in cm [mean±S.D.] and the mean total length of femora on left and right side was measured. The proportion of segments to the total length was also calculated which will help for the stature estimation using standard regression formulae. <b>Results:</b> The mean total length of femora on left side was 43.54 ± 2.7 and on right side it was 43.42 ± 2.4. The measurements of the segments-1, 2, 3, 4 and 5 were 8.06± 0.71, 8.25± 1.24, 10.35 ± 2.21, 13.94 ± 1.93 and 2.77 ± 0.53 on left side and 8.09 ± 0.70, 8.30 ± 1.34, 10.44 ± 1.91, 13.50 ± 1.54 and 3.09 ± 0.41 on right side of femur. <b>Conclusion:</b> The sample size was 150, 72 left and 78 right and ‘p’ value of all the segments was significant (‹0.001). When comparison was made between segments of right and left femora, the ‘p’ value of segment-5 was found to be ‹0.001. Comparison between different segments of femur showed significance in all the segments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2111-2115&id=3465 https://doi.org/10.7860/JCDR/2013/.3465 Comparative Study of Processing of Haemorrhagic Body Fluids by Using Different Techniques Mirza Shabnam, Sangeeta Sharma, Sanjay Upreti, Rani Bansal, Mahip Saluja, Anjali Khare, Meenakshi Tripathi, Shrey Khanna <b>Background:</b> Haemorrhagic fluids are samples which are commonly received for cytological examination. The diagnostic efficacy suffers when large numbers of red blood cells are present in the sample. Haemorrhagic fluids are processed by a variety of techniques and the common goal of each technique is selection and concentration of an adequate number of tumour cells with intact cell morphologies, without losing them during processing. <b>Aim:</b> Present study was undertaken to improve the quality of haemorrhagic fluid by using three different haemolysing agents, namely Carnoy’s Fixative (CF), saline in Normal Saline Rehydration Technique (NSRT) and Glacial Acetic Acid (GAA) for haemolysis and to find out the most effective processing technique for better cytomorphological assessment. <b>Material and Methods:</b> This study was carried out on 51 haemorrhagic fluids. Processing of haemorrhagic fluid was done by using haemolysing agents, namely CF, GAA and NSRT. After processing fluids with these three techniques, three smears were prepared from each of them, out of which one was air dried and two were wet fixed. Fourth type of smear made without application of haemolysing agent was used as control.The smears were stained with Leishman’s stain and wet fixed smears were stained with Hematoxylin and Eosin ( H and E) , and Papanicolou’s stain (Pap) respectively. <b>Results:</b> NSRT showed lysis of red blood cells (RBCs) in 72.5% of cases, followed by that of CF in 60.8% cases and that of GAA in only 3.9% of cases. Retention of epithelial/mesothelial cells was seen in 70.5% cases with NSRT, followed by that of CF in 57.8% of cases and then by that of GAA in 50.9% of cases. Cytomorphological details were best preserved in CF in 60.6% of cases, followed by GAA in 58.8% of cases and NSRT in 52.9% of cases. <b>Conclusion:</b> The most effective method for RBC lysis in smear background and cell retention is NSRT and cytomorphological details are best preserved with CF. But, considering the overall results and procedural simplicity, it was concluded that NSRT was a better technique for processing of haemorrhagic fluid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2186-2188&id=3466 https://doi.org/10.7860/JCDR/2013/.3466 Osteoarticular Tuberculosis-A Three Years’ Retrospective Study Arathi N., Faiyaz Ahmad, Najmul Huda <b>Introduction:</b> Extra pulmonary TB can be encountered in various organ systems, like lymph nodes, serous cavities, genitourinary tract, skeletal. Musculoskeletal TB can cause significant functional impairment. The clinical symptoms are variable, pain and swelling being common symptomatology. Investigations for suspected cases include radiological imaging, histopathological examination, bacteriological examination, and polymerase chain reaction. The mainstay of treatment is multidrug antitubercular chemotherapy. <b>Aims:</b> To study the cases of osteoarticular TB diagnosed on biopsy, to analyse the various microscopic patterns, results of microbiological investigations, correlate the clinical and radiological features and the response to ATT. <b>Settings and Design:</b> A teaching tertiary medical institute in North India in catchment area, where prevalence of tuberculosis is high. A retrospective study of cases with a biopsy diagnosis of bone and/joint TB, retrieved from Histopathology section of Department of Pathology of the tertiary institute. <b>Material and Methods:</b> The study was retrospective and the data was collected for the preceding 3 years. The cases were retrieved from the records of the department of Pathology. A total of 16 cases were diagnosed as/suspected to be tuberculosis of bones and/joints. The clinical information were noted from the case files. Results of laboratory investigations along with relevant microbiologic investigations were noted. The biopsy samples were processed according to protocol. Ziehl–Neelsen stain to detect tubercle bacilli and PAS stain to rule out fungal infection were done. Microscopic features were noted. <b>Results and Conclusion:</b> Sixteen cases with a diagnosis of bone and/joint tuberculosis were found. The average age was 23.6 years. The most common presentation was pain and swelling. Knee joint was most commonly involved (7 cases) followed by spine and ankle (3 each). All the cases showed epithelioid granulomas which was necrotising in 11. AFB positivity was found only in 4 cases. ATT was started in 12 cases with a good response. It is important to suspect osteoarticular TB clinically and investigate accordingly. In resource poor setting, study of biopsy material can aid in diagnosis, further guiding the management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2189-2192&id=3467 https://doi.org/10.7860/JCDR/2013/.3467 Efficacy of Cheiloscopy in Determination of Sex Among South Indians Vijay Kautilya D., Pravir Bodkha, Naveen Rajamohan <b>Introduction:</b> Human identification plays a vital role in any crime investigation. Along with the various other established methods, cheiloscopy also plays a key role in linking the criminal with the crime. The ability of a technique in differentiating the sex of a person in the field can help in screening a large number of suspects. This study evaluated the efficacy of cheiloscopy in determination of sex among South Indians. It also studied the pattern of dimorphism in the lips and lip prints of south Indians. <b>Material and Methods:</b> Lip prints from 100 medical students (50 males and 50 females) were obtained and were analyzed, based on Tsuchihashi and Suzuki classification, to check for dimorphism. Lip dimensions were studied by using standard sliding calipers for dimorphism. <b>Results and Discussion:</b> The most common pattern of lip print among males was Type III as compared to Type I in females. The outer four portions of the lip showed statistically significant differences in males and females. Middle portion of the lip was statistically insignificant in sex determination, based on lip print patterns. Thickness of the lip was significantly larger in males as compared to that in females and this criterion could be used to establish a logistic regression for determination of sex of a person. <b>Conclusion:</b> Lips not only significantly differ among the males and females in the pattern of the lip print that they present, but they also differ in their size. These features can effectively be used to determine the sex of a person accurately. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2193-2196&id=3468 https://doi.org/10.7860/JCDR/2013/.3468 Perception on the Relationship between Cancer and Usage of Tobacco and Alcohol in Hail, Saudi Arabia Ibrahim Abdelmageed Ginawi <b>Aim:</b> Increasing alcohol consumption in many countries is an important cause of cancer worldwide. The aim of this study was to evaluate the burden of tobacco use and alcohol consumption and its related perception among population of Hail, Saudi Arabia. <b>Methodology:</b> A cross-sectional survey from March to April 2012 covering 451 participants, in the city of Hail, Northern Saudi Arabia. <b>Results:</b> Out of 451 respondents, 355(78.7%) were male and 96 (21.3%) were female giving a male to female ratio of 3.7:1. The age range of respondents was 11 – 77 years with a mean of 32 years. Prevalence of tobacco use and alcoholic beverages consumption were 30.3% and 7.5%, respectively. Most of the tobacco users and alcohol consumers showed positive knowledge concerning the relation between tobacco use and/or alcohol consumption and cancer. <b>Conclusion:</b> It is evident that the prevalence of tobacco consumption is rising in the Hail region. Female participation in tobacco and alcohol related studies in the Hail – Saudi Arabia represent a major obstacle since it is considered as social stigma due to complete prohibition by law. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2197-2199&id=3469 https://doi.org/10.7860/JCDR/2013/.3469 Diabetic Profile- Screening of HBA1C - A Random Community Assessment M.R. Suchitra, K. Jaiganesh, S.Parthasarathy <b>Background:</b> Diabetes mellitus is becoming the commonest non–communicable disease in the world. Strict control of diabetes mellitus is associated with fewer incidences of complications. Screening for control of diabetes is a useful intervention, because diabetes is a highly morbid illness with a long asymptomatic phase. Glycosylated Haemoglob in (HbA1C) is the ideal parameter which can be used to assess the diabetic control, as this parameter is not alterable with single day manipulations. <b>Aims:</b> Our main objective was to find out the mean HbA1C in a random assessment. The other supplementary objectives were to find out the prevalence of hypertension, smoking, obesity, vascular events and hypoglycaemic episodes and any possible correlation with HbA1C values. <b>Methodology:</b> The selection of 100 diabetic patients who reported to the diabetic centre in a randomly selected day was done. They were subjected to a simple questionnaire with on spot HbA1c assessment. The questionnaire described the evidence of vascular events, risk factors, hypoglycaemic episodes, etc. <b>Results:</b> A mean HbA1C value of 8.91 was found out, which was far higher than the normal (7.0%). The prevalences of other variables coincided with those which were seen in previous studies. The hypoglycaemic episodes were high, but the patients with such episodes had a higher mean HbA1C. This could be possible as our patients consumed sweet and sugar with such events and had higher mean glucose values. It has been suggested that physicians and patients should work synchronously to achieve better diabetic control. The physician should strictly enforce weight reduction and quitting of smoking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2200-2202&id=3470 https://doi.org/10.7860/JCDR/2013/.3470 Experiences of HIV Positive Mothers From Rural South India during Intra-Natal Period Anbarasi Subramaniyan, Sonali Sarkar, Gautam Roy, Subitha Lakshminarayanan <b>Context:</b> Tamil Nadu comes under group I high prevalence state, with less than 1% prevalence of HIV infection in antenatal women but above 5% prevalence in high risk group. One of the ways to control HIV/AIDS in India is through Prevention of Parent to Child Transmission (PPTCT), the success of which lies in identifying pregnant women with HIV infection. But due to the stigma against HIV/AIDS among health care providers, HIV positive patients face discrimination in the health sector. <b>Aims:</b> To explore the difficulties faced by rural HIV positive mothers during the intra-natal period. <b>Methods:</b> A descriptive qualitative study was conducted among HIV positive mothers, in Gingee block of Villupuram district, Tamil Nadu, India. All the mothers who tested positive between June 2006 and May 2010 were interviewed in-depth using an interview guide. <b>Results:</b> There were 21 HIV positive mothers during this period, 19 of whom gave consent. Majority of the mothers were <30 years of age from families belonging to lower socio-economic class. The discriminations faced from the health staff was avoidance of physical examination, rude behaviour like throwing of records on the face, discriminatory comments, unnecessary referrals and even refusal to provide intra-partum services. The negative attitude of the staff made a few mothers to deliver in some other institution without disclosing their HIV status. <b>Conclusion:</b> Stigma among health care providers towards HIV positive pregnant women acts as a barrier for improving access to PPTCT services in India and it poses high risk to the mothers, babies and also the health care providers. There is a pressing need to improve access to quality PPTCT services especially during the intranatal period https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2203-2206&id=3471 https://doi.org/10.7860/JCDR/2013/.3471 A Clinical Study of Subtype-based Prevalence of Dry Eye Aditya Rege, Varsha Kulkarni, Neelam Puthran, Tejaswini Khandgave <b>Introduction:</b> Dry Eye is a multifactorial disease of the tearfilm and the ocular surface which may be due to reduced tear production or excessive tear evaporation resulting in discomfort, visual disturbance, and tear film instability with a potential damage to the ocular surface. Various population-based studies have been done to find out the prevalence and the magnitude of the problem. Women Health Study reported prevalence of 7.8% after screening 36995 subjects above 49 years by interview. The prevalence reported by Blue Mountain Study was 15.3% .The Beaver Dam Study and Shiphai Eye studies are other studies reporting prevalence of 14.5% and 33.7% respectively. McMonnies questionnaire is a widely used screening instrument for Dry-Eye syndromes with sensitivity reportedly varying between 87% and 98% and specificity between 87% and 97%. Prevalence studies use McMonnie’s questionnaire for screening individuals for Dry Eye, whereafter tests like Schirmer’s test, Tear Film Break Up Time test, Rose Bengal test, Lissamine Green test and Meibomian Gland Dysfunction test are useful for further evaluation. While these tests help to differentiate the subtypes of Dry Eye such as Lipid Anomaly Dry Eye, Aqueous Tear Deficiency and Mucin Layer Deficiency, however, their sensitivity and specificity has not been widely studied. Additionally, very few studies have reported the prevalence of the various subtypes of Dry Eye. <b>Aim and Objectives:</b> To determine the subtype-based prevalence of Dry Eye, to study the specificity and sensitivity of clinical tests for Dry Eye and to correlate McMonnies questionnaire with Dry Eye tests results. <b>Material and Methods:</b> A prospective, cross-sectional, observational study, duly approved by the Institutional Ethics Committee, was conducted from October 2010 to April 2012. A total of 4750 subjects above 18 yrs of age were screened by the McMonnies questionnaire. Respondents having a score greater than 14.5 were subjected to clinical Dry Eye tests. The data obtained was analyzed using chi-square test. P value < 0.005 was considered statistically significant.The specificity and sensitivity of each clinical test was calculated using Schirmer’s test as gold standard. <b>Results:</b> The prevalence of Dry Eye was 15.4%, with a female preponderance (p = 0.01) and a significant increase with age above 60 years was noted (p<0.0001). Tear Film Break Up Time was the most reliable test with a good sensitivity (68.85%) and specificity (78.32%). Lipid Anomaly Dry Eye was the most prevalent (14.48%) followed by Aqueous Tear Deficiency (13.36%) and Mucin Layer Deficiency (3.51%). A positive correlation between McMonnies score and severity of Dry Eye was seen. <b>Conclusion:</b> This study suggests that Lipid Layer Anomaly is the most prevalent subtype in Dry Eye. Tear Film Break Up Time test is the most likely test to diagnose mild Dry Eye. McMonies Questionnaire can be effectively used for screening of a large population. Tear Film Break Up Time was found to have better sensitivity as well as specificity than other tests used for diagnosing Dry Eye. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2207-2210&id=3472 https://doi.org/10.7860/JCDR/2013/.3472 Axial Length, Anterior Chamber Depth-A Study in Different Age Groups and Refractive Errors Veena Bhardwaj, Gandhi Parth Rajeshbhai <b>Introduction:</b> Axial length and anterior chamber depth play an important role in refractive status of the eye in different age groups. <b>Material and Methods:</b> The present study has been done on 240 patients (480 eyes) who attended eye OPD of Department of Ophthalmology at NIMS Medical College & Hospital Jaipur, Rajasthan, India. The patients attending eye OPD between July 2011 to December 2012 of different ages groups were without significant history of any ocular disease. The axial length and anterior chamber depth were measured and compared. <b>Conclusion:</b> Hypermetropic eyes have shallow anterior chamber depth and shorter axial length as compared to myopic and emmtropic eyes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2211-2212&id=3473 https://doi.org/10.7860/JCDR/2013/.3473 A Prospective Real World Experience of Moxonidine Use in Indian Hypertensive Patients–Prescription beyond Current Guidelines Suresh V Sagarad, Sudha Biradar-Kerure, Ramakrishna MR, Chaitanya Kumar S, S S Reddy <b>Objective:</b> The primary objective of this study was to assess the use of moxonidine, a centrally acting anti–hypertensive agent in real world practice. Material and Methods: Patients who attended out-patients clinic with diagnosis of hypertension were enrolled in the study. Demographics with co-morbid illnesses of all patients were recorded. Patient’s prescriptions were recorded and anti-hypertensive medications were also analysed. <b>Results:</b> A total of 990 patients were eligible during the study period. Moxonidine was used in 4.54% of patients. Two groups could be identified in moxonidine users – one Group with resistant hypertension (30 patients, 3.03% of total, 66.66% of moxonidine users) on multiple drugs to control BP and another Group with intolerance to conventional, first line drugs (15 patients 1.51% of total, 33.33% of moxonidine users). Moxonidine was not used in newly diagnosed hypertension cases. Resistant hypertension and renal failure predicted the use of moxonidine. Majority of drug used was as per current guidelines. <b>Conclusions:</b> Our study results reflected real world practice of current anti-hypertensive therapy. Patients generally receive medications in accordance with current recommendations and guidelines. Small but significant proportion of patients may require use of drugs like moxonidine to control high BP. Guidelines need to incorporate these real world practices. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2213-2215&id=3474 https://doi.org/10.7860/JCDR/2013/.3474 Reactions of Nepali Adults to Warning Labels on Cigarette Packages: A Survey with Employee and Medical Students of a Tertiary Care Medical College of Western Region of Nepal Badri Paudel, Klara Paudel, Deepa Timilsina <b>Background:</b> For the past 30 years, there have been no changes in the text-only cigarette warning labels in Nepal. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of the current study was primarily to compare the differences in reactions to different types of warning labels on cigarette packages, with a specific focus on whether the new warning label adopted by WHO FCTC was better than the text only label used by Nepal. <b>Material and Methods:</b> This study was conducted in Gandaki Medical College Teaching Hospital (GMCTH) in 2012, in a tertiary care hospital located in the western region of Nepal. Eligible study participants included in this survey were those aged 18 years and over and those who are studying MBBS/Nursing or who were employees of GMCTH. 500 participants finished the survey. Participants were shown nine types of warning labels found on cigarette packages.They comprised one text only warning label used within Nepalese market and eight foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking. <b>Results:</b> On comparing the Nepalese warning label with other foreign labels with regards to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were found to be more effective. Both smokers and non–smokers thought that warning labels with text plus graphics were substantially more of a deterrent than text-only labels. <b>Conclusion:</b> The findings from this study support previous research that has found that text-plus graphic warning labels were more salient and potentially more effective than text-only labels.Warning labels are one of the component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger Nepalese public health educational efforts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2216-2222&id=3475 https://doi.org/10.7860/JCDR/2013/.3475 Role of Common Investigations in Aetiological Evaluation of Exudative Pleural Effusions Arnab Maji, Malay Kumar Maikap, Debraj Jash, Kaushik Saha, Abhijit Kundu, Debabrata Saha, Sourindranath Banerjee, Anupam Patra <b>Background:</b> Pleural effusion is a common problem encountered in daily practice. To Establish aetiology of exudative effusions is a diagnostic challenge to general practitioners and even to pulmonologists especially in resource poor government hospitals with lack of investigations like thoracoscopy. Some recent studies had shown that around 2% of patients remained undiagnosed even after these investigations. <b>Aims and Objective:</b> To evaluate the role of the commonly available investigations such as pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopy in the aetiological evaluation of exudative effusions and to ascertain the proportion of cases which remain undiagnosed after all the above investigations. <b>Material and Methods:</b> This was a prospective single-centred cross-sectional study carried out at the NRS Medical College, Kolkata, India from February 2008 to February 2013 which included 568 patients of exudative pleural effusions. We performed commonly available procedures like pleural fluid study, blind pleural biopsy, sputum examination, CT scan thorax, bronchoscopic procedures to the diagnosis. <b>Results:</b> Total number of patients studied were 568. Tuberculosis was the most common cause (54.57%) followed by malignancy (28.17%), empyema (10.56%), parapneumonic effusion (5.28%) and others. Carcinoma of the lung was the commonest cause of malignant effusions and bronchoscopic biopsy was given the highest yield of histological diagnosis (84.6%) followed by CT guided FNAC (77.6%) and pleural fluid cytology (55%). Highest yield to diagnose tubercular effusion was found in lymph node FNAC (81.5%) followed by pleural biopsy (62%). Sputum smear for AFB was positive in only 27.4% cases. Bleeding followed by pneumothorax were the most common complications. Complications are very less (1.3% and 0.9% respectively). 2 patients (0.34%) remained undiagnosed even after these all above said investigations. <b>Conclusion:</b> Above mentioned commonly available investigations can ascertain diagnosis in most of the cases in the aetiological evaluation of exudative effusions and they are relatively safe procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2223-2226&id=3476 https://doi.org/10.7860/JCDR/2013/.3476 Clinical Profile of Patients Admitted with Swine-Origin Influenza A (H1N1) Virus Infection: An Experience from A Tertiary Care Hospital Asmita A. Mehta, V.Anil Kumar, Suresh G. Nair, Fini K Joseph, Gireesh Kumar, Sanjeev K. Singh <b>Background:</b> Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. H1N1 critical illness mostly affects young patients and is often fatal. <b>Objective:</b> Primary objective was to study clinical profile of the patients admitted with confirmed H1N1 swine flu infection. Secondary objective was to observe the risk factors associated with complications like need of mechanical ventilation and or death among H1N1 infected patients. <b>Material and Methods:</b> A prospective observational study was conducted in a tertiary care teaching hospital from June 2009, to December, 2011. H1N1 infection was confirmed by reverse transcriptase PCR. Statistical analysis was done by SPSS, version 11. Binary logistic regression was used to find out independent risk factors for morbidity. <b>Results:</b> Total 495 patients were tested for H1N1 infection. Among them, 115 (23%) were positive and 88(76%) required admission. Median age of cohort was 29 years and 87% of the patients were below 54 years of age. Most common presenting symptoms were fever (98%), followed by cough (86%) and sore throat (54%). Out of 88 patients, 14 (16%) required mechanical ventilation and 6(6.8%) died. Lymphopaenia (Lymphocytes <10%) and presence of patchy infiltrates on chest X-ray (CXR) the time of presentation were independent risk factors associated with need of mechanical ventilation or death in H1N1 infected patients by multivariate analysis. <b>Conclusion:</b> Present study showed that H1N1 swine flu mainly affected people who were < 54 years of age. Majority of patients improved with antiviral treatment. Lymphopaenia and CXR which showed bilateral pneumonia at time of presentation were found to be independent risk factors associated with requirement of mechanical ventilation and/or death in H1N1 infection. Pregnant females with flu constituted 33% of total mortality. High priority should be given to such patients. Further community based studies are required to analyze the actual impact of H1N1 infection in the community. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2227-2230&id=3477 https://doi.org/10.7860/JCDR/2013/.3477 Trace Elements in Febrile Seizure Compared to Febrile Children Admitted to an Academic Hospital in Iran, 2011 Sepideh Amouian, Sakineh Mohammadian, Naser Behnampour, Mohsen Tizrou <b>Background and Aim:</b> Pathogenesis of Febrile Convulsion (FC) is unknown but some elements and genetic predispositions have been considered in the top list. This case-control study was designed to compare some trace elements in paediatrics who were admitted with FC and those in febrile ones without seizure attacks at an academic hospital in northeast of Iran. <b>Material and Methods:</b> This case-control study was done from June 2010 to July 2011 on 160 paediatrics (6-months to 5-years old) who were diagnosed with FC and on 160 age-matched febrile children as control group. Data on the age, gender, past history of fever and convulsion, age at the first episode of seizure and family history of FC were gathered by using a designed checklist. Complete Blood Count (CBC), serum iron, Total Iron Binding Capacity (TIBC), zinc, magnesium and calcium were tested after taking informed consents from the parents. Serum levels of trace elements were measured by a photometric method. Independent t-test or non-parametric Mann-Whitney test were used to compare means between two groups. <b>Results:</b> There were no significant differences between the cases and controls with regards to the gender or age. TIBC and magnesium were lower in FC, but calcium, iron and zinc were higher in FC as compared to those in the other group (not significant). <b>Conclusions:</b> So, it could be said that deficiency of trace elements was not significantly related to febrile convulsion in our study and it seemed that these tests were not necessary in FC cases. But further investigations on other trace elements are needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2231-2233&id=3478 https://doi.org/10.7860/JCDR/2013/.3478 A Comparative Study of Clinical Profiles of Vivax and Falciparum Malaria in Children at a Tertiary Care Centre in Uttarakhand Ragini Singh, Shruti Kumar, S.K. Rana, Brijesh Thakur, S.P. Singh <b>Background:</b> Falciparum malaria has been constantly associated with high morbidity and mortality for a long time. Vivax malaria, which was once thought to be a relatively benign condition, is appearing in its more malignant form, with severity gradually becoming a serious concern. <b>Aim:</b> This study is aimed to find out and compare the clinical and pathological manifestations of vivax and falciparum malaria in pediatric age group in Uttarakhand. <b>Setting and Design:</b> A prospective study was carried out at a tertiary care hospital of a medical college in Uttarakhand, India. <b>Material and Methods:</b> This study was done for a period of 2 years, from December 2010 to November 2012. Patients of 18 years age or below from Uttarakhand and nearby regions, who were smear positive or antigen positive were included in the study. <b>Statistical Analysis:</b> p value was calculated using Pearson Chi-square with Yates correction by DAG stat software. <b>Result:</b> Eighty Five patients were found to be suffering from malaria. 61 (71.8%) had vivax malaria, while 24 (28.2%) patients suffered from falciparum. Larger majority of malaria patients in both the groups happened to be males. The detailed study of morbidity profile clearly establishes that the complication related severity, earlier attributed to only falciparum is equally seen in vivax. Thrombocytopenia was the commonest finding in both. Other complications seen in both groups were those of cerebral malaria, severe anemia, ARDS, renal failure, malarial hepatitis, leucocytopenia, pancytopenia, shock with multiorgan dysfunction and hemoglobinuria. Even the mortality in the two groups was of the same order as p value calculated for the difference between the two species was well above 0.05. <b>Conclusion:</b> Vivax malaria is an important cause of mortality and morbidity. The severity of illness is almost similar in both vivax and falciparum malaria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2234-2237&id=3479 https://doi.org/10.7860/JCDR/2013/.3479 Topical Phenytoin Application in Grade I and II Diabetic Foot Ulcers: A Prospective Study Vijaya Patil, Rashmi Patil, P. L. Kariholu, L. S. Patil, Praveeen Shahapur <b>Background:</b> India is fast becoming world diabetes capital. Diabetic foot infections are major problems among innumerable complications associated with diabetes. <b>Material and Methods:</b> A randomized control study was conducted to evaluate the effect of topical phenytoin on healing in diabetic foot ulcers. One hundred patients with grade I/ II diabetic foot ulcers were randomly divided into two equal groups. Patients subjected to topical phenytoin dressing were classified under study and those who underwent normal salinewound dressings were classified as control. Both the groups were compared in terms of discharge, slough, wound area reduction and duration of hospital stay. <b>Results:</b> Discharge and slough from wound reduced significantly by day 14 in phenytoin group and within 21 days in control group. Mean duration of hospital stay in phenytoin group was 20 days, whereas in control group, it was 26 days. This difference was statistically significant (p value <0.005,df 1). <b>Conclusion:</b> Hence, Phenytoin proved to be useful as a topical agent in promoting healing and in controlling infections in diabetic foot ulcers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2238-2240&id=3480 https://doi.org/10.7860/JCDR/2013/.3480 Influence of Endomeriotic Cyst Diameter and the Severity of Endometriosis on the Ovarian Parenchyma Excised During Laparoscopic Cystectomy Amar Ramachandran , Sushma Dhulkhed, Rajesh Bhakta, Rajeshwari G Bhat, Anuradha CK Rao, Akhila Vasudeva, Ashwini Vishalakshi, Pratap Kumar <b>Introduction:</b> Endometrioma is a common form of endometriosis and it is represented by endometriotic deposits within the ovaries which accounts for upto 17-44% of cases. Laparoscopic stripping of ovarian endometriotic cysts is an accepted technique owing to low recurrence rates. Decrease in residual ovarian tissue volume was noted in many studies followed cystectomy. This study aims at estimating whether the size of endometriotic cyst is related to ovarian parenchyma excised along with cyst wall. <b>Material and Methods:</b> Prospective study was done at University teaching hospital for one year. A total of 56 women underwent laparoscopic endometriotic cystectomy. Cystectomy was done by stripping method and endometriosis was staged according to revised American Society of Reproductive Medicine classification (rASRM). The endometrioma wall was evaluated histologically and were categorised into 2 groups based on semi- quantitative scale of 0-4. Group 1 and 2 showed grade 0, 1, 2 and 3, 4 in the cyst wall respectively. <b>Results:</b> Mean age of patients was 31.4 years, duration of infertility was 4.1 years and cyst diameter measured 6.3 cm. 73.2% (n=41) were in Group 1 and 26.8% (n=15) were in Group 2 , mean cyst diameter was being 4.3 cm and 5.0 cm respectively. There was no significant statistical correlation between preoperative cyst diameter and ovarian parenchyma removed (p=0.15). 93.3% (n=14) of group 2, and only 65.8% (n=27 ) of group 1 were found to have moderate to severe endometriosis, indicating there is correlation between disease severity and loss of ovarian tissue (p= 0.04). <b>Conclusion:</b> Endometriotic cystectomy when performed with accurate surgical technique leads to no significant ovarian tissue removal. However, disease severity significantly determines the loss of normal ovarian parenchyma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2241-2243&id=3481 https://doi.org/10.7860/JCDR/2013/.3481 What Type of Lectures Students Want? - A Reaction Evaluation of Dental Students Srinivasan Roopa, Bagavad Geetha M, Anitha Rani, Thomas Chacko <b>Introduction:</b> An one hour didactic lecture is the common method of teaching in dental colleges in India. Lengthy lectures are boring and students are passive recipients of the information. Interactive lectures are suggested as a means of overcoming the disadvantages of regular lectures. <b>Aims:</b> The present study was conducted to pilot various methods of making lectures interactive and to find the students’ reactions to interactive lectures as compared to regular lectures. <b>Material and Methods:</b> An entire batch of first year dental students (n = 78) was exposed to both interactive and regular lectures for the cardiovascular system in physiology. Among the total number of 12 lectures, alternate lectures were conducted in an interactive style. At the end of the 12 lecture series, students’ opinions were obtained using a structured feedback evaluation questionnaire, consisting of five statements, on a five point Likert scale. Statistical Analysis was done using SPSS software, version 15. <b>Results:</b> Interactive lectures were found to be more useful than regular lectures by 92% of the students. Significantly more number of students agreed or strongly agreed that interactive lectures kept them attentive, created interest, overcame monotony, motivated them for self learning and provided well defined learning than regular lectures. Among the different techniques which were used, the students preferred use of video clippings (58.1%), followed by each-one-teach-one. Results of the present study support the use of interactive lectures for ensuring increased interest and attention of students during lectures. <b>Conclusion:</b> Interactive lectures were more accepted and considered to be more useful than regular lectures by the students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2244-2246&id=3482 https://doi.org/10.7860/JCDR/2013/.3482 Sub-Lingual Spray Versus Pearl of TNG as A Provocative Agent for Tilt Table Test Reza Karbasi-Afshar, Amin Saburi, Ayat Shahmari, Arezoo Khosravi <b>Objective:</b> The aim of this study was to determine the false positive ratio of Tilt Table Test (TTT) result by using TNG spray (Sub–lingual; SL) as compared to TNG pearl in patients referred to military service. <b>Material and Methods:</b> This was a prospective study. It was conducted on 110 cases referred for military service, expressed vasovagal symptoms. We divided the subjects into three groups; first Group (60 cases) used TNG pearl for provoking syncope in TTT Group 2 (50 cases) and Group 3 (control cases) used TNG spray in the same dose (0.4 mg). <b>Results:</b> In the first step of tilt study, 10%, and 8% of subjects had fainted on not using provoking drug in cases and controls, respectively. After using the drugs, 36.6%, 96% and 18% showed positive results in pearl, spray and the control groups, respectively (p<0.05). <b>Conclusion:</b> Rather than pearl group, a 40 minute tilt using TNG spray showed significant higher positive results, which may be incorrectly positive. Using this form of TNG seems not useful for distinguishing and diagnosing vasovagal shocks, especially in subjects referred for military service capacity. For constant evidence, a cross–over clinical trial study is required, involving suspected cases divided into two groups, who both will be examined with spray and pearl. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2250-2252&id=3483 https://doi.org/10.7860/JCDR/2013/.3483 Liver Stiffness Measurement by Fibroscan Predicts the Presence and Size of Esophageal Varices in Egyptian Patients with HCV Related Liver Cirrhosis Yasmin Saad, Mohamed Said, Mohamed O. Idris, AyAyman Rabee, Zakaria Salama <b>Background and Aim:</b> Liver stiffness measured by transient elastgraphy correlates with Hepatic vein pressure gradient, liver Stiffness value of 21 kpa predicts significant portal hypertension. Aim is to predict esophageal varices presence by fibroscan and possible grading by degree of liver stiffness in HCV related cirrhotic patients. <b>Material and Methods:</b> Thirty two HCV related cirrhotic patients were recruited, age > 18 years, BMI< 35, no history of: upper GI bleeding, hepatocellular carcinoma, abdominal collaterals, ascites. Patients underwent clinical examination, laboratory investigations, abdominal ultrasonography, upper endoscopy and fibroscan. They divided into (Group I= no varices, Group II =small varices (Grade 1 & 2), Group III = large varices (Grade 3 & 4). <b>Results:</b> Age is higher in Group III than I & II (55+6.6 vs 49.5+4.7 & 48.9+4.7, p-value 0.04) respectively, Groups were gender & BMI matched, fibroscan values in Group I vs II & III were 27 Vs 49.4, p value 0.01, cutoff 29.7 Kpa (sensitivity 95% & specificity 67%) while its value in Group II vs III were 38.4 vs 60.4, p value 0.002, cutoff 38.2 Kpa (sensitivity 100% & specificity77.3%). Platelet count, splenic size, platelet count/splenic size in Group I vs II & III were 107.166 vs 72.900, 13.8 vs 15.4, 803.6 vs 478, p value 0.01, 0.008, 0.005, cutoff 80.000, 14.5, 545, sensitivity & specificity (85%&75%, 75%&75%, 85%&84%) respectively. On multivariate analysis fibroscan (OR 1.113; p=0.005) & platelet count/splenic size (OR 0.995; p=0.012) were positive predictors of esophageal varices presence. <b>Conclusion:</b> Fibroscan is a good non-invasive method to predict esophageal varices presence & possible grading with high sensitivity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2253-2257&id=3484 https://doi.org/10.7860/JCDR/2013/.3484 Effect of Acupressure on Post–Operative Nausea and Vomiting in Cesarean Section: A Randomised Controlled Trial Ashraf Direkvand-Moghadam, Afra Khosravi <b>Background:</b> Because of potential side effects of chemical treatments and in order to decrease the risk of nausea and vomiting in post–operative patients, there is a necessary requirement for some alternative therapeutic methods such as Acupressure. <b>Aim:</b> The present randomized clinical trial study aimed to compare the effects of Acupressure and Metoclopramide on postoperative nausea and vomiting in Caesarean Sections. <b>Setting and Design:</b> The patients who were subjected to caesarean surgeries, who were referred to the Ilam Mustafa Hospital in the west of Iran, were enrolled in this randomised clinical trial study. <b>Material and Methods:</b> Totally, 102 patients who were selected for elective Caesarean Section were included in this study. Patients were randomly assigned to one of three groups, with 34 cases in each group. All groups were matched for effective factors on nausea and vomiting in inclusion and exclusion criteria. The control group did not receive any intervention, the second group received 10 mg Metoclopramide intravenously, immediately prior to anaesthesia induction and in the third group, Acupressure bands were applied at the P6 points on both wrists, 15 minutes before anaesthesia induction. Intra-operative and postoperative emetic episodes were recorded by a trained investigator. The patients who experienced nausea were evaluated on a linear numeric scale which ranged from 0 (no) to 10 (severe). <b>Statistics and Results:</b> The incidence of nausea and vomiting in postoperative periods was lower in Metoclopramide and Acupressure groups as compared that in the control group. The frequency of anti-emetic which was used was significantly higher in control group as compared to those in the other groups (p<0.001). No side effects or complications were caused by any intervention. <b>Conclusion:</b> In parturients who underwent caesarean deliveries which were performed under spinal anaesthesia in this study, use of Metoclopramide and Acupressure was found to be equally effective for reducing emetic symptoms (nausea, retching, and vomiting). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2247-2249&id=3485 https://doi.org/10.7860/JCDR/2013/.3485 Role of Voglibose in the Treatment of Prediabetes in Indian Population: A Cross-Speciality Survey Pavitra Raj Dewda, Sourabh Agrawal <b>Background:</b> Prediabetes is a precursor of overt Type 2 Diabetes Mellitus (DM) and it is associated with insulin resistance and an increased risk for cardiovascular disease. ACE and AACE recommend only lifestyle modifications for the management of prediabetes. A recently published meta-analysis suggested that drug therapy was associated with a better control of diabetes. Voglibose was recently approved for the management of prediabetes in Japan. <b>Material and Methods:</b> A well-structured questionnaire was sent to 117 doctors across India (52 diabetes specialists, 45 general practitioners, and 20 specialists from other branches of medicine) to understand their views on the management of prediabetes, especially with regards to voglibose. <b>Results and Conclusion:</b> There was an equivocal response to the question as to whether only diet and exercise were sufficient for the management of prediabetes. Most of the respondents used metformin for the management of prediabetes, while voglibose was the most favoured second-line drug. Almost all the respondents agreed that the approval which voglibose got in Japan for the management of prediabetes was relevant in India as well. Only 51.3% of all respondents had prescribed voglibose for prediabetes. Thus, voglibose appears to be popular second-line drug for the management of prediabetes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2258-2260&id=3486 https://doi.org/10.7860/JCDR/2013/.3486 Effect of Deep Cervical Flexor Training vs. Conventional Isometric Training on Forward Head Posture, Pain, Neck Disability Index In Dentists Suffering from Chronic Neck Pain Bhuvan Deep Gupta, Shagun Aggarwal, Bharat Gupta, Madhuri Gupta, Neha Gupta Neck pain accounts for 15% of all soft tissue problems seen in general practice and are a common reason for referral to physiotherapy treatment. The prevalence of neck pain in dentists is 74.3%. Musculoskeletal symptoms in dentists are caused due to many reasons for e.g., prolonged static posture, repetitive movements, suboptimal lighting, and genetic predisposition. Since deep cervical muscle activity is required in synergy with superficial muscle activity to stabilize the cervical segments, a study is needed, to compare the effectiveness of deep cervical flexor (DCF) training and posture correction training on neck pain and neck disability index and forward head posture. <b>Aim:</b> To determine and compare the effect of DCF training on forward head posture, neck pain and neck disability index in dentists suffering from chronic non severe neck pain. <b>Material and Methods:</b> Total of 30 subjects were selected, based on inclusion and exclusion criteria, who were further divided into Experimental and Control groups. Baseline information of dependent variables was taken at the beginning of study on day one, for Visual Analogue Scale (VAS) and Neck disability Index (NDI). Forward head posture was measured on day one using digital photograph technique. Then, Experimental group was given DCF training and Control group was given conventional isometrics training (CIT) for 4 weeks under supervision of examiner. All measurements were repeated at end of 4th week, on completion of study. <b>Results:</b> It was observed that pain and disability had reduced in both groups on group analysis. But the forward head posture had improved significantly in experimental group only. <b>Conclusion:</b> DCF training is more effective than CIT in improving forward head posture, decreasing pain and disability in dentists suffering from chronic neck pain. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2261-2264&id=3487 https://doi.org/10.7860/JCDR/2013/.3487 Efficacy of Rajayoga Meditation on Positive Thinking: An Index for Self-Satisfaction and Happiness in Life Ramesh M.G., Sathian B., Sinu E., Kiranmai S. Rai <b>Objectives:</b> Psychological studies have shown that brief period of mindfulness meditation significantly improves critical cognitive skills. But, there are no studies which have assessed the effects of Brahma Kumaris Rajayoga Meditation (BKRM) practice on positive thinking and happiness in life. The present study was designed to test the hypothesis is BKRM enhances positive thinking and that essential to attain higher levels of self-satisfaction and happiness in life. <b>Material and Methods:</b> This study is a cross sectional comparative study which was done between Rajayoga meditators and non-meditators. This study was conducted at BKRM Centres at Manipal and Udupi in Karnataka, India. Fifty subjects were selected for this study, which included those practising BKRM in their normal routine life (n=25) and non-meditators (n=25) who were aged 42.95+/15.29 years. Self-reported Oxford happiness questionnaire (OHQ) was administered to all subjects and their happiness scores and status were assessed and compared. Items related to self-satisfaction in life were selected from the OHQ and compared between meditators and non-meditators. Participants completed self-reported OHQ, from which data of happiness status and self-satisfaction in relation to meditation duration and frequency were analyzed by descriptive statistics and test of hypothesis. <b>Results:</b> Mean happiness scores of BKRM were significantly higher (p<0.001) in meditators as compared to those in non-meditators. The number of meditators experiencing happiness status were significantly higher (p<0.05) in comparison with non-meditators. Additionally, meditators scored significantly higher on self-satisfaction items (p<0.001) as compared to non-meditators. There was no correlation between age and years of meditation practice with happiness score and self-satisfaction score. <b>Conclusion:</b> BKRM helps in significantly increasing self-satisfaction and happiness in life by enhancing positive thinking. Irrespective of age and years of short-term or long-term meditation practice, enhanced positive thinking increases self-satisfaction and happiness in life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2265-2267&id=3488 https://doi.org/10.7860/JCDR/2013/.3488 A Case of Bilaterally Elongated Styloid Process Differing in Osseo-Morphology Hironmoy Roy,Radharaman Mondal, Kuntala Ray, Maitreyee Kar, Narayan Pandit In a cranium of a male cadaver styloid processes have been found to be unusually long with different lengths. Elongation of styloid process involvethe entire ‘Stylohyoid complex/chain’, though not rare as reported in earlier literatures, but the osseomorphological and radiological analysis of present case brings out a unique variety as its described in the article https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2268-2269&id=3489 https://doi.org/10.7860/JCDR/2013/.3489 Co–Infection: Weil´s Syndrome with Hepatitis B Infection– A Diagnostic and Therapeutic Hitch Tina Damodar, Thomas Kuruvilla, Zevita Furtado, Roopa Hegde Undifferentiated Acute Febrile Illness (AFI) is a common clinical syndrome among patients seeking hospital care. Detection of co-infections at the time of presentation is a diagnostic challenge, especially with limited laboratory support. Even if detected, early treatment and cure of these co-infections can be difficult for the clinicians. We are presenting a rare case of Hepatitis B and leptospirosis co-infection with high titres of Salmonella paratyphi A and scrub typhus. There are a few reports of leptospirosis in Hepatitis -B infected individuals but no generalization can be made due to limited data. Prompt and accurate serological diagnosis of multiple infectious agents have becomes mandatory in a healthcare set-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2270-2271&id=3490 https://doi.org/10.7860/JCDR/2013/.3490 Fonsecaea Pedrosoi: A Rare Etiology in Fungal Keratitis Jyoti Sangwan, Sumit Lathwal, Deepak Juyal,Neelam Sharma Fungal corneal ulcer is common in India due to tropical climate and a large agrarian population that is at risk. Fonsecaea pedrosoi is the most common agent of chromoblastomycosis, a chronic localized fungal infection of the skin and subcutaneous tissues mainly involving lower extremities. We report a rare case of corneal chromoblastomycosis caused by F.pedrosoi , which was successfully treated with topical Amphotericin B followed by a long course of oral antifungal therapy. To the best of our knowledge, this is the first case of mycotic keratitis caused by F.pedrosoi , from the foothills of Himalayas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2272-2273&id=3491 https://doi.org/10.7860/JCDR/2013/.3491 Meningitis Due to <italic>Cryptococcus gattii</italic> in an Immunocompetent Patient Rajesh T Patil,Jyoti Sangwan, Deepak Juyal, Sumit Lathwal The incidence of cryptococcal infection is high in developing countries such as India. Cryptococcus gattii, formerly known as Cryptococcus neoformans var gattii, is an encapsulated yeast that causes disease in both immunocompetent and immunosupressed individuals. The organism enters via respiratory tract and causes a spectrum of illness ranging from asymptomatic infection to severe illness, including pneumonia and disseminated infection involving multiple sites, including the central nervous system, eyes and skin. Cryptococcal meningitis is generally considered as rare in immunocompetent patients; therefore, specific treatment is not implemented until the organism is identified or a cryptococcal antigen is detected. We describe the case of a 30-years-old man without prior medical history who presented with meningitis and was treated successfully. This case illustrates the importance of considering infectious causes such as C.gattii in the differential diagnosis of meningitis, regardless of the patient’s immune status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2274-2275&id=3492 https://doi.org/10.7860/JCDR/2013/.3492 Systemic Mastocytosis: Predominantly Involving the Bone, A Case Report Ketan P Mallya, Sushma Belurkar, Annamma Kurian, Laxmi Rao, Bikash Singhania Systemic mastocytosis (SM) is a rare clonal disorder of mast cells that can range from chronic smouldering type to aggressive mast cell leukaemia. It presents with non–specific symptoms like urticaria pigmentosa, unexplained flushing, hypotension and abdominal cramps, which may lead to a misdiagnosis, if there is no high index of clinical suspicion. This is a case report of a 52–year–old lady, with systemic mastocytosis, who presented with severe chronic back ache and no other clinical features. X – ray revealed lytic lesions in the lumbar vertebrae and bone marrow aspiration and a trephine biopsy examination showed infiltration by mast cells, with a positivity for Toluidine blue stain and CD 117. She was also noted to have peripheral eosinophilia, which is frequently encountered with this condition. She was diagnosed to have chronic indolent systemic mastocytosis which involved the bone predominantly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2276-2277&id=3493 https://doi.org/10.7860/JCDR/2013/.3493 Painful Late Recurrence of Dermatofibrosarcoma Protuberans of Breast in a Centurian Female Asitava Deb Roy, Kumar Nishant, Deepti Joshi Dermatofibrosarcoma protuberans (DFSP) of the breast is rare. Late and painful local recurrence of this entity on this site is even more uncommon. We describe such a case in a 102-year-old woman, who at the age of 77 years had been operated for a breast lump for which only a cytopathological diagnosis of fibrohistiocytic tumour was available. Twenty years later, she noticed a small mass in her right breast over the postsurgical scar area, which gradually increased in size over the last five years. She presented to the surgical out-patient clinic with pain and redness over the swelling. Wide local excision of the tumor with generous tissue margin was performed under intercostal block on account of her age and suboptimal cardiac status. The microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP. We report an exceptionally rare case of local recurrence of DFSP in the female breast and discuss in detail the diagnostic and therapeutic implications of this pathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2278-2279&id=3494 https://doi.org/10.7860/JCDR/2013/.3494 Rippled Pattern Extraocular Sebaceous Carcinoma: A Rare Case Report with Brief Review of Literature Amita K., Vijayshankar S., Shobha S.N. Sebaceous carcinoma (SC) is a highly aggressive malignant adnexal tumor of sebaceous gland origin, accounting for less than 1% of cutaneous. Extraocular sebaceous carcinomas are more aggressive than their ocular counterpart with a predilection for the skin of head and neck, trunk, salivary glands and extremities in decreasing order of frequency. Rippled effect literally means “gradually spreading effect”. In histopathology it describes the unique arrangement of tumor cells in palisading pattern. The tumors in which rippled effect has been reported include adnexal tumors like trichoblastoma, trichomatricoma, trichoblastoma with sebaceous differentiation, trichoblastoma with apocrine differentiation, sebaceoma, basal cell carcinoma, fibrohistiocytic tumors, mesenchymal tumors and melanocytic tumors. We report the first case of extra ocular sebaceous carcinoma with rippled effect with emphasis on the fact that differentiation from other tumors demonstrating rippled effect is important in view of different treatment protocols. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2280-2281&id=3495 https://doi.org/10.7860/JCDR/2013/.3495 Eosinophilic Cystitis Mimicking Bladder Tumor – A Rare Case Report Manimaran D, Karthikeyan T M, Sreenivasulu M, Mrinalini V R, Gopinath V A 16–year–old male presented with urinary urgency , a frequency of 4 months duration and intermittent gross haematuria which were there since one month. Eosinophilia was noted in complete blood count and CT KUB with contrast showed a filling defect in the right lateral wall, over the vesicoureteric junction. Cystoscopy revealed a sessile mass lesion over right vesico–ureteric junction, with bullous oedema . Rest of the mucosa was normal. Transurethral resection of lesion was performed and histological examination showed features of eosinophilic cystitis. Patient was treated with corticosteroids , antimicrobial agents and antihistaminics and he is recovering well. We are presenting this case for its rare presentation and its possibility of mimicking a bladder tumour. Biopsy of the lesion was diagnostic and an early treatment showed good results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2282-2283&id=3496 https://doi.org/10.7860/JCDR/2013/.3496 Benign Mass in Tonsil- Cavernous Hemangioma Sumitha Joseph, M. Prakash, Hafida K Mohammed, Aberna Govar Cavernous hemangioma is also called as ‘ANGIOMA CAVERNOSUM’ or ‘CAVERNOMA’ as benign lesion of blood vessels. They are similar to strawberry hemangioma but deeply situated. Although most often associated with skin it is also sometimes found in mucous membrane, brain and the viscera. The diagnosis of hemangiomas is mainly based on clinical evaluation . Isolated hemangiomas in the tonsillar tissue is a rare occurance. In this we report had a case of adult tonsillar hemangioma of left side associated with recurrent tonsillitis . He was effectively managed surgically without any complications https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2284-2285&id=3497 https://doi.org/10.7860/JCDR/2013/.3497 Peripheral Arterial Disease and Digital Gangrene: A Rare Presentation of Diabetic Hand Syndrome Santokh Singh, Gian Chand, Shiv Charan, Sahil Arora, Parampreet Singh Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders, vasculitic disorders and various myeloproliferative disorders or as a part of tropical diabetes hand syndrome which follows trauma. Peripheral arterial disease in diabetics commonly involves lower limbs. The present case, 45–year–old diabetic, presented with dry gangrene in fingertips of both hands for last two weeks without any history of trauma or lower limb gangrene. On examination and workup of the patient was found to have bilateral upper limb arterio-occlusive disease involving ulnar vessels as a macrovascular complication of diabetes mellitus. This presentation of diabetic hand syndrome is very, very rare, hence being reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2286-2287&id=3498 https://doi.org/10.7860/JCDR/2013/.3498 Pseudohypoparathyroidism, Rare Cause of Hypocalcaemia! Rupal V. Dosi, Annirudh P. Ambaliya, Harshal K. Joshi, Rushad D. Patell Pseudohypoparathyroidism is a rare disorder which is characterized by end organ parathormone resistance, which causes hypocalcaemia, hyperphosphataemia and high parathormone levels. We are reporting here case of a young male who had symptoms of chronic hypocalcaemia, with a positive Trousseau’s and Chvostek’s sign on examination, without any features of Albright’s hereditary osteodystrophy. Lab investigations revealed low calcium, high phosphate and high PTH levels. The patient was diagnosed as having Pseudohypoparathyroidism and he was treated successfully with Calcium and Vitamin D supplements. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2288-2289&id=3499 https://doi.org/10.7860/JCDR/2013/.3499 Acute Kidney Injury in A Patient with Membranous Nephropathy – A Case Report Uday Bande, Venkatesh Moger, Vasantha Kamath, Mallikarjunaswamy, Chandrashekar Acute Kidney Injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. Acute Kidney Injury is an important complication of membranous nephropathy. Causes are varied and include hypovolumia, crescentic conversion of preexisting nephropathy, renal vein thrombosis, NSAID’S, vasculitis, and sepsis. In this case report we discuss the case of membranous nephropathy in a young adult complicated by AKI. This report highlights the importance of early renal biopsy in patients with post GE AKI not improving on hemodialysis. Here we also discuss the potential differentials to be considered in a case of membranous nephropathy with AKI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2290-2291&id=3500 https://doi.org/10.7860/JCDR/2013/.3500 Paraplegic Neurodeficit Management Post Endovascular Graft: A Rare Case of Aortic Dissection Vilas Yadavarao Kanse,Dhanaraj Singh Chongtham,Nemichandra S C, Kennysingh Salam Acute aortic dissection is a catastrophic episode that usually presents as a sudden, painful, ripping sensation in the chest or back. It is associated with neurologic sequelae in as many as one-third of patients. We report a case of aortic dissection, presenting as acute paraplegia. A 50-year-old patient presented to us with chief complaints of paraplegia and back pain. On examination, strength was 5/5 in both upper extremities and 0/5 in both lower extremities. Deep tendon reflexes were absent in her legs. CT angiogram of aorta Aortic Dissection Stanford type B / De-Bakey type –III. Patient was treated with endovascular graft for aortic dissection, paraplegia recovered completely. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2292-2293&id=3501 https://doi.org/10.7860/JCDR/2013/.3501 Occupationally Related Outbreak of Chickenpox in Hospital Staff: A Learning Experience Smita Sood Varicella (chicken pox) is a highly contagious disease which is caused by Varicella Zoster Virus (VZV), a ubiquitous human a herpes virus. Nosocomial varicella in hospital employees can be costly to the hospital and disruptive to patient care. This case report describes an occupationally related outbreak of chickenpox in hospital staff and the lessons which were learnt by the hospital during this experience. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2294-2295&id=3502 https://doi.org/10.7860/JCDR/2013/.3502 Unusual Presentation of Intussusception of the Small Bowel with Peutz Jeghers Syndrome: Report of a Case Ashish Shrivastava, Akshara Gupta, Achal Gupta, Jyoti Shrivastava The Peutz Jeghers syndrome (PJS) is an autosomal dominant disorder which is characterised by hamartomatous polyposes of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. We are reporting a case of a 15-year-old male with Peutz Jeghers syndrome, who presented to us with features of chronic intestinal obstruction and anaemia. Initially, patient was managed conservatively, but later on, an elective exploratory laparotomy was done for definitive management of intussusception. Laparotomy revealed a jejuno-jejunal intussusception with spontaneous recanalisation of gut which contained a long segment of gangrenous small bowel in the lumen. Resection and anastomosis of the jejunal segment was done. To the best of our knowledge, this might be the first case report on spontaneous recanalisation of small intestine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2296-2297&id=3503 https://doi.org/10.7860/JCDR/2013/.3503 Phytobezoar: A Rare Cause of Small Bowel Obstruction Anupama Pujar K., Sreekar Pai A., Bharati Hiremath V Phytobezoar is an unusual cause of small bowel obstruction. It accounts for about 0.4%-4% of all mechanical bowel obstruction. However, the symptoms are not very different from those caused by usual aetiologies of small bowel obstruction. The commonest site of obstruction is terminal ileum. Treatment of small bowel obstruction due to Phytobezoar is surgery. Prevention includes avoidance of high fibre diet, prokinetics particularly in patients who have undergone gastric surgery. A 57-year-old male presented with symptoms and signs of small bowel obstruction. On exploratory laparotomy Phytobezoar in the ileum was found to be the cause of obstruction. Diagnosis was confirmed by histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2298-2299&id=3504 https://doi.org/10.7860/JCDR/2013/.3504 Left-sided Gastroschisis: A Rare Congenital Anomaly Ankur Mandelia, Sandeep Agarwawala, Nitin Sharma, Shailesh Solanki, Shashank Panda In gastroschisis, the defect in the abdominal wall is located almost always to the right of the umbilicus. Left-sided gastroschisis is a very rare entity. A case of left sided gastroschisis has been described here, with review of literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2300-2302&id=3505 https://doi.org/10.7860/JCDR/2013/.3505 Prompt Diagnosis and Treatment of Uterine Arcuate Artery Pseudoaneurysm: A Case Report and Review of Literature Nidhi Sharma, Deepa Ganesh, Lakshmi Devi, Jayashree Srinivasan, Upasana Ranga Post–partum haemorrhage is a major determinant of maternal mortality. Traditionally, cases of post–partum haemorrhage caused by arterial injuries were managed by caesarean hysterectomies or bilateral internal iliac artery ligations. The diagnosis of aneurysms or arteriovenous malformations of uterine artery are often missed. Uterine curettage, caesarean section or vaginal delivery can result in uterine vascular anomalies like pseudo aneurysms, arteriovenous malformations, arteriovenous fistula and rupture of uterine vessels. Colour Doppler ultrasound pelvis allows detection of these vascular abnormalities. It helps in differentiating the vascular abnormalities that require embolization from non–vascular abnormalities which can be managed by uterine curretage. Vessel malformations can be treated safely with transcatheter uterine artery embolization, but they can develop disastrous consequences with inadvertent uterine curettage. Transcatheter uterine artery embolization after pelvic angiography is the treatment of choice for uterine artery malformations and it has the advantage of preserving the reproductive capacity. We recommend a routine use of colour Doppler ultrasound pelvis for evaluation of abnormal uterine bleeding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2303-2305&id=3506 https://doi.org/10.7860/JCDR/2013/.3506 Delayed Menopause Due to Ovarian Granulosa Cell Tumour Neetha Vyas M., Lakshmi Manjeera, Supriya Rai A patient presented to us with complaints of inability to attain menopause even at the age of 64. She has been having irregular cycles of bleeding for 5 days every 2-3 months from the age of 54. On evaluation, she was found to have endometrial hyperplasia and ultrasonography showed a homogenous solid ovarian mass of size of the 4 cm x 3.5 cm. She underwent staging laparotomy with total abdominal hysterectomy bilateral salpingo-oophorectomy and infra colic omentectomy. Histopathology confirmed granulosa cell tumour of the ovary. Most commonly granulosa cell tumour presented with post–menopausal bleeding and abnormal uterine bleeding, however, women with delayed menopause also have to be evaluated thoroughly for estrogen secreting ovarian tumours. There should be an element of suspicion if patient doesn’t attain menopause as specified and they need to be evaluated in detail. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2306-2307&id=3507 https://doi.org/10.7860/JCDR/2013/.3507 Negative Pressure Pulmonary Oedema: A Rare Case Report of Two Brothers Molouk Jaafarpour, Javaher Khajavikhan, Ali Khani Negative Pressure Pulmonary O/Edema (NPPE) is potentially life-threatening and it is a general anaesthesia side effect. We are mentioning a rare case report of two brothers who were referred to our hospital for elective surgeries (varicocele and septoplasty) in a 3 years period. Both of them were athletes and their coagulation factors were disturbed after surgeries. Pulmonary oedema was healed after treating it by reintubation, mechanical ventilation by Positive End-Expiratory Pressure (PEEP), diuretics, morphine, Fresh Frozen Plasma (FFP) and liquid bounding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2308-2309&id=3508 https://doi.org/10.7860/JCDR/2013/.3508 Perioperative Respiratory Compromise in Patients Undergoing PCNL-A Case Series Ponnambala Namasivayam S., Gayathri, Indu Percutaneous Nephrolithotomy (PCNL) is a surgical procedure which is used to extract renal pelvic stones. An optimum access tract, without traumatizing the surrounding structures, is essential for the surgery. Trauma to the surrounding structures and extra–vasation of the irrigating fluid may result in complications like hydrothorax, pneumothorax, hydro pneumothorax etc. These complications may produce intra– operative respiratory compromise leading on to arterial hypoxemia and its sequelae. A series of three case reports with review is presented here. First case is accumulation of irrigating fluid in the pleura causing hydrothorax and oxygen desaturation. Second case is extra–vasation of fluid in the abdominal wall and the patient was ventilated artificially for 24 hours. Third patient developed pneumothorax and he needed chest drainage.PCNL is done under general anaesthesia in prone position. The anaesthesiologist should be vigil enough to identify the situation and take appropriate measures to correct it. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2310-2312&id=3509 https://doi.org/10.7860/JCDR/2013/.3509 Cutaneous Larva Migrans Masquerading as Tinea Corporis: A Case Report Manoharan Dhanaraj, Manoharan Ramalingam A 25–year–old male was seen with complaints of itchy skin lesions over left thigh. On examination multiple annular scaly plaques with wavy borders, peripheral papules and central clearing was seen. Closer examination revealed multiple forked tracts with excoriated papules. A diagnosis of cutaneous larva migrans was made and the patient treated using T.Albendazole 400 mg twice daily for 7 days which resulted in complete clinical cure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2313-&id=3510 https://doi.org/10.7860/JCDR/2013/.3510 Acute-Onset of Multiple Painful Nodules over Forearms and Back Praveen Kumar S., Sulatha M. Kamath, A.L. Shyam Prasad, Vijaya V. Mysorekar, T.K Sumathy Angiolipomas are benign encapsulated, well circumscribed tumours, which show excessive degree of vascular proliferation. Clinically, lesions present as sudden onset of multiple painful nodules. Pain usually does not respond to analgesics. We herein, report a case of a young male, presenting with multiple painful nodules over the forearm and back, which on histopathological examination revealed, encapsulated benign tumour, comprising of proliferated small-caliber vascular channels with microthrombi and variable amounts of mature adipose tissue. Pain subsided on treatment with intralesional steroids and the nodules were excised through a narrow-hole extrusion technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2314-2315&id=3511 https://doi.org/10.7860/JCDR/2013/.3511 Hypereosinophilia-An Unusual Cause of Multiple Embolic Strokes and Multi-Organ Dysfunction Geeta A. Khwaja, Ashish Duggal, Amit Kulkarni, Neera Choudhary, Meena Gupta, Debashish Chowdhury, Vikram Bohra, Dhruv Zutshi ‘Eosinophilia’ can occur due to a large number of allergic, infectious, neoplastic, and idiopathic diseases. It can range in severity from a self-limiting condition to a life-threatening disorder. The term ‘hypereosinophilia’ refers to eosinophil levels >1500/µL, and regardless of the underlying cause can be associated with tissue and organ damage1. ‘Hypereosinophilic syndrome (HES)’ is a rare disorder with sustained eosinophilia and multi-organ dysfunction in the absence of a discernable secondary cause. ‘Undefined Hypereosinophilic Syndrome’ is the most common type of primary hypereosinophilic diseases and we are reporting here one such case who presented with acute multiple embolic strokes secondary to biventricular apical thrombi and multi-organ dysfunction of a fulminant nature. This case highlights the limitation in current diagnostic criteria for HES and emphasizes the need for early intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2316-2318&id=3512 https://doi.org/10.7860/JCDR/2013/.3512 An Anatomical Variation in the Formation of the Inferior Root of Ansa Cervicalis Srinivasa Rao Sirasanagandla, Satheesha Nayak B, Naveen Kumar, Jyothsna Patil, Swamy Ravindra S During regular dissections, we observed an unusual organization of the inferior root of Ansa Cervicalis (AC). The superior root of ansa arose normally from the hypoglossal nerve. The ventral ramus of the C2 spinal nerve divided into two branches. One of its branches joined the superior root independently to form a loop at a higher level. Another branch ran along the vagus nerve, joined with the ventral ramus of C3 spinal nerve, finally connected with the superior root and formed the second loop at a lower level. No variation was found in formation of superior root. Knowledge on the possible deviations in the formation of these roots is clinically important, to prevent iatrogenic injuries in surgical procedures such as thyroplasties, arytenoids adductions, and Teflon injections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2319-2320&id=3513 https://doi.org/10.7860/JCDR/2013/.3513 Human Gall-Bladder Communicating with Skin: Rare Anatomical Swerve Arashdeep Singh, Sandeep Bansal Cholecysto-cutaneous fistula is an extremely rare phenomenon in present era. We report a case of this rare entity wherein patient presented with unique history of passage of stones per umbilicus. Newer radiological investigations specifically CT fistulography help in surgical planning by not only delineating external fistulas but only diagnosing any internal fistula. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2321-2322&id=3514 https://doi.org/10.7860/JCDR/2013/.3514 Myofibroblastoma Breast with Unusual Morphological Features. Cytohistopathogical Diagnostic Pitfalls and Role of Immunohistochemistry- Review of Literature B. Shivali, Kataria. S, K.Chandramouleeswari, S.Anita Myofibroblastoma (MFB) is a rare mesenchymal tumour, derived from mammary stromal fibro¬-myofibroblasts, with diverse biological and morphological behaviour. Large and cellular myofibroblastomas, especially those with epitheliod like cells, can mimic various spindle cell lesions and metaplastic carcinomas, thus posing diagnostic challenge. A 50–year woman presented with slow growing, painless lump in the left breast. Fine Needle Aspiration (FNA) smears showed predominant atypical spindle cell population, pleomorphic epithelial like cells and giant cells. Cytodiagnosis of atypical spindle cell lesion with the possibility of metaplastic carcinoma was suggested. Histopathological examination showed fascicles of spindle cell population admixed with epithelial like cells, atypical cells and tumour giant cells, thus raising differential diagnosis of metaplastic carcinoma, low grade spindle cell sarcoma and myofibroblastic tumour. Lymph nodes were negative for metastatic deposits. Immunohistochemistry revealed variable coexpression of markers for vimentin, fibronectin, CD34, SMA (smooth muscle actin), but negative expression for , S-100, CD99, CK7 (cytokeratin 7), HMWK (high molecular weight keratin), ER (oestrogen receptor) and PR(progesterone receptors). Diagnosis of cellular myofibroblastoma with mixed unusual morphological features was defined, based on both histological and immunohistochemical features. MFB may cause a potential diagnostic pitfall while interpreting FNA and histopathological sections due to its wide differential diagnosis. The distinction of MFB from its cytohistological mimics of malignancy is crucial to avoid unnecessary extensive procedures. The case report emphasizes the role of immunohistochemistry as gold standard in diagnosis of MFB. The case is also being presented because of its large size and rare mixed unusual morphological features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2323-2325&id=3515 https://doi.org/10.7860/JCDR/2013/.3515 Prevalence and Incidence of Gemination and Fusion in Maxillary Lateral Incisors in Odisha population and Related Case Report Shashirekha G., Amit Jena <b>Aim:</b> A survey was conducted to analyze the prevalence and incidence of dental anomalies in relation to maxillary lateral incisors in the Odisha population. A multidisciplinary approach for aesthetic management of a geminated tooth is described. <b>Material and Methods:</b> A total of 1062 subject, aged between 15-30 years (724 males and 338 Females) were randomly screened at Institute of Dental Sciences, Bhubaneswar, Odisha India. Each subject was examined clinically and radiovisuographically for dental anomalies in relation to maxillary lateral incisors. In the related case described, endodontic management and aesthetic correction of geminated maxillary lateral incisors was done. <b>Results:</b> Five dental anomalies i.e. gemination, fusion, missing lateral incisors (both unilateral and bilateral), peg shaped incisors (unilateral and bilateral), and dens in dente were observed. Anomalies found were Peg shaped; 2.82%, Missing;1.88%, Gemination;0.28%, Fusion;0.18% and Dens in Dente;0.18%. <b>Conclusion:</b> Comparison of these results with that of other studies indicated that anomalies in lateral incisors occur at different frequencies among various countries and communities in the world. In the case since maxillary lateral incisors are in the aesthetic zone, recognizing these anomalies will facilitate a successful treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2326-2329&id=3516 https://doi.org/10.7860/JCDR/2013/.3516 Clinical Effects of Subgingivally Delivered Spirulina Gel in Chronic Periodontitis Cases: A Placebo Controlled Clinical Trial Jaideep Mahendra, Little Mahendra, Jananni Muthu, Libby John, Georgios E. Romanos <b>Aims and Objectives:</b> The aim of this study was to assess the clinical effects of Spirulina in-situ gel as an adjunct to Scaling And Root Planning (SRP) in the treatment of chronic periodontitis subjects. <b>Material and Methods:</b> 64 sites were selected with probing pocket depth of =5mm and they were divided into 2 groups; 33 sites were treated with SRP along with spirulina gel (Group A) and 31 sites were treated with SRP alone (Group B). Clinical parameters were recorded at baseline before SRP and at 120th day after the treatment therapy. The parameters included Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). <b>Results:</b> Both the groups showed significant improvement in the parameters. However, Group A (SRP along with spirulina) showed statistically significant decrease in mean probing pocket depth and gain in the clinical attachment level after 120 days as compared to Group B SRP alone. <b>Conclusion:</b> Locally delivered spirulina gel, along with scaling and root planning, has been shown to cause a beneficial impact. The efficacy of the product as a local drug delivery system in the non-surgical treatment of periodontitis without any side effects has been proved. Spirulina appears to be promising. It exerts strong anti-inflammatory effects which are closely connected with its antioxidative activity. This study can have a significant impact on the treatment procedures of periodontitis, with the use of blue green algae in the future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2330-2333&id=3517 https://doi.org/10.7860/JCDR/2013/.3517 Rheumatoid Arthritis among Periodontitis Patients in Baddi Industrial Estate of Himachal Pradesh, India: A Cross Sectional Study Yash Paul Dev, Nitin Khuller, Patthi Basavaraj, Suresh G <b>Aim:</b> To determine whether there is a relationship between periodontal disease and rheumatoid arthritis. <b>Methods:</b> A total of 1520 (852 - periodontal group; 668 - general group) individuals of 30-70 years age group and residents of Baddi industrial estate in Himachal Pradesh, India, were assessed for the prevalence of rheumatoid arthritis and Periodontal Disease (PD). The prevalence and severity of periodontitis were determined by recording the Community Periodontal Index (CPI) with loss of attachment, based on WHO guidelines (1997). The criteria considered for diagnosis of rheumatoid arthritis were as those given by American Rheumatism Association -1988. Frequency distributions for bivariate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables. <b>Results:</b> In patients referred for periodontal treatment, the prevalence of rheumatoid arthritis was 4.4%. Females (3.2%) and subjects aged above 50 years (3.5%) showed a significantly higher prevalence in comparison to their counterparts (p<0.001). The odds of rheumatoid arthritis in females were nearly three times (OR=2.813) higher than those in males, which was also statistically significant (p<0.05). <b>Conclusion:</b> The findings provide evidence of a relationship, suggesting that individuals with moderate to severe periodontal disease are at higher risk of suffering from rheumatoid arthritis and vice versa. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2334-2337&id=3518 https://doi.org/10.7860/JCDR/2013/.3518 Doxycycline Poly E–Caprolactone Nanofibers in Patients with Chronic Periodontitis – A Clinical Evaluation T.P. Chaturvedi,Ruchi Srivastava,A.K. Srivastava,Varun Gupta, Pushpendra Kumar Verma <b>Aim:</b> To develop a low-dose controlled-release delivery system for the treatment of periodontal infections. A new sustained release drug system of Poly e-caprolactone (PCL) nanofibers containing doxycycline (DOX) was successfully electrospun and evaluated clinically for periodontal diseases. The retentive doxycycline nanofibres were shown to provide a controlled delivery of the drug. <b>Material and Methods:</b> Nanofibers were prepared with DOX in PCL by electrospinning technique. The drug-coated nanofibres provided sustained effect up to a period of 11 days (264 h) and followed first order release. Forty sites in 7 patients (4 females and 3 males) with chronic periodontitis (5-8mm probing depth) were allocated in 2 experimental treatment groups, Group A-SRP (Scaling and Root Planing) + DOX nanofibers and Group B –SRP (Scaling and Root Planing) alone (control group). All these patients were evaluated clinically for probing depth (PD), plaque index (PI) and gingival index (GI). <b>Results:</b> Both the treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PD, PI and GI. <b>Conclusion:</b> Combination of SRP (Scaling and Root Planing) + DOX nanofibers (Group A) resulted in added benefits compared to the control group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2339-2342&id=3519 https://doi.org/10.7860/JCDR/2013/.3519 A Comparative Evaluation of the Effect of Bonding Agent on the Tensile Bond Strength of Two Pit and Fissure Sealants Using Invasive and Non–invasive Techniques: An in–vitro Study Shamsher Singh, Vivek Adlakha, Prashant Babaji, Preetika Chandna, Abi M. Thomas, Saroj Chopra <b>Background:</b> Newer technologies and the development of pit and fissure sealants have shifted the treatment philosophy from ‘drill and fill’ to that of ‘seal and heal’. Aims: The purpose of this in–vitro study was to evaluate the effects of bonding agents on the tensile bond strengths of two pit and fissure sealants by using invasive and non-invasive techniques. <b>Study Design and Methods:</b> One hundred and twenty bicuspids were collected and teeth were divided into two groups: Group-I (Clinpro) and Group-II (Conseal f) with 60 teeth in each group. For evaluating tensile bond strengths, occlusal surfaces of all the teeth were flattened by reducing buccal and lingual cusps without disturbing fissures. Standardised polyvinyl tube was bonded to occlusal surfaces with respective materials. Sealants were applied, with or without bonding agents, in increments and they were light cured. Tensile bond strengths were determined by using Universal Testing Machine. <b>Statistical Analysis:</b> Data were then statistically analysed by using Student t–test for comparison. <b>Results:</b> A statistically significant difference was found in tensile bond strength in invasive with bonding agent group than in non-invasive with bonding agent group. <b>Conclusion:</b> This study revealed that invasive techniques increase the tensile bond strengths of sealants as compared to non- invasive techniques and that the use of a bonding agent as an intermediate layer between the tooth and fissure sealant is beneficial for increasing the bond strength. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2343-2347&id=3520 https://doi.org/10.7860/JCDR/2013/.3520 Establishing an Association between Renal Failure and Periodontal Health: A Cross Sectional Study Mehak Chhokra, Srishti Manocha, Vidya Dodwad, Udayan Gupta, Shubhra Vaish Periodontal infections can act as focus of infection, aggravating the immunocompromised state of End Stage Renal Disease patients (ESRD). <b>Aim:</b> Evaluation of the periodontal health status of ESRD patients undergoing haemodialysis and establishing the underlying association between renal failure and periodontal disease. <b>Material and Methods:</b> Eighty control and test subjects were included in the study, after matching age and sex. Creatinine and GFR were measured in each patient. Oral hygiene index- Simplified (OHI-S), Gingival Index (GI), Pocket Depth (PD) and Clinical Attachment Level (CAL) were recorded as periodontal parameters to assess the correlation between the subjects of the two groups. Further, the test group was divided into three sub–groups, on basis of duration, as less than 6 months, from 6 months to one year and more than one year. Statistical Analysis: Student’s t – test and ANOVA were used to analyze the inter–group and intragroup comparisons. <b>Results:</b> Statistical significant difference was observed for all periodontal parameters between the test and control group. However, difference amongst periodontal parameters on basis of duration of haemodialysis was seen between the subgroups of test subjects, it was not found to be statistically significant. <b>Conclusion:</b> Severity of periodontal diseases in ESRD patients undergoing haemodialysis majorly affected due to debilitating condition of the subjects. Dialysis vintage has only a small role to play in worsening of the condition. Further research is needed to potentiate the establishment of two–way relationship https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2348-2350&id=3521 https://doi.org/10.7860/JCDR/2013/.3521 Bone Scintigraphy and Panoramic Radiography in Deciding the Extent of Bone Resection in Benign Jaw Lesions Anshuman Jamdade, Ani John <b>Objective:</b> To find out the value of correlating radiographic and scintigraphic imaging for defining the extent and nature of benign jaw lesions (BJL). <b>Material and Methods:</b> Twenty patients with histologically proven benign lesions of the jaws were investigated pre-operatively by panoramic radiography (PR) and bone scintigraphy (BS). To test the efficacy of combination of these two imaging modalities, their results were compared with intra-operative and histopathological findings. </b>Result:</b> Most of the benign lesions presented radiographically as well-defined bone destructions with fine sclerotic rims. Such lesions were found to be silent on scintigraphs and the extent of radionuclide uptake was same as radiographically visible extent of bone involvement. However, aggressive lesions showed ill-defined bone destructions without sclerotic rims on radiographs and their scintigraphic uptake correctly exceeded the radiographic extent of the bone involvement. <b>Conclusion:</b> The efficacy of combination of both complementary imagings is rewarding in defining the extent of the BJL, especially when radiographic margins are not so well defined. So, that surgical excisions will be complete and the possibility recurrences is reduced. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2351-2355&id=3522 https://doi.org/10.7860/JCDR/2013/.3522 Characteristics of Palatal Rugae Patterns in West Godavari Population of India Ghanta Suresh Babu, T. Sreenivasa Bharath, N. Govindraj Kumar Palatal rugae refer to the ridges on the anterior part of the palatal mucosa, each side of the median palatal raphe and behind the incisive papilla. Various studies on different populations have reported unique rugal patterns within each population. <b>Aim:</b> To study, analyse and report the significant palatal rugae patterns among West Godavari District population and compare with the patterns reported in the literature, which can aid as an additional method of identification in cases of crime or mass disasters. <b>Material and Methods:</b> Pre–orthodontic casts of 100 samples (50 males and 50 females) were selected. The method of identification of the rugae pattern used was that of Thomas et al (1983) which includes the number, shape and unification patterns of rugae. The different types of rugae between males and females were statistically analyzed and compared with other population studies in the literature. <b>Results:</b> A statistically insignificant (p>0.05) higher mean primary rugae scores was found in males (7.48±2.45) while secondary (3.38±2.02) and tertiary (2.56±1.84) rugae were more among females. Both genders showed predominance in wavy (males = 4.82±1.91 and females = 4.74±1.98) type of distribution.Commonly observed pattern in the mode of unification was converging (58%) in males and diverging pattern (62%) among femaleswhich was statistically significant (p=0.04). <b>Conclusions:</b> The findings showed a specific rugae pattern in this group when compared to other populations reported in the literature. Palatal rugae patterns are definitely associated with regional variation and can aid as an additional tool in forensic identification procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2356-2359&id=3523 https://doi.org/10.7860/JCDR/2013/.3523 An Evaluation of the Adherence of Candida albicans on the Surface of Heat Cure Denture Base Material Subjected to Different Stages of Polishing Ashish Satpathy, Dhakshaini M.R., Anil Kumar Gujjari <b>Background:</b> Candidiasis is common in denture wearers. Rough surfaces of dentures promote denture plaque formation and maturation, thus justifying the need for smooth surfaces. Proper finishing and polishing of dentures provide smooth surfaces. Thus, this study was done to assess the adherence of Candida to heat polymerized acrylic resin surfaces which were subjected to different stipulated polishing methods. <b>Material and Methods:</b> A total of 48 acrylic resin specimens of dimension 10x10x3 mm3 were fabricated and divided into four groups, A, B,C and D, with 12 specimens in each group, according to method of polishing step which was employed. Subsequently, they were subjected to an adherence assay. All the data was statistically analyzed by using One-way ANOVA and differences within the groups were analyzed by using independent sample t-test. <b>Results:</b> Results revealed that group A which was unpolished had a mean adherence of 2.92 and it was finished by using sand papers. Group B had a mean adherence of 0.5 and it was finished by using sand papers, followed by polishing with pumice. Group C had a mean adherence of 2.92 and finishing was done by using sandpaper which was followed by polishing with the use of pumice and rouge. Group D had a mean adherence of 37.1667. <b>Conclusion:</b> Finishing specimens of heat cure denture base resin with sand paper of progressive grits alone exhibited minimum Candidal adherence. Specimens which were finished by using sand papers of progressive grits, followed by polishing with pumice reduced Candidal adherence marginally as compared to that in control group. Finishing specimens of heat cure denture base resin by using above steps, followed by rouge, showed maximum Candidal adherence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2360-2363&id=3524 https://doi.org/10.7860/JCDR/2013/.3524 Use of Fisiograft in Intrabony Defects- A Clinical and Radiological Study Ruchi Pandey, R. Madhumala, R. Saranyan, P. Sreekanth <b>Aim:</b> To evaluate the efficacy of Polylactic Acid/Polygycolic Acid (PLA/PGA -Fisiograft®) with Open Flap Debridement (OFD) and OFD alone in the treatment of intrabony defects over a period of 9 months. <b>Material and Methods:</b> Twenty Nine systemically healthy subjects with total of 30 defects were included in the present, randomized, controlled and two arm parallel study. Tests were treated with OFD along with Fisiograft® and controls with OFD alone. <b>Results:</b> On intra-group comparison, clinical parameters at 6 and 9 months showed statistically significant results. On comparing between the two groups, the reduction in Defect Specific Bleeding Score (DSBS), Defect Specific Plaque Score (DSPS), Probing Depth (PD) and gain in Clinical Attachment Level (CAL) revealed no statistical significances other than Recession Depth (REC) which was more in controls. The mean radiographic parameters at 9 months post-operatively in both the groups were statistically significant. However, the inter-group comparison revealed no statistically significant values. <b>Conclusions:</b> The overall results at the end study proved that the adjunctive use of Fisiograft® was not beneficial when compared with OFD alone. Clinical Significance: Synthetic bone replacement graft materials are commonly used for periodontal regeneration. The present study was conducted by using PLA/PGA reveals no additional benefit over OFD alone in treatment of intrabony defects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2364-2367&id=3525 https://doi.org/10.7860/JCDR/2013/.3525 Comparative Study on the Efficacy of Gingival Retraction using Polyvinyl Acetate Strips and Conventional Retraction Cord – An in Vivo Study M. ShivaSaKthy, Syeda Sharafali <b>Statement of Problem:</b> A new material is proposed in dentistry in the form of strips for producing gingival retraction. The clinical efficacy of the material remains untested. <b>Purpose of the Study:</b> This study aimed to determine whether the polyvinyl acetate strips are able to effectively displace the gingival tissues in comparison with the conventional retraction cord. <b>Material and Methods:</b> Complete metal ceramic preparation with supra-gingival margin was performed in fourteen maxillary incisors and gingival retraction was done using Merocel strips and conventional retraction cords alternatively in 2 weeks time interval. The amount of displacement was compared using a digital vernier caliper of 0.01mm accuracy. Results were analyzed statistically using Paired students t-test. <b>Results:</b> The statistical analysis of the data revealed that both the conventional retraction cord and the Merocel strip produce significant retraction. Among both the materials, Merocel proved to be significantly more effective. <b>Conclusion:</b> Merocel strip produces more gingival displacement than the conventional retraction cord. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2368-2371&id=3526 https://doi.org/10.7860/JCDR/2013/.3526 Fexible Thermoplastic Denture Base Materials for Aesthetical Removable Partial Denture Framework Kunwarjeet Singh, Himanshu Aeran, Narender Kumar, Nidhi Gupta Conventional fixed partial dentures, implant supported Fixed Partial Dentures (FDPs) and removable partial dentures are the most common treatment modalities for the aesthetic and functional rehabilitation of partially edentulous patients. Although implants and FDP have certain advantages over removable partial dentures, in some cases, removable partial dentures may be the only choice which is available. Removable cast partial dentures are used as definitive removable prostheses when indicated, but location of clasps may affect aesthetics. So, when patient is concerned about aesthetics, flexible partial dentures which is aesthetically superior to flipper and cast partial dentures, may be considered. But for the success of flexible removable partial denture, proper diagnosis, treatment planning and insertion technique of this prosthesis is very important, which have been thoroughly described in this article. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2372-2373&id=3527 https://doi.org/10.7860/JCDR/2013/.3527 Multidisciplinary Approach to the Rehabilitation in Management of Child with Early Childhood Caries: A Case Report Neeraj Sharma, Sidhi Passi, Vinay V. Kumar The aesthetic requirement of severely mutilated primary anterior teeth in case of Early Childhood Caries (ECC) has been a challenge to paediatric dentists. ECC involves the upper anterior teeth early in life and by the time the dentist sees the child, most of the coronal structure is lost. This article presents the clinical sequence of rehabilitation of maxillary anterior primary teeth, and the mandibular posterior teeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2374-2375&id=3528 https://doi.org/10.7860/JCDR/2013/.3528 Placement of Dental Implant in a Knife Edge Ridge in Anterior Aesthetic Zone Narpat Singh Rajput, J. Bhaskar, Mohan Valiathan, S.C. Chandrasekaran, Md. Nazish Alam Dental implants are established alternatives for replacing missing teeth. Dental implants are artificial tooth root, positioned in the jaw bone, in order to sustain the replacement tooth or bridge. Recent advance in dental implant technology has made it more convenient, efficient and affordable for patients. In the anterior maxilla, esthetic demands not only require well-anchored implants but also sufficient soft and hard tissue in order to achieve natural looking result. Augmentation of the resorbed alveolar crest can be achieved, for example, with onlay bone grafts, membrane techniques, bone distraction and bone splitting. This report highlights the placement of implants in compromised alveolar ridges with good results. Implant was successfully restored and follow-up done for one year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2376-2377&id=3529 https://doi.org/10.7860/JCDR/2013/.3529 Tonsillolith: A Panoramic Radiograph Presentation Balaji Babu B., Avinash Tejasvi M.L., C.K. Anulekha Avinash, Chittaranjan B. Tonsilloliths are calcifications within a tonsillar crypt, involve primarily the palatine tonsil caused by dystrophic calcification as a result of chronic inflammation. Tonsilloliths are very uncommon and are microscopic. Tonsillar concretions sometimes produce symptoms which include non-specific chronic halitosis, irritable cough, dysphagia, otalgia and foreign body-like sensation or foul taste. Patients with tonsillolithiasis may also be asymptomatic, with their lesions being discovered incidentally on panoramic radiographs. This article presents an unusual case of multiple bilateral and asymptomatic tonsilloliths which were found during a routine panoramic radiographic examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2378-2379&id=3530 https://doi.org/10.7860/JCDR/2013/.3530 E.coli Associated Extensive Bilateral Maxillary Osteomyelitis: A Rare Case Report Subrat Kumar Padhiary, Gunjan Srivastava, Swagatika Panda, Santosh Subudhi, Sthitaprajna Lenka With the advent of broad spectrum antibiotics, chronic osteomyelitis of jaw, especially of maxilla, has become a rare lesion. Osteomyelitis of jaw is associated with a complex microbiota, the most common oral microorganism being, Staphylococcus sp. Reported cases of jaw osteomyelitis caused by enteric bacteria are very few in literature. Hereby, we are reporting a case of E.coli associated osteomyelitis in a diabetic individual who had presented with very aggressive bilateral maxillary necrosis. After extensive literature search, to the best of our knowledge, this is the first case of maxillary osteomyelitis associated with E.coli which we have come across. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2380-2382&id=3531 https://doi.org/10.7860/JCDR/2013/.3531 Hemifacial Microsomia: A Series of Three Case Reports Lora Mishra, Satya Ranjan Misra, Manoj Kumar, Ramanupam Tripathy Hemifacial Microsomia (HFM) is an asymmetric craniofacial malformation which results in hypoplasia of the components of the first and second branchial arches. There can be various anomalies, which include conductive hearing loss which is caused by external and middle ear deformities. HFM is the second most common congenital facial anomaly which is seen after cleft lip/palate. For the pre-surgical evaluation of this anomaly, diagnostic imaging and classification of the facial structures, based on OMENS classification, is of prime importance. The management of this developmental malformation is multidisciplinary. We are presenting a series of three cases with diverse clinical and radiographic features which ranged from mild facial asymmetry and ear malformation to facial paralysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2383-2386&id=3532 https://doi.org/10.7860/JCDR/2013/.3532 Full Mouth Rehabilitation of Severe Fluorozed Teeth with an Interdisciplinary Approach (6 Handed Dentistry) Koppolu Pradeep, Nagesh Patil, Tanusree Sood, Uttam Akula, Rajani Gedela Whenever the treatment revolves around structural balance and aesthetic harmony, the crux remains to be the periodontal health of the existing dentition. In such scenarios where restorations and aesthetics are of concern, biologic width (BW) is the initial and final frontier. Considering attrition of teeth, the resistance which is offered by them is definitely at a lower level as compared to teeth with adequate height. Clinical crowns of worn out teeth are seriously handicapped when it comes to bearing the occlusal loads, which can be brought back to normalcy by crown lengthening . Crown lengthening includes the surgical removal of soft and hard periodontal architecture to gain (vertical dimension) a supracrestal tooth length, thus allowing a longer clinical crown reestablishment of BW. This paper has described the full mouth rehabilitation of severe fluorozed and attrited teeth in a 35–year male with the use of an interdisciplinary approach (6 Handed Dentistry). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2387-2389&id=3533 https://doi.org/10.7860/JCDR/2013/.3533 Notching in the Posterior Border of the Ramus of Mandible in a Patient with Neurofibromatosis Type I – A Case Report Bhuvana Krishnamoorthy, Parul Singh, Suma Gundareddy N, Manisha Lakhanpal Sharma, Manu Dhillon Neurofibromatosis Type I (NFI) is a relatively common hereditary, autosomal dominant neurocutaneous condition. It is a benign peripheral nerve sheath tumour arising from Schwann cells and peripheral fibroblasts. Even though it is a neurocutaneous disorder, NF I has significant skeletal manifestations. Oral and maxillofacial skeletal structures are also often involved in the form of deepening of sigmoid notch, enlarged mandibular canal and notching of inferior border of mandible. In this paper, we are reporting a female patient of NF I who presented with a notching in the posterior border of ascending ramus of mandible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2390-2391&id=3534 https://doi.org/10.7860/JCDR/2013/.3534 Non-Surgical Management of Mandibular Molar with Multiple Intra–oral Sinus Tracts: A Case Report Ruchi Gupta, Vijay Prakash Multiple intra–oral sinus tracts of dental origin are an uncommon condition. Patients with this condition may undergo surgical extraction, biopsies and antibiotic regimens, but all of them fail with the recurrence of the sinus tract. A proper diagnosis and management are important, to avoid any complications. This case report has described the conventional root canal treatment of a patient who had three distant intra–oral sinuses which had occurred due to an intact tooth with pulp necrosis, who had a history of accidentally biting on a hard food object and having a periapical radiolucency which indicated a chronic periradicular abscess. At follow up examination, the tooth was found to be asymptomatic and radiographically, it showed repair of the lesion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2392-2393&id=3535 https://doi.org/10.7860/JCDR/2013/.3535 Management of Severe Gag Reflex by An Unique Approach: Palateless Dentures Anoop Jain, Vijayalaxmi V, R.M. Bharathi, Veena Patil, Jyoti Alur Gagging is most common protective reflex that prevents the foreign bodies from entering trachea. But some patients have abnormally active gag reflex. The purpose of this paper was to describe method of managing gagging patients , based on modified treatment approaches, starting from impression making to design of the prosthesis i.e. palateless denture, to help the patient tolerate prosthesis in his/her mouth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2394-2395&id=3536 https://doi.org/10.7860/JCDR/2013/.3536 Prosthodontic Treatment Using Vital and Non Vital Submerged Roots-Two Case Reports Y. Ravi Shankar, K. Srinivas, HemChand Surapaneni, S.V. Sudhakar Reddy Residual ridge resorption has been considered as an inevitable consequence after extraction of the teeth. There is a gradual loss of the alveolar bone due to the pattern of bone remodeling. In spite of the availability of newer treatment modalities like endodontic restoration and periodontic procedures for preservation of the remaining teeth they are not feasible for the patients in severe stages where restoration might not be possible. The only reliable method of preserving the remaining bone is by maintaining the functional health of the teeth. Over the years, many studies showed that roots which are fractured and left behind during extractions are retained into the alveolar bone with no evidence of pathosis. Over denture as a treatment option was developed in an effort to preserve the remaining alveolar bone by retaining the natural teeth or roots. In over denture treatment, the teeth selected as abutments are prone to caries and periodontal disease over a period of time, hence evolved the vital or non vital root submergence concept. After a thorough radiographic and clinical examination, few teeth without pathosis are retained that eventually are surgically submerged in the alveolar ridge. After healing, the over denture with reaining vital or non vital teeth preserve the integrity of the bone, making the treatment an effective and successfull preventive prosthodontic treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2396-2399&id=3537 https://doi.org/10.7860/JCDR/2013/.3537 Treatment of Internal Resorption with Mineral Trioxide Aggregates: A Case Report Pankaj Yadav, Yogesh Rao, Anurag Jain, Nikhil Relhan, Sandeep Gupta Tooth resorption is a common sequel which follows injuries or irritation to the periodontal ligament and/or tooth pulp. The course of tooth resorption involves an elaborate interaction among inflammatory cells, resorbing cells, and hard tissue structures. The key cells which are involved in resorption are multi–nucleated giant cells. Internal root resorptions are usually non–symptomatic and they are discovered occasionally through periapical radiographs, which reveal very defined and regular outlines. Many techniques and materials have been used to fill internal resorptive defects. Among them, Mineral Trioxide Aggregates (MTAs) have satisfactory properties, which include: biocompatibility, a favourable sealing ability, mechanical strength and a capacity to promote a periradicular tissue healing. Thus, a Mineral Trioxide Aggregate (MTA) repair of a maxillary left central incisor tooth with an inflammatory resorptive defect, in the middle third of the root canal, has been reported here. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2400-2401&id=3538 https://doi.org/10.7860/JCDR/2013/.3538 Space Maintainers in Dentistry: Past to Present Vikas Setia, Inder Kumar Pandit, Nikhil Srivastava, Neeraj Gugnani, Harveen kaur Sekhon The version that appears in Online First is the definitive article, edited to the JCDR's normal standards and will be available only as a PDF file. It will be semi formatted, devoid of page numbers, and HTML version. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2402-2405&id=3539 https://doi.org/10.7860/JCDR/2013/.3539 Composite Compound Odontoma-A Case Report K.S. Kannan, Ramachandra Prabhakar, R. Saravanan, Karthikeyan, Rajvikram Composite Compound Odontoma is a rare odontogenic tumour most commonly occuring in the anterior region of maxilla. An 11-year-old female patient reported a complaint of missing left central incisor. Clinical and diagnostic investigation revealed an odontogenic mass in the region of 21. This rare case report appraises the clinical diagnosis, surgical and orthodontic intervention which was planned and performed for its management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2406-2407&id=3540 https://doi.org/10.7860/JCDR/2013/.3540 Artefacts :A Diagnostic Dilemma – A Review Varun Rastogi, Naveen Puri, Swati Arora, Geetpriya Kaur, Lalita Yadav, Rachna Sharama The significance of proper handling of biopsy specimens is important and obvious for any histopathological diagnosis. Accuracy of tissue diagnosis by the pathologists is heavily dependent upon the competence of histotechnologists. The aim of a good histopathological technique is to produce microscopic preparation of tissues, usually stained, that represents as closely as possible, their structures in life. But this is not always possible and some sort of tissue morphology is bound to be seen. The ability of oral pathologists in interpreting a biopsy correctly is directly proportional not only to the quality, but also to the quantity of the specimen. There are many ways through which the exact interpretation of tissue specimen becomes compromised and the major pitfall is the presence of artefacts. These artefacts may occur during surgical removal, fixation, processing, embedding, microtomy and staining procedures. It is therefore important to identify the common occurring artefacts during interpretation of oral biopsies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2408-2413&id=3541 https://doi.org/10.7860/JCDR/2013/.3541 A Boulder in the Brain Shivali Vaibhav Kashikar, Bhushan N Lakhkar https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2414-2415&id=3545 https://doi.org/10.7860/JCDR/2013/.3545 The Effects of Smoking on the Hearing Status - A Hospital Based Study Nisha Shantakumari, Aji Gopakumar, Jayadevan Sreedharan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2416-&id=3543 https://doi.org/10.7860/JCDR/2013/.3543 Fine Needle Aspiration Cytologic Diagnosis of Lactating Adenoma: Report of two Cases Priavadhana Rajan Prasaad https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=October&volume=7&issue=10&page=2417-2418&id=3544 https://doi.org/10.7860/JCDR/2013/.3544